Inclusion of health care for people with disabilities in Brazilian undergraduate medical education / Inclusão do cuidado com a saúde das pessoas com deficiência nos currículos de medicina do Brasil

Abstract: Introduction: In Brazil, official data estimate there are 45.6 million people with some type of disability and legislation establishes that medical schools should prepare future professionals for the essential care for people with disabilities (PWD). Health disparities faced by PWD are due, among other factors, to inadequate access to healthcare and poor training of professionals to deal with these situations. Objective: To identify the presence of aspects related to PWD healthcare in the curricula of medical courses in Brazil. Method: A documentary analysis of curricula and syllabuses was performed and included research in websites of 328 medical courses (42% public and 58% private) authorized by the Brazilian Ministry of Education. The Brazilian National Curricular Guidelines (NCG) were adopted as a theoretical framework (Brazil, 2014). The classification considered was: Class I - minimum attendance of the pedagogical project to the recommendations on care for PWD, due to the strict transcription of the NCG text and Class II - inclusion in the syllabus and programmatic content of the reference curricular components to the development of specifically related clinical skills to the health care of the PWD, including communication, clinical examination skills and ethical aspects. Results: Documents from 171 courses were available for analysis and the inclusion of aspects related to PWD healthcare was identified in 89 courses (52%). This inclusion was more prevalent in public courses (n=56; 62,9%) than in private ones. The inclusion of the teaching of the Brazilian Sign Language (Libras) was observed In 50 courses (29.2%). The curricular contents were predominantly focused on the Class I (n=80;89,9%) with an absolute lack of description of the procedural strategies to promote the development of clinical competencies related to PWD care. Conclusion: Our study reinforces the need to improve this approach in medical school curricula since providers can play an essential role in mitigating health disparities faced by PWD through competent care. In the Brazilian context, our data point out to a dramatic situation consistent with the invisibility of PWD issues; a need for the development and implementation of PWD-specific educational curricula.

Resumo: Introdução: No Brasil, estima-se que haja 45,6 milhões de pessoas com alguma deficiência. As disparidades de saúde enfrentadas pelas pessoas com deficiência (PCD) decorrem, entre outros fatores, do acesso inadequado aos cuidados de saúde e da formação deficiente dos profissionais para lidar com essas situações. Objetivo: Este estudo teve como objetivo identificar a presença de aspectos relacionados com a atenção à saúde das PCD nos currículos dos cursos de Medicina do Brasil. Método: Foi realizada análise documental dos projetos pedagógicos dos cursos, dos currículos, das ementas de componentes curriculares e dos conteúdos programáticos, incluindo pesquisas em sites de 328 cursos de Medicina (42% públicos e 58% privados) autorizados pelo Ministério da Educação. As Diretrizes Curriculares Nacionais (DCN) do Curso de Graduação em Medicina foram adotadas como referencial teórico. A classificação considerada foi: classe I - atendimento mínimo do projeto pedagógico às recomendações sobre o cuidado para PCD, pela estrita transcrição do texto das DCN, e classe II - inclusão nas ementas e nos conteúdos programáticos dos componentes curriculares de atividades voltadas ao desenvolvimento de competências clínicas especificamente relacionadas ao cuidado destinado à saúde das PCD, incluindo comunicação, exame clínico e aspectos éticos. Resultado: Documentos de 171 cursos estavam disponíveis para análise adequada. Desse total, em 89 cursos (52%) foi identificada a inclusão de aspectos relacionados ao cuidado com PCD, sendo mais prevalente nos cursos públicos (n = 56; 62,9%). Em 50 (29,2%) cursos, observou-se a inclusão do ensino da Língua Brasileira de Sinais (Libras). Os conteúdos curriculares identificados foram predominantemente focados na classe I (n = 80; 89,9%), com absoluta falta de descrição das estratégias processuais para promover o desenvolvimento de competências clínicas relacionadas ao cuidado para PCD. Conclusão: No contexto brasileiro, os dados apontam para uma situação dramática no que se refere à invisibilidade das questões relativas às PCD na formação médica e para a necessidade de desenvolvimento e implementação de estratégias educacionais especificamente voltadas para o cuidado com as PCD nos currículos médicos. O estudo reforça o papel essencial do cuidado competente destinado à saúde das PCD como estratégia que visa à mitigação das iniquidades de saúde enfrentadas por essas pessoas.

