Parathyroidectomy after kidney transplantation: short- and long-term impact on renal function

INTRODUCTION: Kidney transplantation corrects endocrine imbalances. Nevertheless, these early favorable events are not always followed by rapid normalization of parathyroid hormone secretion. A possible deleterious effect of parathyroidectomy on kidney transplant function has been reported. This study aimed to compare acute and longterm renal changes after total parathyroidectomy with those occurring after general surgery. MATERIALS AND METHODS: This was a retrospective case-controlled study. Nineteen patients with persistent hyperparathyroidism underwent parathyroidectomy due to hypercalcemia. The control group included 19 patients undergoing various general and urological operations. RESULTS: In the parathyroidectomy group, a significant increase in serum creatinine from 1.58 to 2.29 mg/dl (P < 0.05) was noted within the first 5 days after parathyroidectomy. In the control group, a statistically insignificant increase in serum creatinine from 1.49 to 1.65 mg/dl occurred over the same time period. The long-term mean serum creatinine level was not statistically different from baseline either in the parathyroidectomy group (final follow-up creatinine = 1.91 mg/dL) or in the non-parathyroidectomy group (final follow-up creatinine = 1.72 mg/dL). CONCLUSION: Although renal function deteriorates in the acute period following parathyroidectomy, long-term stabilization occurs, with renal function similar to both preoperative function and to a control group of kidney-transplanted patients who underwent other general surgical operations by the final follow up

Respostas de cortisol e testosterona em jogadores de futebol: uma revisão de literatura

The present study aimed to review the results obtained in the literature about influence of the physical exercise on cortisol and testosterone concentrations and a probable relation with the physical performance of professional soccer players. The descriptors used were: football, cortisol, testosterone, testosterone/cortisol ratio, performance monitoring, researched in Pubmed, Lilacs and Sportdiscus databases. Cortisol and testosterone were increased and decreased, respectively, throughout the season. This data may reflect a probable accumulation of physical stress corresponding to the expressive number of games and training.El presente estudio tuvo como objetivo revisar los resultados obtenidos en la literatura sobre la influencia del ejercicio físico en las concentraciones hormonales de cortisol y testosterona y una probable relación con desempeño físico de jugadores profesionales de fútbol. Los descriptores utilizados fueron: fútbol, cortisol, testosterona, relación testosterona/cortisol y, monitoreo de desempeño, buscados en las bases de datos Pubmed, Lilacs y Sportdiscus. El aumento de cortisol y la disminución de la testosterona se observó a lo largo de la temporada. Este dato indica una probable acumulación de estrés físico correspondiente al expresivo número de juegos y entrenamientos.O presente estudo teve como objetivo revisar os resultados obtidos na literatura sobre a influência do exercício físico nas concentrações hormonais de cortisol e testosterona e uma provável relação com desempenho físico de jogadores profissionais de futebol. Os descritores usados foram: futebol, cortisol, testosterona, relação testosterona/cortisol e, monitoramento de performance, buscados nas bases de dados Pubmed, Lilacs e Sportdiscus. Aumento de cortisol e diminuição de testosterona foram observadas ao longo da temporada. Esse dado indica um provável acúmulo de estresse físico correspondentes ao expressivo número de jogos e treinamentos.

A simple prescription for simulating and characterizing gravitational arcs

Simple models of gravitational arcs are crucial to simulate large samples of these objects with full control of the input parameters. These models also provide crude and automated estimates of the shape and structure of the arcs, which are necessary when trying to detect and characterize these objects on massive wide area imaging surveys. We here present and explore the ArcEllipse, a simple prescription to create objects with shape similar to gravitational arcs. We also present PaintArcs, which is a code that couples this geometrical form with a brightness distribution and adds the resulting object to images. Finally, we introduce ArcFitting, which is a tool that fits ArcEllipses to images of real gravitational arcs. We validate this fitting technique using simulated arcs and apply it to CFHTLS and HST images of tangential arcs around clusters of galaxies. Our simple ArcEllipse model for the arc, associated to a S\'ersic profile for the source, recovers the total signal in real images typically within 10%-30%. The ArcEllipse+S\'ersic models also automatically recover visual estimates of length-to-width ratios of real arcs. Residual maps between data and model images reveal the incidence of arc substructure. They may thus be used as a diagnostic for arcs formed by the merging of multiple images. The incidence of these substructures is the main factor preventing ArcEllipse models from accurately describing real lensed systems.Comment: 12 pages, 11 figures, accepted for publication in A&

Community-based mental health care network: the Santo André experience

Os distúrbios psiquiátricos constituem um grave problema de saúde pública. Por muitos anos, a única terapêutica disponível ao portador de transtornos mentais era a internação em hospitais psiquiátricos. Hoje a Organização Mundial da Saúde recomenda os serviços de base comunitária como modelo de tratamento em saúde mental. Assim, o objetivo é descrever as características de uma rede de atenção à saúde mental de base comunitária no município de Santo André, SP. Foi realizado um estudo retrospectivo do tipo descritivo, em dados secundários do período de 1987 a 2006. O estudo incidiu sobre o histórico, a infra-estrutura, os recursos humanos, a produção, as práticas e processos de trabalho dos serviços de saúde mental de Santo André. Foram analisados documentos do Programa Municipal de Saúde Mental, da Secretaria Municipal de Saúde, da Prefeitura de Santo André, da Associação José Martins de Araújo Júnior/Organização Social De Volta Para Casa. A Secretaria Municipal de Saúde proveu meios para uma transformação dos serviços de saúde mental no período estudado, partindo de um atendimento exclusivamente manicomial para uma rede de serviços de saúde mental com modelo centrado na comunidade, focando a doença no aspecto psicossocial e com abordagem por equipe multiprofissional. Estas ações no município de Santo André forarm corroborativas aos esforços da sociedade civil e o pleno desenvolvimento da mudança do modelo hospitalocêntrico.Psychiatric impairments are a critical public health problem. For many years, the only therapy available to individuals with mental disorders was hospitalization at psychiatric institutions. Nowadays the World Health Organization recommends community-based services as a model of mental health treatment. Therefore, the aim of this study is to describe the characteristics of a community-based mental health care network in the city of Santo André, state of São Paulo. A descriptive and retrospective study was carried out, based on secondary data from the period between 1987 and 2006. The study investigated the history, infrastructure, human recourses, production, practices and work processes of the mental health services of Santo André. Documents of the Municipal Mental Health Program of the Municipal Health Department of Santo André, and of the José Martins de Araújo Júnior Association/Social Organization De Volta Para Casa were analyzed. The Municipal Health Department promoted the transformation of the mental health services in the studied period: from assistance provided exclusively at asylums to a network of mental health services whose model was based on the community, focusing on the psychosocial aspect of the disease and with multi-professional teams. These actions in Santo André corroborated the civil society's efforts and the development of changes in the hospital-centered model

Avaliação quantitativa da evolução da tuberculose em hamsters tratados 8 semanas consecutivas com Triclorfon e infectados com Mycobacterium bovis, cepa AN5

The evolution of disease by intraperitoneal inoculation of Mycobacterium bovis (strain AN5) was evaluated in hamsters (Mesocricetus auratus) treated daily, from Monday to Friday, with 30 mg/kg of Trichlorfon given subcutaneously, for a period of 8 consecutive weeks. The criteria used for the evaluation were post infection survival time and quantitative cultures of mycobacteria from spleen, kidney, liver and lung taken at 1, 15, 29 and 45 days after inoculation.Histopathologic examinations were also performed at each scheduled time. Treated and control animals developed progressive disease. The results of quantitative cultures and survival time after inoculation were not influenced byTrichlorfon as related to the evolution of tuberculosis.A evolução da doença causada pela inoculação intraperitoneal de Mycobacterium bovis (cepa AN5) foi avaliada em hamsters (Mesocrícetus auratus) tratados de segundas a sextas-feiras, com doses subcutâneas de 30 mg/kg de Triclorfon, por um período de 8 semanas consecutivas. Os critérios adotados para essa avaliação foram o tempo de sobrevivência após ainoculação e a quantificação do agente no baço, fígado, rim e pulmão colhidos aos 1, 15, 29 e 45 dias após a inoculação. Nessas oportunidades também foram realizados exames histopatológicos. Os animais do grupo tratado com Triclorfon e do grupo controle desenvolveram tuberculose progressiva. Os resultados da quantificação do agente nos órgãos examinados, e do tempo de sobrevivência após a inoculação, não mostraram qualquer influência da administração do Triclorfon

Fracture-dislocation of the thoracic spine during second trimester of pregnancy: case report and literature review

