Treatment of idiopathic congenital clubfoot using the Ponseti method: ten years of experience

AbstractObjectiveTo evaluate outcomes of 229 idiopathic clubfeet (ICF) treated using the Ponseti method, from 2001 to 2011, comparing two groups with different follow-ups.Method155 patients (229 ICF) were treated separated in two groups: Group I: 72 patients (109 ICF – 47.6%) with a follow up of 62 to 128 months (mean of 85). Group II: 83 patients (120 ICF – 52.4%) with a follow up of 4 to 57 months (mean of 33.5). We have considered satisfactory outcomes for cases which correction of all deformed components, without surgery.ResultsMean age for the initial assessment was 5.4 months in Group I and 3.2 in Group II. Satisfactory outcomes were obtained in 85.4% in Group I and 97.5% in Group II. Mean cast placements were 9.5 in Group I and 7 in Group II. 67% were submitted to percutaneous Achilles tenotomy in Group I and 65% in Group II. Deformity relapses, when using abducted braces, occurred in 41 (37.6%) feet from Group I; 11 were treated surgically. In Group II, 17 feet relapsed (14.1%); three of them were submitted to surgery.ConclusionThe method was successful in both groups, in low number of complications. The results were statistically superior in Group II when deformity correction, cast placements, relapses and surgery indication

POST-HEPATIC JAUNDICE ASSOCIATED WITH PLATINOSOMIASIS IN A CAT

A platinossomíase é uma infecção parasitária causada pelo trematódeo Platynosomum spp., encontrado no fígado de gatos domésticos. O felino é o hospedeiro definitivo e a severidade da doença depende da quantidade de parasitos, tempo de parasitismo e resposta do hospedeiro. O objetivo deste trabalho foi relatar um caso de icterícia pós-hepática em um gato decorrente de platinossomíase. Um gato, macho, jovem, sem raça definida, foi recebido para exame pós morte com histórico de icterícia grave, emagrecimento progressivo e morte repentina. Uma amostra de conteúdo biliar foi submetida ao método de sedimentação por centrifugação para a busca de ovos de helmintos, que revelou numerosos ovos marrom-escuros, ovais, monoperculados e embrionados, morfologicamente compatíveis com ovos de Platynosomum. O exame direto do fígado em estereoscópio e a histopatologia confirmaram a parasitose sob a identificação de formas adultas do parasito que apresentavam características morfológicas compatíveis com Platynosomum illiciens. As lesões histológicas incluíram colangio-hepatite, ectasia com obstrução ductal, fibrose, regeneração micronodular e lipidose. A icterícia pós-hepática foi relacionada à estase biliar resultante do acúmulo de muco e parasitos. Neste caso, os achados macroscópicos (icterícia intensa, fibrose hepática e colestase extra-hepática obstrutiva) e histológicos associados à identificação de parasitos adultos recuperados dos ductos biliares foram fundamentais para o diagnóstico definitivo da doença.Platinosomiasis is a parasitic infection caused by the trematode Platynosomum spp., found in the liver of domestic felines. The feline is the definitive host of Platynosomum, and the severity of the disease depends on the amount of parasites, time of parasitism and host response. The aim of this work was to report a case of post-hepatic jaundice resulting from feline platinosomiasis. A male, young, mixed breed feline was presented with a history of severe jaundice, progressive weight loss and sudden death. A sample of the bile content was collected and analyzed by sedimentation through centrifugation to search for helminth eggs, resulting in the observation of innumerous dark brown, oval, monoperculated and embryonated eggs, morphologically compatible with eggs of Platynosomum. The stereoscopy of fresh liver samples and histopathology confirmed the parasitism through the identification of adult specimens, whose morphological features were compatible with Platynosomum illiciens. The post-hepatic jaundice was related to bile stasis resulting from the accumulation of intraductal mucus and parasites. In this particular case, the pathological findings associated with the identification of adults recovered from the biliary content were essential for the definitive diagnosis of the disease

Icterícia pós-hepática associada à platinossomíase em um gato

A platinossomíase é uma infecção parasitária causada pelo trematódeo Platynosomum spp., encontrado no fígado de gatos domésticos. O felino é o hospedeiro definitivo e a severidade da doença depende da quantidade de parasitos, tempo de parasitismo e resposta do hospedeiro. O objetivo deste trabalho foi relatar um caso de icterícia pós-hepática em um gato decorrente de platinossomíase. Um gato, macho, jovem, sem raça definida, foi recebido para exame pós morte com histórico de icterícia grave, emagrecimento progressivo e morte repentina. Uma amostra de conteúdo biliar foi submetida ao método de sedimentação por centrifugação para a busca de ovos de helmintos, que revelou numerosos ovos marrom-escuros, ovais, monoperculados e embrionados, morfologicamente compatíveis com ovos de Platynosomum. O exame direto do fígado em estereoscópio e a histopatologia confirmaram a parasitose sob a identificação de formas adultas do parasito que apresentavam características morfológicas compatíveis com Platynosomum illiciens. As lesões histológicas incluíram colangio-hepatite, ectasia com obstrução ductal, fibrose, regeneração micronodular e lipidose. A icterícia pós-hepática foi relacionada à estase biliar resultante do acúmulo de muco e parasitos. Neste caso, os achados macroscópicos (icterícia intensa, fibrose hepática e colestase extra-hepática obstrutiva) e histológicos associados à identificação de parasitos adultos recuperados dos ductos biliares foram fundamentais para o diagnóstico definitivo da doença

