Discal Cyst: a Rare Cause of Neurologic Compression in the Young Adult

Introduction: discal cysts are rare pathology. Its clinical presentation can be mistaken for disc herniation, with back pain, radiculopathy and neurological defi cit. It is more common in male patients in their fourth life decade. Because they are rare, there is no consensus about the treatment. A great variety of procedures, from medication for the pain to endoscopic or microdiscectomy excision, have been described. Objetive: Describe a case of discal cyst on the l4-l5 level with compression of l5 right nerve root treated successfully with a minimal invasive procedure. Study design: Case report. Methods: Review medical records, pertinent images, interview with the patient and surgical team, intraoperative and histopathological fi ndings. The surgical technique used was minimally invasive. Results: Magnetic resonance imaging (MRI) demonstrated a cystic lesion imaging at the level of the L4-L5 disc. The cystic mass displaced the thecal sac dorsally compressed the L5 transversing root. The patient was submitted to a minimally invasive microendoscopic technique using a tubular retractor. He recovered completely after the procedure, presenting absence of leg pain and went back to his regular activities 3 weeks after the surgery. Histopathological examination of the cyst revealed thick fi brous connective tissue interspersed with areas of chronic infl ammation. Conclusion: Discal cysts are rare intraspinal lesions. They can trigger severe neurological symptoms, and should be differentiated from other forms of epidural cysts and tumors. There are many treatment options that can be chosen from but no consensus. We used a treatment that was less invasive than the ones described in the literature

Modulação autonômica cardíaca durante diferentes modos de desmame em ventilação mecânica

Introduction: Heart rate variability (HRV) is a noninvasive method to analyze variations of time intervals between heart beats. HRV is a promising method to analyze autonomic balance quantitatively. During the weaning process of mechanical ventilation, alterations occur in the autonomic activity. Methods to identify increased risk for weaning failure are needed. Objective: To analyze the behavior of cardiac autonomic modulation in different phases of weaning mechanical ventilation. Methods: Cardiorespiratory parameters (SBP, DBP, MAP, RR, SpO2) of 18 participants were collected and a cardio-frequency meter was placed. The subjects were kept in supine Fowler's position t, ventilating for 10 minutes in the assist-controlled (A/C) ventilation mode the synchronized intermittent mandatory ventilation (SIMV) mode, pressure support ventilation (PSV) 18 and 10, and with nebulization through a T-piece. At the end of all ventilator modes, the pre-specified variables were measured. The HRV parameters were analyzed in the domains of time, frequency and geometric indexes. Results: There was an increase in the mean rMSSD of the A/C moment of 20.67 ± 19.36ms for the PSV 10 time 29.96 ± 21.26ms (p = 0.027), increase between the SIMV moments of 24.04 ± 18.31ms and PSV 10 to 29.96 ± 21.26ms (p = 0.042), but reduced between PSV 10 and T-Tube moments 21.22 ± 13.84ms (p = 0.035). There was an increase in the LF mean of the SIMV moments 158.46 ± 229.77ms2 and PSV 10 265.50 ± 359.88ms2 for T-tube 408.92 ± 392.77ms2 (p = 0.011 and p = 0.037 respectively). The mean LF showed a decrease between C/A and SIMV moments, respectively, 62.48 ± 17.99nu and 54.29 ± 15.29nu (p = 0.024), increase in SIMV moments 54.29 ± 15.29nu and PSV 10 55.05 ± 23.07nu for TUBE T 65.57 ± 17.08nu (p = 0.049 and p = 0.027 respectively). HF increased between SIMV moments 162.89 ± 231.19ms2 and PSV 10 247.83 ± 288.99ms2 (p = 0.020) and also between SIMV and T-Tube moments 248.28 ± 214.46 ms2 (p = 0.044). There was a reduction in mean HF between PSV 10 times 44.71 ± 22.95nu and T-tube 34.22 ± 17.03nu (p = 0.026). Conclusions: The present study showed that in comparison with spontaneous breathing, controlled breathing was associated with lower HRV during weaning from mechanical ventilation.Introdução: A variabilidade da frequência cardíaca (VFC) é um método não invasivo para analisar variações de intervalos de tempo entre batimentos cardíacos. A VFC é um método promissor para analisar o balanço autonômico quantitativamente. Durante o processo de desmame da ventilação mecânica, ocorrem alterações na atividade autonômica. Objetivo: Analisar o comportamento da modulação autonômica da frequência cardíaca em diferentes modos do desmame da VM. Método: 18 pacientes foram estudados. Os parâmetros cardiorrespiratórios (PAS, PAD, PAM, FR, SpO2) iniciais e finais foram registrados em uma ficha. Um cardiofrequencimetro foi posicionado (relógio no punho e cinta no tórax). Os pacientes foram mantidos em decúbito Fowler e permaneceram 10’ em cada modo ventilatório (A/C, SIMV, PSV 18 e 10 e nebulização com Tubo T). Os sinais captados pelo cardiofrequencimetro foram analisados através do software Kubios®. Resultados: Os parâmetros da Variabilidade da Frequência Cardíaca foram analisados nos domínios do tempo, frequência e índices geométricos. Houve aumento na média rMSSD - modulação parassimpática, do momento A/C para o momento PSV 10 (p=0,027), aumento entre os momentos SIMV e PSV 10 (p=0,042), mas reduziu entre os momentos PSV 10 e TUBO T (p=0,035). Houve aumento na média do LF (low frequency) -modulação simpática, dos momentos SIMV e PSV 10 para TUBO T (p=0,011 e p=0,037). A média de LF apresentou queda entre os momentos A/C e SIMV (p=0,024), aumento nos momentos SIMV e PSV 10 para TUBO T (p =0,049 e p=0,027). HF (high frequency) - modulação simpática aumentou entre os momentos SIMV e PSV 10 (p=0,020) e também entre os momentos SIMV e TUBO T (p=0,044). Houve redução na média HF entre os momentos PSV e TUBO T (p=0,026). Conclusão: Modos controlados apresentaram diminuição da VFC e maior predomínio simpático em relação a modos espontâneos

