Feeding tube replacement: not always that simple!

Although surgical gastrostomy is not a technically troublesome surgery, the procedure may be accompanied by unfavorable outcomes. Most complications occur early in the post-operative period and include feeding tube dislodgment, stomal infection, peritonitis, and pneumonia. The authors report the case of an 83-year-old man who underwent a surgical gastrostomy because of a swallowing disorder after an ischemic stroke. Nine months after the procedure, the feeding tube dislodged and a new tube was inserted with a certain delay and with some difficulty, causing a false path and consequently an intrabdominal abscess after diet infusion. The outcome was fatal. The authors call attention for meticulous care with the insertion of feeding tubes and advise the performance of imaging control to assure its precise positioning

Curriculum Infusion Through Case Studies: Engaging Undergraduate Students In Course Subject Material and Influencing Behavior Change

This study investigated infusing health promotion topics into an engineering course via problem-based case studies and lecture to assess student learning and self-reported behavior. Junior-level systems engineering students in two sections participated: one section with 52 students and one with 36. One section received a celebratory drinking case; one received distracted driving case and a lecture about hazardous drinking. Student ability ratings related to the course subject matter generally improved with both cases. The lecture appeared to enhance health promotion knowledge. Students self-reported behavior change with both cases. Case studies as a form of curriculum infusion for health promotion topics show promise. The use of case studies overall was well-received by students and coupled with lecture material can increase student health promotion knowledge and behavior change

Whole-body magnetic resonance imaging for staging and follow-up of pediatric patients with Hodgkin's lymphoma: comparison of different sequences

OBJECTIVE: To compare the performance of the T1, T2, STIR and DWIBS (diffusion-weighted whole-body imaging with background body signal suppression) sequences in the staging and follow-up of pediatric patients with Hodgkin's lymphoma in lymph node chains, parenchymal organs and bone marrow, and to evaluate interobserver agreement. MATERIALS AND METHODS: The authors studied 12 patients with confirmed diagnosis of Hodgkin's lymphoma. The patients were referred for whole body magnetic resonance imaging with T1-weighted, T2-weighted, STIR and DWIBS sequences. RESULTS: The number of lymph node sites characterized as affected by the disease on T1- and T2-weighted sequences showed similar results (8 sites for both sequences), but lower than DWIBS and STIR sequences (11 and 12 sites, respectively). The bone marrow involvement by lymphoma showed the same values for the T1-, T2-weighted and DWIBS sequences (17 lesions), higher than the value found on STIR (13 lesions). A high rate of interobserver agreement was observed as the four sequences were analyzed. CONCLUSION: STIR and DWIBS sequences detected the highest number of lymph node sites characterized as affected by the disease. Similar results were demonstrated by all the sequences in the evaluation of parenchymal organs and bone marrow. A high interobserver agreement was observed as the four sequences were analyzed.OBJETIVO: Comparar o desempenho das sequências T1, T2, STIR e DWIBS (difusão de corpo inteiro com supressão do sinal de fundo) na identificação de sítios caracterizados como acometidos pelo linfoma de Hodgkin nas cadeias linfonodais, órgãos parenquimatosos e medula óssea, e avaliar a concordância entre os examinadores. MATERIAIS E MÉTODOS: Foram estudados 12 pacientes com diagnóstico confirmado de linfoma de Hodgkin. Os pacientes foram encaminhados para o exame de ressonância magnética, sendo realizadas as sequências ponderadas em T1, T2, STIR e DWIBS. RESULTADOS: O número de sítios linfonodais caracterizados como acometidos nas sequências ponderadas em T1 e T2 apresentaram resultados semelhantes (8 sítios), mas inferiores às sequências STIR e DWIBS (11 e 12 sítios, respectivamente). Quanto ao acometimento da medula óssea, observaram-se os mesmos valores para as sequências T1, T2 e DWIBS (17 lesões), superiores ao valor encontrado na sequência STIR (13 lesões). Quando realizada a comparação entre os examinadores, nota-se que há alta concordância entre as quatro sequências. CONCLUSÃO: As sequências STIR e DWIBS detectaram maior número de linfonodos caracterizados como acometidos. Todas as sequências apresentaram resultados semelhantes na avaliação dos órgãos parenquimatosos e medula óssea. Em todas as sequências analisadas houve alta concordância entre os examinadores.Universidade Federal de São Paulo (UNIFESP) Departamento de Diagnóstico por ImagemUniversidade Federal de São Paulo (UNIFESP) Instituto de Oncologia Pediátrica GRAACCClínica CentrusUniversidade Federal de São Paulo (UNIFESP) Instituto de Oncologia Pediátrica Centro de Diagnóstico por ImagemUNIFESP, Depto. de Diagnóstico por ImagemUNIFESP, Instituto de Oncologia Pediátrica GRAACCUNIFESP, Instituto de Oncologia Pediátrica Centro de Diagnóstico por ImagemSciEL

