Síndrome compartimental aguda em membro inferior direito: um relato de caso: Acute compartment syndrome in the lower right limb: a case report

A Síndrome Compartimental Aguda (SCA) é a elevação da pressão intersticial intracompartimental, associada à redução crítica do fluxo sanguíneo no compartimento, que pode acarretar em isquemia e necrose dos tecidos e comprometimento funcional. Sua incidência é predominante entre os jovens e a fratura da diáfise tibial é a causa mais frequente (36% dos casos), seguindo de lesão de partes moles (23%), fratura distal do rádio (9,8%), na diáfise do antebraço (7,9%), diáfise do fêmur (3%), platô tibial (2,5%) e pé (1,8%). Sabe-se que mecanismos de alta energia causa lesões mais graves, que, no caso relatado, localizava-se na tíbia proximal, possuindo um aumento substancial do risco de desenvolvimento de SC. Os primeiros sinais e sintomas clínicos incluem dor, edema, parestesia, palidez, pulsação ausente, hipoestesia e paralisia. O diagnóstico é essencialmente clínico e deve ser realizado o (quanto antes) mais breve possível, por se tratar de uma emergência cirúrgica em todos os casos. O atraso na identificação e na instauração do tratamento (fasciotomia) pode causar danos irreversíveis, como amputação do membro e contraturas. O tratamento é realizado pela fasciotomia, procedimento cirúrgico no qual a fáscia muscular é cortada visando a descompressão muscular e a restauração da circulação. O objetivo deste estudo é relatar um caso de fratura do platô tibial que evoluiu para SC, tendo a fasciotomia de emergência como tratamento. Ressalta-se a importância do diagnóstico precoce e abordagem cirúrgica em caráter de urgência para o sucesso do tratamento e assim, reduzir sequelas e complicações para o paciente.

Possíveis abordagens terapêuticas para o tratamento do líquen plano oral: uma revisão de literatura / Possible therapeutic approaches for the treatment of oral lichen plane: a literature review

O presente estudo tem por objetivo revisar a literatura acerca das possíveis terapias para tratamento do líquen plano oral. Foi realizada uma revisão da literatura, com busca por artigos publicados no PubMed e SciELO entre 2016 a 2021, nos idiomas português, inglês e espanhol. Os artigos foram selecionados através do cruzamento dos descritores  ‘’Patologia Bucal’’,  ‘’Líquen Plano Bucal’’, ‘’Protocolos Clínicos’’, “Tratamento”, junto ao operadores booleanos ‘’AND’’ e ‘’OR’’, com seus correspondentes em inglês e espanhol, seguido pela leitura dos títulos, dos resumos e, por fim, dos artigos na íntegra. Os corticóides tópicos são a primeira escolha para o tratamento do líquen plano oral. Entretanto, seu uso a longo prazo, pode ocasionar efeitos colaterais indesejáveis. Em decorrência disso, houve a necessidade de recorrer a terapias alternativas como cirurgia nos casos de líquen plano oral mais delimitados, laserterapia como coadjuvante na diminuição da dor e aceleração no processo de cicatrização e fitoterapia como uma modalidade alternativa em casos de comprometimento sistêmico e baixo custo. A principal dificuldade para o tratamento do líquen plano oral, deve-se principalmente por não haver uma modalidade de tratamento que seja totalmente curativa. As terapias usadas limitam apenas ao controle da patologia, com isso, o tratamento requer acompanhamento a longos prazos. Segundo a literatura, é impossível alcançar a erradicação completa da doença com os métodos disponíveis. O tratamento deve visar atingir objetivos específicos, como a eliminação e redução de lesões atróficas e ulcerativas, o alívio dos sintomas e a redução do risco de transformação maligna

Doenças endocrinológicas com repercussões psiquiátricas: revisão sistemática / Endocrinological disorders with psychiatric repercussions: a systematic review

