Endoscopic Lumbar Sympathectomy for Women: Effect on Compensatory Sweat

INTRODUCTION: Plantar hyperhidrosis is present in 50% of patients with hyperhidrosis. Thoracic sympathectomy is an important tool for the treatment of this condition, which is successful in about 60% of patients. For the remaining patients, lumbar sympathectomy is the procedure of choice. As new minimally invasive techniques have been developed, a significant demand for this type of access has led to its adaptation to the lumbar sympathectomy. The objective of this study was to evaluate the effectiveness of endoscopic retroperitoneal lumbar sympathectomy in controlling plantar hyperhidrosis and its effects on compensatory sweat. MATERIALS AND METHODS: Thirty female patients with persistent plantar hyperhidrosis after thoracic sympathectomy were enrolled. They were randomly assigned to laparoscopic retroperitoneal lumbar sympathectomy (Group A) or no surgical intervention (Group B - control) groups. Quality-of-life modifications were assessed by specific questionnaires before and after surgery. In the same manner, direct sweat measurements were also performed pre- and post-intervention by evaluating trans-epidermal water loss. Despite the lack of intervention, the control group was evaluated at similar timepoints. RESULTS: In Group A, no major complications occurred in the peri-operative period. During the immediate post-operative period, three patients (20%) experienced prolonged pain (more than ten days). Eight patients suffered from worsened compensatory sweating (53.3%). In Group A, after lumbar sympathectomy, the quality of life significantly improved (p<0.05, intra-group comparison) beyond that of the control group (p<0.05, inter-group comparison). Also, lumbar sympathectomy resulted in significantly lower values of foot sweat (pre- vs. post-operative periods, p<0.05; Group A vs. Group B, p<0.05). These patients also developed higher values of sweat measurements on specific points of their dorsal and abdominal regions after the procedure (p<0.05). CONCLUSIONS: The endoscopic retroperitoneal lumbar sympathectomy diminishes plantar sweat and improves the quality of life of women with plantar hyperhidrosis. However, about half of the patients develop increased compensatory hyperhidrosis in other areas of the body

Evaluation of the effectiveness of a modified liposuction protective device: an experimental study in swine

Liposuction is one of the most common procedures in the plastic surgery specialty. In the 2018 ISAPS survey, it was the second most performed surgery worldwide. Due to the repetitive movements typical of the surgery, significant friction is generated at the site, and the consequences are skin burns that can leave unsightly scars and dyschromias. This study aims to create a skin protective device prototype from an old model, which serves this purpose, and to observe its functionality and its effects on the pigskin. The tests were carried out on dead animals without suffering provided by the Veterinary Medicine sector at Universidade Positivo. Three incisions were made in the animal's abdomen to pass the liposuction cannula and another three for the insertion and use of the prototype to compare it with the model device. The established time for liposuction movements was twenty minutes, performed with the 5mm cannula directly in contact with the skin and inside the prototype. The prototype's ergonomics, ease of insertion, and good locking on the skin with different tractions were evaluated. Observation and evaluation of the skin were performed after procedures and incisions' measurements (cm). The cutaneous liposuction protective device prototype presented easy handling and a more efficient skin locking mechanism than the model used. The skin incision for using the prototype was slightly larger, and the skin showed no burning signs

ANÁLISE DO USO DE MEDICAMENTOS POTENCIALMENTE INAPROPRIADOS PARA IDOSOS EM UMA UNIDADE DE URGÊNCIA DE UM HOSPITAL DO RIO GRANDE DO SUL

Objective: to Evaluate the prevalence of potentially inappropriate medications (MPI) prescription in an emergency unit of a hospital in Rio Grande do Sul. Methodology: a retrospective cross-sectional study through secondary data on medical prescriptions containing MPI of elderly hospitalized by the Unified Health System in a teaching hospital in the interior of Rio Grande do Sul. Results: a whole of 98 medical prescriptions were observed in which 21 MPIs were found for the elderly, with metoclopramide, regular insulin, omeprazole, clonazepam and clonidine being the most prescribed. In this context, the use of 10.2 drugs per patient was found, constituting an important polypharmacy picture in the elderly. Conclusion: thus, the rationalization of the prescription of MPI for the elderly is relevant because it offers more safety and quality in the drug treatment of geriatric patients in order to avoid possible unnecessary polypharmacy.Objetivo: avaliar a prevalência de prescrição de medicamentos potencialmente inapropriados (MPI) em uma unidade de urgência de um hospital do Rio Grande do Sul. Metodologia: estudo transversal retrospectivo através de dados secundários das prescrições médicas contendo MPI de idosos hospitalizados pelo Sistema Único de Saúde em um hospital de ensino no interior do Rio Grande do Sul. Resultados: foi observado, ao todo, 98 prescrições médicas na qual encontrou-se a prescrição de 21 MPIs para idosos,sendo metoclopramida, insulina regular, omeprazol, clonazepam e clonidina os mais prescritos. Nesse contexto, encontrou-se, em média, o uso de 10,2 remédios por paciente, configurando-se importante quadro de polifarmácia no idoso. Conclusão: desse modo, a racionalização da prescrição de MPI para idosos é relevante pois oferece mais segurança e qualidade no tratamento medicamentoso de pacientes geriátricos a fim de evitar possível quadro de polifarmácia desnecessário

Hemangioma infantil em ponta de nariz: relato de caso

O Hemangioma Infantil (HI) é um dos crescimentos tumorais mais comuns da infância e apresenta incidência global de aproximadamente 4-5%, sendo o tumor benigno mais comum da infância. Acomete mais o sexo feminino e seu crescimento ocorre por meio da hiperplasia de células endoteliais. O HI não está presente ao nascimento, ao contrário do hemangioma congênito, e se caracteriza por três fases: proliferativa, regressão espontânea, e fase de equilíbrio final. A maioria dos hemangiomas infantis não exigem tratamento. Contudo, casos capazes de causar cicatrizes e desfiguração facial permanente devem ser avaliados quanto à importância e à necessidade serem tratados. O relato a seguir apresenta um caso de hemangioma infantil tratado com cloridrato de propranolol

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Healthcare workers hospitalized due to COVID-19 have no higher risk of death than general population. Data from the Spanish SEMI-COVID-19 Registry

Aim To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW). Methods Observational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. Results As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age, male sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.211, 95%CI 0.067-0.667, p = 0.008). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). Conclusions Hospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality