ESTENDER O LIMIAR PARA SALVAR O MEMBRO, UMA ABORDAGEM MULTIDISCIPLINAR

Caso clínico: Homem indigente, 48 anos, com antecedentes de tabagismo e etilismo crónico. Encaminhado ao SU um mês após queda com traumatismo do MIE. Ao EO apresentava extensa úlcera (25x15cm) na face antero-medial da perna esquerda, com tecido desvitalizado e sinais de infeção no leito, bem como exposição óssea significativa da diáfise da tíbia. Sem pulso femoral no membro esquerdo. O caso foi discutido com equipa de SU de cirurgia plástica tendo sido decidido internar o doente para posterior abordagem multidisciplinar. Angiografia diagnóstica demonstrou oclusão da artéria ilíaca externa e da artéria femoral superficial esquerdas. Procedeu-se à realização de bypass aorto-bifemoral com prolongamento à artéria poplítea supra-articular com veia grande safena. Cumpriu antibioterapia EV de largo espectro e cuidados de penso com hipoclorito e  soro fisiológico, seguido de limpeza cirúrgica da ferida. Posteriormente, realizou-se plastia do defeito com retalho livre de músculo grande dorsal, seguido de enxerto de pele parcial. Alta após 10 dias. Atualmente doente assintomático, com cicatrização total da lesão. Conclusão:  Em casos extremos, mesmo após revascularização eficaz, o grau de lesão tecidual pode não ser compatível com um processo de cicatrização favorável. Nestes casos, uma abordagem multidisciplinar constitui a única via para evitar a amputação. Este caso é um exemplo paradigmático onde a avaliação e intervenção conjuntas por cirurgia vascular e cirurgia plástica foram decisivas para salvar o membro de um homem de 48 anos

SÍNDROME DO DESFILADEIRO TORÁCICO COMPLICADA POR DUPLO ANEURISMA SUBCLÁVIO — UMA ABORDAGEM HÍBRIDA

Introdução: Aneurismas da artéria subclávia (AAS) são uma complicação extremamente rara da síndrome do desfiladeiro torácico (SDT). A dilatação arterial ocorre normalmente distalmente ao local de compressão que está na base do SDT. Descrevemos um caso particularmente raro de um doente com SDT neurológico com dois volumosos AAS proximal e distal ao triângulo interescaleno. Caso Clínico: Mulher, 55 anos, sem antecedentes de relevo. Actividade profissional desde a adolescência implica transporte manual de caixas pesadas diversas vezes ao dia. Foi referenciada à consulta de cirurgia vascular por sintomas neurológicos compatíveis com SDT. Angio-TC revelou a presença de dois volumosos AAS, de 31 e 42mm, separados pelo musculo escaleno anterior. Os aneurismas foram excluídos com stent recoberto (Viabahn) após ter sido comprovada patência do polígono de Willis por Doppler transcraniano. Subsequentemente a doente foi submetida a escalenotomia anterior. Constatou-se reversão total dos sintomas, tendo a doente tido alta 2 dias após a cirurgia. Angio-TC de controlo comprovou exclusão dos 2 AAS. Doente mantém-se assintomática aos 6 meses de follow-up. Discussão: O termo SDT foi originalmente utilizado em 1956 por RM Peet para descrever a compressão do feixe neurovascular ao nível do outlet torácico. O desenvolvimento de AAS é uma complicação rara, mas potencialmente perigosa da SDT. Embora historicamente tenha sido abordado por cirurgia aberta, os novos métodos endovasculares afirmam-se como uma opção elegante e de menor risco no tratamento de AAS. Embora a exérese da primeira costela se esteja a assumir como o tratamento a oferecer para a descompressão do desfiladeiro torácico, neste caso particular, a imagem e a história clínica foram altamente sugestivas de compressão pelo músculo escaleno. Este caso demonstra como as abordagens endovascular e aberta se podem conjugar para oferecer resultados aliciantes. Do nosso conhecimento, esta é a primeira descrição na literatura de dois aneurismas em série da artéria subclávia no contexto de SDT

Safinamide: a new hope for Parkinson's disease?

