Successful treatment of vancomycin-resistant enterococcus ventriculitis in a child

Enterococci are an uncommon cause of CNS infection. A 20 month-old boy, diagnosed with hydrocephalus with ventriculoperitoneal shunt and history of lengthy hospitalization and use of wide spectrum antibiotics, was admitted to the pediatric intensive care unit diagnosed with ventriculitis. On the 14th day of empirical antibiotic therapy (vancomycin and meropenem) the child presented fever while the CSF sample culture evidenced vancomycin-resistant Enterococcus faecium. The patient received intravenous linezolid achieving cerebrospinal fluid sterilization. Conclusion: Intravenous linezolid appears to be a safe and effective therapy for vancomycin-resistant enterococcus ventriculoperitoneal shunt infection.Federal University of São Paulo State Hospital of Diadema Department of PediatricsUNIFESP, State Hospital of Diadema Department of PediatricsSciEL

Que conhecimentos e habilidades estão em teste no enem? : Análise de Performance Induzida Reversa

Two instruments based on real questions of the Brazilian National Exam ("ENEM") were presented to two randomized groups of high school students. One group received real questions (n=1,631), and the other received the same questions (n=1,400) with abridged context information, but with the same command and alternatives. Results were analyzed with statistical tools, showing higher performance in some questions with abridged information (reverse induced performance). Qualitative tools were used to explain this awkward phenomenon. Conclusions show that students' performance may rely more heavily on perception of subtleties in questions' alternatives, reading skills and time management ability than on previous knowledge and mental skills

Which knowledge and skills are assessed in enem? Analysis of Reverse Induced Performance

Two instruments based on real questions of the Brazilian National Exam (“ENEM”) were presented to two randomized groups of high school students. One group received real questions (n=1,631), and the other received the same questions (n=1,400) with abridged context information, but with the same command and alternatives. Results were analyzed with statistical tools, showing higher performance in some questions with abridged information (reverse induced performance). Qualitative tools were used to explain this awkward phenomenon. Conclusions show that students’ performance may rely more heavily on perception of subtleties in questions’ alternatives, reading skills and time management ability than on previous knowledge and mental skills

Anatomia endoscópica do acesso à região selar e plano esfenoidal

The productive work between otolaryngologists and neurosurgeons has resulted in the emergence of endoscopic endonasal skull base surgery. The goal of the present study is to describe the endoscopic anatomy of the endonasal approach to the sellar region and planum sphenoidale, highlighting the key points of the surgical approach and the neurovascular landmarks. METHOD: Descriptive study of the endoscopic endonasal dissection of 9 fresh cadavers with exposure of the anatomic structures. RESULTS: The endoscopic endonasal ethmoidectomy and sphenoidotomy allows an expanded access to the sellar area and planum sphenoidale. The surface anatomy of the sphenoid sinus is easily identifiable and provides safe landmarks, guiding the intracranial dissection. CONCLUSION: The endoscopic endonasal approach to the skull base by the ENT and neurosurgeon is feasible, but it requires adequate anatomical knowledge and endoscopic skills for its realization, which can be obtained by practicing in cadavers.O trabalho cooperativo entre otorrinolaringologistas e neurocirurgiões resultou no aprimoramento das técnicas cirúrgicas e no surgimento da cirurgia endoscópica endonasal da base do crânio. O estudo tem como objetivo descrever a anatomia endoscópica do acesso endonasal da região selar e plano esfenoidal, destacando os pontos fundamentais do acesso cirúrgico e referências neuro-vasculares. MÉTODO: Estudo descritivo da dissecção endoscópica endonasal de 9 cadáveres frescos com exposição das estruturas anatômicas. RESULTADOS: A etmoidectomia e esfenoidotomia endonasal endoscópica permite um acesso estendido à região selar e plano esfenoidal. A anatomia de superfície do seio esfenoidal é facilmente identificada e fornece pontos de referência seguros, guiando a dissecção intracraniana. CONCLUSÃO: O acesso endoscópico endonasal para a base do crânio pelo otorrinolaringologista e neurocirurgião é perfeitamente viável, mas para isso o conhecimento anatômico da região e de seus pontos de referência é essencial, o que pode ser obtido pelo treinamento em cadáveres

Síndrome de "nevo em bolha de borracha azul"

