Digital organization of Plastic Surgery Service

The attention and enthusiasm of doctors in the pre- and postoperative period is of extreme importance in maintaining good doctor/patient relationships. An adequate organization and documentary record contributes to achieving a good relationship and ensures an important legal tool for physicians. With current technological advances, the electronic medical record is a secure and democratic way to deal with this information. The government has sought to implement this system in public institutions; however, results are still modest, perhaps mainly due to the lack of resources for investment in this area. In light of this, and given the relevance of practical, informative, and dynamic medical records, we aim to present our experience with the use of a complementary digital resource that is commonly associated with medical records and uses a free of cost digital platform for storing data in the "cloud". This system can provide additional information about each patient, including outpatient follow-up, as well as photographic records of the pre-, intra-, and post-operative periods, and also facilitates quick, synchronized, and remote access through the internet. The system generates optimization of resources, surgical planning, and improvement in patient/ doctor relationships. It also leads to greater integration of the medical team, particularly in the discussion of cases and distribution of surgeries by preceptors and residents. Thus, it is an alternative resource to improve medical charts with important data regarding the performance of medical teams, paying special attention to the peculiarities of plastic surgery

Zygomatic-palpebral flap: an optional technique for lower eyelid reconstruction

Introduction: Lower eyelid reconstruction represents a unique challenge to plastic surgeons, since it involves a facial region of aesthetic and functional importance. The objective is to present an optional technique for the reconstruction of lower eyelid defects using zygomatic-palpebral skin flap. This technique represents an alternative in cases of scleroatrophic skin in older patients, and for young people who do not have an upper eyelid skin redundancy, which prevents, for example, the use of upper eyelid grafts or flaps such as those of Fricke or Tripier. Methods: The authors describe the flap used in cases of cicatricial ectropion and reconstruction after resection of neoplasms and association with other flaps, such as those of Hughes, or for coverage of cartilage grafts. The flap consisted of a transposition flap made up of skin and underlying subcutaneous tissues, randomized . The technique was based on the use of a local flap with highly similar characteristics to the defect area, which allowed it to mimic functions, while being safe and feasible. Results: The immediate and late results in terms of aesthetics and function were satisfactory and well accepted by patients and the surgical team, with adequate eyelid occlusion and preserved ocular lubrication. Conclusion: The advantages of the zygomatic-palpebral flap are its ease of execution, minimal bleeding, low morbidity of the donor area, and the use of local anesthesia. The reconstruction of eyelid defects aims to restore anatomy and function. This can be a challenging task, especially in cases with larger defects that may be present after oncologic procedures both in young and old patients presenting with scleroatrophic skin and minimal tissue laxity

Jambolão extract and potassium sorbate as antimicrobial components in active packaging

This study aimed to use the raw extract of jambolão (Syzygium cumini L.) and potassium sorbate as antimicrobial components in cellulose acetate films and evaluate their potential for application as active packaging forsugar-free banana preserve. The films  were prepared using the casting method and evaluated for thickness and inhibition potential. The efficiency of the films as active packaging, in situ, was evaluated through the enumeration of aerobic mesophiles and mold and yeast over 36 days of storage of banana preserves.Furthermore, in order to analyze the fungicidal effect of the films against banana preserve with an initial load of microorganisms, mold and yeast were counted for 25 days of storage. The results showed that the incorporation of crude jambolão extract increased the film thickness, and its inhibition potential was similar to the film with incorporated potassium sorbate. Furthermore, the film with crude jambolão extract reduced mold and yeast growth by up to 1 log cycle over 36 days of storage. Furthermore, the use of the film with potassium sorbate promoted the same effect as this preservative added directly to the fruit preserve and proved to be efficient even with relevant initial contamination. Thus, the use of these active packagings presents an opportunity for industries as they reduce health risks and improve the safety and quality of preserves.This study aimed to use the raw extract of jambolão (Syzygium cumini L.) and potassium sorbate as antimicrobial components in cellulose acetate films and evaluate their potential for application as active packaging forsugar-free banana preserve. The films  were prepared using the casting method and evaluated for thickness and inhibition potential. The efficiency of the films as active packaging, in situ, was evaluated through the enumeration of aerobic mesophiles and mold and yeast over 36 days of storage of banana preserves

