Comparing Intramedullary Nailing, External Fixation, and External Fixation followed by Intramedullary Nailing as management for open fractures of the tibial shaft: a Systematic Review

Background: The treatment of open fractures of the tibial shaft is often a dilemma since it requires particular caution and individual assistance for each case. Methods and Findings: Systematic review of the literature was conducted on the following databases: PubMed and VHL from 2000 to 2013 aiming to compare Intramedullary Nailing (IM Nailing), External Fixation (EF), and EF followed by IM Nailing in the treatment of open fractures of the tibial shaft. After analysis by inclusion criteria 24 articles met the eligibility criteria. The healing time was under 32 weeks, and the nonunion and defective healing rates were under 13.35% and 16.6%, respectively. The infection rate ranged from 3% to 53% for patients treated with EF as definitive management; from 0% to 22% for those treated with IM Nailing as definitive management; and from 0% to 16.7% for those who underwent EF followed by IM Nailing. Conclusion: The cases treated with EF as definitive management presented shorter healing time as for the analyzed samples. The nonunion cases with greater percentages were those of EF followed by IM Nailing. The studies using IM Nailing as definitive management presented more healing cases defective. Even though few studies analyze hospital stay, it was found to be shorter in the sample treated with EF as definitive management.Â

Phytochemical screening and evaluation of cytotoxicity of stem bark extracts of Anaxagorea dolichocarpa and Duguetia chrysocarpa (Annonaceae)

Purpose: To investigate the phytochemistry and cytotoxic activity of stem bark extracts from Anaxagorea dolichocarpa and Duguetia chrysocarpa - two species of the Annonaceae family.Methods: The crude ethanol bark extracts (EtOH) of the plants were obtained by maceration. The crude extracts were suspended in a mixture of methanol (MeOH) and water (H2O) (proportion 3:7 v/v) and partitioned with hexane, chloroform (CHCl3) and ethyl acetate (AcOEt) in ascending order of polarity to obtain the respective fractions. The extracts were evaluated on thin layer chromatography (TLC) plates of silica gel to highlight the main groups of secondary metabolites. Cytotoxicity was tested against human tumor cell lines - OVCAR-8 (ovarian), SF-295 (brain) and HCT-116 (colon) - using 3- (4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay.Results: The screening results demonstrated that all the extracts were positive for the presence of flavonoids and tannins. The presence of alkaloids also was detected in some extracts. The hexane extract of A. dolichocarpa showed the strongest cytotoxicity against HCT-116 with cell growth inhibition of 89.02 %.Conclusion: The findings demonstrate for the first time the cytotoxic activity of the extracts of A. dolichocarpa and D. chrysocarpa, thus providing some evidence that plants of the Annonaceae family are a source of active secondary metabolites with cytotoxic activity.Keywords: Annonaceae, Anaxagorea dolichocarpa, Duguetia chrysocarpa, Anti-cancer agents, Ovarian, brain and colon cell line

Experiences Of Mothers Of Children With Congenital Heart Disease

Introduction: This article discusses the experience of mothers during the process of falling ill of their children with congenital heart disease. Method: This is a descriptive research with qualitative approach conducted with nine mothers who had their babies admitted to a pediatric cardiology unit in a reference center for treatment of congenital heart disease in the North and Northeast regions in Brazil located in Fortaleza, Ceará. Information and reports on the experience of these mothers emerging from the diagnosis process, surgery, treatment and hospitalization were collected in semi-structured individual interviews. After interviews, the testimonies of mothers were transcribed in full-length, identifying the speeches with the codes M1, M2,...M9, thereby ensuring anonymity. We used the thematic analysis technique of Minayo (2012) for treatment of information and design of the content of this article. This article is part of the research project: Breastfeeding babies with heart disease, approved by the Research Ethics Committee of the Messejana Hospital, under Opinion No 1,285,784. Results: The study demonstrated that infants with congenital heart disease require specific and specialized care and that mothers undertake a long and sometimes painful journey in the search for the healing of their child. Conclusion: Based on the collected speeches, we learned that mothers also need to be assisted by professionals of the health team. They must support the mother's empowerment in the child care and strengthen the relationship of the mother-infant binomial, and help in coping and adapting to the reality in the process of falling ill and healing of their child.   Key words: Congenital heart disease. Experience of mother

Traumatic brain injury (TBI): morbidity, mortality and economic implications

Traumatisms, in general, result in high costs for health systems worldwide. They consist of the leading cause of death in young adults, primarily males. Traumatic brain injury (TBI) represents good part of this spending, reaching globally significant mortality rate, around 1.5 million victims a year. Only in the United States (US) attendances related to traumatic brain injuries in emergency departments revolve around 1.35 million annually, plus about 275,000 hospitalizations and 52,000 deaths. In Brazil, only in 2012 was spent over one billion dollars with hospitalizations related to external causes, including TBI. Mild TBI (Glasgow Coma Scale (GCS) 14-15) occur in about 80% of the total demand, moderate (GCS 9-13) in 10% and serious (GCS 3-8) in 10 %. Regarding mortality rate, this is relatively low compared to the total number, since much of fatal outcomes fits in the moderate to severe groups. One of lesions a valuable prognostic factor related to the TBI is the subdural hematoma (SDH), responsible for complications in up to 45% of cases of TBI, expressing mortality between 60-80% depending on the implemented workup and may even reach 90% when in delay of appropriate treatment. The acute subdural hematoma (ASDH) thus represents a neurosurgical emergency, taking most of these patients to be subjected to urgent evacuation of the hematoma by craniotomy, which also is not without risks, with several reports in literature of new contralateral hematoma formation after craniotomy for evacuation of hematoma, further aggravating the patient's prognosis. For best results of the TBI is needed better understanding of the pathophysiology, identification of newer parameters of brain function and development of innovative therapeutic modalities. According to the Centers for Disease Control and Prevention (CDC), under the Department of Health and Human Services, population data on TBI are fundamental for understanding its impact on the society and know the profile of patients and the mechanisms trauma, to assist in the formulation of prevention strategies and in setting priorities for research and support services to patients living with traumatic brain injury

