Fratura do anel apofisário associada à hérnia discal extrusa de dois níveis: relato de caso e revisão da literatura

Apophyseal ring fractures are rare injuries that may be associated with lumbar disc herniation in young patients. We report a unique case in the literature of a 15-year-old male patient who played football and was admitted at our service complaining of sciatica radiating into the left leg. An apophysial ring injury of L5 vertebral body was observed. This injury caused two extruded disc herniation in adjacent levels. Surgical procedure was indicated after failure of conservative treatment.As fraturas do anel apofisário são lesões raras, que podem estar associadas à hérnia de disco lombar nos pacientes jovens. Apresentamos aqui um caso único na literatura de paciente de 15 anos, gênero masculino, praticante de futebol, com queixa de ciatalgia para o membro inferior esquerdo. Houve lesão do anel apofisário, nos planaltos superior e inferior do corpo vertebral de L5, ocasionando hérnias discais extrusas nos níveis adjacentes. O procedimento cirúrgico foi indicado após a falha do tratamento conservador.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Leptospira Seroprevalence in Capybaras from a Brazilian Urban Area

Background: Leptospirosis remains the most widespread zoonotic disease in the world. As a clinical entity it is strongly associated with regional occupational and environmental exposures.  While the exact global disease burden remains unknown, recent estimates by the leptospirosis Burden Epidemiology Reference Group (LERG) at the World Health Organization have set the number of human cases of severe leptospirosis to over 500,000 per year. This number almost certainly represents an under-representation due to poor surveillance and difficult diagnosis. Leptospira spp. belong to the order Spirochaetales, family Leptospiraceae, composed by 13 pathogenic Leptospira species with more than 260 serovars. Wildlife species are commonly considered to be important epidemiological carriers, mainly because of their frequent reactivity to Leptospira serovars native to their habitat. Capybara (Hydrochaeris hydrochaeris), a known leptospirosis host, is a widespread species in South America. However, reports regarding the importance of this animal in the epidemiology of leptospirosis are rare. Therefore, the objective of this study was to report the results of leptospirosis serological survey of capybaras from a residential park area in southeastern Brazil.Materials, Methods & Results: A total of 172 capybaras were sampled at Itú Municipality, state of São Paulo, southeastern Brazil, from December 2012 to May 2013. Sera samples were examined for Leptospira antibodies by the microscopic agglutination test (MAT), using live antigens grown in liquid medium (EMJH). A complete panel of 7 serogroups (including 10 reference serovars) was used as antigens: serogroup Sejroe (serovars Hardjo and Wolffi), serogroup Grippotyphosa (serovar Grippotyphosa), serogroup Canicola (serovar Canicola), serogroup Icterohaemorrhagiae (serovars Icterohaemorrhagiae and Copenhageni), serogroup Australis (serovars Australis and Bratislava), serogroup Pomona (serovar Pomona), and serogroup Autumnalis (serovar Butembo).   As a results, 46 (26.75%) were serologically positive: 29 (63.05%) for serogroup Sejroe, 7 (15.22%) for serogroup Icterohaemorrhagiae; 9 (19.56%) were seropositive for serogroups Sejroe and Icterohaemorrhagiae; and 1 (2.17%) was positive for serogroups Sejroe and Grippotyphosa.Discussion: L. interrogans sensu stricto is responsible for the most frequent and severe cases of human and animal leptospirosis. Considering the results of our serological survey, it is important to reinforce that in tropical countries, mainly Brazil, India, Thailand, Vietnam, Australia and Barbados, serovars belonging to the Icterohaemorrhagiae serogroup (Icterohaemorrhagiae and Copenhageni) are generally the most prevalent. Therefore, the report of different serogroups in capybaras (as observed in our study) it is an important observation reported. Human leptospirosis is usually due to serovars that are maintained by the animal populations of a region, which spread the bacterium on the environment; thus, it may represent an important additional risk factor for human population. Our study identified a greater serum reactivity to strains that belongs to serogroup Sejroe. In Brazil this serogroup is highly predominant in livestock; thus, our main hypothesis is that some animals were contaminated with Sejroe serovars when they were at their natural habitat and, once in the park, they maintained these serovars through cross transmission.  Therefore, based on our results, it was possible to observe a significant prevalence of serovars belonging to serogroup Icterohaemorrhagiae, and there was also a high prevalence of samples positive to serogroup Sejroe. Thus, our serologic survey showed that capybaras living in an urban area could represent a risk factor for leptospirosis for the human population eventually exposed

