Apical bleeding: a rare cause of blindness after orbital decompression / Sangramento apical: uma causa rara de cegueira pós descompressão orbitária

ABSTRACT Orbital decompression is widely performed for the management of proptosis for cosmetic and functional cases of Graves orbitopathy. The main side effects include dry eye, diplopia, and numbness. Blindness after orbital decompression is extremely rare. The mechanisms of vision loss after decompression are not well described in the literature. Considering the devastating effect and rarity of this complication, this study presented two cases of blindness after orbital decompression. In both cases, vision loss was provoked by slight bleeding in the orbital apex.

RESUMO A descompressão orbitária é uma cirurgia amplamente empregada para correção da proptose em casos cosméticos e funcionais da orbitopatia de Graves. Os principais efeitos colaterais induzidos pela descompressão são olho seco, diplopia e parestesias. Amaurose pós descompressão é uma complicação extremamente rara e cujos mecanismos são pouco discutidos na literatura. Considerando o efeito devastador representado pela perda visual e a escassez de relatos dessa complicação, os autores apresentam dois relatos de amaurose após descompressão orbitária. Nos dois casos a perda visual ocorreu devido a sangramento de pequena monta no ápice orbitário.

Revisiting the orbital complications of acute rhinosinusitis

Abstract Objective: The present study revisited three classification systems of orbital complications of acute rhinosinusitis (ARS) (Chandler, Mortimore & Wormald, and Velasco e Cruz & Anselmo-Lima) and observed which of them presented the best clinical applicability. Methods: Clinical data and CT scan findings of patients with orbital infection were retrospectively collected. To compare the three classification systems, we revised and graded all CT images accordingly, and divided the patients into four groups: Eyelid cellulitis (EC), orbital cellulitis (OC), subperiosteal abscess (SA), and orbital abscess (OA). The groups were compared regarding the presence of sinus opacification, the need for hospitalization and/or surgical treatment, and the presence of further complications/sequelae. Results: 143 patients were included. The median number of sinuses involved in patients in the OC, SA, and OA groups was 2.0. ARS was rarely associated with signs of EC (present in both Chandler's and Mortimore & Wormald's classifications. The hospitalization rate was significantly lower in the EC group compared to the other three groups. Surgery was performed in all cases in the OA group, in 58.1% in the SA group, 19.4% in the OC group, and 12.5% in the EC group (p-value < 0.0001 ). Complications were present at higher rates in the OA group compared to the other three groups. Conclusions: ARS was rarely associated with Eyelid Cellulitis. The stratification in the other three groups showed to be clinically relevant. Velasco e Cruz & Anselmo-Lima's classification system proved valid, simple, and effective for categorizing orbital complications of ARS. Level of evidence: 3.

Clinical and histopathological study of a hollow and posteriorly multiperforated polymethylmethacrylate implant in eviscerated rabbit eyes / Análise clínica e histopatológica de um implante de polimetilmetacrilato oco e multiperfurado em sua porção posterior em olhos eviscerados de coelhos

ABSTRACT Purpose: The study aimed to evaluate the clinical and tissue response to a hollow polymethylmethacrylate orbital implant with a multiperforated posterior surface in an animal model after evisceration. Methods: Sixteen New Zealand rabbits had their right eye eviscerated. All animals received a hollow polymethylmethacrylate implant 12 mm in diameter that is multiperforated in its posterior hemisphere. The animals were divided into four groups, and each one had the eye exenterated at 7, 30, 90, and 180 days post-evisceration. Clinical signs were assessed daily for 14 days post-evisceration and then every 7 days until 180 days. Inflammatory pattern, collagen structure, and degree of neovascularization generated with implant placement were analyzed with hematoxylin-eosin, picrosirius red, and immunohistochemistry staining. Results: There were no signs of infection, conjunctival or scleral thinning, or implant exposure or extrusion in any animal during the study. On day 7, the new tissue migrated into the implant and formed a fibrovascular network through the posterior channels. Inflammatory response reduced over time, and no multinuclea­ted giant cells were found at any time. Conclusion: Hollow polymethylmethacrylate orbital implants with a multiperforated posterior surface enable rapid integration with orbital tissues by fibrovascular ingrowth. We believe that this orbital implant model can be used in research on humans.