Can the combination of internal iliac temporary occlusion and uterine artery embolization reduce bleeding and the need for intraoperative blood transfusion in cases of invasive placentation?

OBJECTIVES: Women with invasive placentation (IP) are at high risk of life-threatening hemorrhage. In the last two decades, less invasive surgical approaches combined with endovascular procedures have proven to be safe. Most case series describe the use of temporary balloon occlusion and embolization, either combined or not. Concerning hemorrhage rates, each separate interventional approach performs better than surgery alone does, yet it is not clear whether the combination of multiple interventional techniques can be beneficial and promote a lower incidence of intrapartum bleeding. We aim to evaluate whether combining temporary balloon occlusion of the internal iliac artery and uterine artery embolization promotes better hemorrhage control than do other individual interventional approaches reported in the scientific literature in the context of cesarean birth followed by hysterectomy in patients with IP. METHODS: This is a retrospective analysis of patients with confirmed IP who underwent temporary balloon occlusion and embolization of the internal iliac arteries followed by puerperal hysterectomy. We compared patient results to data extracted from a recent systematic review and meta-analysis of the current literature that focused on interventional procedures in patients with IP. RESULTS: A total of 35 patients underwent the procedure during the study period in our institution. The mean volume of packed red blood cells and the estimated blood loss were 487.9 mL and 1193 mL, respectively. Four patients experienced complications that were attributed to the endovascular procedure. CONCLUSION: The combination of temporary balloon occlusion and uterine artery embolization does not seem to promote better hemorrhage control than each procedure performed individually does.

Effects of environment, dietary regime and ageing on the dengue vector microbiota: evidence of a core microbiota throughout Aedes aegypti lifespan

Abstract Mosquito midgut microbiota is a key component of vector competence, as gut bacteria can disturb pathogen development. In this study, we addressed the microbiota composition of Aedes aegypti during its lifespan, under field conditions. We also investigated the possible effects of environment, dietary regime and ageing on the gut community composition. We employed culture independent and dependent approaches to characterise vector microbiota. There was evidence of a lifelong stable core microbiota after mosquitoes were released into an urban settlement, where they presumably fed on a range of vertebrate hosts and carbohydrate sources. This core was formed mainly of bacteria belonging to the genera Pseudomonas, Acinetobacter, Aeromonas and Stenotrophomonas and to the families Oxalobacteraceae, Enterobacteriaceae and Comamonadaceae. We showed that both dietary regime and age were associated with the abundance of some bacterial groups in the Ae. aegypti microbiota. The majority of the bacterial groups we identified have been detected in the midgut of Ae. aegypti from laboratory and wild populations, indicating a possible core microbiota associated with this mosquito species. Our findings suggest that Ae. aegypti harbours a stable bacterial community during its adult life, similar to mosquito populations from distinct geographic areas, which may be further explored for arbovirus biocontrol strategies.

Perdas de nitrogênio do solo e resposta do pessegueiro à adição de composto orgânico / Loss of soil nitrogen and peach yield with the addition of organic compost

