Training the osteoplastic flap technique in dogs

SummaryAccess to frontal sinus using the osteoplastic flap technique is indicated in lesions that do not yield endonasal approach. This technique can be practiced with dogs, although delineation of sinusal perimeter in canines is not as easy as it is in humans.AimThis study aims at presenting a method to access and delineate the frontal sinus of canines to reproduce the osteoplastic flap technique in man.Study designSurgical technique in animal.Material and MethodIn adult dogs, two straight lines were drawn: one along the median line of the frontal region; and the other at 45° from the pupil. At the intersection point, 1-1.5 cm forward and 1 cm backward was measured; from these points, an incomplete rectangle delineating the frontal sinusal perimeters was drawn.ResultsThis procedure was performed 12 times during one year with participation of medical residents. Opening the animals' frontal sinuses was an easy procedure, and the osteoplastic technique to locate the sinus was performed without failures.ConclusionThe method of locating and delineating the frontal sinus of dogs was useful to show that the osteoplastic technique is realistically reproducible in men

Surgery of frontal sinus fractures. Epidemiologic study and evaluation of techniques

SummaryThe frontal sinus trauma is not rare and it is 8% of the facial fractures. It can affect the anterior and/or posterior plates, with or without hitting the nasofrontal duct. It has a large potential of complications and its management still being a controversy. Objective: To present the casuistic of fractures frontal sinus, the epidemiology and clinical and surgical management of frontal sinus fractures. Materials and Methods: Not randomized retrospective study of 24 patients with frontal sinus fractures Hospital of Clinics, School of Medicine Botucatu, São Paulo, Brazil. Results: From the 24 patients, we had 16 (66,6%) fractures of the extern plate and 8 (33,4%) of both. In 2 patients the nasofrontal duct was involved. Others facial fractures were associated in 20 (83,4%) cases and major lesions of the cerebral segment were found in 13 (54,2%). Subpalpebral incision was performed in the majority with satisfactory aesthetic results. The basis of the surgical treatment was reduction and fixation with different materials (steel wire, mononylon, titanium miniplates) and if necessary we used alogen implants or parietal bone to reconstruct the anterior plate. Conclusion: The principal cause of frontal sinus fractures is crashed car. The management depends of the complexity, because commonly there are cranioencephalic lesions associated. The surgical thecniques used are the incisions, bicoronal flap or browglabella, infra-orbital rim (“butterfly”), associated a endoscopy sinus surgery in cases of infection, cerobrospinal fluid leak and orbital complications

Etiology and incidence facial fractures in children and adults

SummaryFacial trauma has presented an increasing occurrence in the last four decades, due especially to the growth of accidents with automobiles as well as to the urban violence. Both of which continue being the main cause of such traumas. Aim: To evaluate the features of the population victim of facial trauma as to gender, age, occupation, origin, type of fracture and its cause. Design study: retrospective clinical with transversal cohort. Material and Method: Retrospective study consulting hospital registers of 513 patients victms of the facial trauma. Results: There was a higher incidence of facial trauma on men (84,9%), white (82,7) and with an average age of 29. Regarding occupation, the trauma was mostly occurred to students (16,6%) and Masons (11,2%). The jaw was the most affected place (35%), followed by zygoma (24%) and by the nose (23%), though most patients presented a single facial fracture (82,5%). Among the causes, accidents with automobiles (28,3%), aggressions (21%) and accidental fall s (19,5%) were the most common. Conclusions: Accidents with automobiles continue being the main cause of facial trauma, especially of multiple factures due to the great transmission of kinetic energy

Mecanismo de crescimento e caracterização de cristais formados na superfície de águas residuais de salinas