RESUMO Objetivo: Avaliar a resposta tecidual e clínica a um implante orbitário de polimetilmetacrilato, oco e multiperfu­rado em sua porção posterior em modelo animal após evisceração. Métodos: Dezesseis coelhos da raça Nova Zelândia foram submetidos à evisceração do globo ocular direito. Todos receberam implante oco de polimetilmetacrilato de 12 mm de diâmetro, multiperfurado em sua semiesfera posterior. O estudo foi dividido em avaliação clínica e histopatológica. A avaliação clínica foi diária até 14 dias pós-evisceração e, a cada sete dias, até completar 180 dias. Os animais foram divididos em grupos de quatro animais e cada um foi submetido à exenteração com 07, 30, 90 e 180 dias e depois à eutanásia. A análise histopatológica teve por fim caracterizar o padrão inflamatório, a estrutura do colágeno e o grau de neovascularização. Para isso, além da tradicional coloração pela hematoxilina-eosina, utilizou-se o corante Picrosirius Red (PSR) e imuno-histoquímica com o marcador CD 34. Resultados: Não houve sinais de infecção, afinamento conjuntival ou escleral, exposição ou extrusão do implante em nenhum animal durante o estudo. Já no sétimo dia, o tecido neoformado migrou para dentro do implante formando uma rede fibrovascular através dos canais posteriores. A resposta inflamatória diminuiu ao longo do tempo avaliado e não foram encontradas células gigantes multinucleadas. Conclusão: O implante analisado permite a sua integração aos tecidos orbitários pelo crescimento fibrovascular em seu interior. Os autores acreditam que este modelo de implante orbital pode fazer parte de testes com humanos.

Effects of using different root canal sealers and protocols for cleaning intraradicular dentin on the bond strength of a composite resin used to reinforce weakened roots / Efectos del uso de diferentes selladores de conductos radiculares y protocolos para limpiar la dentina intrarradicular sobre la fuerza de unión de una resina compuesta utilizada para reforzar raíces debilitadas

Background: This study evaluated the effects of using different root canal sealers and protocols for cleaning intraradicular dentin on the bond strength of a composite resin used to reinforce weakened roots. Material and Methods: Sixty-four roots of extracted human maxillary canines were weakened, prepared and filled with two different endodontic sealers (Endofill and AH Plus). In half of the sample, set aside for each respective sealer, excess filling material was cleaned. In the other half, the weakened areas were not cleaned, and the excess of sealer was spread on the intraradicular dentin. Intentionally worn areas inside each root were restored with a microhybrid light-cure composite resin (Z100) to reinforce them, with and without acid etching. Prefabricated metal posts were fixed with a dual resin cement (RelyX ARC), and the specimens were submitted to a pull-out test. Statistical analysis was performed by means of Shapiro-Wilk, analysis of variance (one-way ANOVA) and Tukey-Kramer tests (p<0.05). Results: The groups filled with Endofill (GI, GII, GIII, GIV) had the lowest bond strength values, which were similar among each other (p>0.05).The greatest bond strength values were observed in roots filled with AH Plus (GV, GVI, GVII, GVIII), mainly without cleaning of the weakened areas, and followed by acid etching (GVII), and also with cleaning of the weakened areas, however, with no acid etching (GVI) (p<0.05). Conclusion: The greatest bond strength values were observed in roots filled with AH Plus; (1) without cleaning of the weakened areas and with acid etching, and; (2) with cleaning of the weakened areas, but without acid etching.

Antecedentes: este estudio evaluó los efectos del uso de diferentes selladores de conductos radiculares y protocolos para limpiar la dentina intrarradicular sobre la fuerza de unión de una resina compuesta utilizada para reforzar las raíces debilitadas. Material y Métodos: Sesenta y cuatro raíces de caninos maxilares humanos extraídos fueron debilitadas, preparadas y rellenadas con dos selladores endodónticos diferentes (Endofill y AH Plus). En la mitad de la muestra, reservada para cada sellador respectivo, se limpió el exceso de material de relleno. En la otra mitad, las áreas debilitadas no se limpiaron y el exceso de sellador se esparció sobre la dentina intrarradicular. Las áreas desgastadas intencionalmente dentro de cada raíz se restauraron con una resina compuesta fotopolimerizable microhíbrida (Z100) para reforzarlas, con y sin grabado ácido. Los postes metálicos prefabricados se fijaron con un cemento de resina dual (RelyX ARC) y los especímenes se sometieron a una prueba de extracción. El análisis estadístico se realizó mediante Shapiro-Wilk, análisis de varianza (ANOVA de una vía) y pruebas de Tukey-Kramer (p<0,05). Resultados: Los grupos rellenos con Endofill (GI, GII, GIII, GIV) presentaron los valores más bajos de fuerza de unión, los cuales fueron similares entre sí (p>0,05). Los mayores valores de fuerza de unión se observaron en raíces rellenas con AH Plus (GV, GVI, GVII, GVIII), principalmente sin limpieza de las áreas debilitadas, seguido de grabado ácido (GVII), y también con limpieza de las áreas debilitadas aunque sin grabado ácido (GVI) (p<0.05). Conclusión: Los mayores valores de fuerza de unión se observaron en las raíces rellenas con AH Plus; (1) sin limpieza de las áreas debilitadas y con grabado ácido, y; (2) con limpieza de las áreas debilitadas, pero sin grabado ácido.