Spinal fractures associated with spinal cord injury rarely affect pregnant patients. The authors present the case of a 20-year-old woman in her 20th week of pregnancy, who suffered fracture-dislocation of the thoracic spine (T4-T5) and underwent decompression, reduction and posterior fusion with pedicle screws. Despite the complete spinal cord injury presented, the pregnancy progressed uneventfully and resulted in birth via normal delivery of a healthy newborn at term. Some particular features of this case, like the care needed in using ionizing radiation, the surgical approach and delivery, use of steroids and pregnancy complications in such patients are discussed here. Only a multidisciplinary team composed by physicians from different specialties (spinal surgeons, obstetricians and physiatrists), nurses and physiotherapists is capable of assisting pregnant patients with spinal cord injuries satisfactorily.Fraturas da coluna vertebral associadas à lesão medular raramente acometem pacientes gestantes. Os autores apresentam o caso de uma mulher de 20 anos de idade, com gestação de 20 semanas, que sofreu fratura-luxação da coluna torácica (T4-T5) e foi submetida a descompressão, redução e artrodese posterior com parafusos pediculares. Apesar de apresentar lesão medular completa, a gestação evoluiu sem intercorrências e resultou no nascimento, por parto normal, de uma criança saudável a termo. Algumas particularidades, como o cuidado com o uso de radiação ionizante, via de acesso cirúrgico e de parto, corticoterapia e complicações gestacionais em pacientes nessas condições são discutidas neste artigo. Somente uma equipe multidisciplinar, formada por médicos de diferentes especialidades (cirurgiões de coluna, obstetras e fisiatras), enfermeiras e fisioterapeutas é capaz de assistir a essas pacientes de modo satisfatório.Universidade Federal de São Paulo (UNIFESP)Universidade Metropolitana de SantosUNIFESPSciEL

Back pain: an assessment in breast hypertrophy patients

OBJECTIVE: To evaluate the influence of breast hypertrophy on the incidence of back pain and how much they can interfere in patients' daily activities. METHODS: This was a cross-sectional analytic study in patients examined at the Outpatient Orthopedics and Plastic Surgery Departments at Samuel Libânio University Hospital in Pouso Alegre, MG. 100 women were examined, 50 presenting breast hypertrophy (study group) and 50 with normal breast size (control group). Breasts were classified according to Sacchini's criteria. The Numerical Rating Scale (NRS) and the Roland-Morris questionnaire were used in order to evaluate the magnitude of back pain and the limitations arising from these symptoms. RESULTS: The mean age of the patients in the study group was 32.2 years and 32.7 for the control group. The scores in the NRS scale and Roland- Morris Questionnaire were higher in the study group when compared to the control group. CONCLUSION: The results achieved showed that back pain is more severe and determined more extensive limitations in the daily activities for patients presenting breast hypertrophy.OBJETIVO: Avaliar a influência da hipertrofia mamária sobre as dores na coluna e o quanto poderão comprometer as atividades habituais das pacientes. MÉTODOS: Realizou-se estudo transversal analítico em pacientes dos ambulatórios de Ortopedia e Cirurgia Plástica do Hospital Universitário Samuel Libânio, Pouso Alegre - MG. Foram examinadas 100 mulheres, 50 com hipertrofia mamária (grupo estudo) e 50 com mamas normais (grupo controle). O tamanho das mamas foi classificado conforme critérios de Sacchini.. A Escala Numeral Analógica (NRS) e o questionário de Roland-Morris foram utilizados para avaliar a intensidade das dores na coluna e as limitações resultantes destes sintomas. Realizado teste estatístico comparando os grupos em relação as variáveis analisadas. RESULTADOS: A média da idade das pacientes do grupo estudo e controle foram de 32,2 anos e de 32,7 anos respectivamente, e o IMC foi maior no grupo estudo. Os escores do NRS e do Roland-Morris foram maiores no grupo de estudo em relação ao grupo controle com significância estatística. CONCLUSÃO: Os resultados obtidos mostraram que as dores nas costas são mais intensas e determinaram maior limitação das atividades habituais em pacientes portadoras de hipertrofia mamária.Universidade do Vale do Sapucaí Hospital das Clínicas Samuel Libânio Departamento de Ortopedia TraumatologiaUNIFESPUniversidade do Vale do Sapucaí Hospital Clínicas Samuel Libânio Divisão de Cirurgia PlásticaUNIVÁS Departamento de BioestatísticaUNIFESPSciEL

Quality of life and self-esteem after mastectomy in patients who did or did not undergo breast reconstruction

