Bases anatómicas para el bloqueo anestésico del plexo braquial por vía infraclavicular

BACKGROUND AND OBJECTIVES: This study shows the constant infraclavicular fossa presence, aiming at using it as a pathway for infraclavicular brachial plexus block. Determining the point where brachial plexus fascicles may be located within the fossa, the authors have proposed measurements from the anterior surface of the clavicle and the angle formed by the deltoid muscle and the clavicle (deltoclavicular angle). The first measurement allows the in-depth location of the site crossed by the brachial plexus. The second determines fascicles projection within the fossa, corresponding to the needle insertion point on the skin. METHODS: Measurements were made between the anterior surface of the clavicle and brachial plexus fascicles, and from the deltoclavicular angle to superficial fascicles projection. Based on the anatomic findings a technique of infraclavicular brachial plexus approach was proposed. RESULTS: A hundred infraclavicular regions in cadavers were analyzed. Infraclavicular fossa was detected in 96 cases where brachial plexus fascicles were totally or partially (97.9%) located. The distance between the anterior surface of the clavicle and brachial plexus fascicles was in average of 2.49 cm and from the deltoclavicular angle to superficial fascicles projection was 2.21 cm. CONCLUSIONS: Values obtained allow for the precise location of the needle insertion point which, when perpendicular to the skin, reaches brachial plexus without danger of causing pneumothorax or vascular injury, providing more safety to anesthesiologists and allowing the return to the practice of brachial plexus block below the clavicle.JUSTIFICATIVA Y OBJETIVOS: Buscamos demostrar en este estudio la presencia constante de la fosa infraclavicular, con la finalidad de su utilización como vía de acceso para el bloqueo anestésico del plexo braquial por via infraclavicular. Con la idea de solucionar el punto donde los fascículos del plexo braquial pueden ser localizados en el interior de la fosa, propusimos medidas a partir de la face anterior de la clavícula y del ángulo formado por el encuentro del músculo deltóide con la clavícula (ángulo deltoclavicular). La primera medida permite localizar en profundidad el local donde pasa el plexo braquial. Ya la segunda, determina la proyección de los fascículos dentro de la fosa, lo que corresponde al punto de entrada de la aguja en la superficie cutánea. MÉTODO: Fueron efectuadas medidas entre la face anterior de la clavícula y los fascículos del plexo braquial, y del ángulo deltoclavicular hasta la proyección superficial de los fascículos. Con base en los encuentros anatómicos fue propuesta una técnica de abordaje del plexo braquial por via infraclavicular. RESULTADOS: Fueron analizadas 100 regiones infraclaviculares de cadáveres fijados. La fosa infraclavicular fue detectada en 96 casos. En ésas, los fascículos del plexo braquial se localizan totalmente o parcialmente en 97,9%. La medida comparada entre la face anterior de la clavícula y los fascículos del plexo, fue de 2,49 cm y del ángulo deltoclavicular hasta la proyección superficial de los fascículos estaba en 2,21 cm. CONCLUSIONES: Los datos obtenidos permiten la determinación exacta del punto de introducción de la aguja, la cual, dirigida perpendicular a la piel, alcanza el plexo braquial sin peligro de provocar pneumotórax o lesión vascular, posibilitando una mayor seguridad a los anestesiologistas, y permitiendo la vuelta de la práctica del bloqueo del plexo abajo de la clavícula.JUSTIFICATIVA E OBJETIVOS: Procuramos demonstrar neste estudo a presença constante da fossa infraclavicular, com a finalidade de sua utilização como via de acesso para o bloqueio anestésico do plexo braquial por via infraclavicular. Visando solucionar o ponto onde os fascículos do plexo braquial podem ser localizados no interior da fossa, propusemos medidas a partir da face anterior da clavícula e do ângulo formado pelo encontro do músculo deltóide com a clavícula (ângulo deltoclavicular). A primeira medida permite localizar em profundidade o local onde passa o plexo braquial. Já a segunda, determina a projeção dos fascículos dentro da fossa, o que corresponde ao ponto de entrada da agulha na superfície cutânea. MÉTODO: Foram efetuadas medidas entre a face anterior da clavícula e os fascículos do plexo braquial, e do ângulo deltoclavicular até a projeção superficial dos fascículos. Com base nos achados anatômicos foi proposta uma técnica de abordagem do plexo braquial por via infraclavicular. RESULTADOS: Foram analisadas 100 regiões infraclaviculares de cadáveres fixados. A fossa infraclavicular foi detectada em 96 casos. Nessas os fascículos do plexo braquial localiza-se totalmente ou parcialmente em 97,9%. A medida aferida entre a face anterior da clavícula e os fascículos do plexo, foi de 2,49 cm e do ângulo deltoclavicular até a projeção superficial dos fascículos estava em 2,21 cm. CONCLUSÕES: Os dados obtidos permitem a determinação precisa do ponto de introdução da agulha, a qual, dirigida perpendicular à pele, atinge o plexo braquial sem perigo de provocar pneumotórax ou lesão vascular, possibilitando uma segurança maior aos anestesiologistas, e permitindo a volta da prática do bloqueio do plexo abaixo da clavícula.Universidade Federal de Alagoas Departamento de MorfologiaUniversidade Federal de AlagoasEscola Paulista de MedicinaUNIFESP, EPMSciEL