Depression, anxiety, and drug usage history indicators among institutionalized juvenile offenders of Brasilia

Abstract Introduction: One of the most serious socio-educational measures for children and adolescents in conflict with the law in Brazil is their internment. This measure may represent an additional source of stress to this population and present significant impacts in the mental health context. This study aims to describe anxiety levels, depression, and addictive consumption, as well as to estimate the causalities and interactions of these variables. Methods: Herein, we report a study in which 175 male juveniles from youth detention institutions of the Federal District voluntarily completed the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and a short self-rating questionnaire asking whether and how often they had experienced cannabis, alcohol, and other "hard" psychotropic drugs (e.g., crack, cocaine, amphetamine) 1 year prior to institutionalization. Results: Of the total participants, 28.00% showed moderate to severe depression scores and 34.28% showed moderate to severe anxiety scores. In addition, the vast majority of participants also reported some antecedent drug abuse, including cannabis, alcohol, and other "hard drugs." The BDI scores moderately correlated with BAI, but none of these parameters considerably correlated with the antecedent drug abuse. Conclusions: The data indicate potentially concerning levels of emotional distress in these institutionalized juveniles which seem to be independent of addictive behaviors. These data deserve attention and further investigation. Thus, a need for preventative mental health for the general population and socio-educational intervention aimed at interned youth which can decrease levels of emotional stress is emphasized.

Upper eyelid contour symmetry measurement with Bézier curves / Medida da simetria do contorno da pálpebra superior com curvas de Bézier

ABSTRACT Purpose: The purpose of the present work is to measure the interocular upper lid contour symmetry using a new method of lid contour quantification. Methods: The Bézier curve tool of the Image J software was used to extract the right and left upper eyelid contours of 75 normal subjects. Inter-observer variability of 29 right lid contours obtained by two independent observers was estimated using the coefficient of overlap of two curves and an analysis of the differences of the contour peak location. A two-way analysis of variance was used to test the mean value of the coefficient of overlap of the right and left contours in males and females and lid segments. The same analysis was performed to compare the location of the contour peak of the right and left contours. Results: The coefficient of contour overlap obtained by independent observers ranged from 93.5% to 98.8%, with a mean of 96.1% ± 1.6 SD. There was a mean difference of 0.02 mm in the location of the contour peak. Right and left contour symmetry did not differ between females and males and was within the range of the method variability for contour overlap and location of the contour peak. Conclusions: The upper eyelid contour is highly symmetrical. Bézier lines allow a quick and fast quantification of the lid contour, with a mean inter-observer variability of 3.9%.

RESUMO Objetivo: O objetivo do presente estudo é mensurar a simetria interocular do contorno da pálpebra superior por meio de um novo método de quantificação de contorno palpebral com curvas de Bézier. Métodos: A ferramenta de curva de Bézier do software ImageJ foi utilizada para extrair os contornos palpebrais direito e esquerdo de 75 sujeitos normais. A variabilidade interobservador de 29 contornos palpebrais do olho direito obtidos por dois observadores diferentes foi estimada pelo coeficiente de superposição de duas curvas e pela análise das diferenças das posições do pico do contorno. Análise de variância de dois fatores foi empregada para testar a média do coeficiente de superposição entre os contornos direito e esquerdo quanto ao sexo e segmento palpebral. A mesma análise foi utilizada para comparar a localização do pico do contorno dos olhos direito e esquerdo. Resultados: O coeficiente de superposição obtidos por observadores independentes variou ente 93,5% e 98,8% com média de 96,1% ± 1,6 DP. A diferença das médias da localização do pico do contorno palpebral foi de 0,02 mm. A simetria entre os contornos dos olhos direito e esquerdo não diferiu entre o sexo feminino e masculino e esteve na faixa de variabilidade do método para o coeficiente de superposição e localização do pico do contorno. Conclusões: O contorno da pálpebra superior é altamente simétrico. As linhas Bézier permitem uma rápida e prática quantificação do contorno palpebral com uma média de variabilidade interobservador de 3,9%.

Prevalencia de anticuerpos anti toxoplasma gondii en donantes sangre de la región oriental de Cuba / Prevalence of anti-toxoplasma gondii antibodies among blood donors from Cuba's eastern region

Introducción: La toxoplasmosis es una zoonosis ampliamente distribuida, un tercio de la población mundial tiene anticuerpos contra Toxoplasma gondii. El hombre se infecta principalmente por vía oral, por la ingesta de alimentos o aguas contaminadas, a través de la placenta al feto, por vía hematógena, por trasplantes de órganos o transfusiones de sangre contaminada. La circulación de Toxoplasma gondii se ha demostrado en la parte occidental de Cuba. Objetivo: Determinar la seroprevalencia en la región oriental de Cuba en donantes de sangre. Métodos: Las muestras de suero de 3365 donantes de sangre se evaluaron con previo consentimiento informado. La técnica de inmunofluorescencia indirecta se utilizó para detectar anticuerpos contra este parásito. Resultados: La positividad al Toxoplasma gondii fue de un (38,4 por ciento) 1292 muestras positivas en los donantes estudiados, siendo la seropositividad del área rural mayor que en el área urbana, y no se observó relación entre seroprevalencia edad y sexo. Conclusiones: Se demuestra la exposición y la circulación del parásito en esta región. Se recomienda la certificación de donaciones de sangre para Toxoplasma gondii antes de su uso(AU)

