Rinossinusopatia crônica como manifestação inicial da Doença de Behçet: relato de caso/ Chronic rhinosinusopathy as an initial manifestation of Behçet's Disease: case report

A Doença de Behçet (DB) é uma vasculite sistêmica autoimune de etiologia desconhecida, cuja descrição clássica é de uma tríade clínica de úlceras genitais, aftas orais e lesão ocular (uveíte). Há poucos relatos na literatura que envolvem a mucosa nasossinusal. Os autores descrevem um caso de rinossinusite crônica em uma paciente de 50 anos, sexo feminino, que foi submetida a diversos tratamentos, e com melhora após terapêutica para DB. Relatam ainda os achados clínicos, critérios diagnósticos, tratamento e revisão de literatura. Consideramos importante o relato deste caso em vista do amplo espectro de manifestações clínicas que a doença pode apresentar

Overview of recent TJ-II stellarator results

The main results obtained in the TJ-II stellarator in the last two years are reported. The most important topics investigated have been modelling and validation of impurity transport, validation of gyrokinetic simulations, turbulence characterisation, effect of magnetic configuration on transport, fuelling with pellet injection, fast particles and liquid metal plasma facing components. As regards impurity transport research, a number of working lines exploring several recently discovered effects have been developed: the effect of tangential drifts on stellarator neoclassical transport, the impurity flux driven by electric fields tangent to magnetic surfaces and attempts of experimental validation with Doppler reflectometry of the variation of the radial electric field on the flux surface. Concerning gyrokinetic simulations, two validation activities have been performed, the comparison with measurements of zonal flow relaxation in pellet-induced fast transients and the comparison with experimental poloidal variation of fluctuations amplitude. The impact of radial electric fields on turbulence spreading in the edge and scrape-off layer has been also experimentally characterized using a 2D Langmuir probe array. Another remarkable piece of work has been the investigation of the radial propagation of small temperature perturbations using transfer entropy. Research on the physics and modelling of plasma core fuelling with pellet and tracer-encapsulated solid-pellet injection has produced also relevant results. Neutral beam injection driven Alfvénic activity and its possible control by electron cyclotron current drive has been examined as well in TJ-II. Finally, recent results on alternative plasma facing components based on liquid metals are also presentedThis work has been carried out within the framework of the EUROfusion Consortium and has received funding from the Euratom research and training programme 2014–2018 under Grant Agreement No. 633053. It has been partially funded by the Ministerio de Ciencia, Inovación y Universidades of Spain under projects ENE2013-48109-P, ENE2015-70142-P and FIS2017-88892-P. It has also received funds from the Spanish Government via mobility grant PRX17/00425. The authors thankfully acknowledge the computer resources at MareNostrum and the technical support provided by the Barcelona S.C. It has been supported as well by The Science and Technology Center in Ukraine (STCU), Project P-507F

Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study

Background: There are no specific recommendations regarding the optimal management of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid. Methods: A multicenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intra-abdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure. Results: A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II-IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4-64, P =0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2-19.9, P =0.023), with 88% of success compared to 96% without free fluid ( P <0.001). The rate of treatment failure with nonoperative management during the first year of follow-up was 16.5%. Conclusion: Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation

Ice cream as a vehicle for incorporating health-promoting ingredients: conceptualizationand overview of quality and storage stability aspects

Ice cream is a product with peculiar textural and organoleptic features and is highly appreciated by a very broad spectrum of consumers. Ice cream’s structure and colloidal design, together with its low-temperature storage, renders it a very promising carrier for the stabilization and in vivo delivery of bioactive compounds and beneficial microorganisms. To date, many applications related to the design and development of functional ice cream have been documented, including products containing probiotics, prebiotics, synbiotics, dietary fibers, natural antioxidants such as polyphenols, essential and polyunsaturated fatty acids, and low glycemic index blends and blends fortified with mineral or trace elements. In this review, promising strategies for the incorporation of innovative functional additives to ice cream through the use of techniques such as microencapsulation, anoemulsions, and oleogels are discussed, and current insights into the implications of matrix, processing, and digestion on bioactive compounds in frozen dairy desserts are comprehensively reviewed, thereby providing a holistic overview of the current and emerging trends in this functional food sector

Validity of bedside screening tests performed for aspiration detection in patients admitted to a public rehabilitation hospital