Ejercicio de práctica por individuos con diabetes mellitus

O diabetes mellitus (DM) está associado a um grupo de doenças metabólicas caracterizadas por hiperglicemia crônica, decorrente de defeitos na ação ou na secreção de insulina. O tratamento não farmacológico representa papel primordial na melhoria e controle do DM. Este tratamento engloba uma série de aspectos, tais como: mudança do estilo de vida, hábitos alimentares e prática de exercício físico. O presente estudo teve como objetivo evidenciar por meio de uma revisão bibliográfica os benefícios da pratica de exercícios físicos por indivíduos com Diabetes Mellitus. Trata-se de uma revisão de literatura do tipo integrativa, para a construção da mesma utilizou-se das seguintes bases de dados: Scielo, BVS e Google acadêmico. Foi possível verificar que o incentivo para mudanças do estilo de vida, relacionado as mudanças de hábitos alimentares, prática de exercício físico, pode prevenir ou retardar o Diabetes Mellitus, melhorando o controle de glicose no sangue, complicações metabólicas, possibilitando uma melhor qualidade de vida aos indivíduos com Diabetes Mellitus. Diabetes mellitus (DM) is associated with a group of metabolic diseases characterized by chronic hyperglycemia, due to defects in insulin action or secretion. Non-pharmacological treatment plays a major role in DM improvement and control. This treatment encompasses a number of aspects such as: lifestyle change, eating habits and exercise. This study aimed to highlight through a literature review the benefits of physical exercise practice by individuals with diabetes mellitus. This is an integrative literature review, for its construction we used the following databases: Scielo, VHL and Google academic. It was found that the incentive for lifestyle changes, related to changes in eating habits, physical exercise, can prevent or delay diabetes mellitus, improving blood glucose control, metabolic complications, enabling a better quality of life. to individuals with diabetes mellitus.La diabetes mellitus (DM) está asociada con un grupo de enfermedades metabólicas caracterizadas por hiperglucemia crónica, debido a defectos en la acción o secreción de insulina. El tratamiento no farmacológico juega un papel importante en la mejora y el control de la DM. Este tratamiento abarca una serie de aspectos como: cambio de estilo de vida, hábitos alimenticios y ejercicio. Este estudio tuvo como objetivo destacar a través de una revisión de la literatura los beneficios de la práctica de ejercicio físico en individuos con diabetes mellitus. Esta es una revisión de literatura integradora, para su construcción utilizamos las siguientes bases de datos: Scielo, VHL y Google Academic. Se descubrió que el incentivo para los cambios en el estilo de vida, relacionados con los cambios en los hábitos alimenticios, el ejercicio físico, puede prevenir o retrasar la diabetes mellitus, mejorar el control de la glucosa en la sangre, las complicaciones metabólicas, lo que permite una mejor calidad de vida. a personas con diabetes mellitus

A atuação da toxina botulínica no tratamento da espasticidade pós-AVE: Acidente Vascular Encefálico

Objetivo: Revisar na literatura, tendo como embasamento o acervo literário artigos periódicos científicos, relatos de caso e revisões narrativas, para contribuição de um maior número de feitos bibliográficos. Revisão Bibliográfica: Sendo uma patologia com declínio nítido e abrupto sobre a qualidade de vida e capacidade funcional do corpo, o acidente vascular encefálico (AVE) também afeta a espasticidade muscular. Dessa forma, pesquisadores tem relatado ações positivas acerca da toxina botulínica (BTX-A) e, paralelamente, o uso da BTX-A no tratamento de pacientes que tiveram sequelas pós AVE. Portanto, torna-se indispensável o objetivo de potencializar estudos coletivos e unir opiniões científicas acerca dos benefícios da toxina botulínica. Considerações Finais: Tendo em mente que a toxina botulínica A é temporária, será necessário refazer as aplicações em pacientes que tiveram sequelas pós-AVE geralmente entre 4-6 meses. Não obstante, pesquisas e relatos científicos afirmam que, mesmo diante de sua efetividade a curto prazo, torna-se atualmente o método mais eficaz e rápido para o tratamento de sequelas em pacientes com espasticidade.&nbsp