Introduction: Toxoplasmosis is a broadly distributed zoonosis. One third of the world population has anti-Toxoplasma gondii antibodies. The main sources of infection in humans are the oral route, i.e. the intake of contaminated food or water, mother-to-fetus transmission, the hematogenous route, organ transplantation and contaminated blood transfusions. Toxoplasma gondii has been shown to circulate in the western region of Cuba. Objective: The purpose of the study was to determine the seroprevalence of Toxoplasma gondii among blood donors from Cuba's eastern region. Methods: Serum samples from 3 365 blood donors were evaluated prior informed consent. Indirect immunofluorescence technique was used to detect antibodies against the study parasite. Results: Positivity for Toxoplasma gondii was 38.4 percent, i.e. 1 292 positive samples among the study donors. Seropositivity was higher in the rural area than in the urban area, and no relationship was found between seroprevalence, age and sex. Conclusions: Exposure and circulation of the parasite were shown to occur in the study region. It is recommended that blood donations are certified for Toxoplasma gondii before use(AU)

Oxidative state of ewes with different number of parity during gestation and lactation / Estado oxidativo na gestação e lactação de ovelhas com diferentes números de partos

This study was conducted to assess the changes in some indicators of oxidative status during pregnancy and lactation in sheep of different parity. Dorset x Suffolk ewes were classified by number of parity: 1, 2 and ≥4. They were sampled before pregnancy and on the first, second, third, and fourth months, then on day 143 of pregnancy, as well as on day 5 after birth and after one month of lactation. Antioxidant capacity was found to have two reductions, the first during the second month of pregnancy and the second on day 5 of lactation. Susceptibility to lipid oxidation decreased with an increased number of parturitions. A reduction in lipid oxidation was observed on day 143 of gestation relative to the other samplings during gestation and lactation. Total glutathione peroxidase activity increased when the two reductions in antioxidant capacity took place. Ascorbic acid decreased during lactation and gestation; the lowest values were recorded in the third month of gestation. It is concluded that susceptibility to lipid oxidation decreases with the number of parturitions and that in ewes, during gestation and lactation, there is a mechanism that prevents lipid oxidation involving changes in antioxidant capacity, glutathione peroxidase and ascorbic acid.(AU)

Este estudo foi conduzido para avaliar as mudanças em alguns indicadores do estado oxidativo durante a gestação e lactação em ovelhas com diferentes números de partos. Ovelhas Dorset x Sufolk foram classificadas pelo número de partos: 1, 2 e ≥4. Amostras foram coletadas antes da prenhez e no primeiro, segundo, terceiro e quarto mês e no dia 143 de gestação, assim como no dia 5 após o parto e com um mês de lactação. Encontrou-se que a capacidade antioxidativa teve duas reduções, a primeira durante o segundo mês de gestação e a segunda no dia 5 de lactação. A atividade total da glutationa peroxidase aumentou quando se deram as reduções de capacidade antioxidante. O ácido ascórbico diminuiu durante a gestação e lactação, com o valor mais baixo foi no terceiro mês de gestação. Conclui-se que a suscetibilidade a oxidação diminui com o número de partos, e que nas ovelhas durante a gestação e lactação há um mecanismo que previne a oxidação lipídica ocasionando mudanças na capacidade antioxidante, e das atividades glutationa peroxidase e ácido ascórbico.(AU)

Therapeutic effect of transcranial direct current stimulation on neuropsychological symptoms of an elderly patient: A case report / Efeito terapêutico da estimulação transcraniana de corrente direta nos sintomas neuropsicológicos de um paciente idoso: relato de caso

ABSTRACT Although growing evidence points to the potential therapeutic effects of transcranial Direct Current Stimulation (tDCS), there is still no consensus on the most appropriate protocol to be used in specific neurological and neuropsychological symptoms. This case report evaluated the neuromodulatory therapeutic effects of two 15-day courses of tDCS on an elderly female patient, aged 78 years with mild neurocognitive disorder, chronic pain and depression-related symptoms. Results indicated an overall significant improvement of cognitive and executive functions, as well as reduction in both depression and chronic pain symptoms. These results highlight the potential of tDCS as a safe and useful neuromodulatory clinical tool in the rehabilitation of elderly patients.