Sob condições ainda desconhecidas, cristais denominados de flor de sal, ou fleur de sel, como é comumente conhecido, pode ser formado na superfície de uma salmoura supersaturada durante a evaporação da água do mar nas salinas. Visando produzir flor de sal de uma maneira controlada e fazer melhor uso da solução residual de salinas, denominada de água-mãe, o presente trabalho foi proposto. O mecanismo de crescimento, morfologia, microestrutura e composição química dos sais obtidos foram estudados durante a evaporação da água-mãe, cuja densidade variou de 1,230 g/cm³ para 1,244 g/cm³, mantendo fixos o gradiente térmico e umidade relativa do ar. Análises quimicas, microestruturais e morfológicas foram usadas para caracterização. Cristais cúbicos ocos foram obtidos cujas concentrações iônicas foram dependents da densidade da solução. O tamanho e massa dos cristais também foram dependentes da densidade da solução. As amostras apresentaram fases contendo sulfatos como NaK3(SO4)2, Mg (SO4). (H2O) e K2SO4, cuja porcentagem aumentou levemente com o aumento da densidade. Mesmo assim, as porcentagens de NaCl foram acima de 90% para todas as amostras, mostrando que é possível extrair flor de sal de alta pureza a partir de uma solução residual hipersalina.Palavras chaves: flor de sal, água-mãe, crescimento de cristais, mecanismo, salina.

Evaluation of the re bleeding average in pediatric patients with portal vein thrombosis that used endoscopic and/or prophylactic drug therapy

Introdução: A hipertensão portal (HP) resulta da obstrução venosa portal extra-hepática cuja principal etiologia na faixa etária pediátrica é a trombose da veia porta. A complicação mais temida da HP é a hemorragia digestiva alta decorrente da ruptura das varizes esofágicas. Estima-se que cerca de 70-79% das crianças com Trombose de veia prota (TVP) apresentarão pelo menos um episódio de hemorragia digestiva alta durante sua vida. A abordagem é dividida da seguinte forma: profilaxia primária, tratamento de episódios hemorrágicos agudos e profilaxia secundária. Os métodos profiláticos disponíveis englobam modalidades farmacológica, terapia endoscópica e cirurgia. Objetivos: avaliar a taxa de ressangramento por ruptura de varizes esofágicas e/ou gástricas em pacientes que utilizam profilaxia secundária com propranolol e/ou procedimentos endoscópicos, acompanhados no ambulatório de hepatologia pediátrica do IMIP. Método: Estudo analítico, retrospectivo, realizado por meio da análise do prontuário do paciente. O programa utilizado para análise estatística foi o software “R” versão 3.3.1 Resultados: A taxa global de ressangramento independente do tipo de profilaxia utilizada foi de 1,5 vezes. Os procedimentos mais utilizados para controle de sangramento foram o tratamento endoscópico com escleroterapia e ligadura elástica (n=10), seguidos do uso de tratamento endoscópico e medicamentoso com propranolol (n=9). Ao avaliar a frequência de ressangramento observa-se que os pacientes que realizaram apenas escleroterapia (n=6) apresentaram média de ressangramento de 2,16 vezes. Os pacientes que realizaram apenas ligadura elástica (n=2) ou propranolol (n=3) não apresentaram novos sangramentos. Conclusões: O presente estudo mostra uma menor média de ressangramento naqueles pacientes que fizeram uso de ligadura elástica ou propranolol isoladamente. No entanto, novos estudos na faixa etária pediátrica, são necessários para avaliação da real eficácia e segurança de cada método especificamente.Introduction: Portal hypertension is a consequence of extra-hepatic portal vein obstruction , and portal vein thrombosis is its main etiology in pediatric age. The most feared portal hypertension complication is upper digestive hemorrhage caused by rupture of esophageal varicose veins. It´s estimated that over 70-79 per cent of children with deep vein thrombosis (DVT) will present at least one episode of upper digestive hemorrhage on their lives. The approach is divided in: primary prophylaxis, treatment of acute hemorrhage episode and secondary prophylaxis. Available prophylactic methods are: pharmacologic, endoscopic therapy, and surgery. Objectives: Evaluate the rebleeding rate due to esophageal and/or gastric varicose veins rupture in patients using secondary prophylaxis with propanolol and/or endoscopic procedures/methods, followed up in IMIP’s pediatric hepatology ambulatorial service. Methods: It's an analytical, and retrospective study, with the analysis of patient’s medical records. A computer software “R” version 3.3.1. was used for the statistical analysis. Results: Rebleeding global rate was 1,5 times, in spite of prophylaxis’s type used. The most utilized procedures for bleeding control were endoscopic treatment with sclerotherapy and elastic ligature (N=10) followed by endoscopic and drug therapy with propanolol (N=9). Analyzing rebleeding frequency, it can be noticed that patients which the only treatment realized was sclerotherapy presented re-bleed average of 2,16 times. Patients who realized only elastic ligature (N=2) or propanolol (N=3) had not presented new bleeding episodes. Conclusions: The present study reveals a small average of rebleeding in patients that used only elastic ligature or propanolol. However, new studies in pediatric age group are needed to evaluate the security and efficacy of specific methods.&nbsp