O objetivo do estudo foi realizar uma revisão sistemática de literatura sobre doenças endocrinológicas com repercussões psiquiátricas. Para isso, realizou-se uma revisão sistemática de literatura, através de uma busca nas bases de dados Latino-Americana e do Caribe em Ciências da Saúde, Google Scholar e Scientific Electronic Library Online, utilizando-se os descritores: Endocrinology, Mental Disorders, Psychiatric Symptoms, Cushing’s syndrome, Hyperthyroidism, Hypothyroidism, Addison disease. Através disso, foram selecionados 12 artigos que compunham os critérios de inclusão e exclusão do presente estudo. Dessa forma, destaca-se que os estudos evidenciaram que diversos são as repercussões psiquiátricas em pacientes com doenças endocrinológicas, variando desde transtornos de ansiedade, depressão, transtorno de déficit de atenção/hiperatividade e psicose, cabendo aos profissionais o diagnóstico correto e em tempo hábil para auxiliar na qualidade de vida do indivíduo. 

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Valor nutritivo de silagens de milho (Zea mays L.) produzidas com inoculantes enzimo-bacterianos

Este trabalho foi desenvolvido a partir de dois experimentos. No primeiro, avaliaram-se o pH, a relação nitrogênio amoniacal/nitrogênio total (N-NH3/Ntotal), a composição química e a digestibilidade in vitro da matéria seca (DIVMS) de silagens de milho produzidas ou não com inoculantes enzimo-bacterianos, utilizando-se silos laboratoriais. Adotou-se um arranjo fatorial 6 x 3, composto por seis períodos de fermentação (1, 3, 7, 14, 28 e 56 dias) e três inoculantes (um controle e dois inoculantes comerciais), em um delineamento inteiramente casualizado, com três repetições. Avaliaram-se os seguintes inoculantes microbianos: controle (sem inoculante), Maize All (Alltech do Brasil) e Biomax (Christian Hansen). Constatou-se efeito da interação inoculante × período sobre o teor de MS, registrando-se maiores valores para as silagens inoculadas, independentemente do período de fermentação. O teor de PB foi influenciado pelo inoculante, registrando-se menor valor (6,23%) para a silagem não tratada. Para os teores de FDN e FDA, observou-se efeito apenas de período, estimando-se decréscimos de 0,302353 e 0,063321 unidades/dia de fermentação, respectivamente. A DIVMS também foi influenciada apenas pelo período, estimando-se incrementos de 0,0546305 unidades/dia de fermentação. No segundo experimento, avaliaram-se o consumo e a digestibilidade aparente total dos nutrientes das silagens do experimento 1, utilizando-se 18 ovinos adultos, castrados, distribuídos em três tratamentos, segundo um delineamento em blocos casualizados, com seis repetições. Adotou-se relação volumoso:concentrado de 90:10, com base na matéria seca. O consumo dos nutrientes não foi influenciado pelas dietas experimentais, registrando-se valores médios de 1,26; 0,14 e 0,84 kg/dia para os consumos de MS, PB e NDT, respectivamente. Para a digestibilidade aparente total dos nutrientes, detectou-se efeito de inoculante somente para a PB, observando-se maior valor para a silagem tratada com o inoculante Biomax (66,0%). A adição de inoculantes à planta de milho não promoveu alterações na composição química e no consumo dos nutrientes das silagens.Two inoculated corn silage experiments are reported. In the first one, pH value, ammonia nitrogen in total nitrogen (N-NH3/Total N), chemical composition and in vitro drymatter digestibility of corn silages with or without enzymatic-bacterial inoculants were evaluated in laboratory silos. A 6 x 3 factorial arrangement of treatments, with six fermentation periods (01, 03, 07, 14, 28 and 56 days) x three inoculants (control and two commercial inoculants: Maize All (Alltech of Brazil) and Biomax (Christian Hansen) was used in a completely randomized design, with three replications. Effect of the inoculant × fermentation period interaction was detected on silages DM content, larger values corresponding to the inoculated silages, independent of the fermentation period. Inoculants favored silage crude protein (CP) concentration, the smallest value (6.23%) being observed in control silage. It was also observed an effect of fermentation period on neutral detergent fiber (NDF) and acid detergent fiber (ADF), which decreased by 0.302353 and 0.063321 units/fermentation day, respectively. The in vitro dry matter digestibility increased with fermentation period, with increments of 0.0546305 unit/day. In the second experiment, intake and total apparent digestibility of silage nutrients were evaluated with rams. Eighteen castrated adult rams were assigned to three treatments, in a randomized blocks design, with six replicates. The diets consisted of 90:10 forage to concentrate ratio in a dry matter basis. The intake of nutrients was not influenced by the experimental diets, being observed mean values of 1.26; 0.14 and 0.84 kg/day for dry matter (DM), crude protein intake (CP) and total digestive nutrients (TDN) intake, respectively. An inoculant effect was observed on CP apparent digestibility, greater value being observed for silage treated with the Biomax inoculant (66.0%). The inoculant addition to corn plant changed nor silage chemical composition, neither the intake of its nutrients by the animal.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Degradação in situ da matéria seca e da fração fibrosa do capim marandu obtido por diferentes métodos de amostragem, no período seco do ano Dry matter and fibrous fraction in situ degradability of palissade grass sampled through different methods in the dry season