Evaluation of acute bacterial rhinosinusitis in asthma patients based on clinical parameters and imaging studies, together with ear, nose and throat examination

OBJECTIVE: To evaluate paranasal sinuses in patients with stable or acute asthma in order to determine the prevalence of acute bacterial rhinosinusitis. METHODS: A cross-sectional study including 30 patients with acute asthma (73% females) treated in the emergency room and 30 patients with stable asthma (80% females) regularly monitored as outpatients. All patients completed a questionnaire on respiratory signs and symptoms and were submitted to ear, nose and throat (ENT) examination, as well as to X-ray and computed tomography (CT) imaging of the sinuses. RESULTS: Based on the clinical diagnosis, the prevalence of acute bacterial rhinosinusitis was 40% in the patients with acute asthma and 3% in those with stable asthma. The ENT examination findings and the imaging findings in isolation were not useful to confirm the diagnosis. CONCLUSIONS: In themselves, ENT examination findings, X-ray findings and CT findings were not useful for the diagnosis of acute bacterial rhinosinusitis. Our results provide further evidence that a clinical diagnosis of bacterial rhinosinusitis should be made with caution.OBJETIVO: Avaliar os seios paranasais em pacientes com asma estável ou asma aguda para determinar a prevalência de rinossinusite bacteriana aguda. MÉTODOS: Estudo transversal incluindo 30 pacientes com asma aguda (73% do sexo feminino) tratados na sala de emergência e 30 pacientes com asma estável (80% do sexo feminino) regularmente acompanhados em ambulatório. Todos os pacientes responderam a um questionário sobre sinais e sintomas respiratórios e foram submetidos a exame otorrinolaringológico e a radiograma e tomografia computadorizada de seios paranasais. RESULTADOS: Com base no diagnóstico clínico, a prevalência de rinossinusite bacteriana aguda foi de 40% nos pacientes com asma aguda e de 3% nos com asma estável. O exame otorrinolaringológico e os exames de imagem isoladamente não foram úteis para a confirmação diagnóstica. CONCLUSÕES: O exame otorrinolaringológico e o radiograma e a tomografia de seios paranasais por si só não foram úteis para o diagnóstico de rinossinusite bacteriana aguda. Nossos resultados confirmam a evidência de que o diagnóstico clínico de rinossinusite aguda deve ser dado com cautela.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Diagnóstico por ImagemUNIFESP, EPM, Depto. de MedicinaUNIFESP, EPM, Depto. de Diagnóstico por ImagemSciEL

Painful hip in children

Universidade Federal de São Paulo (UNIFESP) Departamento de Diagnóstico por ImagemUNIFESP Setor de Reumatologia PediátricaUNIFESPUNIFESP, Depto. de Diagnóstico por ImagemUNIFESP, Setor de Reumatologia PediátricaUNIFESPSciEL