COVID-19 outcomes in people living with HIV: Peering through the waves

Objective: To evaluate clinical characteristics and outcomes of COVID-19 patients infected with HIV, and to compare with a paired sample without HIV infection. Methods: This is a substudy of a Brazilian multicentric cohort that comprised two periods (2020 and 2021). Data was obtained through the retrospective review of medical records. Primary outcomes were admission to the intensive care unit, invasive mechanical ventilation, and death. Patients with HIV and controls were matched for age, sex, number of comorbidities, and hospital of origin using the technique of propensity score matching (up to 4:1). They were compared using the Chi-Square or Fisher's Exact tests for categorical variables and the Wilcoxon for numerical variables. Results: Throughout the study, 17,101 COVID-19 patients were hospitalized, and 130 (0.76%) of those were infected with HIV. The median age was 54 (IQR: 43.0;64.0) years in 2020 and 53 (IQR: 46.0;63.5) years in 2021, with a predominance of females in both periods. People Living with HIV (PLHIV) and their controls showed similar prevalence for admission to the ICU and invasive mechanical ventilation requirement in the two periods, with no significant differences. In 2020, in-hospital mortality was higher in the PLHIV compared to the controls (27.9% vs. 17.7%; p = 0.049), but there was no difference in mortality between groups in 2021 (25.0% vs. 25.1%; p > 0.999). Conclusions: Our results reiterate that PLHIV were at higher risk of COVID-19 mortality in the early stages of the pandemic, however, this finding did not sustain in 2021, when the mortality rate is similar to the control group

Assessment of risk scores to predict mortality of COVID-19 patients admitted to the intensive care unit

ObjectivesTo assess the ABC2-SPH score in predicting COVID-19 in-hospital mortality, during intensive care unit (ICU) admission, and to compare its performance with other scores (SOFA, SAPS-3, NEWS2, 4C Mortality Score, SOARS, CURB-65, modified CHA2DS2-VASc, and a novel severity score).Materials and methodsConsecutive patients (≥ 18 years) with laboratory-confirmed COVID-19 admitted to ICUs of 25 hospitals, located in 17 Brazilian cities, from October 2020 to March 2022, were included. Overall performance of the scores was evaluated using the Brier score. ABC2-SPH was used as the reference score, and comparisons between ABC2-SPH and the other scores were performed by using the Bonferroni method of correction. The primary outcome was in-hospital mortality.ResultsABC2-SPH had an area under the curve of 0.716 (95% CI 0.693–0.738), significantly higher than CURB-65, SOFA, NEWS2, SOARS, and modified CHA2DS2-VASc scores. There was no statistically significant difference between ABC2-SPH and SAPS-3, 4C Mortality Score, and the novel severity score.ConclusionABC2-SPH was superior to other risk scores, but it still did not demonstrate an excellent predictive ability for mortality in critically ill COVID-19 patients. Our results indicate the need to develop a new score, for this subset of patients

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions