Aspectos clínicos de pacientes com lesão traumática do plexo braquial após tratamento cirúrgico

ResumoObjetivoAvaliar aspectos sociodemográficos e clínicos de pacientes operados de lesão traumática do plexo braquial (LTPB).MétodoEstudo retrospectivo, revisão de prontuários, amostra de conveniência, 48 pacientes operados entre 2000 e 2010. Avaliados: 1) ADM – em graus, do ombro, cotovelo e punho/mão; 2) grau de força do ombro, cotovelo e punho/mão; 3) sensibilidade; 4) EVA (0 a 10). Testes de t de Student, qui‐quadrado, Friedman, Wilcoxon e Kruskal‐Wallis (p<0,05).ResultadosIdade de 30,6 anos, 60,4% acidentes motociclísticos. Politraumatismo 52,1%. Tempo até a cirurgia de 8,7 meses (2 a 48). Trinta e um (64,6%) com lesão total do plexo. Cirurgias mais frequentes: neurais em 39 (81,3%). ADM≥30° do ombro 20 pacientes (41,6%) de 30° a 90°, média 73° (p=0,001); 13 (27,1%) já tinham força no ombro≥M3 (p=0,001). Cotovelo≥80° de flexão, 27 pacientes (56,2%) de 30° a 160°, com média de 80,6° (p<0,001); 22 com força≥M3 (p<0,001). Extensão do punho≥30° partindo de 45° de flexão em 22 pacientes (45,8%), de 30° a 90°, média 70° (p=0,003); 27 (56,3%) tinham força de extensão do punho/mão≥M3 (p=0,002); 45 (93,8%) hipoestesia e três (6,2%) anestesia (p=0,006). EVA inicial 4,5 (1 a 9) e EVA final 3 (1 a 7) (p<0,001).ConclusãoAs LTPB tem maior prevalência em jovens (21‐40 anos), homens, urbanos, trabalhadores braçais, acidentes motociclísticos, com politrauma, lesão total do plexo. Cirurgias neurais, seguidas em segundo tempo, pelas transferências miotendíneas. A cirurgia para LTPB mostrou melhoria significativa de ADM e força em ombro, cotovelo e punho/mão, da sensibilidade do membro afetado e diminuição da dor final.AbstractObjectiveTo evaluate sociodemographic and clinical aspects of patients undergoing operations due to traumatic lesions of the brachial plexus.MethodThis was a retrospective study in which the medical files of a convenience sample of 48 patients operated between 2000 and 2010 were reviewed. The following were evaluated: 1) range of motion (ROM) of the shoulder, elbow and wrist/hand, in degrees; 2) grade of strength of the shoulder, elbow and wrist/hand; 3) sensitivity; and 4) visual analogue scale (VAS) (from 0 to 10). The Student's t, chi‐square, Friedman, Wilcoxon and Kruskal‐Wallis tests were used (p<0.05).ResultsThe patients’ mean age was 30.6 years; 60.4% of them had suffered motorcycle accidents and 52.1%, multiple trauma. The mean length of time until surgery was 8.7 months (range: 2 to 48). Thirty‐one patients (64.6%) presented complete rupture of the plexus. The frequent operation was neurosurgery, in 39 cases (81.3%). The ROM achieved was ≥ 30° in 20 patients (41.6%), with a range from 30° to 90° and mean of 73° (p=0.001). Thirteen (27.1%) already had shoulder strength ≥ M3 (p=0.001). Twenty‐seven patients (56.2%) had elbow flexion ≥ 80°, with a range from 30° to 160° and mean of 80.6° (p<0.001). Twenty‐two had strength ≥ M3 (p<0.001). Twenty‐two patients (45.8%) had wrist extension ≥ 30° starting from flexion of 45°, with a range from 30° to 90° and mean of 70° (p=0.003). Twenty‐seven (56.3%) presented wrist/hand extension strength ≥ M3 (p=0.002). Forty‐five (93.8%) had hypoesthesia and three (6.2%) had anesthesia (p=0.006). The initial VAS was 4.5 (range: 1.0 to 9.0) and the final VAS was 3.0 (range: 1.0 to 7.0) (p<0.001).ConclusionTraumatic lesions of the brachial plexus were more prevalent among young adults (21‐40 years), men, people living in urban areas, manual workers and motorcycle accidents, with multiple trauma and total rupture of the plexus. Neurosurgery, with a second procedure consisting of muscle‐tendon transfer, was the commonest operation. Surgery for traumatic lesions of the brachial plexus resulted in significant improvement in the ROM and strength of the shoulder, elbow and wrist/hand, improvement of the sensitivity of the limb affected and reduction of the final pai

The impact of multivisceral liver resection on short- and long-term outcomes of patients with colorectal liver metastasis: A systematic review and meta-analysis

The impact of Multivisceral Liver Resection (MLR) on the outcome of patients with Colorectal Liver Metastasis (CRLM) is unclear. The present systematic review aimed to compare patients with CRLM who underwent MLR versus standard hepatectomy regarding short- and long-term outcomes. MLR is a feasible procedure but has a higher risk of major complications. MLR did not negatively affect long-term survival, suggesting that an extended resection is an option for potentially curative treatment for selected patients with CRLM

AVALIAÇÃO HIGIÊNICO-SANITÁRIA DA VENDA DE PESCADO NO MUNICÍPIO DE CAUCAIA

Fish consumption has increased significantly in recent years in Brazil, especially in the Northeast. Despite the large fish trade in the region of the municipality of Caucaia in Ceará, it is not known about the quality, hygienic and, sanitary conditions of the fish sold in this locality. Therefore, the objective of this study was to evaluate the hygienic-sanitary conditions of Caucaia’s fish outlets, as well as the freshness characteristics of this product marketed in this municipality. Twenty-two fish outlets were visited (3 in the center of Caucaia and 19 beach huts). It was observed that the points of sale located in both the urban center and the beach region did not obey the binary shelf-temperature time and did not present adequate conservation infrastructures, where 50% of the visited establishments did not have basic sanitation. All fish marketing sites in the municipality did not follow the rules of good handling and hygiene practices. In addition, the marketed fish presented characteristics that were outside the quality standards for consumption. In view of this, it can be concluded that establishments that sell fish in the municipality of Caucaia present inadequate conditions for handling and conservation of products, characterizing as a potential risk to the food safety of consumers.O consumo de pescado tem aumentado muito nos últimos anos no Brasil, principalmente na região Nordeste. Apesar do grande comércio de pescado na região do município de Caucaia no Ceará, não se conhece sobre a qualidade do pescado vendido nessa localidade, condições higiênico-sanitárias dos estabelecimentos. Diante disso, o objetivo deste trabalho foi avaliar as condições higiênico-sanitárias dos pontos de venda de pescado em Caucaia, assim como as características de frescor desse produto comercializado nesse município. Foram visitados 22 postos de venda de pescado (3 no centro de Caucaia e 19 barracas de praia). Observou-se que os pontos de vendas localizados tanto no centro urbano quanto na região praiana não obedeciam ao binário tempo de prateleira-temperatura e não apresentavam infraestruturas adequadas de conservação, onde 50% dos estabelecimentos visitados não dispunham de saneamento básico. Todos os locais de comercialização de pescado do município não seguiam às normas de boas práticas de manipulação e higiene. Além disso, o pescado comercializado apresentava características fora dos padrões de qualidade para consumo. Diante disso, pode-se concluir que os estabelecimentos que comercializam pescado no município de Caucaia apresentam condições inadequadas de manipulação e conservação dos produtos, caracterizando-se como um risco potencial à segurança alimentar dos consumidores

Sustentabilidade, desenvolvimento e saúde: desafios contemporâneos

RESUMO Esse ensaio teve por objetivo a discussão da saúde como elemento intrínseco do processo de sustentabilidade pela ação setorial e na sua relação com os condicionantes econômicos, sociais e ambientais. Apresenta um debate pautado na temática da Rio+20, no sentido de apontar caminhos de consolidação da relação da saúde com o desenvolvimento sustentável, dialogando com a formulação do conceito de economia verde e na construção de processos de governança. Apresenta a discussão do território como espaço de organização social em que a saúde interage com os processos de desenvolvimento, das múltiplas dimensões que compõem a governança da e para a saúde, do ambiente e para o desenvolvimento sustentável

Microtomografia computadorizada de raios-X na caracterização morfométrica dos poros de Neossolo Regolítico Eutrofico

O arranjo, orientação e organização dos grãos do solo de diferentes características são fatores determinísticos da estrutura do solo, como também, da porosidade desse meio. A porosidade possui forte influência na aeração, na transferência de água/solutos/gases/calor, na resistência à penetração e ramificação de raízes e no desenvolvimento de microorganismos, podendo ser um elemento importante na determinação da qualidade de um solo. A avaliação morfométrica do espaço poroso de um Neossolo Regolítico Eutrófico (NRe) utilizando a Microtomografia Computadorizada de Raios-x é objetivo deste estudo, onde foram analisados os atributos físicos do solo e os tamanhos, as formas e as inclinações dos vazios intra-agregados. O NRe apresentou uma porosidade de 28% (27% de vazios inter-agregados e 1% de vazios intra-agregados) e 73% de agregados. Cerca de 73% dos vazios intra-agregados possuem volumes entre 1,278 x 10-4 a 6,545 x 10-2 mm³. Há um maior volume de vazios complexos e alongados, os quais favorecem a condução de água pelo solo, e um maior volume de poros achatados, podendo indicar um certa compactação desse meio. Os vazios apresentaram-se em sua maioria como quase horizontais e inclinado, resultado da resistência a penetração de raízes devido a presença de lamelas argilosas nesse solo. A aplicação de microtomografia computadorizada de raios-X se mostrou eficiente na caracterização micromorfométrica da porosidade do solo