O estudo do funcionamento da visão humana: uma análise dos livros didáticos de física / The study of the functioning of human vision: an analysis of physics teaching books

Sabemos que o livro didático possui um papel muito importante no processo educativo, uma vez que, muitas vezes, ele é adotado como única ferramenta pelo professor no processo de ensino e aprendizagem. Dentro deste contexto, a pesquisa apresentada trata-se de uma análise de alguns livros didáticos da física relacionados ao conteúdo de ótica referente ao 2º ano do ensino médio, especificamente sobre o estudo do funcionamento da visão humana. A pesquisa foi realizada para o cumprimento da disciplina de Pesquisa em ensino de física, do curso de licenciatura em física da UEPB. As analises seguiram alguns critérios pré-estabelecidos, expostos pelo autor, tais como a averiguação da proposta segundo as ênfases curriculares atuais para o ensino médio. Após as análises observou-se que, apesar de algumas mudanças obtidas ao longo dos anos, os livros didáticos em física ainda deixam a desejar em diversos quesitos, apontando para uma reflexão sobre o mesmo, suas potencialidades e limitações.

Covid-19 misinformation in Portuguese-speaking countries: agreement with content and associated factors

In the wake of the COVID-19 pandemic, a complex phenomenon called the “infodemic” has emerged, compromising coping with the pandemic. This study aims to estimate the prevalence of agreement with misinformation about COVID-19 and to identify associated factors. A web survey was carried out in Portuguese-speaking countries in two stages: 1. the identification of misinformation circulating in the included countries; 2. a multicentric online survey with residents of the included countries. The outcome of the study was agreement or disagreement with misinformation about COVID-19. Multivariate analyzes were conducted using the Poisson regression model with robust variance, a logarithmic link function, and 95% confidence intervals. The prevalence of agreement with misinformation about COVID-19 was 63.9%. The following factors increased the prevalence of this outcome: having a religious affiliation (aPR: 1454, 95% CI: 1393–1517), having restrictions on leisure (aPR: 1230, 95% CI: 1127–1342), practicing social isolation (aPR: 1073, 95% CI: 1030–1118), not avoiding agglomeration (aPR: 1060, 95% CI: 1005–1117), not seeking/receiving news from scientific sources (aPR: 1153, 95% CI: 1068–1245), seeking/receiving news from three or more non-scientific sources (aPR: 1114, 95% CI: 1049–1182), and giving credibility to news carried by people from social networks (aPR: 1175, 95% CI: 1104–1251). There was a high prevalence of agreement with misinformation about COVID-19. The quality, similarity, uniformity, and acceptance of the contents indicate a concentration of themes that reflect “homemade”, simple, and easy methods to avoid infection by SARS-CoV-2, compromising decision-making and ability to cope with the disease.info:eu-repo/semantics/publishedVersio

The complete genome sequence of Chromobacterium violaceum reveals remarkable and exploitable bacterial adaptability

Chromobacterium violaceum is one of millions of species of free-living microorganisms that populate the soil and water in the extant areas of tropical biodiversity around the world. Its complete genome sequence reveals (i) extensive alternative pathways for energy generation, (ii) ≈500 ORFs for transport-related proteins, (iii) complex and extensive systems for stress adaptation and motility, and (iv) wide-spread utilization of quorum sensing for control of inducible systems, all of which underpin the versatility and adaptability of the organism. The genome also contains extensive but incomplete arrays of ORFs coding for proteins associated with mammalian pathogenicity, possibly involved in the occasional but often fatal cases of human C. violaceum infection. There is, in addition, a series of previously unknown but important enzymes and secondary metabolites including paraquat-inducible proteins, drug and heavy-metal-resistance proteins, multiple chitinases, and proteins for the detoxification of xenobiotics that may have biotechnological applications

Global variations in diabetes mellitus based on fasting glucose and haemogloblin A1c

Fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) are both used to diagnose diabetes, but may identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening had elevated FPG, HbA1c, or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardised proportion of diabetes that was previously undiagnosed, and detected in survey screening, ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the agestandardised proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global gap in diabetes diagnosis and surveillance.peer-reviewe

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants.

BACKGROUND: Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS: We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS: The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING: WHO

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. Copyright (C) 2021 World Health Organization; licensee Elsevier