RESUMO Embora evidências crescentes apontem para os potenciais efeitos terapêuticos da estimulação transcraniana por corrente contínua (ETCC), ainda não há consenso sobre o protocolo mais adequado a ser usado em sintomas neurológicos e neuropsicológicos específicos. Este relato de caso avaliou os efeitos terapêuticos neuromoduladores de dois protocolos de 15 dias de ETCC em paciente idosa, com idade de 78 anos com comprometimento cognitivo leve, dor crônica e sintomas relacionados à depressão. Os resultados indicaram uma melhoria global significativa das funções cognitivas e executivas, bem como a redução tanto na depressão quanto nos sintomas da dor crônica. Isso destaca o potencial do ETCC como uma ferramenta clínica neuromoduladora segura e útil na reabilitação de pacientes idosos.

Enfermería Basada en la Evidencia: plan de cuidados para pacientes con VIH/SIDA (parte 2) / Evidence-Based Nursing: plan of care for patients with HIV/AIDS (part 2)

ResumenEn lo que respecta al cuidado de enfermería a las personas afectadas por el VIH/SIDA o sus familiares y amigos, en el Instituto Mexicano del Seguro Social se lleva a cabo un modelo que atiende las respuestas humanas y fisiopatológicas, con la finalidad de recuperar el bienestar de la persona y reintegrarla a su entorno sociocultural en las mejores condiciones posibles. Para ello se han implementado dos herramientas, la metodología del proceso y el lenguaje estandarizado, los cuales se hacen explícitos en el plan de cuidados mediante el establecimiento de una interrelación entre el diagnóstico de enfermería, las intervenciones y los resultados esperados. La metodología utilizada en la elaboración del plan de cuidados incluyó la conformación de grupos nominales de expertos, reuniones de trabajo, la selección del problema que se iba a abordar, la priorización de etiquetas diagnósticas, la búsqueda de información sistematizada, la definición del alcance y los objetivos, la adopción de taxonomías, el análisis crítico de la evidencia científica, la adopción y adaptación de recomendaciones de guías internacionales y la validación interna del documento final por pares.

AbstractWith regards to nursing care for patients with HIV/AIDS, as well as their families and friends, in the Instituto Mexicano del Seguro Social we carried out a model that addresses the human and pathophysiological responses, in order to recover the welfare of these patients and reintegrate them in the best possible conditions into their sociocultural environments. For this we used two tools, the methodology of process and the standardized language, which are made explicit in the nursing care plan, by establishing a relationship between the nursing diagnosis, interventions and expected outcomes. The methodology used in developing the nursing care plan included the creation of nominal groups of experts, meetings, selection of the problem to be addressed, prioritization of diagnostic labels, search systematized information, defining the scope and objectives, adoption of taxonomy, critical analysis of scientific evidence, adoption and adaptation of recommendations of international guidelines and internal validation of the final document for peer reviewing.

Evidence against the participation of a pharmacokinetic interaction in the protective effect of single-dose curcumin against gastrointestinal damage induced by indomethacin in rats / 中西医结合学报

<p><b>OBJECTIVE</b>To determine the role of a pharmacokinetic interaction in the protective effect of curcumin against the gastric damage induced by indomethacin administration as such or as its prodrug acemetacin.</p><p><b>METHODS</b>Wistar rats orally received single dose of indomethacin (30 mg/kg) with and without curcumin (30 mg/kg); gastric injury was evaluated by determining the total damaged area. Additional groups of rats received an oral single dose of indomethacin (30 mg/kg) or its prodrug acemetacin (34.86 mg/kg) in the presence or absence of curcumin (30 mg/kg). Indomethacin and acemetacin concentrations in plasma from blood draws were determined by high-performance liquid chromatography.Plasma concentration-against-time curves were constructed, and bioavailability parameters, maximal concentration (C) and area under the curve to the last sampling time (AUC) were estimated.</p><p><b>RESULTS</b>Concomitant administration of indomethacin and curcumin resulted in a significantly reduced gastric damage compared to indomethacin alone. However, co-administration of curcumin did not produce any significant alteration in the bioavailability parameters of indomethacin and acemetacin after administration of either the active compound or the prodrug.</p><p><b>CONCLUSION</b>Curcumin exhibits a protective effect against indomethacin-induced gastric damage, but does not produce a reduction of the bioavailability of this nonsteroidal anti-inflammatory drug, indomethacin. Data thus suggest that a pharmacokinetic mechanism of action is not involved in curcumin gastroprotection.</p>

Oxidative status and fertility of ewes supplemented coffee pulp during estrous ¤ synchronization and early pregnancy / Estado oxidativo y fertilidad en ovejas suplementadas con pulpa de café durante la sincronización estral y gestación temprana / Estado oxidativo e fertilidade nas ovelhas suplementadas com a polpa de café durante sincronização do estro e gestação inicial