A aplicação de composto orgânico no solo pode incrementar a produção de pêssego, porém parte do N pode ser perdido por lixiviação e volatilização. O trabalho objetivou avaliar o estado nutricional das plantas, a produção de pêssego, a lixiviação de formas de N no solo e a volatilização de N-NH3 em um pomar de pessegueiro com a adição de composto orgânico produzido a partir de resíduos de agroindústrias de suco, resíduos de abatedouro de aves e serragem. O pomar foi implantado em 2009 e, em julho de 2010, 2011 e 2012, foram aplicados 0, 3, 6, 12 e 24L de composto por m2 e avaliaram-se os teores totais de nutrientes nas folhas e a produção. Em 2012, usando lisímetros instalados a 20 e a 40cm de profundidade, avaliaram-se as formas de N lixiviadas na solução percolada nos tratamentos 0 e 24L de composto. Usando câmeras coletoras, foi avaliada a volatilização de N-NH3 em todos os tratamentos até 478h depois da deposição do composto no solo. A aplicação de composto na superfície do solo incrementou o teor de K e N nas folhas completas, aumentando a produção de frutos. A aplicação de composto no florescimento aumentou a concentração de nitrato na solução do solo, somente na profundidade de 20cm. A emissão de amônia aumentou com o incremento da dose de composto aplicado, especialmente e nos períodos de maior temperatura.

The application of organic compost to the soil can increase the production of peach, although part of the N may be lost by leaching and volatilization. The aim of this study was to evaluate the nutritional status, yield of peaches, leaching of N forms and volatilization of NH3-N in a peach orchard with the addition of compost produced from agroindustrial juice waste, poultry slaughterhouse residues and sawdust. The orchard was established in 2009, and in july 2010, 2011 and 2012 the quantities of 0, 3, 6, 12 and 24L of organic compost per m2 were applied on a peach orchard and the total nutrient content in leaves and production was evaluated. In 2012, using lysimeters installed at 20 and 40cm deep in the soil, it was measured the forms of N in the solution in the treatments of 0 and 24L of compost. The volatilization of NH3-N was assessed in all the treatments up to 478h after compost application on the soil. The application of compost on the soil surface increased the content of K and N in whole leaves, increasing fruit production. The compost application at flowering increased the concentration of nitrate in the soil solution at a depth of only 20cm. The ammonia emission increased especially with the augmenting dose of compost applied, and in periods of higher temperature.

She’s a femme fatale: low-density larval development produces good disease vectors

Two hypotheses for how conditions for larval mosquitoes affect vectorial capacity make opposite predictions about the relationship of adult size and frequency of infection with vector-borne pathogens. Competition among larvae produces small adult females. The competition-susceptibility hypothesis postulates that small females are more susceptible to infection and predicts frequency of infection should decrease with size. The competition-longevity hypothesis postulates that small females have lower longevity and lower probability of becoming competent to transmit the pathogen and thus predicts frequency of infection should increase with size. We tested these hypotheses for Aedes aegypti in Rio de Janeiro, Brazil, during a dengue outbreak. In the laboratory, longevity increases with size, then decreases at the largest sizes. For field-collected females, generalised linear mixed model comparisons showed that a model with a linear increase of frequency of dengue with size produced the best Akaike’s information criterion with a correction for small sample sizes (AICc). Consensus prediction of three competing models indicated that frequency of infection increases monotonically with female size, consistent with the competition-longevity hypothesis. Site frequency of infection was not significantly related to site mean size of females. Thus, our data indicate that uncrowded, low competition conditions for larvae produce the females that are most likely to be important vectors of dengue. More generally, ecological conditions, particularly crowding and intraspecific competition among larvae, are likely to affect vector-borne pathogen transmission in nature, in this case via effects on longevity of resulting adults. Heterogeneity among individual vectors in likelihood of infection is a generally important outcome of ecological conditions impacting vectors as larvae.

Discrepancies between Aedes aegypti identification in the field and in the laboratory after collection with a sticky trap

Currently, sticky traps are regularly employed to assist in the surveillance of Aedes aegypti infestation. We tested two alternative procedures for specimen identification performed by local health agents: directly in the field, as recommended by certain manufacturers, or after transportation to the laboratory. A total of 384 sticky traps (MosquiTRAP) were monitored monthly during one year in four geographically representative Brazilian municipalities. When the same samples were inspected in the field and in the laboratory, large differences were noted in the total number of mosquitoes recorded and in the number of specimens identified as Ae. aegypti by both procedures. Although field identification has the potential to speed vector surveillance, these results point to uncertainties in the evaluated protocol.