Tumor de Frantz em paciente do sexo feminino com diarreia: relato de caso de neoplasia pancreática rara

O tumor pseudopapilar sólido, também conhecido como tumor de Frantz, é um tumor raro do pâncreas. Relatamos o caso de uma paciente de 25 anos com dor abdominal, febre, diarréia e perda de peso.TC de abdome com contraste revelou pâncreas alargado com lesão hipodensa de aparência nodular e calcificações periféricas. Foi decidido realizar pancreatectomia subtotal com linfadenectomia e optou-se pela esplenectomia com biópsia hepática intra-operatória. O anatomopatológico da ressecção cirúrgica do tumor pancreático revelou tumor pseudopapilar sólido compatível com o tumor de Frantz. A imuno-histoquímica confirmou os achados histopatológicos. Ela evoluiu com fístula pancreática e pancreatite resolvida após 15 dias. Atualmente, está sendo acompanhada ambulatorialmente em nosso serviço com remissão completa dos sintomas.Solid pseudopapillary tumor, also known as frantz tumor, is a rare tumor of the pancreas. We report a case of 25-year-old female patient with abdominal pain, fever, diarrhea and weight loss. Contrast abdominal CT showed enlarged pancreas with a hypodense lesion of nodular appearance and peripheral calcifications.It was decided to perform subtotal pancreatectomy with lymphadenectomy, and opted for splenectomy and intraoperative liver biopsy. The pathology of surgical resection of the pancreatic tumor showed solid pseudopapillary tumor compatible with Frantz’s tumor. Immunohistochemistry confirmed histopathological findings. She evolved with pancreatic fistula and pancreatitis resolved after 15 days. Currently, it is being followed up in our service with complete remission of symptoms

Extracts and Essential Oils from Medicinal Plants and Their Neuroprotective Effect

Current therapies for neurodegenerative diseases offer only limited benefits to their clinical symptoms and do not prevent the degeneration of neuronal cells. Neurological diseases affect millions of people around the world, and the economic impact of treatment is high, given that health care resources are scarce. Thus, many therapeutic strategies to delay or prevent neurodegeneration have been the subject of research for treatment. One strategy for this is the use of herbal and essential oils of different species of medicinal plants because they have several bioactive compounds and phytochemicals with neuroprotective capacity. In addition, they respond positively to neurological disorders, such as dementia, oxidative stress, anxiety, cerebral ischemia, and oxidative toxicity, suggesting their use as complementary treatment agents in the treatment of neurological disorders

Use of fruit epicarps to formulate pectin-based bioactive films / Utilização de epicarpos de frutos para formulação de filmes bioativos à base de pectinas

The functional properties of biofilms can vary according to the biopolymer used as the raw material; thus, in the search for alternative sources for preparation of biodegradable films, fruits and vegetables have been used to extract compounds of interest with applications in the food industry. The objective of this work was to obtain and characterize bioactive films based on pectin extracted from the epicarps (skin) of the fruit. The genipap (Genipa americana), red pitaya (Hylocereus polyrhizus) and star fruit (Averrhoa carambola) were collected, washed, pulped and dried at 50 °C for 24 h, and their epicarps were ground and subjected to pectin extraction using the casting method. The films were characterized as to their visual appearance, moisture, pH, water solubility and antioxidant activity. The pectin-based films of G. americana and H. polyrhizus showed a yellowish color, while A. carambola was dark brown. The highest pectin yield (29%) and moisture content (13.9%) were obtained from the H. polyrhizus film, while A. carambola showed the highest solubility in water (98.6%) and had the highest pH (3.9). Additionally, the film based on A. carambola showed greater antioxidant potential against ABTS (30.5%) and DPPH (34%), as well as greater reducing power (0.262 absorbance at 750 nm) and content of total phenolic compounds (553 mg GAE/100 g), whereas H. polyrhizus had a higher percentage of chelating ability (27%). The physicochemical characteristics and bioactive properties exhibited make the film formulation a viable alternative for the food industry

Bioethics Inserted in Oncologic Palliative Care: a Systematic Review

Introduction: Bioethics emerges in oncologic palliative care from the reflctions of that care at the end of life for cancer patients are usually inadequate because the individuals has little relief of symptoms, adverse reactions to treatment, threats of physical, social and psychological destruction and loss of functions.Material and Findings: Systematic review in MEDLINE, IBECS, LILACS and SciELO from 1 st January, 2006 to 10th January. The searchvwas conducted with the descriptors "CuidadosPaliativos" (DeCS);"Oncologia" (DeCS); "Morte e Morrer" (Keyword); and "Bioética" (DeCS) during the month of December 2013. The literature points out that physicians should not accept something as absolute truth; and to help them in their choices at the moment comes to bioethics, which does not provide ready answers, but, with its pluralistic view, makes us exercise the capacity for reflction in choosing the best conduits for the patient. It is necessary to rescue more widely the value of the care that was in the background before the search for the cure of diseases, which in a broader sense, encompasses human, spiritual and social aspects. In Brazil, the practice of euthanasia or assisted suicide are illegal conduct that typify the crime of murder, however, the suspension of therapeutic effort is not prohibited (SET), extensively comment, orthothanasia.Conclusion: Despite the possible philosophical and ideological differences, it is necessary that health professionals to really take care of severe patients, prove conscious and attentive to the rights of the individual, the real meaning of the concepts of health and disease, issues the lack of therapeutic possibilities, extreme old age and death