MEDICINES WASTE POLICIES AND THE POPULATION KNOWLEDGE IN BRAZIL

Objective: To investigate the degree of knowledge of the patients enrolled in the Unified Health System of the Medicine School of ABC (Faculdade de Medicina do ABC) regarding the proper use and disposal of medicaments. Methods: Participants were recruited for convenience, during their medical appointments at the clinic of the Medical School of ABC (Santo André, Sao Paulo, Brazil) in the period from 04 August to 30 September 2014. Data collection was conducted through a self-administered poll designed specifically for the purpose of this study, which consisted of 25 questions multiple choice about socioeconomic issues and the subject disposal of drugs, consumption and environmental pollution. Results: We selected the 140 patients’ polls. Most of them is of white ethnicity (58%) and female (58%). Level of education: 31% have completed secondary education (31%) or incomplete graduation (19%). Most of the participants (76%) buy drugs without a prescription, and most families (76%) seek understanding by reading the labels. 71.43% reported knowing that incorrect disposal of drugs could contaminate the environment, but 78% reported never having seen or received information about these. After using, 22.15% maintains the medication at home for future use, 55% of subjects reported improper disposal sites and 13% are delivered in health care institutions. Conclusion: Our study has showed that most participants inappropriately use and dispose of drugs, even though they know they can contaminate the environment

Factors associated with survival of burned patients

Background: It is scarce in the literature studies regarding treatment and objective analysis of the survival chances of burned patients. Some investigations indicates the need for obtaining specific data to the population studied and characteristics such as social condition and nutritional status are suggested to be relevant to the patient’s evolution. We aimed to describe the mortality of a Treatment Center Burn Unit (BU) in Brazil. Methods: We analyzed 76 burned victims hospitalized with a fatal outcome in the General Hospital of São Matheus in 10 years (1999-2009). The following collected data were investigated were: age, sex, period of permanence,  body surface burned (BSB), degree of burns, the causal agent, inhalation injury, nature of the event, clinical complications, mortality and survival rates. Results: We observed predominantly male and the median age was 44 years old. The highest incidence was on June. The mean body surface area burned was 40%, and upper limbs, the most affected region. The causative agents involved were more flammable agents and fire. Pulmonary infection was the most frequent clinical complication. The mortality found in this center was 4.9%. The subgroup of suicide were predominantly female and the mortality rate was 22.44%. When studying survival rate, patients with inhalation injury and trauma were associated with shorter survival. Patients with sepsis remained alive for longer. Conclusion:The clinical, epidemiological and survival of patients with burns, enables the design of peculiar characteristics of this trauma in the studied area, thus, from these data, charts be established treatment and prognostic estimates, and assist in developing preventive  public health policy more effective. Factors associated with survival of burned patient