Bionomics of Culex quinquefasciatus within urban areas of Rio de Janeiro, Southeastern Brazil / Bionomia de Culex quinquefasciatus em áreas urbanas no Rio de Janeiro, RJ / Bionomía de Culex quinquefasciatus en áreas urbanas en Rio de Janeiro, Brasil

OBJECTIVE: To evaluate density, parity rates, daily survival and longevity of natural populations of Culex quinquefasciatus in three neighborhoods with distinct socio-economic and infrastructure profiles. METHODS: Mosquito collections of the Culex quinquefasciatus species were performed weekly during two four month periods, from August to November 2008 (spring) and March to June 2009 (fall), in a favela (slum), a suburban area and a middle class area of Rio de Janeiro, Southeastern Brazil. Collections were performed with backpack aspirators, in 20 randomly selected houses in each area per week, during 15-20 minutes per house. Ovaries were removed from captured females and classified as initial, intermediary or final stage. Furthermore, females were dissected for determination of parity based on the condition of the tracheal system. Mosquito survival rate and longevity were estimated on a per month basis for each neighborhood. RESULTS: We collected a total of 2,062 Culex quinquefasciatus, but monthly vector density was not correlated with temperature and rainfall. We dissected the ovaries of 625 Culex quinquefasciatus, and overall, there was a higher proportion of nulliparous females during the dryer months, while gravid females were more frequent in rainy months. In the middle class neighborhood, the parity rate reached up to 93.75% with survivorship of 0.979. Lower parity and survival rates were obtained in the suburban area (as low as 36.4% parity and 0.711 daily survival). Up to 84.7% of Culex quinquefasciatus females could survive the eight day period needed to complete West Nile Virus incubation. CONCLUSIONS: The survival rate of Culex quinquefasciatus varied significantly between the neighborhoods. This suggests that vectorial capacity and disease transmission risk may vary greatly between different urban areas, which is potentially useful information for vector control programs.

OBJETIVO: Avaliar densidade, taxa de paridade, sobrevivência diária e longevidade de populações naturais de Culex quinquefasciatus de três localidades com diferentes perfis socioeconômicos e de infraestrutura. MÉTODOS: Mosquitos da espécie Culex quinquefasciatus foram coletados semanalmente em dois períodos de quatro meses, de agosto a novembro de 2008 e de março a junho de 2009, em uma comunidade, uma área de subúrbio e um bairro de classe média no Rio de Janeiro, RJ. As coletas foram realizadas com o auxílio de aspiradores costais em 20 domicílios, aleatoriamente selecionados por semana e por área, durante 15-20 minutos por domicílio. As fêmeas capturadas tiveram os ovários removidos e classificados em estágios inicial, intermediário e final. Adicionalmente, as fêmeas foram dissecadas para determinação da paridade de acordo com as condições do sistema traqueal. A taxa de sobrevivência e a longevidade das fêmeas foram estimadas por mês, para cada localidade. RESULTADOS: Foram coletados 2.062 Culex quinquefasciatus, porém a densidade mensal deste vetor não apresentou correlação com temperatura e precipitação. Dissecamos os ovários de 625 Culex quinquefasciatus e obtivemos maior proporção de fêmeas nulíparas durante os meses mais secos, enquanto fêmeas grávidas foram mais frequentes nos meses chuvosos. A taxa de paridade foi de até 93,75% no bairro de classe média, com sobrevivência de 0,979. Menores valores de paridade e sobrevivência foram obtidos no subúrbio (começando em 36,4% de paridade e 0,711 de sobrevivência diária). Até 84,7% das fêmeas de Culex quinquefasciatus poderiam sobreviver ao período de oito dias, necessário para completar o período de incubação do vírus da febre do Nilo Ocidental. CONCLUSÕES: A taxa de sobrevivência de Culex quinquefasciatus variou significativamente entre os bairros, o que sugere que a capacidade vetorial e o risco de transmissão de doenças podem variar entre diferentes áreas urbanas, informação relevante para o planejamento dos programas de controle de vetores.