Biomaterials for orbital reconstruction: literature review

The treatment of traumatic lesions of the orbit remains a challenge for the maxillofacial surgeon. When surgical correction is not performed or is performed incorrectly, may occur enophthalmos, diplopia, ocular dystopia, restriction of ocular movements and dysfunction of the infraorbital nerve. The importance of surgery is to release the herniated orbital tissue at the fracture site, restoring the normal architecture of the orbit, aiming at an adequate functional and aesthetic results. In recent decades, many advances have occurred in the surgical treatment of these fractures, as well as in diagnostic methods. With the development of multislice CT, it became possible to analyze three-dimensional orbit, as well as its volumetric evaluation, which revolutionized the surgical management of these fractures. Another factor with direct impact on the reconstruction of the orbits, is the availability of various biomaterials for the restoration of the orbital walls. The objective of this paper is to review the materials available for reconstruction in cases of fractures of the orbital floor, its applicability to compare practices and highlight those most used in the Plastic Surgery Service, Hospital de Clinicas, Unicamp, in recent years. Among the materials of choice in our service, we highlight the autogenous skull bone, cartilage of ear shell, the titanium mesh and porous high density polyethylene. Each biomaterial has specific indications, according to the characteristics of orbital fracture, being considered for choosing the material, the long-term results and experience of surgeon.O tratamento de lesões traumáticas da órbita permanece um desafio para o cirurgião maxilofacial. Quando a correção cirúrgica não é realizada ou é feita de maneira inadequada, pode ocorrer enoftalmia, diplopia, distopia ocular, restrição da movimentação ocular e disfunção do nervo infraorbital. A importância da cirurgia consiste em liberar o tecido orbitário herniado pelo foco de fratura, restaurar a arquitetura normal da órbita, objetivando um resultado estético e funcional adequado. Nas últimas décadas, vários avanços ocorreram no tratamento cirúrgico destas fraturas, bem como nos métodos diagnósticos. Com o desenvolvimento de tomografias computadorizadas de múltiplos detectores, tornou-se possível a análise tridimensional da órbita, assim como sua avaliação volumétrica, o que revolucionou o manejo cirúrgico destas fraturas. Outro fator com impacto direto nas reconstruções das órbitas é a disponibilidade de diversos biomateriais, para restauração das paredes orbitárias. Assim, o objetivo desse artigo é revisar os materiais disponíveis para reconstrução nos casos de fraturas do assoalho da órbita, comparar suas aplicabilidades práticas e destacar aqueles mais utilizados no Serviço de Cirurgia Plástica do Hospital de Clínicas da Unicamp, nos últimos anos. Dentre os materiais de escolha, em nosso Serviço, destacamos o osso autógeno de calota craniana, a cartilagem de concha auricular, a tela de titânio e o polietileno poroso de alta densidade. Cada biomaterial apresenta indicações específicas, de acordo com as características da fratura orbitária, sendo considerados, para a escolha do material, os resultados a longo prazo e a experiência do cirurgião.33734

Minilipoabdominoplasty with umbilicus detachment: indications and comparison of surgical tactics for umbilicus reintegration, an prospective study

INTRODUCTION: The minilipoabdominoplastia with umbilicus detachment represents a surgical procedure restricted to cases in which isolated liposuction would cause worsening of sagging skin, while the conventional abdominoplasty would imply excessive skin resection. It allows xyphopubic plication of the rectus abdominis muscle and good resection of the excessive lower abdominal skin. The objective is to provide patients with high umbilucus treated with liposuction, mini-abdominoplasty with umbilucus detachment and reinsertion below, and comparison of two techniques for umbilical reinsertion. METHODS: We included six women aged 32- to 50-year-old and who underwent surgery under spine and general anesthesia from January to June 2013 in the Hospital of the Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil. RESULTS: After surgery, patients had natural silhouettes of body contours and umbilicus repositioned without external scars. CONCLUSION: The technique used allows treatment of moderate sagging skin of upper and lower abdomen with need of a small incision, the technique provides umbilicus scarring without external scarring and less chance of complications due to the small detachment

Equivalência e avaliação da necessidade de sorologia de controle entre esquemas de pré-exposição à raiva humana