Este trabalho foi realizado na Faculdade de Ciências Agrárias Veterinárias - Unesp - Jaboticabal e foi conduzido, com o objetivo de avaliar a influência do método de amostragem do pasto sobre a degradabilidade in situ da matéria seca e da fração fibrosa de capim Marandu, colhido no período seco dos anos de 2003 e 2005. O experimento foi instalado em delineamento de blocos casualizados com parcela subdividida, com três repetições, representadas pelos piquetes amostrados. Nas parcelas, foram avaliados cinco métodos de amostragens de forragem (método do quadrado metálico; método de avaliação através de extrusa de bovino da raça Nelore; método de avaliação por meio de extrusa de bovino Cruzado (Red Angus x Nelore); método de avaliação por meio do pastejo, simulando bovino da raça Nelore; método de avaliação por meio do pastejo, simulando bovino Cruzado (Red Angus x Nelore) e as subparcelas foram constituídas pelos anos de amostragem, 2003 e 2005. Foram determinadas as frações da cinética ruminal: solúvel "A"; insolúvel potencialmente degradável "B"; taxa de degradação "Kd"; degradação potencial (DP) e fração não degradável "C" da MS e degradação potencial (DP), fração não degradável "C" e taxa de degradação "Kd" da FDN e da FDA. De acordo com os resultados obtidos, observou-se que o método do quadrado metálico subestimou as características da degradação do capim. Os métodos do pastejo simulado se assemelharam muito ao das extrusas, no entanto, a prática do simulador é que assegurou a amostragem eficiente, conforme foi constatado pelos dados obtidos no ano de 2003 e 2005.<br>This experiment was carried out at the Faculdade de Ciências Agrárias Veterinárias - Unesp - Jaboticabal during dry season, to evaluate the effects of sampling methods on the Marandu grass dry matter and cell wall in situ degradability. The data were analyzed according to a randomized block design with three replications (paddock), in a split plot scheme. Five sampling methods were evaluated on the parcels: metallic square method; Nellore steers extrusa, Red Angus x Nellore crossbreeding steers extrusa, simulated grazing of the Nellore, simulated grazing of Red Angus x Nellore crossbreeding, and two years (2003 and 2005) on the subparcels. The following rumen kinetic fractions were determined: soluble "A", degradable potential "B", degradability rate "Kd", the potential degradability (DP) and no degradable fraction "C" of the FDN, and FDA. According to the results obtained, the metallic square method underestimated the characteristics of the forage degradation. The results of the simulated grazing method resembled the extrusas method; however, it was the simulator practice that assured efficient sampling, as shown by evidence from data obtained between 2003 and 2005