The loss of dopaminergic neurons (DAn) and reduced dopamine (DA) production underlies the reasoning behind the gold standard treatment for Parkinson's disease (PD) using levodopa (L-DOPA). Recently licensed by the European Medicine Agency (EMA) and US Food and Drug Administration (FDA), safinamide [a monoamine oxidase B (MOA-B) inhibitor] is an alternative to L-DOPA; as we discuss here, it enhances dopaminergic transmission with decreased secondary effects compared with L-DOPA. In addition, nondopaminergic actions (neuroprotective effects) have been reported, with safinamide inhibiting glutamate release and sodium/calcium channels, reducing the excitotoxic input to dopaminergic neuronal death. Effects of safinamide have been correlated with the amelioration of non-motor symptoms (NMS), although these remain under discussion. Overall, safinamide can be considered to have potential antidyskinetic and neuroprotective effects and future trials and/or studies should be performed to provide further evidence for its potential as an anti-PD drug.The authors acknowledge funding from the Portuguese Foundation for Science and Technology (IF development grant IF/ 00111/2013 to A.J.S.) and a postdoctoral fellowship to F.G.T. (SFRH/BPD/118408/2016). This work was funded by FEDER funds, through the Competitiveness Factors Operational Programme (COMPETE), and by national funds, through the Foundation for Science and Technology (FCT), under the scope of the project POCI-01-0145-FEDER-007038. This article has also been developed under the scope of the project NORTE-01-0145-FEDER-000023, supported by the Northern Portugal Regional Operational Programme (NORTE 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER)

Pulmonary changes on HRCT scans in nonsmoking females with COPD due to wood smoke exposure

OBJECTIVE: To identify and characterize alterations seen on HRCT scans in nonsmoking females with COPD due to wood smoke exposure. METHODS: We evaluated 42 nonsmoking females diagnosed with wood smokerelated COPD and 31 nonsmoking controls with no history of wood smoke exposure or pulmonary disease. The participants completed a questionnaire regarding demographic data, symptoms, and environmental exposure. All of the participants underwent spirometry and HRCT of the chest. The COPD and control groups were adjusted for age (23 patients each). RESULTS: Most of the patients in the study group were diagnosed with mild to moderate COPD (83.3%). The most common findings on HRCT scans in the COPD group were bronchial wall thickening, bronchiectasis, mosaic perfusion pattern, parenchymal bands, tree-in-bud pattern, and laminar atelectasis (p < 0.001 vs. the control group for all). The alterations were generally mild and not extensive. There was a positive association between bronchial wall thickening and hour-years of wood smoke exposure. Centrilobular emphysema was uncommon, and its occurrence did not differ between the groups (p = 0.232). CONCLUSIONS: Wood smoke exposure causes predominantly bronchial changes, which can be detected by HRCT, even in patients with mild COPD.OBJETIVO: Identificar e caracterizar alterações na TCAR de tórax em mulheres com DPOC causada por exposiçãoà fumaça da combustão de lenha. MÉTODOS: Foram selecionadas 42 pacientes com DPOC relacionada à exposição à fumaça de lenha, não fumantes, e 31 mulheres não fumantes e sem história de exposição à fumaça de lenha ou de doença pulmonar. Empregou-se um questionário para a obtenção de dados demográficos e informações sobre sintomas e exposições ambientais. Todas as participantes realizaram espirometria e TCAR de tórax. Os grupos DPOC e controle foram ajustados por idade, com 23 pacientes cada. RESULTADOS: A maioria das pacientes do grupo de estudo apresentava DPOC de leve a moderado (83,3%). Os achados de TCAR mais frequentes no grupo DPOC foram espessamento das paredes brônquicas, bronquiectasias, perfusão em mosaico, bandas parenquimatosas, padrão de árvore em brotamento e atelectasias laminares (p < 0,001 para todos na comparação com o grupo controle). As alterações, em geral, foram leves e de pequena extensão. Houve uma associação positiva entre espessamento das paredes brônquicas e duração da exposição à fumaça de lenha em horas-ano. O achado de enfisema centrolobular foi infrequente e não diferiu entre os grupos (p = 0,232). CONCLUSÕES: A exposição à fumaça de lenha provoca alterações predominantemente brônquicas, que podem ser detectadas por TCAR, mesmo nos casos de DPOC leve.Universidade Federal de Goiás Faculdade de MedicinaUniversidade Federal de Goiás Faculdade de EnfermagemUniversidade Federal de Goiás Faculdade de Medicina Hospital das ClínicasUniversidade Federal de Goiás Faculdade de Medicina Departamento de Imagenologia e PatologiaClínica Multimagem DiagnósticosUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Magnetic field strength and orientation effects on Co-Fe discontinuous multilayers close to percolation

Magnetization and magnetoresistance in function of the magnitude and orientation of applied magnetic field were studied in Co-Fe discontinuous multilayers close to their structural percolation. The high pulsed magnetic fields up to 33 T were used in the 120–310 K temperature range. Comparison between longitudinal and transverse (with respect to the film plane) field configurations was made in the low-field and high-field regimes in order to clarify the nature of the measured negative magnetoresistance. Coexistence of two distinct magnetic fractions, superparamagnetic (SPM, consisting of small spherical Co-Fe granules) and superferromagnetic (SFM, by bigger Co-Fe clusters), was established in this system. These fractions were shown to have different relevance for the system magnetization and magnetotransport. While the magnetization is almost completely (up to ∼97%) defined by the SFM contribution and practically independent of temperature (in this range), the magnetoresistance experiences a crossover from a regime dominated by Langevin correlations (suppressed with temperature) between neighbor SPM and SFM moments at low fields, to that dominated by spin scattering (enhanced with temperature) of charge carriers within SFM clusters at high fields. Also, the demagnetizing effects, sensitive to the field orientation, were found to essentially define the low-field behavior and characteristic crossover field

Spurious infection by Calodium hepaticum (Bancroft, 1983) Moravec, 1982 and intestinal parasites in forest reserve dwellers in Western Brazilian Amazon

Subsistence hunting is the main source of protein for forest reserve dwellers, contributing to the development of spurious infections by Calodium hepaticum, frequently associated with the consumption of the liver from wild mammals. The prevalence of infections by soil-transmitted helminths (STHs) and intestinal protozoa is considered an indicator of the social vulnerability of a country, besides providing information on habits, customs and quality of life of a given population. Intestinal parasites mostly affect poor rural communities with limited access to clean water and adequate sanitation. This study reports the results of a parasitological survey carried out in 2017 and 2019, in two municipalities (Xapuri and Sena Madureira) in Acre State. Stool samples were collected from 276 inhabitants. Upon receipt, each sample was divided into two aliquots. Fresh samples without preservative were processed and examined by the Kato-Katz technique. Samples fixed in 10% formalin were processed by the spontaneous sedimentation and the centrifugal sedimentation techniques. Calodium hepaticum eggs were found in three stool samples. The overall STH prevalence was 44.9%. The hookworm prevalence (19.2%) was higher than that of Ascaris lumbricoides (2.5%) and Trichuris trichiura (0.7%), an unexpected finding for municipalities belonging to the Western Brazilian Amazon. When considering parasites transmitted via the fecal-oral route, Endolimax nana and Entamoeba coli showed the highest positivity rates, of 13% and 10.9%, respectively. This study is the first report of spurious infection by C. hepaticum among forest reserve dwellers that consume undercooked liver of lowland pacas. Additionally, this is the first report of Blastocystis sp. in Acre State

RECEPTORES DE MEMBRANA CD114 PODEM AUXILIAR NA AVALIAÇÃO DA MORTALIDADE MOLECULAR EM MEDULOBLASTOMAS?

Introduction: Medulloblastomas are the most common solid tumors of childhood and many studies seek to develop new chemotherapy drugs by identifying genes whose expression is new molecular targets for drugs, such as membrane receptors associated with cell replication. Objective: To review existing knowledge about the association of CD114 expression with mortality in medulloblastoma. Method: Narrative review collecting information with material for reading and analysis selected from research on virtual platforms (SciELO, Pubmed and Scopus). Initially, a search was carried out for descriptors related to the topic, which were identified through MESH using the following terms: “neurosurgery, surgical oncology, molecular targeted therapy, medulloblastoma” with AND or OR search, considering the title and/or abstract. After, the search was carried out, the title and abstract were analyzed and those that could be included were read in full. Results: 23 articles were included. Conclusion: There is no direct relationship between the expression of the CD114 membrane receptor and mortality in patients with medulloblastoma, and additional studies should be carried out on the intracellular signaling pathways associated with this receptor and its gene, CSF3RIntrodução: Meduloblastomas são os tumores sólidos mais comuns da infância e muitos estudos buscam desenvolvimento de novos quimioterápicos com a identificação de genes cuja expressão sejam novos alvos moleculares para drogas, como receptores de membrana associados à replicação celular. Objetivo: Revisar o cohecimento existente sobre a associação da expressão de CD114 com a mortalidade no meduloblastoma. Método: Revisão narrativa colhendo informações com o material para leitura e análise selecionado a partir de pesquisa em plataformas virtuais (SciELO, Pubmed e Scopus). Inicialmente foi realizada busca por descritores relacionados ao tema, os quais foram identificados por meio do DeCS utilizando os seguintes termos: “neurocirurgia, oncologia cirúrgica, terapia de alvo molecular, meduloblastoma” ” e seus equivalentes em inglês &nbsp;“neurosurgery, surgical oncology, molecular targeted therapy, medulloblastoma” com busca AND ou OR, considerando o título e/ou resumo. Feita a busca, foi realizada análise do título, resumo e lidos na íntegra aqueles que poderiam ser incluídos. &nbsp;Resultados: Foram incluídos 23 artigos. Conclusão: Não há relação direta entre a expressão do receptor de membrana CD114 e a mortalidade em pacientes portadores de meduloblastoma e estudos adicionais devem ser feitos sobre as vias de sinalização intracelulares associadas a esse receptor e ao seu gene, o CSF3R

Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts

We aimed to compare patient's and physician's ratings of inhaled medication adherence and to identify predictors of patient-physician discordance.(SFRH/BPD/115169/2016) funded by Fundação para a Ciência e Tecnologia (FCT); ERDF (European Regional Development Fund) through the operations: POCI-01-0145-FEDER-029130 ('mINSPIRERS—mHealth to measure and improve adherence to medication in chronic obstructive respiratory diseases—generalisation and evaluation of gamification, peer support and advanced image processing technologies') cofunded by the COMPETE2020 (Programa Operacional Competitividade e Internacionalização), Portugal 2020 and by Portuguese Funds through FCT (Fundação para a Ciência e a Tecnologia).info:eu-repo/semantics/publishedVersio

Factors Associated with Emotion Regulation in Men with Internet Access Living in Brazil during the COVID-19 Pandemic

Publisher Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland.Objective: to evaluate the factors associated with emotion regulation in men with internet access living in Brazil during the COVID-19 pandemic. Method: an epidemiological survey, conducted with 1015 men. An electronic form was applied containing sociodemographic and occu-pational characteristics, support and coping strategies, as well as emotional and behavioral aspects. Emotion regulation was assessed using the Emotion Regulation Questionnaire. Results: The prevalence values observed were 44.6% for Low Cognitive Reappraisal and of 47.1% for High Emotional Sup-pression. The following factors were identified as associated: (a) with Low Cognitive Reappraisal: being aged 30 years old or more, practicing physical activity, worrying about social distancing and having positive emotions and feelings; and (b) with High Emotional Suppression: being heterosexual, non-white race/skin color, having security support or public administration, not sanitizing food, worrying about lack of physical activity and not having negative emotions. Conclusion: the adoption of emotion regulation strategies was associated with individual, contextual and emotional/behavioral characteristics. Masculinity ideals seem to exert an influence on these relationships.publishersversionpublishe