The blue rubber nevus syndrome consists of multiple venous malformations in the skin and gastrointestinal tract associated with intestinal hemorrhage and iron deficiency anemia. Other organs may be involved. The causes of this syndrome are unknown. Its most common presentation is in the form of sporadic cases, but dominant autosomal inheritance has been described. It is a condition that affects both sexes equally, and its occurrence is rare in the black race. We present a case of this syndrome diagnosed in a 11-year-old patient. He had severe anemia and a venous swelling on the trunk. Similar lesions were found in the stomach, bowel, and on his foot. We emphasize the main clinical aspects: intestine, eyes, nasopharynx, parotids, lungs, liver, spleen, heart, brain, pleura, peritoneum, pericardium, skeletal muscles, bladder, and penis lesions, systemic complications that may occur to these patients which are thrombosis and calcification, as well as consumptive coagulopathy and thrombocytopenia that may occur within the nevi.A síndrome do nevo em bolha de borracha azul "blue rubber bled nevus syndrome" é caracterizada por malformações venosas da pele e trato gastrointestinal, associadas a hemorragia intestinal e anemia ferropriva. Outros órgãos podem estar envolvidos. As causas desta síndrome são desconhecidas e sua apresentação mais comum é na forma de casos esporádicos, mas herança autossômica dominante já foi descrita. É uma condição que afeta igualmente ambos os sexos e sua ocorrência é rara na raça negra. Apresentamos um caso desta síndrome diagnosticada em criança de onze anos de idade. Ela apresenta anemia grave e tumoração venosa do tronco. Lesões semelhantes foram encontradas no estômago, intestino e um dos pés. São enfatizados os aspectos clínicos principais - lesões no intestino, olhos, nasofaringe, parótida, pulmões, fígado, baço, coração, cérebro, pleura, peritônio, pericárdio, músculo esquelético, bexiga e pênis - e complicações sistêmicas que podem ocorrer nestes pacientes - trombose e calcificação dos nevus, assim como coagulopatia de consumo e trombocitopenia

Three-Months of Neuromotor Fitness Program Affect the Body Composition and Physical Performance in Untrained Women

International Journal of Exercise Science 12(4): 1346-1354, 2019. The purpose of this study was to investigate the effect of three months of neuromotor fitness on body composition and physical performance in untrained women. Nine untrained women (age: 38.1 ± 6.9 years; total body mass: 79.3 ± 10.7 kg; height: 161.5 ± 3.9 cm; body mass index: 30.4 ± 4.1) participated in the present study. Subjects attended the laboratory on twenty-seven occasions during a three-month period at least forty-eight hours in between sessions. Sessions 1 and 2 were used to measure morphology and body composition, and to familiarize all subjects with the experimental procedure and physical performance tests (muscle power, balance, muscular endurance, and flexibility). During sessions 3 to 26, all exercises were performed twice a week during 60-min in each session. All exercises were divided into three different circuit programs composed by12 stations with one-min exercise and a passive recovery of thirty-sec. There were significant decreases (p \u3c 0.005) for circumference in the right and left arm, pectoral, waist, abdomen, hip, and right and left calf. There were significant increases in lean body mass (p \u3c 0.005) and total body weight (p \u3c 0.005). There were significant decreases for body mass index (p \u3c 0.005), fat mass (p \u3c 0.005), and fat percentage (p \u3c 0.05). There were significant decreases (p \u3c 0.005) for skinfold in triceps, pectoral, subaxilar, shoulder blade, abdomen, hip, and thigh. There were significant increases for power test (p \u3c 0.005), muscular endurance test (p \u3c 0.005), and functional test (p \u3c 0.005). There were no significant differences for flexibility (p \u3c 0.005). The neuromotor fitness program affects the body composition and increases the physical performance in untrained women

O DIREITO FUNDAMENTAL À NACIONALIDADE E A PROBLEMÁTICA DOS APÁTRIDAS NO BRASIL

O presente artigo tem como objetivo analisar o direito à nacionalidade a partir da conjuntura dos apátridas, principalmente no Brasil. Deseja-se compreender as normas relacionadas a este grupo socialmente vulnerável, bem como as dificuldades na aplicação e a real eficácia dos direitos nesse âmbito. Para isso, optou-se pelo estudo dos instrumentos nacionais e internacionais relacionados ao direito à nacionalidade e da jurisprudência nessa temática, trazendo à luz a concessão de nacionalidade às irmãs Maha e Souad Mamo, que impulsionou uma campanha global de combate à apatridia. Como resultado, espera-se o entendimento das nuances que envolvem essas violações de direitos e a disseminação da necessidade de pôr fim a um problema que, infelizmente, persiste

