Surgical treatment of inflammatory periapical cyst: a clinical case report

Among the odontogenic cysts, there are radicular cysts or also called periapical cysts, are the most common odontogenic cyst. They develop at the apex of a tooth with pulp necrosis, which may be the consequence of dental caries or trauma. they are asymptomatic, grow slowly, and are discovered on routine radiographs. With the proliferation of the ERM and its activation, there is an increase in osmotic pressure, causing the cyst to expand, normally this ERM is not activated, so only granulation tissue develops at the apex of the affected tooth. Granulation tissue is called periapical granuloma and, as such, histologically lacks an epithelial lining. In the present study, a case of a 65-year-old female patient with an inflammatory periapical cyst in the region of the lower incisors is reported

Anharmonicities of giant dipole excitations

The role of anharmonic effects on the excitation of the double giant dipole resonance is investigated in a simple macroscopic model.Perturbation theory is used to find energies and wave functions of the anharmonic ascillator.The cross sections for the electromagnetic excitation of the one- and two-phonon giant dipole resonances in energetic heavy-ion collisions are then evaluated through a semiclassical coupled-channel calculation.It is argued that the variations of the strength of the anharmonic potential should be combined with appropriate changes in the oscillator frequency,in order to keep the giant dipole resonance energy consistent with the experimental value.When this is taken into account,the effects of anharmonicities on the double giant dipole resonance excitation probabilities are small and cannot account for the well-known discrepancy between theory and experiment

Post-neurosurgical meningitis caused by KPC-producing Klebsiella pneumoniae: report of two cases

Nosocomial bacterial infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) is associated with high mortality in neurosurgical patients. There are few reports in the literature on meningitis caused by CRKP. We report two cases of CRKP meningitis after neurosurgery. The K. pneumoniae identification and antimicrobial susceptibility testing were performed using the Vitek Compact System. Minimum inhibitory concentrations of polymyxin B were determined using the broth microdilution method. Molecular typing of K. pneumoniae isolates was investigated using multilocus sequence typing. Antimicrobial susceptibility testing showed that the K. pneumoniae isolates were multidrug resistant and coproduced extended-spectrum β-lactamases and KPC enzymes. The patients were treated with intrathecal polymyxin. Genetic polymorphism analyses revealed two different K. pneumoniae clones (ST1298 and ST2687), which were observed for the first time in CRKP infections. We recommend intravenous administration of intrathecal polymyxin for treating meningitis caused by multidrug-resistant K. pneumoniae

Biossorção de compostos fenólicos e aumento da bioacessibilidade / Biossorption of phenolic compounds and increased bioaccessibility

Esta revisão bibliográfica teve por objetivo analisar artigos científicos que contemplaram o processo de biossorção empregando a levedura Saccharomyces cerevisiae, bem como o aumento da bioacessibilidade dos elementos adsorvidos, em específico os compostos fenólicos. As informações e dados apresentados foram extraídos de banco de dados e bibliotecas virtuais. Foi possível constatar que a levedura Saccharomyces cerevisiae é amplamente empregada como biossorvente, enquanto compostos fenólicos, principalmente oriundos de frutas e resíduos agroindustriais, são utilizados como adsorbatos. Os trabalhos revisados reportam a eficiência e a importância da biossorção para o desenvolvimento de novos produtos alimentícios. Além disso, estudos relatam aumento significativo na bioacessibilidade dos compostos bioativos após a biossorção, promovendo valorização nutricional dos produtos desenvolvidos

Posição da Sociedade Brasileira de Hérnia e Parede Abdominal sobre o tratamento de grandes hérnias de hiato.

Large hiatal hernias (LHH) besides being more prevalent in the elderly, have different clinical presentation: fewer reflux, more mechanical symptoms and a greater possibility of acute, life-threatening complications such as gastric volvulus, ischemia and visceral mediastinal perforation. Thus, surgical indications are distinct from gastroesophageal reflux disease (GERD-related), sliding hiatal hernias. Heartburn tends to be less intense, while symptoms of chest pain, cough, discomfort, and tiredness are reported more frequently. Complaints of vomiting and dysphagia may suggest the presence of associated gastric volvulus. Signs of iron deficiency and anemia are found. Surgical indication is still controversial and was previously based on high mortality reported in emergency surgeries for gastric volvulus. Postoperative mortality is especially related to three factors: body mass index (BMI above 35), age over 70 years and presence of comorbidity. Minimally invasive elective surgery should be offered to symptomatic individuals with good or reasonable performance status, regardless of age group. In asymptomatic and oligosymptomatic patients, besides obviously identifying the patient's desire, case-by-case analysis of surgical risk factors such as age, obesity and comorbidities, should be taken under consideration. One should also pay attention to situations with greater technical difficulty and risks of acute migration due to increased abdominal pressure (abdominoplasty, manual workers, spastic diseases). Technical alternatives such as partial fundoplication and anterior gastropexy can be considered. We emphasize the importance of performing surgical procedures in cases of LHH in high-volume centers, with experienced surgeons.As grandes hérnias de hiato (HHG), além de serem mais prevalentes em idosos, têm apresentação clínica diferente: menos refluxo, mais sintomas mecânicos e maior possibilidade de complicações agudas e potencialmente fatais, como vólvulo gástrico, isquemia e perfuração mediastinal visceral. Assim, as indicações cirúrgicas são distintas das hérnias de hiato por deslizamento, relacionadas à doença do refluxo gastroesofágico (DRGE). A azia tende a ser menos intensa, enquanto os sintomas de dor no peito, tosse, desconforto e cansaço são relatados com maior frequência. Queixas de vômitos e disfagia podem sugerir a presença de volvo gástrico associado. São encontrados sinais de deficiência de ferro e anemia. A indicação cirúrgica ainda é controversa e foi anteriormente baseada na alta mortalidade relatada em cirurgias de emergência para volvo gástrico. A mortalidade pós-operatória está especialmente relacionada a três fatores: índice de massa corporal (IMC acima de 35), idade superior a 70 anos e presença de comorbidades. A cirurgia eletiva minimamente invasiva deve ser oferecida a indivíduos sintomáticos, com desempenho bom ou razoável, independentemente da faixa etária. Em pacientes assintomáticos e oligossintomáticos, além de obviamente identificar o desejo do paciente, deve-se levar em consideração a análise caso a caso dos fatores de risco cirúrgico, como idade, obesidade e comorbidades. Deve-se atentar também para situações de maior dificuldade técnica e riscos de migração aguda por aumento da pressão abdominal (abdominoplastia, trabalhos manuais, doenças espásticas). Alternativas técnicas como fundoplicatura parcial e gastropexia anterior podem ser consideradas. Ressaltamos a importância da realização de procedimentos cirúrgicos nos casos de GHH em centros de grande volume, com cirurgiões experientes