Introdução: a detecção precoce da disfagia e especificamente da aspiração é essencial para prevenir e reduzir as complicações de pacientes internados em hospitais de reabilitação. A avaliação inicial dos distúrbios da deglutição em pacientes internados é geralmente feita por testes de triagem à beira do leito (bedside screening tests) que tem baixa sensibilidade e especificidade. Identificar quais testes melhor discriminam pacientes com aspiração auxiliaria a programar a avalição racional destes pacientes. Objetivo: determinar a validade de testes de triagem realizados à beira do leito em detectar aspiração, com a videoendoscopia de deglutição (VED) como teste de referência. Métodos: um estudo prospectivo observacional foi realizado em 150 pacientes consecutivos admitidos no setor de reabilitação e readaptação de um hospital público terciário, submetidos à avaliação de preditores clínicos, ao questionário Eating Assessment Tool 10 (EAT-10), a um instrumento para avaliação da força e resistência da língua (Iowa Oral Performance Instrument [IOPI]), à medição do tempo de fonação máxima (TFM) e a um teste de deglutição (Volume-Viscosity Swallow Test [V-VST]). A validade dos testes de triagem em detectar aspiração, confirmada pela VED, foram calculadas. Resultados: dos 144 pacientes incluídos, 113 (78%) não tiveram aspiração e 31 (22%) tiveram aspiração. A força máxima da língua apresentou alta sensibilidade (92,3%) e baixa especificidade (18,6%) e acurácia (33,1%) para detectar aspiração. O V-VST mostrou sensibilidade, especificidade e acurácia para aspiração de 83,3%, 72,6% e 74,8%, respectivamente. A sensibilidade do EAT-10 e TMF para aspiração foi de 82,8% e 88% e especificidade foi de 57,7% e 32,4%, respectivamente. Conclusão: o resultado do presente estudo sugere que V-VST e o EAT-10 são bons métodos de triagem para detectar aspiração em pacientes admitidos em centro de reabilitação. O IOPI e TMF, apesar da excelente sensibilidade, apresentam baixa especificidade com baixo poder discriminatório entre paciente que não aspiram e aspiramIntroduction: early detection of dysphagia and specifically aspiration is essential to prevent and reduce complications of hospitalized patients in Rehabilitation Centers. Bedside screening tests are commonly used for the initial evaluation of swallowing in these settings, but they present insufficient and inconsistent sensitivity and specificity. To identify which tests better discriminate aspirating patients would allow defining a better diagnostic approach for these patients. Objective: to determine the validity of various bedside screening tests in detecting aspiration, with Flexible Endoscopic Evaluation of Swallowing (FEES) as the reference test. Methods: a prospective observational study was performed in 150 consecutive patients of a tertiary rehabilitation hospital, submitted to assessment of clinical predictors, the Eating Assessment Tool 10 (EAT-10) questionnaire, an instrument for assessing tongue strength and endurance (Iowa Oral Performance Instrument [IOPI]), Maximum phonation time (MPT) and a swallowing test (Volume- Viscosity Swallow Test [V-VST]). The validity of bedside screening tests in detecting aspiration, as confirmed by FEES, was calculated. Results: of the 144 patients included, 113 (78%) had no aspiration and 31 (22%) had aspiration. The maximum tongue strength presented high sensitivity (92.3%) and low specificity (18.6%) and accuracy (33.1%) to detect aspiration. The V-VST showed a sensitivity, specificity and accuracy for aspiration of 83.3%, 72.6% and 74.8%, respectively. The sensitivity of EAT-10 and TMF for aspiration was 82.8% and 88% and specificity was 57.7% and 32.4%, respectively. Conclusion: the results of the present study suggest that V-VST and EAT-10 are good screening methods for aspiration detection in patients admitted to a rehabilitation center. The IOPI and MPT, despite the excellent sensitivity, have low specificity with low discrimination power between patients who do and do not aspirat

Assessment of symptom improvement following nasal septoplasty with or without turbinectomy Avaliação da melhora dos sintomas nasais após septoplastia com ou sem turbinectomia