The Lipodystrophy Syndrome as a Risk Marker for Cardiovascular Disease in Patients with HIV/AIDS Treated with HAART

Introduction: The classic risk factors for cardiovascular disease in healthy individuals are well known, however, it lacks in the literature the mechanisms that predicts cardiovascular disease in the population living with HIV-AIDS treated with HAART and presenting syndrome lipodystrophy. We aimed to investigate the risk of cardiovascular disease in HIV-AIDS patients treated with HAART and lipodystrophy syndrome. Methods: A search was performed in Medline, SciELO, Lilacs and Cochrane using the intersection between the keywords: "cardiovascular disease", "HIV", "AIDS", "HAART" and "lipodystrophy syndrome". Results: The selected studies demonstrated that metabolic disorders such as hyperlipidemia, central adipose hypertrophy and peripheral lipoatrophy, besides the metabolic syndrome and lipodystrophy are maker clear risks of developing cardiovascular disease in these individuals. Conclusion: The metabolic alterations in HIV-AIDS treated with HAART and presenting lipodystrophy syndrome may potentiate the development of cardiovascular diseases

Cardiac autonomic modulation of children with severe liver disease undergoing liver transplantation

Introdução: O sistema cardiovascular sofre influência direta do sistema nervoso autônomo, suas mudanças afetam a variabilidade da frequência cardíaca e são indicadores sensíveis das alterações fisiológicas. A disfunção autonômica e manifestada em até 60% dos pacientes com cirrose. Objetivo: Analisar os índices da variabilidade da frequência cardíaca no pré e pós-cirúrgico de crianças submetidas ao transplante de fígado. Método: Estudo longitudinal no qual foi analisada a variabilidade da frequência cardíaca, pré e pós transplante de fígado em crianças de ambos os sexos de 6 meses de vida a 10 anos, atendidas no ambulatório de cirurgia pediátrica na fila para o transplante de fígado no Instituto da Criança. Para análise dos dados da VFC foram realizadas analises não lineares (SD1 e SD2), assim como analises lineares da frequência cardíaca como SDNN, low frequency (LF), high frequency (HF) e a relação LF/HF. Resultados: A análise do comportamento da modulação autonômica cardíaca, no período antecedente ao transplante de fígado e após a cirurgia mostrou aumento dos parâmetros lineares da VFC: SDNN e TINN. No domínio do tempo houve também aumento do índice HFms2 e LFms2. Nas análises não lineares o índice SD2 aumentou após o transplante quando comparados com os mesmos dados pré transplante. Conclusão: a análise do período antecedente ao transplante de fígado e dois meses após a cirurgia mostrou aumento dos parâmetros lineares da VFC SDNN, TINN, HFms2, LFms2 e Total Power representando a melhora global da VFC. No domínio do tempo houve também aumento do índice HFms2, tônus parassimpático da VFC. Nas análises não lineares o índice SD2 também representou uma melhora global da VFCIntroduction: The cardiovascular system is directly influenced by the autonomic nervous system, its changes affect heart rate variability and are sensitive indicators of physiological changes. Autonomic dysfunction is manifested in up to 60% of patients with cirrhosis. Aim: To analyze the indexes of heart rate variability in the pre- and post-surgery of children submitted to liver transplantation. Method: Heart rate variability, pre and post liver transplantation in children of both genders from 6 months of age to 10 years, attended at the pediatric surgery in the queue for liver transplantation at the Children\'s Institute were analyzed. Non-linear analyzes (SD1 and SD2), as well as linear analyzes of heart rate such as SDNN, SDANN, low frequency (LF), high frequency (HF) and LF / HF. Results: The analysis of the behavior of cardiac autonomic modulation, in the period prior to liver transplantation and two months after surgery, showed an increase in HRV linear parameters SDNN, TINN, HFms2. In the time domain there was also an increase in the HFms2 index. In the non-linear analysis the SD2 index increased after transplantation when compared with the same pre-transplant data. Conclusion: the analysis of the period preceding liver transplantation and two months after surgery showed an increase in the HRV linear parameters SDNN, TINN, LFms2 and Total Power representing the global HRV improvement. In the time domain there was also an increase in the HFms2 index, parasympathetic tone of the HRV. In the non-linear analyzes the SD2 index also represented an global HRV improvemen