Summary Background: it is known that coffee pulp can modify the oxidative status and fertility in dairy cows. Objective: to evaluate the effect of dietary supplementation with coffee pulp on the antioxidant capacity, lipid oxidation and reproductive characteristics of ewes during estrous synchronization and early gestation. Methods: forty Dorset-Suffolk crossbred ewes with 3 or 4 parturitions were allocated to two treatments: T0 (n = 21), ewes supplemented with 450 g of a control feed; and T1 (n = 19), ewes supplemented with 450 g of the feed with 25% coffee pulp. Supplementation began 14 days before estrous synchronization and ended 25 days after breeding. During estrous synchronization, progestogen (CIDR, Controlled Internal Drug Release) was inserted and left in situ for 11 days. Eighteen hours later, estrous detection began with the aid of rams. Blood samples were collected at different times of synchronization and during early pregnancy to determine antioxidant capacity, lipid oxidation and blood progesterone concentration. Pregnancy diagnosis was performed 30 and 60 days after CIDR removal. Results: supplementation with coffee pulp did not affect estrous onset, estrous response or progesterone concentration, but fertility decreased from 100 to 78.95%. The antioxidant capacity measured using the FRAP technique was greater in coffee pulp supplemented ewes only before progestogen insertion. Coffee pulp did not modify lipid oxidation; however, this variable was affected by sampling time, decreasing after progestogen removal to its lowest values at 22 days into pregnancy. Conclusion: although supplementation with coffee pulp at 25% in the concentrate increased antioxidant capacity of ewes before insertion of progestogen, it is not recommended to use this percentage during synchronization or early pregnancy since it can negatively affect gestation rate.

Resumen Antecedentes: se sabe que la pulpa de café puede modificar el estado oxidativo y la fertilidad en vacas lecheras. Objetivo: evaluar los efectos del suministro dietario de pulpa de café y su capacidad antioxidante, oxidación lipídica, y características reproductivas en ovejas durante la sincronización del estro y la gestación temprana. Métodos: cuarenta ovejas cruzadas Suffolk x Dorset de 3 y 4 partos fueron asignadas a dos grupos: T0 (n = 21), suplementación con 450 g de alimento (grupo testigo); y T1 (n = 19), suplementación con 450 g de alimento con 25% de pulpa de café. La suplementación inició 14 días antes de la sincronización del estro y terminó 25 días después del apareamiento. El progestágeno (CIDR, Dispositivo Intravaginal de Liberación Controlada) fue insertado en los animales por 11 días. Dieciocho horas después de su retiro se inició la detección de estros. Se muestreó a diferentes tiempos después de la sincronización y durante la gestación temprana para determinar capacidad antioxidante, oxidación lipídica y concentración de progesterona. El diagnóstico de preñez se realizó 30 y 60 días después de la remoción del CIDR. Resultados: la suplementación con pulpa de café no afectó el inicio del estro, la respuesta al estro ni la concentración de progesterona. Sin embargo, la fertilidad disminuyó de 100 a 78,95%. La capacidad antioxidante, medida mediante la técnica FRAP, fue mayor en ovejas suplementadas con pulpa de café, pero solo antes de la inserción del progestágeno. La pulpa de café no modificó la oxidación lipídica; sin embargo, si fue modificada por el tiempo de muestreo, decreciendo desde la remoción del progestágeno hasta los 22 días de preñez. Conclusión: aunque la suplementación del concentrado con 25% de pulpa de café incrementó la capacidad antioxidante antes de la inserción del progestágeno, no se recomienda ese porcentaje durante la sincronización y gestación temprana, ya que redujo el porcentaje de gestación de las ovejas.

Resumo Antecedentes: a polpa de café pode modificar o estado oxidativo e a fertilidade em vacas leiteiras. Objetivo: avaliar a polpa de café na capacidade antioxidante, oxidação da gordura e nas características reprodutivas das ovelhas durante sincronização do estro e gestação inicial. Métodos: quarenta ovelhas cruzas Suffolk e Dorset de 3 e 4 nascimentos foram agrupadas no T0 (n = 21), suplementação com 450 g de alimento controle e T1 (n = 19), suplementação com 450 g de alimento com 25% de polpa de café. A suplementação iniciou 14 dias antes da sincronização do estro e terminou 25 dias depois do acasalamento. O hormônio progestina (CIDR, dispositivo intravaginal de libertação controlada de fármaco) foi inserido por 11 dias. Dezoito horas depois da retirada iniciouse a detecção do estro. Fizeram-se amostras de diferentes tempos do período e da gestação inicial para determinar a capacidade antioxidante, oxidação dos lipídeos e concentração de progesterona. Realizou-se o diagnóstico de gestação 30 e 60 dias depois de remover o CIDR. Resultados: a suplementação com a polpa de café não afetou o início do estro, a resposta ao estro e a concentração de progesterona, mas a fertilidade decresceu de 100 a 78,95%. A capacidade antioxidante que foi medida pela técnica de FRAP foi maior nas ovelhas suplementadas com a polpa de café somente antes da inserção do progestágeno. A polpa de café não modificou a oxidação dos lipídeos; no entanto, estes foram modificados pelo tempo de amostra, decrescendo depois de remover o progestágeno até 22 dias de gestação. Conclusão: ainda que a polpa de café a 25% de concentração incrementa a capacidade antioxidante antes da inserção do progestágeno, não é recomendado este percentual para as ovelhas durante a sincronização do estro e a gestação inicial, já que decresce a porcentagem de gestação.

Transcranial magnetic stimulation and transcranial direct current stimulation appear to be safe neuromodulatory techniques useful in the treatment of anxiety disorders and other neuropsychiatric disorders / Uso clínico da estimulação magnética transcraniana e da estimulação transcraniana por corrente direta em transtornos de ansiedade e de transtornos neuropsiquiátricos

ABSTRACT Transcranial magnetic stimulation (TMS) has recently been investigated as a possible adjuvant treatment for many neuropsychiatric disorders, and has already been approved for the treatment of drug-resistant depression in the United States and in Brazil, among other countries. Although its use in other neuropsychiatric disorders is still largely experimental, many physicians have been using it as an off-label add-on therapy for various disorders. More recently, another technique, transcranial direct current stimulation (tDCS), has also become available as a much cheaper and portable alternative to TMS, although its mechanisms of action are different from those of TMS. The use of off-label therapeutic TMS or tDCS tends to occur in the setting of diseases that are notoriously resistant to other treatment modalities. Here we discuss the case of anxiety disorders, namely panic and post-traumatic stress disorders, highlighting the uncertainties and potential problems and benefits of the clinical use of these neuromodulatory techniques at the current stage of knowledge.

RESUMO A estimulação magnética transcraniana (TMS) foi recentemente proposta como um possível tratamento adjuvante para muitos distúrbios neuropsiquiátricos, e já foi aprovada para o tratamento de depressão fármaco-resistente nos Estados Unidos e no Brasil, entre outros países. Apesar do fato de que seu uso em outros transtornos neuropsiquiátricos ainda é em grande parte experimental, muitos médicos têm utilizado essas técnicas como uma terapia off-label em várias doenças. Mais recentemente, uma outra técnica, a estimulação transcraniana por corrente contínua (ETCC), tornou-se também disponível como uma alternativa muito mais barata e portátil do que a TMS, embora os seus mecanismos de ação sejam diferentes daqueles da TMS. O uso off-label de TMS ou ETCC tende a ocorrer no caso de doenças que são notoriamente resistentes a outras modalidades terapêuticas. Aqui nós discutimos o caso dos transtornos de ansiedade, ou seja, transtorno do pânico e estresse pós-traumático, destacando as incertezas, benefícios e problemas potenciais inerentes ao uso clínico dessas técnicas neuromoduladoras no atual estágio do conhecimento.

La Toxoplasmosis observada como un problema no resuelto / Toxoplasmosis: an unsolved problem

Un tercio de la población mundial poseen anticuerpos contra Toxoplasma gondii. El hombre se infecta a través de los esporozoitos provenientes de las heces de los gatos que contaminan la tierra, frutas, verduras y al agua; de los bradizoitos presentes en carnes que lo infectan cuando la consume poco cocinada o por su manipulación y por trofozoitos circulantes durante la fase hematógena en el hombre, infecta al feto a través de la placenta y a individuos seronegativos por órganos sólidos trasplantados o transfundidos con elementos formes de la sangre; son los llamados grupos de riesgos los más vulnerables a desarrollar formas graves de esta enfermedad que los puede conducir a la muerte. Estudios resientes corroboran la relación de esta infección con trastornos neurosiquiatricos, en particular con la esquizofrenia, así como su relación con accidentes de tránsito en conductores seropositivos; es de gran importancia tener presente las formas de adquirir la enfermedad y las medidas de precaución sobre todo cuando se ha demostrado que nunca se ha padecido la enfermedad.

One third of the world population have antibodies against Toxoplasma gondii. Human beings may be infected by sporozoites from cat faeces contaminating the ground, fruits, vegetables and water, by bradyzoites present in insufficiently cooked or improperly manipulated meat, or by trophozoites circulating during the hematogenous phase. Fetuses may be infected through the placenta, and seronegative individuals by solid organs transplanted or transfused with formed elements of the blood. These are the risk groups most prone to develop serious, life-threatening forms of the disease. Recent studies confirm the relationship of this infection to neuropsychiatric disorders, particularly schizophrenia, as well as its relationship to traffic accidents among seropositive drivers. It is paramount to bear in mind the ways in which the disease may be acquired and the corresponding prevention measures, especially for persons who have never had the disease.