BACKGROUND: The number of breast cancer cases has sharply increased in the Brazilian population. Therefore, quality of life (QOL) and self-esteem (SE) are major causes of concern since removal of the breast can have substantial psychological and physical impacts. With the advancement of surgical techniques, however, breast reconstruction has become a standard procedure, even in the Brazilian Public Health System. METHODS: In this exploratory qualitative study, 22 recruited volunteers were divided into 2 groups: Group 1 (n = 11) consisted of women who underwent mastectomy, whereas Group 2 (n = 11) comprised women who underwent mastectomy plus breast reconstruction. All subjects completed the Rosenberg Universidade Federal de São Paulo (UNIFESP)/Escola Paulista de Medicina, European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30, and Visual Analogue Scale questionnaires. RESULTS: Group 1 subjects had a lower average emotional function than Group 2 subjects. No statistically significant difference between the two groups was observed in the SE; however, statistically significant differences were noted according to age. No differences in pain level were seen between groups . CONCLUSIONS: Women who did not undergo breast reconstruction were more emotionally fragile; however, further studies are required in an effort to obtain more statistically relevant values.INTRODUÇÃO: O número de casos de câncer de mama vem crescendo abruptamente na população brasileira. Portanto a qualidade de vida (QV) e a autoestima são pautas importantes quando o assunto é abordado, visto que a retirada da mama pode causar grande impacto tanto psicológico como físico. Entretanto, com o avanço de técnicas cirúrgicas, a reconstrução de mama já é prática constante até mesmo no Sistema Único de Saúde (SUS). MÉTODO: Trata-se de um estudo qualitativo de caráter exploratório, que recrutou 22 voluntárias, divididas em dois grupos, de acordo com a cirurgia realizada. O grupo 1 (n = 11) foi formado por mulheres mastectomizadas e o grupo 2 (n = 11), por mulheres pós-reconstrução da mama. As voluntárias dos dois grupos responderam aos questionários de Rosenberg UNIFESP/EPM, EORTC QLQ-C30 e EVA. RESULTADOS: Os resultados sugerem que, em relação à qualidade de vida, quando se observa a função emocional, as voluntárias do grupo 1 apresentam pior média em relação ao grupo 2. Em relação à autoestima, não foi observada diferença estatisticamente significante entre os dois grupos; porém, quando considerada a idade, os resultados apresentam diferenças estatisticamente significantes. Quanto ao nível de dor, os grupos não apresentaram diferença estatisticamente significante. CONCLUSÕES: Os resultados obtidos revelam que mulheres que ainda não passaram pela reconstrução mamária possuem maior fragilidade emocional, porém novos estudos devem ser realizados para obtenção de valores estatisticamente mais relevantes.Universidade Anhembi Morumbi Estética e Fisioterapia DermatofuncionalUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Disciplina de Cirurgia PlásticaSociedade Brasileira de Cirurgia PlásticaUNIFESP-EPMSBCPUAMUNIFESP Disciplina de Cirurgia PlásticaUNIFESP, EPM, Disciplina de Cirurgia PlásticaUNIFESP-EPMUNIFESP, Disciplina de Cirurgia PlásticaSciEL

Assessment of the quality of life and self-esteem of mastectomized patients submitted or not to breast reconstruction

INTRODUCTION: After diagnosis and treatment of breast cancer, some women go through physical, social, and emotional changes that often have an impact on their quality of life and self-esteem. This study aimed to assess the quality of life and self-esteem of mastectomized patients with or without breast reconstruction a month after surgery. METHODS: The study consisted of 89 patients aged ≥ 30 years with or without breast reconstruction. They were recruited from the Plastic Surgery and Mastology clinic of São Paulo Hospital and Pérola Byington Hospital. Group 1 (n = 30) consisted of mastectomized patients without breast reconstruction; group 2 (n = 29) consisted of mastectomized patients with breast reconstruction; and group 3 (n = 30) consisted of patients without changes in the breasts. The EORTC QLQ-C30 and Rosenberg Self-Esteem Scale UNIFESP/EPM instruments, which are validated in Brazil, were used to assess their quality of life. RESULTS: There were no observed effects in the quality of life and self-esteem of the patients who underwent mastectomy with or without breast reconstruction a month after surgery. CONCLUSION: The women with mastectomy with or without breast reconstruction a month after surgery showed no changes in their quality of life and self-esteem when compared among themselves and to women with no cancer history. It is necessary that this assessment, employing the EORTC QLQ-C30 and QLQ-BR23 questionnaires, be performed from the time of breast cancer diagnosis until after breast reconstruction to identify the stage when the quality of life and self-esteem are affected

Spatial spillovers of the cultural employment growth in Brazilian municipalities

The Brazilian cultural sector is rarely explored in the literature, especially considering all municipalities at the same time in an economic and spatial perspective. This paper aims to measure the level of specialization, urbanization and diversification externalities on the cultural employment growth rate in Brazilian municipalities between 2006 and 2016. To do so, spatial econometric models are used. The main results indicate there are no spatial associations regarding cultural employment growth in Brazil. The lack of complementarity of this sector, associate with the lack of incentives for its development, particularly in small municipalities, helps to explain our results