Relationship between neuropsychological and clinical aspects and suicide attempts in euthymic bipolar patients

Some studies have investigated the possible relationship between suicide attempts and impulsivity in patients with bipolar disorder. The objective of this study was to assess the relationship between neuro-psychological and clinical aspects and suicide behavior in euthymic bipolar patients. The Iowa Gambling Task and the Conner's Continuous Performance Test evaluated impulsivity in 95 euthymic bipolar patients - 42 suicide attempters and 115 normal control participants. A factorial analysis evaluated the adequacy of the instruments. Furthermore, a multiple regression analysis was done in order to develop a model to predict suicide attempts. Our results point to a specific type of impulsivity related to making decisions, lack of planning and borderline personality disorder comorbidity. This type of impulsivity is a risk factor for suicide attempts in patients with bipolar disorder

Subtractive phage display selection from canine visceral leishmaniasis identifies novel epitopes that mimic leishmania infantum antigens with potential serodiagnosis applications

Visceral leishmaniasis (VL) is a zoonotic disease that is endemic to Brazil, where dogs are the main domestic parasite reservoirs, and the percentages of infected dogs living in regions where canine VL (CVL) is endemic have ranged from 10% to 62%. Despite technological advances, some problems have been reported with CVL serodiagnosis. The present study describes a sequential subtractive selection through phage display technology from polyclonal antibodies of negative and positive sera that resulted in the identification of potential bacteriophage-fused peptides that were highly sensitive and specific to antibodies of CVL. A negative selection was performed in which phage clones were adhered to purified IgGs from healthy and Trypanosoma cruzi-infected dogs to eliminate cross-reactive phages. The remaining supernatant nonadhered phages were submitted to positive selection against IgG from the blood serum of dogs that were infected with Leishmania infantum. Phage clones that adhered to purified IgGs from the CVL-infected serum samples were selected. Eighteen clones were identified and their reactivities tested by a phage enzyme-linked immunosorbent assay (phage-ELISA) against the serum samples from infected dogs (n 31) compared to those from vaccinated dogs (n 21), experimentally infected dogs with cross-reactive parasites (n 23), and healthy controls (n 17). Eight clones presented sensitivity, specificity, and positive and negative predictive values of 100%, and they showed no crossreactivity with T. cruzi- or Ehrlichia canis-infected dogs or with dogs vaccinated with two different commercial CVL vaccines in Brazil. Our study identified eight mimotopes of L. infantum antigens with 100% accuracy for CVL serodiagnosis. The use of these mimotopes by phage-ELISA proved to be an excellent assay that was reproducible, simple, fast, and inexpensive, and it can be applied in CVL-monitoring programsThis work was supported by grants from the Pró-Reitoria de Pesquisa of UFMG (supported 03/2013), the Instituto Nacional de Ciência e Tecnologia em Nano-Biofarmacêutica (INCT Nano-Biofar), Rede Nanobiotec/Brasil-UFU (CAPES), PRONEX-FAPEMIG (APQ-01019- 09), FAPEMIG (APQ-00496-11 and APQ-00819-12), and CNPq (APQ- 472090/2011-9 and APQ-482976/2012-8). E.A.F.C. and L.R.G. are recipients of grants from CNPq. M.A.C.-F. is the recipient of a grant from FAPEMIG/CAPE

MIF Participates in Toxoplasma gondii-Induced Pathology Following Oral Infection

BACKGROUND: Macrophage migration inhibitory factor (MIF) is essential for controlling parasite burden and survival in a model of systemic Toxoplasma gondii infection. Peroral T. gondii infection induces small intestine necrosis and death in susceptible hosts, and in many aspects resembles inflammatory bowel disease (IBD). Considering the critical role of MIF in the pathogenesis of IBD, we hypothesized that MIF participates in the inflammatory response induced by oral infection with T. gondii. METHODOLOGY/PRINCIPAL FINDINGS: Mif deficient (Mif(-/-)) and wild-type mice in the C57Bl/6 background were orally infected with T. gondii strain ME49. Mif(-/-) mice had reduced lethality, ileal inflammation and tissue damage despite of an increased intestinal parasite load compared to wt mice. Lack of MIF caused a reduction of TNF-α, IL-12, IFN-γ and IL-23 and an increased expression of IL-22 in ileal mucosa. Moreover, suppressed pro-inflammatory responses at the ileal mucosa observed in Mif(-/-) mice was not due to upregulation of IL-4, IL-10 or TGF-β. MIF also affected the expression of matrix metalloproteinase-9 (MMP-9) but not MMP-2 in the intestine of infected mice. Signs of systemic inflammation including the increased concentrations of inflammatory cytokines in the plasma and liver damage were less pronounced in Mif(-/-) mice compared to wild-type mice. CONCLUSION/SIGNIFICANCE: In conclusion, our data suggested that in susceptible hosts MIF controls T. gondii infection with the cost of increasing local and systemic inflammation, tissue damage and death