Enfermería Basada en la Evidencia: plan de cuidados para pacientes con VIH/SIDA (parte 1) / Evidence-Based Nursing: care plan for patients with HIV / AIDS (part 1)

Resumen:

Introducción: la infección por el virus de inmunodeficiencia humana (VIH) sigue siendo un importante problema de salud pública a nivel mundial. La fase más avanzada de la infección es el síndrome de inmunodeficiencia adquirida (SIDA). El tratamiento con fármacos antirretrovirales pueden controlar el virus y ayudar a prevenir su transmisión, de modo que las personas con VIH o con alto riesgo de contraerlo pueden disfrutar de una vida saludable y productiva. En ese sentido, el personal de enfermería debe proporcionar atención integral con una visión holística a las personas a las personas afectadas por el VIH/SIDA, sus familiares y amigos.

Desarrollo: la elaboración del plan de cuidados basado en la evidencia, incluye la conformación de grupos nominales de expertos, selección del problema a abordar, priorización de etiquetas diagnósticas, búsqueda de información sistematizada, análisis crítico de la evidencia científica, uso de taxonomía enfermera y modelo de priorización de razonamiento en red, así como la adopción y adaptación de recomendaciones de Guías de Práctica Clínica (GPC) nacionales e internacionales y validación interna por pares del documento final.

Conclusiones: el cuidado de enfermería debe basarse en un plan que apoye al personal de enfermería en la toma de decisiones, mediante una metodología ordenada y eficiente, que conduzca a la solución del problema de salud del paciente.

Abstract:

Introduction: Infection with human immunodeficiency virus (HIV) remains a major public health problem worldwide. The most advanced stage of infection is acquired immunodeficiency syndrome (AIDS). Treatment whit antiretroviral drugs can control the virus and help prevent transmission, so that people with HIV or at high risk of contracting it can enjoy a healthy and productive life. In that sense, the nursing staff should provide comprehensive care with a holistic view to people affected by HIV/AIDS, their families and friends.

Development: The preparation of care plan included the creation of nominal groups of experts, meetings, selection of the problem to be addressed, prioritization of diagnostic labels, search of systematic information, critical analysis of scientific evidence, use of nursing taxonomy and prioritization model of reasoning network, adopting and adapting national and international recommendations of Clinical Practice Guidelines (CPG) and internal validation by peers to the final document. Conclusions: The care provided by the nurse should be based on a care plan that supports nursing staff in decision-making through an organized and efficient methodology, leading to the solution of the patient's health problem.

Minimally invasive treatment of vesicourethral leak after laparoscopic radical prostatectomy / Tratamento minimamente invasivo para fístula vesicouretral após prostatectomia radical videolaparoscópica

ABSTRACT Objective: to describe our experience with a minimally invasive approach for persistent vesicourethral anastomotic leak (PVAL) after Laparoscopic Radical Prostatectomy (LRP). Methods: from 2004 to 2011, two surgeons performed LRP in 620 patients. Ten patients had PVAL, with initially indicated conservative treatment, to no avail. These patients underwent a minimally invasive operation, consisting of an endoscopically insertion of two ureteral catheters to direct urine flow, fixed to a new urethral catheter. We maintained the ureteral catheters for seven days on average to complete resolution of urine leakage. The urethral catheter was removed after three weeks of surgery. Results: the correction of urine leakage occurred within a range of one to three days, in all ten patients, without complications. There were no stenosis of the bladder neck and urinary incontinence on long-term follow-up. Conclusion: the study showed that PVAL after laparoscopic radical prostatectomy can be treated endoscopically with safety and excellent results.

RESUMO Objetivo: descrever nossa experiência com uma abordagem minimamente invasiva para fístula de anastomose vesicouretral persistente (FAVP) após prostatectomia radical laparoscópica (PRL). Métodos: de 2004 a 2011, 620 pacientes foram submetidos à prostatectomia radical laparoscópica realizada por dois cirurgiões. Dez pacientes apresentaram FAVP e o tratamento conservador foi inicialmente indicado sem sucesso. Esses pacientes foram submetidos a uma reoperação minimamente invasiva, por via endoscópica, com inserção de dois cateteres ureterais para direcionar o fluxo urinário, fixados a um novo cateter uretral. Os cateteres ureterais foram mantidos por sete dias, em média, até a completa resolução do vazamento de urina. O cateter uretral foi removido após três semanas da cirurgia. Resultados: a correção do vazamento de urina ocorreu dentro de um intervalo de um a três dias em todos os dez pacientes, sem complicações. Não foram observadas estenose de colo vesical ou incontinência urinária após acompanhamento em longo prazo. Conclusão: o estudo mostrou que a FAVP após a prostatectomia radical laparoscópica pode ser tratada por via endoscópica com segurança e excelentes resultados.