OBJECTIVE: To evaluate the humoral immune response to the pre-exposure schedule of human rabies vaccination through intradermal and intramuscular routes, as well as the need for serological monitoring. METHODS: A randomized and controlled intervention study was carried out in São Paulo, Southeastern Brazil, from 2004-2005. There were 149 volunteers, of which 127 completed the vaccination schedule (65 intradermal and 62 intramuscular) and underwent humoral immune response evaluation at ten, 90 and 180 days post-vaccination. Two outcomes were considered for comparing the two routes of administration: the geometric average of neutralizing antibody titers and the proportion of individuals with satisfactory titers (>; 0.5 IU/mL) at each evaluation point. The association of the humoral immune response with anthropometric and demographic data was analyzed through a normal distribution test and a chi-square test with a Yates correction. After completion of the vaccination schedule, the proportion of seropositive results was compared by the Kruskall Wallis test, and the average titers were compared by variance analysis. RESULTS: the average antibody titers were higher in patients who were vaccinated intramuscularly. The percentage of volunteers with satisfactory titers (>; 0.5% IU/mL) decreased over time in both groups. However, in the group vaccinated intradermally the rate of satisfactory titers on day 180 ranged from 20% to 25%, while the intramuscular route varied from 63% to 65%. An association between the humoral immune response and the demographic and anthropometric variables was not observed. CONCLUSIONS: Serology after the third dose can be considered unnecessary in unexposed patients, since 97% and 100% of volunteers respectively vaccinated by the intradermal and intramuscular route presented satisfactory antibody levels (>; 0.5% IU/mL).OBJETIVO: Evaluar la respuesta inmune humoral del esquema de pre-exposición de la rabia humana realizado por las vías intramuscular e intradérmica y la necesidad de serología de control. MÉTODOS: Estudio de intervención controlado y aleatorio, realizado en Sao Paulo, Sureste de Brasil, en 2004-2005. Fueron reclutados 149 voluntarios, de los cuales 127 (65 intradérmica y 62 intramuscular) completaron el esquema de vacunación y realizaron evaluación de la respuesta inmune humoral 10, 90 y 180 días posterior al término de la vacunación. Fueron considerados dos resultados para la comparación entre las dos vías de aplicación: el promedio geométrico del título de anticuerpos neutralizantes y la proporción de individuos con títulos satisfactorios (>; 0,5 UI/mL) en cada momento de la evaluación. Fue analizada la asociación de la respuesta humoral con datos antropométricos y demográficos por medio de prueba de medias y chi-cuadrado con corrección de Yates. Posterior a la conclusión del esquema fueron realizadas la comparación de la proporción de seropositivos por la prueba de Kruskall Wallis y la comparación de los títulos promedios por análisis de varianza. RESULTADOS: Los títulos promedios de anticuerpos fueron mayores en los individuos que recibieron las vacunas por vía intramuscular. El porcentaje de voluntarios con títulos satisfactorios (>; 0,5 UI/mL) disminuyó con el tiempo en ambos grupos, sin embargo, en el grupo que recibió vacuna por vía intradérmica la proporción de títulos satisfactorios en el día 180 varió de 20% a 25%, mientras que por la vía intramuscular varió de 63% a 65%. No se observó asociación de la respuesta inmune humoral con las variables demográficas o antropométricas. CONCLUSIONES: La serología posterior a la tercera dosis puede ser considerada innecesaria en individuos bajo control con respecto a la exposición, una vez que 97% y 100% de los voluntarios vacunados, respectivamente por vía intradérmica y por la vía intramuscular, presentaron niveles de anticuerpos satisfactorios (>; 0,5 UI/mL).OBJETIVO: Avaliar a resposta imune humoral do esquema de pré-exposição da raiva humana realizado pelas vias intramuscular e intradérmica e a necessidade de sorologia de controle. MÉTODOS: Estudo de intervenção controlado e randomizado, realizado em São Paulo, SP, em 2004-2005. Foram recrutados 149 voluntários, dos quais 127 (65 intradérmica e 62 intramuscular) completaram o esquema de vacinação e realizaram avaliação da resposta imune humoral dez, 90 e 180 dias após o término da vacinação. Foram considerados dois desfechos para a comparação entre as duas vias de aplicação: a média geométrica do título de anticorpos neutralizantes e a proporção de indivíduos com títulos satisfatórios (>; 0,5 UI/mL) em cada momento de avaliação. Foi analisada a associação da resposta humoral com dados antropométricos e demográficos por meio de teste de médias e qui-quadrado com correção de Yates. Após a conclusão do esquema foram feitas a comparação da proporção de soropositivos pelo teste de Kruskall Wallis e a comparação dos títulos médios por análise de variância. RESULTADOS: Os títulos médios de anticorpos foram maiores nos indivíduos que receberam as vacinas por via intramuscular. A percentagem de voluntários com títulos satisfatórios (>; 0,5 UI/mL) diminuiu com o tempo em ambos os grupos, porém, no grupo que recebeu as vacinas por via intradérmica, a proporção de títulos satisfatórios no dia 180 variou de 20% a 25%, enquanto pela via intramuscular variou de 63% a 65%. Não se observou associação da resposta imune humoral com as variáveis demográficas ou antropométricas. CONCLUSÕES: A sorologia após a terceira dose pode ser considerada desnecessária em indivíduos sob controle quanto à exposição, uma vez que 97% e 100% dos voluntários vacinados, respectivamente por via intradérmica e pela via intramuscular, apresentaram níveis de anticorpos satisfatórios (>; 0,5 UI/mL)

Trends and factors associated with dengue mortality and fatality in Brazil.