Bimanual grasp planning reflects changing rather than fixed constraint dominance

We studied whether motor-control constraints for grasping objects that are moved to new positions reflect a rigid constraint hierarchy or a flexible constraint hierarchy. In two experiments, we asked participants to move two plungers from the same start locations to different target locations (both high, both low, or one high and one low). We found that participants grasped the plungers symmetrically and at heights that ensured comfortable or easy-to-control end postures when the plungers had the same target heights, but these grasp tendencies were reduced when the plungers had different target heights. In addition, when the plungers had different mass distributions, participants behaved in ways that suggested still-different emphases of the relevant grasp constraints. When the plungers had different mass distributions, participants sacrificed bimanual symmetry for end-state comfort. The results suggest that bimanual grasp planning relies on a flexible rather than static hierarchy. Different constraints take on different degrees of importance depending on the nature of the task and on the level of task experience. The results have implications for the understanding of perceptual-motor skill learning. It may be that one mechanism underlying such learning is changing the priorities of task constraints

O setor de bebidas no Brasil

Bibliografia: p. 128-129.O presente trabalho traz um panorama da evolução recente do setor de bebidas através da análise de dados oficiais de produção, consumo, investimentos e balança comercial. Além disso, comentam-se as principais características de mercado que atualmente impactam a competitividade das empresas produtoras de bebidas. Busca-se, assim, analisar dados e organizar informações a fim de traçar perspectivas para o setor nos próximos anos

Diversidade e estrutura genética em populações naturais de Hancornia speciosa var. speciosa Gomes no nordeste do Brasil

Hancornia speciosa Gomes is a fruit tree native from Brazil that belongs to Apocinaceae family, and is popularly known as Mangabeira. Its fruits are widely consumed raw or processed as fruit jam, juices and ice creams, which have made it a target of intense exploitation. The extractive activities and intense human activity on the environment of natural occurrence of H. speciosa has caused genetic erosion in the species and little is known about the ecology or genetic structure of natural populations. The objective of this research was the evaluation of the genetic diversity and genetic structure of H. speciosa var. speciosa. The genetic variability was assessed using 11 allozyme loci with a sample of 164 individuals distributed in six natural populations located in the States of Pernambuco and Alagoas, Northeastern Brazil. The results showed a high level of genetic diversity within the species (<img border=0 id="_x0000_i1026" src="/img/revistas/rbf/v34n4/a23img01.jpg" align=absmiddle>e= 0.36) seeing that the most of the genetic variability of H. speciosa var. speciosa is within its natural populations with low difference among populations ( <img border=0 id="_x0000_i1027" src="/img/revistas/rbf/v34n4/a23img02.jpg" align=absmiddle > or = 0.081). The inbreeding values within (<img border=0 id="_x0000_i1028" src="/img/revistas/rbf/v34n4/a23img03.jpg" align=absmiddle> = -0.555) and among populations (<img border=0 id="_x0000_i1029" src="/img/revistas/rbf/v34n4/a23img04.jpg" align=absmiddle> =-0.428) were low showing lacking of endogamy and a surplus of heterozygotes. The estimated gene flow ( <img border=0 id="_x0000_i1030" src="/img/revistas/rbf/v34n4/a23img05.jpg" align=absmiddle>m ) was high, ranging from 2.20 to 13.18, indicating to be enough to prevent the effects of genetic drift and genetic differentiation among populations. The multivariate analyses indicated that there is a relationship between genetic and geographical distances, which was confirmed by a spatial pattern analysis using Mantel test (r = 0.3598; p = 0.0920) with 1000 random permutations. The high genetic diversity index in these populations indicates potential for in situ genetic conservation

Grasping trapezoidal objects

When grasping rectangular or circular objects with a precision grip the digits close in on the object in opposite directions. In doing so the digits move perpendicular to the local surface orientation as they approach opposite sides of the object. This perpendicular approach is advantageous for accurately placing the digits. Trapezoidal objects have non-parallel surfaces so that moving the digits in opposite directions would make the digits approach the contact surfaces at an angle that is not 90°. In this study we examined whether this happens, or whether subjects tend to approach trapezoidal objects’ surfaces perpendicularly. We used objects of different sizes and with different surface slants. Subjects tended to approach the object’s surfaces orthogonally, suggesting that they aim for an optimal precision of digit placement rather than simply closing their hand as it reaches the object