Hemorrhagic Septic Thrombophlebitis in Horses

 Background: Thrombophlebitis represents the main disease of the cardiovascular system of horses, its occurrence is strongly associated with the use of inappropriate materials and techniques. Its clinical presentation varies according to the degree of vessel obstruction and the appearance of complications, in the diagnosis it is essential to assess the extent of damage and the severity of the case. Establishing appropriate treatments, it should be noted that these are mostly clinical, reserving surgical interventions for severe cases, so the aim of the study is report a case of hemorrhagic septic thrombophlebitis treated by partial phlebectomy of the left jugular vein.Case: A 9-year-old male castrated equine, with no defined racial pattern, weighing 345 kg, used in the practice of vaquejada was attended at the Veterinary Hospital (HV) of the Federal University of Campina Grande (UFCG), Campus Patos (PB). During the anamnesis, it was reported that the animal presented colic a month ago, it was treated, recovered and since then, it started presenting an area with increase in volume in the neck region that ruptured the day before the HV attendance, where blood and pus came from. On physical exam, slight edema was noted in the left masseteric region, a volume rise involving the middle and cranial third of the neck with firm consistency in the left jugular sulcus, sensitivity to palpation and little drainage of purulent bloody secretion was observed. Additionally, tachycardia, tachypnea and intestinal hypomotility were found. In turn, in the ultrasound exam, a hypoechoic structure was seen, causing partial obstruction of the vessel, proximal to the fistulated region and total obstruction distal to it. With this information, antibiotic therapy was prescribed, a warm compress followed by the use of anti-inflammatory gel every 8 hours. By choice of the owner, the animal returned to the farm, in the next day returned to the Veterinary Hospital, due to extensive bleeding observed on the estate, immediately tried to stanch the bleeding by compressive banding, without success, we opted for the surgical intervention aiming to perform ligation and partial resection of the jugular vein. Pre-anesthetic medication was performed and under general anesthesia a rectilinear incision was made over the left jugular vein of the neck caudal region to bifurcation of lingual and facial veins, blunt dissection aiming to loosen the vessel and hemostasis of the installed neovascularization, transfixing proximal ligation with 1-0 nylon thread, diaeresis, removal of the vessel, reduction of the subcutaneous space, application of drain, dermorrhaphy in simple continuous pattern and use of compressive curative. For the postoperative period, maintenance of the initial antibiotic therapy was prescribed, adding flunixin meglumine 1.1 mg/kg, i.m, SID, 4 applications, tetanus serum 5000 UI/IM, antiphlogistic massage in the masseter region and wound treatment by washing with hypersaturated solution, use of sugar, healing pomade and repellent. One month after surgery, the animal received medical release with satisfactory healing, recovery from anemic and infectious condition, without circulatory complications.Discussion: The present report shows the feasibility of unilateral partial phlebectomy of the jugular vein as a therapeutic option in complicated cases of thrombophlebitis. In which thrombectomy techniques are contraindicated and ineffective clinical treatments, another alternative is vascular transplantation, which encounters many logistical difficulties in the routine. Despite the interruption of blood flow being pointed out as an aggravating factor, it should be noted that often thrombophlebitis itself leads to this condition, and the development of collateral circulation secondary to venous flow obstruction has been observed

O DIREITO FUNDAMENTAL À NACIONALIDADE E A PROBLEMÁTICA DOS APÁTRIDAS NO BRASIL

O presente artigo tem como objetivo analisar o direito à nacionalidade a partir da conjuntura dos apátridas, principalmente no Brasil. Deseja-se compreender as normas relacionadas a este grupo socialmente vulnerável, bem como as dificuldades na aplicação e a real eficácia dos direitos nesse âmbito. Para isso, optou-se pelo estudo dos instrumentos nacionais e internacionais relacionados ao direito à nacionalidade e da jurisprudência nessa temática, trazendo à luz a concessão de nacionalidade às irmãs Maha e Souad Mamo, que impulsionou uma campanha global de combate à apatridia. Como resultado, espera-se o entendimento das nuances que envolvem essas violações de direitos e a disseminação da necessidade de pôr fim a um problema que, infelizmente, persiste