INTRODUCTION: Studies that generate information that may reduce the dengue death risk are essential. This study analyzed time trends and risk factors for dengue mortality and fatality in Brazil from 2001 to 2011. METHODS: Time trends for dengue mortality and fatality rates were analyzed using simple linear regression. Associations between the dengue mortality and the case fatality rates and socioeconomic, demographic, and health care indicators at the municipality level were analyzed using negative binomial regression. RESULTS: The dengue hemorrhagic fever case fatality rate increased in Brazil from 2001 to 2011 (β=0.67; p=0.036), in patients aged 0-14 years (β=0.48; p=0.030) and in those aged ≥15 years (β=1.1; p<0.01). Factors associated with the dengue case fatality rate were the average income per capita (MRR=0.99; p=0.038) and the number of basic health units per population (MRR=0.89; p<0.001). Mortality rates increased from 2001 to 2011 (β=0.350; p=0.002).Factors associated with mortality were inequality (RR=1.02; p=0.001) high income per capita (MRR=0.99; p=0.005), and higher proportions of populations living in urban areas (MRR=1.01; p<0.001). CONCLUSIONS: The increases in the dengue mortality and case fatality rates and the associated socioeconomic and health care factors, suggest the need for structural and intersectoral investments to improve living conditions and to sustainably reduce these outcomes

The therapeutic play in nursing graduation: from theory to practice / O brinquedo terapêutico na graduação de enfermagem: da teoria à prática

Objetivo: identificar o uso do brinquedo terapêutico pelos acadêmicos de enfermagem no cuidado à criança hospitalizada e discutir as implicações de seu uso na trajetória do acadêmico de enfermagem. Método: pesquisa qualitativa, desenvolvida em uma Escola de Enfermagem Federal no Rio de Janeiro com 17 acadêmicos. A coleta de dados foi realizada em outubro e novembro de 2016 por meio de entrevista semiestrutura e tratados com a técnica de análise de conteúdo temática. Resultados: o brinquedo terapêutico é apresentado ao aluno no conteúdo teórico, porém sem a oportunidade de aplicá-lo na prática. Sua aplicação prática o deixaria mais seguro para prestar assistência à criança, somado a qualidade do cuidado prestado e os benefícios para ela. Conclusão: o ensino do brinquedo terapêutico deve acontecer em campo prático, e não somente no teórico, contribuindo assim, para melhor formação do enfermeiro e melhoria da qualidade da assistência pediátrica.

Epidemiologia da exposição pré-natal à cocaína e suas repercussões no recém-nascido

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Development and assessment of concentrate salty yogurt added spices.

Atualmente, nota-se um grande aumento da demanda por produtos diferenciados com ampla variedade de sabores e aromas e que tragam benef?cios para a sa?de. Diante disso, o objetivo deste trabalho foi avaliar a influ?ncia de diferentes concentra??es de especiarias no desenvolvimento de iogurtes concentrados salgados. Para isso foi utilizado o delineamento de misturas para estudar as intera??es entre or?gano, salsa e manjeric?o desidratados em iogurtes concentrados salgados. Foram realizadas an?lises f?sico-qu?micas, de compostos bioativos, sensoriais e microbiol?gicas. Os resultados obtidos indicaram que as formula??es de iogurtes concentrados salgados apresentaram elevado teor de umidade (73,67% a 78.85%) e que a utiliza??o de diferentes concentra??es de especiarias aumenta o pH e diminuem os teores de prote?nas dos produtos elaborados, al?m de obter formula??es com diferentes teores de cinzas e lip?dios. Em rela??o aos teores de compostos bioativos, as formula??es de iogurtes concentrados salgados n?o ofereceram elevados valores (0,01 a 0,11 mg GAE/ g de especiarias; 425,33 a 360877,52 EC50 ? g de especiarias/g DPPH), provavelmente por causa da quantidade de especiarias adicionada (0,25% em todas as formula??es) e que as formula??es mais aceitas s?o aquelas que utilizam concentra??es de 10% de manjeric?o a 90% de or?gano.Nowadays, there is a great increase in the demand for differentiated products with a wide variety of flavors and aromas that bring health benefits. Therefore, the objective of this study was to evaluate the influence of different concentrations of spices on the development of concentrated salty yoghurt. For this, mixture design experiments was used to study the interactions between oregano, parsley and basil dehydrated in concentrated salty yoghurt. Physicochemical, compounds bioactive, sensorial and microbiological analyses were performed. The results indicated that concentrated salty yoghurt formulations presented high moisture content (73.67% to 78.85%) and that the use of different concentrations of spices increases the pH and decrease the protein content of the elaborated products, besides obtaining formulations with different levels of ash and lipids. Regarding the contents of bioactive compounds, concentrated salty yoghurt formulations did not offer high values (0.01 to 0.11 mg GAE/g of spices, 425.33 to 360877.52 EC50 - g of spices/g DPPH), probably because of the amount of spices added (0.25% in all formulations) and that the most accepted formulations are those using concentrations of 10% basil to 90% oregano