OBJETIVO: Evaluar densidad, tasa de paridad, sobrevivencia diaria y longevidad de poblaciones naturales de Culex quinquefasciatus de tres localidades con diferentes perfiles socioeconómicos y de infraestructura. MÉTODOS: Mosquitos de la especie Culex quinquefasciatus fueron colectados semanalmente en dos períodos de cuatro meses, de agosto a noviembre de 2008 y de marzo a junio de 2009, en un barrio, un área de suburbio y una urbanización de clase media en Rio de Janeiro, Litoral Sudeste de Brasil. Las colectas se realizaron con ayuda de aspiradores costales en 20 domicilios, aleatoriamente seleccionados por semana y por área, durante 15-20 minutos por domicilio. A las hembras capturadas se les retiraron los ovarios y clasificaron en fases inicial, intermediario y final. Adicionalmente, las hembras fueron diseccionadas para determinar la paridad de acuerdo con las condiciones del sistema traqueal. La tasa de sobrevivencia y la longevidad de las hembras fueron estimadas por mes para cada localidad. RESULTADOS: Se colectaron 2.062 Culex quinquefasciatus, sin embargo, la densidad mensual del vector no presentó correlación con la temperatura y precipitación. Se diseccionaron los ovarios de 625 Culex quinquefasciatus y se obtuvo mayor proporción de hembras nulíparas durante los meses más secos, mientras que las hembras grávidas fueron más frecuentes en los meses de lluvia. La tasa de paridad alcanzó el 93,75% en la urbanización de clase media, con sobrevivencia de 0,979. Menores valores de paridad y sobrevivencia se obtuvieron en el suburbio (comenzando en 36,4% de paridad y 0,711 de sobrevivencia diaria). El 84,7% de las hembras de Culex quinquefasciatus podrían sobrevivir al período de ocho días, necesario para completar el período de incubación del virus de la fiebre del Oeste del Nilo. CONCLUSIONES: La tasa de sobrevivencia de Culex quinquefasciatus varió significativamente entre las urbanizaciones, sugiriendo que la capacidad vectorial y el riesgo de transmisión de enfermedades pueden variar entre diferentes áreas urbanas, información relevante para la planificación de los programas de control de vectores.

Why do we need alternative tools to control mosquito-borne diseases in Latin America?

In this opinion paper, we discuss the potential and challenges of using the symbiont Wolbachia to block mosquito transmitted diseases such as dengue, malaria and chikungunya in Latin America.

Evaluation of RbCl and CrCl3 as markers of Triatoma brasiliensis (Hemiptera: Reduviidae) nymphs: persistence and influence of Rb and Cr on triatomine biology

In order to mark Triatoma brasiliensis, the vector of Chagas disease in Brazil, two chemical compounds, rubidium chloride (RbCl) and chromium chloride (CrCl3), were tested. First, 199 N2-N5 nymphs were fed on blood with 0.025M RbCl. Rb marker positivity ranged from 2.5 percent (N3)-70 percent (N2), with a maximum persistence of 98 days. Second, 265 N2-N5 nymphs were fed on blood containing 0.0015M CrCl3. Cr marker positivity ranged up to 93 percent (N5), with a maximum persistence of 119 days. Finally, we blood fed 213 T. brasiliensis to investigate whether CrCl3 altered the biology of this insect. The developmental time of T. brasiliensis was unaltered, but the survival of the Cr-marked group was lower than that of the control group. Differences in the mean fecundity of the control (mean of 156.1) and experimental (mean of 135.6) groups were not statistically significant and 100 percent of the egg batches of females Cr-marked as nymphs were positive. In conclusion, CrCl3 is a useful tool for marking T. brasiliensis nymphs due to its high positivity and persistence.