Impact of surgeons’ experience on accuracy of radiographic segmental kyphosis assessment in thoracolumbar fractures: a prospective observational study

BACKGROUND: The thoracolumbar region is where most fractures of the spine are located. Segmental kyphosis is an important factor for treatment decisions. There are various methods for measuring segmental kyphosis in thoracolumbar fractures. Our objective was to evaluate if the experience of the surgeon has any influence on kyphosis measurement by analyzing three different categories of orthopedic surgeons and evaluate possible clinical impacts. MATERIAL AND METHODS: Six physicians separated into three categories according to the level of experience evaluated 30 lateral view radiographs of the thoracic spine of patients with single-level fracture taken during their outpatient follow-up visits. Images had segmental kyphosis measured by five distinct methods. The x-rays were evaluated twice and in a random order after an eight-week interval. The reproducibility of the measurements was analyzed by the intraclass correlation coefficient (ICC) and its respective 95% confidence interval. RESULTS: The intraclass correlation coefficient (ICC) was calculated to evaluate the inter- and intra-examiner reliability for each method. The methods that disregard the fractured vertebra (1 and 4) achieved the highest intra and inter-observers reliability among the participants. The measurements from methods 3 and 5 were poorly reproducible between examiners. The difference between the averages of the measurements of the five methods studied was greater than 5 degrees in methods 1 and 2, suggesting risk for patient safety. CONCLUSION: Methods that exclude the fractured vertebra were more reproducible for the evaluation of segmental kyphosis in thoracolumbar fractures. The evaluation of the spine fracture must be coupled with other radiographic criteria, more complex image exams and the patient’s clinical state to assist the surgeon in deciding between conservative or surgical treatment. The authors suggest that the measurements should be performed by methods that exclude the fractured vertebra and conducted by experienced doctors

Inclusive charged hadron elliptic flow in Au + Au collisions at sNN\sqrt{s_{NN}} = 7.7 - 39 GeV

A systematic study is presented for centrality, transverse momentum ($p_T$) and pseudorapidity ($\eta$) dependence of the inclusive charged hadron elliptic flow ($v_2$) at midrapidity($|\eta| < 1.0$) in Au+Au collisions at $\sqrt{s_{NN}}$ = 7.7, 11.5, 19.6, 27 and 39 GeV. The results obtained with different methods, including correlations with the event plane reconstructed in a region separated by a large pseudorapidity gap and 4-particle cumulants ($v_2{4}$), are presented in order to investigate non-flow correlations and $v_2$ fluctuations. We observe that the difference between $v_2{2}$ and $v_2{4}$ is smaller at the lower collision energies. Values of $v_2$, scaled by the initial coordinate space eccentricity, $v_{2}/\varepsilon$, as a function of $p_T$ are larger in more central collisions, suggesting stronger collective flow develops in more central collisions, similar to the results at higher collision energies. These results are compared to measurements at higher energies at the Relativistic Heavy Ion Collider ($\sqrt{s_{NN}}$ = 62.4 and 200 GeV) and at the Large Hadron Collider (Pb + Pb collisions at $\sqrt{s_{NN}}$ = 2.76 TeV). The $v_2(p_T)$ values for fixed $p_T$ rise with increasing collision energy within the $p_T$ range studied ($< 2 {\rm GeV}/c$). A comparison to viscous hydrodynamic simulations is made to potentially help understand the energy dependence of $v_{2}(p_{T})$. We also compare the $v_2$ results to UrQMD and AMPT transport model calculations, and physics implications on the dominance of partonic versus hadronic phases in the system created at Beam Energy Scan (BES) energies are discussed.Comment: 20 pages, 12 figures. Version accepted by PR

III Diretriz Brasileira de Insuficiência Cardíaca Crônica

Universidade de São Paulo Faculdade de Medicina Hospital das ClínicasUniversidade Federal do Rio Grande do Sul Hospital de Clínicas de Porto AlegreUniversidade de Pernambuco Faculdade de Ciências Médicas de PernambucoUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade Federal de Minas Gerais Faculdade de MedicinaFaculdade de Medicina de São José do Rio PretoFundação Universitária de Cardiologia do Rio Grande do Sul Instituto de CardiologiaRede Labs D'OrUniversidade Federal FluminenseUniversidade do Estado do Rio de Janeiro Faculdade de Ciencias MédicasInstituto Dante Pazzanese de CardiologiaSanta Casa de MisericórdiaUniversidade de Pernambuco Pronto Socorro Cardiológico de PernambucoHospital Pró CardíacoHospital de MessejanaPontifícia Universidade Católica do ParanáUniversidade Federal de Goiás Faculdade de MedicinaUniversidade de São Paulo Faculdade de Medicina de Ribeirão PretoReal e Benemerita Sociedade de Beneficência PortuguesaFaculdade de Ciências Médicas de Minas GeraisUNIFESP, EPMSciEL

DISTRIBUIÇÃO HORÁRIA DA PRECIPITAÇÃO EM PORTO VELHO-RO

O objetivo deste trabalho é analisar a variabilidade média das precipitações em Porto Velho – RO entre 1998 e 2013. Foram utilizados dados de precipitação horária de duas estações meteorológicas próximas, cerca de 200 metros uma da outra, instalados dentro do perímetro urbano de Porto Velho. Foi calculado a frequência relativa para cada hora do dia para todos os eventos de precipitação com volume horário superior a 0,2 mm e também para volumes horários superiores a 10 mm, sendo estes considerados neste artigo como “eventos intensos de precipitação”. Com as frequências relativas horárias de todo o período estudado trabalhadas, pode-se fazer a distribuição horária média dos dados de forma anual e também sazonal, separado por estações do ano. A frequência relativa anual de todos os eventos precipitantes apresentou maiores frequências as 15:00 horas (horário local) com um segundo máximo as 05:00 horas, enquanto que dos eventos intensos as maiores frequências se concentravam apenas à tarde, principalmente às 16:00 horas. Na frequência relativa sazonal de todos os eventos, o período da tarde foi preferencial em quase todas as estações, com a exceção do Verão, onde as chuvas ocorrem preferencialmente no fim da madrugada. Na frequência relativa sazonal das precipitações intensas, todas as estações do ano apresentam maiores frequências à tarde. Com os resultados alcançados nesta pesquisa, espera-se que os mesmos sejam de grande valia na caracterização da precipitação em Porto Velho

The Brazilian Registry of Adult Patient Undergoing Cardiovascular Surgery, the BYPASS Project: Results of the First 1,722 Patients

Objective: To report the early results of the BYPASS project - the Brazilian registrY of adult Patient undergoing cArdiovaScular Surgery - a national, observational, prospective, and longitudinal follow-up registry, aiming to chart a profile of patients undergoing cardiovascular surgery in Brazil, assessing the data harvested from the initial 1,722 patients. Methods: Data collection involved institutions throughout the whole country, comprising 17 centers in 4 regions: Southeast (8), Northeast (5), South (3), and Center-West (1). The study population consists of patients over 18 years of age, and the types of operations recorded were: coronary artery bypass graft (CABG), mitral valve, aortic valve (either conventional or transcatheter), surgical correction of atrial fibrillation, cardiac transplantation, mechanical circulatory support and congenital heart diseases in adults. Results: 83.1% of patients came from the public health system (SUS), 9.6% from the supplemental (private insurance) healthcare systemsand 7.3% from private (out-of-pocket) clinic. Male patients comprised 66%, 30% were diabetics, 46% had dyslipidemia, 28% previously sustained a myocardial infarction, and 9.4% underwent prior cardiovascular surgery. Patients underwent coronary artery bypass surgery were 54.1% and 31.5% to valve surgery, either isolated or combined. The overall postoperative mortality up to the 7th postoperative day was 4%for CABG was 2.6%, and for valve operations, 4.4%. Conclusion: This first report outlines the consecution of the Brazilian surgical cardiac database, intended to serve primarily as a tool for providing information for clinical improvement and patient safety and constitute a basis for production of research protocols.Univ Fed Sao Paulo UNIFESP EPM, Hosp Sao Paulo, Sao Paulo, SP, BrazilHosp Caridade Sao Vicente Paulo, Jundiai, SP, BrazilInst Med Integral Prof Fernando Figueira IMIP, Recife, PE, BrazilHosp Base FUNFARME & FAMERP, Sao Jose Do Rio Preto, SP, BrazilIMC, Sao Jose Do Rio Preto, SP, BrazilIrmandade Santa Casa Sao Paulo INCT HPV, Fac Ciencias Med Santa Casa Sao Paulo, Sao Paulo, SP, BrazilFundacao Univ Cardiol, Inst Cardiol Rio Grande do Sul, Porto Alegre, RS, BrazilInst Coracao Natal, Natal, RN, BrazilInst Cardiol Dist Fed, Brasilia, DF, BrazilUniv Fed Maranhao HU UFMA, Univ Hosp, Sao Luis, MA, BrazilHosp Evangelico, Cachoeiro De Itapemirim, ES, BrazilHosp Coracao Sergipe, Aracaju, SE, BrazilHosp Nossa Senhora Salete, Inst Cirurgia Cardiovasc ICCV, Cascavel, PR, BrazilHosp Wilson Rosado, Mossoro, RN, BrazilHosp Bosque Saude, Sao Paulo, SP, BrazilHosp Univ Santa Maria, Santa Maria, RS, BrazilHosp Coracao HCor, Sao Paulo, SP, BrazilHosp Coracao IP HCor, Ins Pesquisa, Sao Paulo, SP, BrazilInst Coracao InCor, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP EPM, Hosp Sao Paulo, Sao Paulo, SP, BrazilWeb of Scienc

Behaviour of the foramen ovale flow in fetuses with intrauterine growth restriction

Foramen ovale (FO) flow may be altered in IUGR. .is study was designed to test this hypothesis. Methods. Forty pregnant women (24–38 weeks) were divided into 3 groups: group I (IUGR), group II (adequate growth and maternal hypertension), and group III (normal controls). Impedance across the FO was assessed by the FO pulsatility index (FOPI): (systolic velocity − presystolic velocity)/mean velocity. Statistical analysis utilized ANOVA, Tukey test, and ROC curves. Results. Mean FOPI in IUGR fetuses (n=15) was 3.70 ± 0.99 (3.15–4.26); in the group II (n=12), it was 2.84 ± 0.69 (2.40–3.28), and in the group III (n=13), it was 2.77 ± 0.44 (2.50–3.04) (p=0.004). FOPI and UtA RI were correlated (r= 0.375, p= 0.017), as well as FOPI and UA RI (r= 0.356, p= 0.024) and, inversely, FOPI and MCA RI (r= −0.359, p= 0.023). Conclusions. .e FO flow pulsatility index is increased in fetuses with IUGR, probably as a result of impaired left ventricular diastolic functio

Photography-based taxonomy is inadequate, unnecessary, and potentially harmful for biological sciences

The question whether taxonomic descriptions naming new animal species without type specimen(s) deposited in collections should be accepted for publication by scientific journals and allowed by the Code has already been discussed in Zootaxa (Dubois & Nemésio 2007; Donegan 2008, 2009; Nemésio 2009a–b; Dubois 2009; Gentile & Snell 2009; Minelli 2009; Cianferoni & Bartolozzi 2016; Amorim et al. 2016). This question was again raised in a letter supported by 35 signatories published in the journal Nature (Pape et al. 2016) on 15 September 2016. On 25 September 2016, the following rebuttal (strictly limited to 300 words as per the editorial rules of Nature) was submitted to Nature, which on 18 October 2016 refused to publish it. As we think this problem is a very important one for zoological taxonomy, this text is published here exactly as submitted to Nature, followed by the list of the 493 taxonomists and collection-based researchers who signed it in the short time span from 20 September to 6 October 2016

Efeitos da Drenagem Linfática Manual na Diminuição do Edema de Membros Inferiores em Gestantes

Avaliar os efeitos da drenagem linfática na prevenção e diminuição do edemade membros inferiores em gestantes no segundo e terceiro trimestre gestacional.Trata-se de uma série de caso. A população foi composta por 10 gestantes no segundoe terceiro trimestre gestacional. A drenagem linfática foi realizada com a paciente emdecúbito dorsal, a 45 graus. Foi iniciada com a estimulação na região cervical por 15minutos, em seguida estímulos nos linfonodos inguinais de ambos os membros inferiores,poplíteo e maleolar. Cada membro inferior foi drenado durante 20 minutos.Houve redução do edema nos membros inferiores das gestantes em média de doiscentímetros logo após a primeira sessão (efeito agudo) e após a última sessão (efeitotardio) com redução de até cinco centímetros. Houve diferença significativa tanto noefeito agudo quanto no efeito tardio em relação à dor e a fadiga nos membros inferiores.Todas as gestantes ficaram satisfeitas e recomendariam o tratamento. A técnica dedrenagem linfática manual se mostrou eficiente na prevenção e diminuição do edema,dor e fadiga nos membros inferiores em fase aguda e no efeito tardio. Todas as gestantesficaram satisfeitas com a drenagem linfática e recomendariam o tratamento