Most studies show that objective measures to quantify and determine surgical success in the treatment of nasal obstruction do not correlate with subjective improvement as reported by patients. AIM: To evaluate the subjective improvement of nasal symptoms in patients undergoing septoplasty with or without turbinectomy. MATERIALS AND METHODS: A prospective study. We evaluated 72 septoplasty patients with or without partial inferior turbinectomy; the patients answered a questionnaire preoperatively and on the 60th day after surgery. RESULTS: Septoplasty was done associated with bilateral partial inferior turbinectomy in 83.3% of patients; it was unilateral in 9.7%; there was no need for turbinate reduction in 6.9%. An improvement of all symptoms was observed after surgery. Nasal obstruction had improved in 68 patients (94.4%) by the 60th postoperative day. The average nasal obstruction score in patients with and without allergic symptoms was similar before surgery and on the 60th postoperative day. Older patients had milder preoperative allergic symptoms. CONCLUSIONS: Nasal symptoms in patients undergoing septoplasty, with or without turbinectomy, improved. Patients with and without allergic symptoms showed a similar improvement of nasal obstruction on the 60th postoperative day.A maioria dos estudos mostra que medidas objetivas para quantificar e determinar o sucesso das cirurgias para a obstrução nasal não têm correlação com a melhora subjetiva relatada pelo paciente. OBJETIVO: Avaliar a melhora dos sintomas nasais nos pacientes submetidos à septoplastia, com ou sem turbinectomia. MATERIAL E MÉTODO: Estudo prospectivo. Foram avaliados 72 pacientes submetidos à septoplastia, com ou sem turbinectomia inferior parcial, que responderam ao questionário no préoperatório até o 60º dia de pós-operatório (PO). RESULTADOS: Foi realizada septoplastia associada à turbinectomia inferior parcial bilateral em 83,3% dos pacientes, unilateral em 9,7% e não houve necessidade de redução das conchas nasais em 6,9%. Foi observada melhora para todos os sintomas no pós-operatório. Sessenta e oito (94,4%) pacientes apresentaram melhora da obstrução nasal no 60º PO. A média da nota da obstrução nasal entre os pacientes com e sem sintomas alérgicos foi semelhante no pré-operatório e no 60º PO. Os pacientes mais velhos apresentaram menor intensidade dos sintomas alérgicos no pré-operatório. CONCLUSÕES: Os pacientes submetidos à septoplastia, com ou sem turbinectomia, evoluem com melhora de todos os sintomas nasais. Os pacientes com e sem sintomas alérgicos apresentam melhora da obstrução nasal de forma semelhante no 60º PO

Nariz torto: avaliação de resultados em rinoplastia

A crooked nose is the result of deformities that might involve the bony nasal pyramid, the upper and lower lateral cartilages, and nasal septum, causing complaints of aesthetic and/or functional nature.Purpose: To evaluate how satisfied are those patients who underwent rhinoplasty to correct crooked nose, through the questionnaire Rhinoplasty Outcomes Evaluation (ROE).Material and method: A longitudinal study with retrospective analysis of preoperative satisfaction and prospective analysis of postoperative satisfaction of patients who underwent rhinoplasty. ROE questionnaire was applied twice in the same visit aiming at measuring patient satisfaction in both pre and postoperative periods. Nineteen patients who underwent rhinoplasty answered the ROE.Results: For all patients who underwent rhinoplasty, the average preoperative satisfaction score was of 24.6 +/- 11.3, while the average postoperative score was of 76.1 +/- 19.5 (p= 30-year-old patients (p=0.05).Conclusion: From the Rhinoplasty Outcomes Evaluation questionnaire, it is possible to demonstrate the impact that rhinoplasty to correct a crooked nose determines the quality of life of patients. Approximately 90% of patients undergoing rhinoplasty believed they achieved a good or excellent postoperative result.Univ Fed Sao Paulo, Grad Program Otorhinolaryngol & Head & Neck Surg, Sao Paulo, BrazilUniv Fed Sao Paulo, HSPM, Sao Paulo, BrazilHosp Servidor Publ Municipal Sao Paulo HSPM, Sao Paulo, BrazilUniv Fed Sao Paulo, Grad Program Otorhinolaryngol & Head & Neck Surg, Sao Paulo, BrazilUniv Fed Sao Paulo, HSPM, Sao Paulo, BrazilWeb of Scienc

Evaluation About the Requirement to Use a Pack After Septoplasty with Turbinectomy

Introduction: Septoplasty associated with a partial inferior turbinectomy is one of the most frequent surgeries performed in patients with nasal obstruction. The nasal pack has been used to control primary bleeding in these surgeries. Several complications have been related to the nasal pack, besides causing pain and a relevant discomfort. Some studies have investigated both the efficiency of the nasal pack to control bleeding and the complications after septoplasty and turbinectomy. Objective: To compare the degree of nasal bleeding among patients submitted to septoplasty with partial bilateral inferior turbinectomy, whether using the nasal pack or not. Method:An outlook study was performed to evaluate 60 patients diagnosed of a deviated nasal septum with an inferior concha hypertrophy. The patients were submitted to bilateral turbinectomy septoplasty under direct visualization. They were divided into 2 groups: without pack and with pack (Merocel* and protective sheath). These were evaluated after surgery, based on the evaluation of bleeding intensity. Result: It was observed that the post-surgical bleeding degree of the group submitted to partial bilateral inferior turbinectomy, who used the nasal pack, was lower than the group not using a pack. Conclusion: Patients submitted to septoplasty with partial bilateral inferior turbinectomy, not using a post-surgical nasal pack, appeared to bleed more than patients using a nasal pack