Direct evidence for phosphorus limitation on Amazon forest productivity

The productivity of rainforests growing on highly weathered tropical soils is expected to be limited by phosphorus availability1. Yet, controlled fertilization experiments have been unable to demonstrate a dominant role for phosphorus in controlling tropical forest net primary productivity. Recent syntheses have demonstrated that responses to nitrogen addition are as large as to phosphorus2, and adaptations to low phosphorus availability appear to enable net primary productivity to be maintained across major soil phosphorus gradients3. Thus, the extent to which phosphorus availability limits tropical forest productivity is highly uncertain. The majority of the Amazonia, however, is characterized by soils that are more depleted in phosphorus than those in which most tropical fertilization experiments have taken place2. Thus, we established a phosphorus, nitrogen and base cation addition experiment in an old growth Amazon rainforest, with a low soil phosphorus content that is representative of approximately 60% of the Amazon basin. Here we show that net primary productivity increased exclusively with phosphorus addition. After 2 years, strong responses were observed in fine root (+29%) and canopy productivity (+19%), but not stem growth. The direct evidence of phosphorus limitation of net primary productivity suggests that phosphorus availability may restrict Amazon forest responses to CO2 fertilization4, with major implications for future carbon sequestration and forest resilience to climate change.The authors acknowledge funding from the UK Natural Environment Research Council (NERC), grant number NE/L007223/1. This is publication 850 in the technical series of the BDFFP. C.A.Q. acknowledges the grants from Brazilian National Council for Scientific and Technological Development (CNPq) CNPq/LBA 68/2013, CNPq/MCTI/FNDCT no. 18/2021 and his productivity grant. C.A.Q., H.F.V.C., F.D.S., I.A., L.F.L., E.O.M. and S.G. acknowledge the AmazonFACE programme for financial support in cooperation with Coordination for the Improvement of Higher Education Personnel (CAPES) and the National Institute of Amazonian Research as part of the grants CAPES-INPA/88887.154643/2017-00 and 88881.154644/2017-01. T.F.D. acknowledges funds from FundacAo de Amparo a Pesquisa do Estado de SAo Paulo (FAPESP), grant 2015/50488-5, and the Partnership for Enhanced Engagement in Research (PEER) programme grant AID-OAA-A-11-00012. L.E.O.C.A. thanks CNPq (314416/2020-0)

Direct evidence for phosphorus limitation on Amazon forest productivity

The productivity of rainforests growing on highly weathered tropical soils is expected to be limited by phosphorus availability1. Yet, controlled fertilization experiments have been unable to demonstrate a dominant role for phosphorus in controlling tropical forest net primary productivity. Recent syntheses have demonstrated that responses to nitrogen addition are as large as to phosphorus2, and adaptations to low phosphorus availability appear to enable net primary productivity to be maintained across major soil phosphorus gradients3. Thus, the extent to which phosphorus availability limits tropical forest productivity is highly uncertain. The majority of the Amazonia, however, is characterized by soils that are more depleted in phosphorus than those in which most tropical fertilization experiments have taken place2. Thus, we established a phosphorus, nitrogen and base cation addition experiment in an old growth Amazon rainforest, with a low soil phosphorus content that is representative of approximately 60% of the Amazon basin. Here we show that net primary productivity increased exclusively with phosphorus addition. After 2 years, strong responses were observed in fine root (+29%) and canopy productivity (+19%), but not stem growth. The direct evidence of phosphorus limitation of net primary productivity suggests that phosphorus availability may restrict Amazon forest responses to CO2 fertilization4, with major implications for future carbon sequestration and forest resilience to climate change

Ibicaba revisitada outra vez: espaço, escravidão e trabalho livre no oeste paulista

Ibicaba Farm, property of Senator Nicolau Pereira de Campos Vergueiro during the 19th century, was the subject of studies that focused on the experience with the sharecropping system. This article intends to undertake a revisit to Ibicaba through new lenses of observation. At first, it tries to insert Vergueiro's farm in the context of the changing World-economy of the first decades of the nineteenth century, and then highlight the importance of the spatial dimension of reality in this historical context. In the following two subitems, which constitute the core of the article, an analysis is made of the protocols - especially spatial - of control of the workers, used by the Vergueiros in order to extract the maximum of labor from slaves and sharecroppers, as well as the strategies that captives and immigrants used to escape from this surveillance. Finally, a brief recapitulation of the main points exposed and some considerations about the tensions that emerged in Ibicaba during the studied period are made.A Fazenda Ibicaba, propriedade do Senador Nicolau Pereira de Campos Vergueiro ao longo do século XIX, foi objeto de estudos que enfocaram a experiência com o sistema de parceria que ela abrigou. Este artigo pretende revisitar Ibicaba por meio de novas lentes de observação. Em um primeiro momento, buscar-se-á inserir a fazenda de Vergueiro no contexto de mudança pela qual a Economia-mundo passava nas primeiras décadas do Oitocentos para, em seguida, salientar a importância que a dimensão espacial da realidade cumpria nesse contexto histórico. Nos dois subitens seguintes, que constituem o núcleo do artigo, analisam-se os protocolos - sobretudo espaciais - de controle da mão de obra utilizados pelos Vergueiro, com vistas à máxima extração de trabalho de escravos e colonos, bem como as estratégias de que cativos e imigrantes lançaram mão para escapar dessa vigilância. Faz-se, ao fim, uma breve recapitulação dos principais pontos expostos e algumas considerações sobre as tensões que emergiram em Ibicaba durante o período estudado

Updated cardiovascular prevention guideline of the Brazilian Society of Cardiology: 2019

Sem informação113478788

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701