Home-based therapy programmes for upper limb functional recovery following stroke

Background: With an increased focus on home-based stroke services and the undertaking of programmes, targeted at upper limb recovery within clinical practice, a systematic review of home-based therapy programmes for individuals with upper limb impairment following stroke was required. Objectives: To determine the effects of home-based therapy programmes for upper limb recovery in patients with upper limb impairment following stroke. Search methods: We searched the Cochrane Stroke Group's Specialised Trials Register (May 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), MEDLINE (1950 to May 2011), EMBASE (1980 to May 2011), AMED (1985 to May 2011) and six additional databases. We also searched reference lists and trials registers. Selection criteria: Randomised controlled trials (RCTs) in adults after stroke, where the intervention was a home-based therapy programme targeted at the upper limb, compared with placebo, or no intervention or usual care. Primary outcomes were performance in activities of daily living (ADL) and functional movement of the upper limb. Secondary outcomes were performance in extended ADL and motor impairment of the arm. Data collection and analysis: Two review authors independently screened abstracts, extracted data and appraised trials. We undertook assessment of risk of bias in terms of method of randomisation and allocation concealment (selection bias), blinding of outcome assessment (detection bias), whether all the randomised patients were accounted for in the analysis (attrition bias) and the presence of selective outcome reporting. Main results: We included four studies with 166 participants. No studies compared the effects of home-based upper limb therapy programmes with placebo or no intervention. Three studies compared the effects of home-based upper limb therapy programmes with usual care. Primary outcomes: we found no statistically significant result for performance of ADL (mean difference (MD) 2.85; 95% confidence interval (CI) -1.43 to 7.14) or functional movement of the upper limb (MD 2.25; 95% CI -0.24 to 4.73)). Secondary outcomes: no statistically significant results for extended ADL (MD 0.83; 95% CI -0.51 to 2.17)) or upper limb motor impairment (MD 1.46; 95% CI -0.58 to 3.51). One study compared the effects of a home-based upper limb programme with the same upper limb programme based in hospital, measuring upper limb motor impairment only; we found no statistically significant difference between groups (MD 0.60; 95% CI -8.94 to 10.14). Authors' conclusions: There is insufficient good quality evidence to make recommendations about the relative effect of home-based therapy programmes compared with placebo, no intervention or usual care

Segurança no trabalho de catadores de reciclados / Work safety of recyclers

Este artigo demonstra a segurança do trabalho nas atividades desenvolvidos pelos catadores de resíduos sólidos, ou seja, de reciclados no município de Itaú de Minas, onde foi realizado uma entrevista com os mesmos, analisando suas respostas e demonstrando comparativos. O projeto conscientiza o uso de equipamento de proteção individual, e outras técnicas. O artigo aponta também outros meios de se prevenir doenças provenientes do lixo, a necessidade de se interessar por meios que aumentem o benefício da saúde, higiene, e aumento da qualidade devida.

Reconstruction of an extensive anterior chest wall defect after mediastinitis with an omentum flap: a case report

We report the case of a 70-year-old patient who developed an extensive skin defect in the anterior chest wall after undergoing myocardial revascularization and postoperative mediastinitis. Owing to the impossibility of using cutaneous and muscular flaps on the region, we performed the reconstruction with an omentum flap based on the left gastroepiploic artery and meshed skin graft

Modelagem e simulação do processo de atendimento cardiológico em um posto de saúde visando menor tempo de espera do paciente / Modeling and simulation of the process of cardiac care in a health center aiming at shorter patient waiting time

A simulação em eventos discretos vem sendo utilizado com maior frequência como uma importante ferramenta de auxílio na tomada de decisão em diversos setores e áreas. Esse artigo tenta solucionar a grande ocorrência de filas de espera para atendimento em um PSF (Programa da saúde da família), de forma que aumento do número de atendimento possa fazer diminuir o tempo de espera, que hoje é de 29 dias para o atendimento com o cardiologista após a primeira consulta com o clínico geral. O uso da simulação por meio do software ProModel vem para auxiliar na tomada de decisão para implantação da nova metodologia, entendendo que para sua aplicação é necessário passar por três etapas, sendo elas a concepção, a implementação e a análise. Com a aplicação do software para construção do modelo atual foi possível deslumbrar um novo parâmetro, demonstrando um crescimento das filas com baixo número de atendimento. Para melhorar este cenário, executaram-se experimentos e visualizou-se a necessidade de se aumentar a frequência do número de atendimentos do cardiologista e acrescentar mais um médico desse mesmo seguimento, conseguindo, assim, reduzir o tempo de espera para apenas 10 dias nasimulação.