Valor prognóstico do Escore de Risco GRACE versus Escore de Risco TIMI em síndromes coronarianas agudas / Prognostic Value of GRACE Scores versus TIMI Score in acute coronary syndromes

FUNDAMENTO: Embora o Escore de Risco TIMI seja o mais utilizado em síndromes coronarianas agudas sem supradesnível do segmento ST (SCA), o Escore GRACE tem potencial superioridade prognóstica, pois foi criado a partir de um registro observacional, parte das variáveis são tratadas de forma semiquantitativa e a função renal é computada em seu cálculo. OBJETIVO: Testar a hipótese de que o Escore de Risco GRACE tem superior valor prognóstico hospitalar, comparado ao Escore TIMI em pacientes admitidos com SCA. MÉTODOS: Foram incluídos indivíduos com angina instável ou infarto do miocárdio sem supradesnível do segmento ST, consecutivamente internados em unidade coronariana entre agosto de 2007 e janeiro de 2009. RESULTADOS: Foram estudados 154 pacientes, idade 71 ± 13 anos, 56 por cento do gênero feminino, mediana do GRACE de 117 e mediana do TIMI de 3. Durante o período de internamento, a incidência de eventos foi 8,4 por cento (12 óbitos e 1 infarto não fatal). O teste de Hosmer-Lemeshow aplicado ao Escore GRACE apresentou χ2 de 5,3 (P = 0,72), enquanto Escore TIMI apresentou χ2 de 1,85 (P = 0,60). Desta forma, ambos os escores apresentaram boa calibração. Quanto à análise de discriminação, o Escore GRACE apresentou estatística-C de 0,91 (95 por cento IC = 0,86 - 0,97), significativamente superior à estatística-C de 0,69 do Escore TIMI (95 por cento IC = 0,55 - 0,84) - P = 0,02 para diferença entre os escores. CONCLUSÃO: Em relação à predição de eventos hospitalares em pacientes com SCA, o Escore GRACE tem superior capacidade prognóstica quando comparado ao Escore TIMI.

BACKGROUND: Although the TIMI score is the one most frequently used in acute coronary syndromes (ACS) without ST-segment elevation, the GRACE score has potential prognostic superiority, as it was created based on an observational registry, part of the variables is treated in a semi-quantitative form and renal function is taken into account in its calculation. OBJECTIVE: To test the hypothesis that the GRACE risk score has superior in-hospital prognostic value, when compared to the TIMI score in patients admitted with ACS. METHODS: Individuals with unstable angina or myocardial infarction without ST-segment elevation, consecutively admitted at the Coronary Unit between August 2007 and January 2009, were included in the study. RESULTS: A total of 154 patients aged 71 ± 13 years, of which 56 percent were females, with a GRACE median of 117 and a TIMI median of 3 were studied. During the hospitalization period, the incidence of events was 8.4 percent (12 deaths and 1 non-fatal infarction). The Hosmer-Lemeshow test applied to the GRACE score presented an χ2 of 5.3 (P = 0.72), whereas the TIMI score presented an χ2 of 1.85 (P = 0.60). Therefore, both scores presented good calibration. As for the analysis of discrimination, the GRACE score presented a C-statistics of 0.91 (95 percentCI= 0.86 - 0.97), significantly superior to the C-statistics of 0.69 of the TIMI score (95 percentCI = 0.55 - 0.84) - P = 0.02 for the difference between the scores. CONCLUSION: Regarding the prediction of hospital events in patients with ACS, the GRACE score has superior prognostic capacity when compared to the TIMI score.

Osteotomia alta da tíbia com cunha de abertura medial: relevância biomecânica da cortical oposta / Open wedge tibial osteotomy: biomechanical relevance of the opposite cortex for the fixation method

OBJETIVO: Avaliar o impacto da integridade da cortical lateral osteo-tomia alta de tíbia (OAT) com cunha de abertura. MÉTODOS: Modelos experimentais artificiais em poliuretano foram fixados com placa DCP® 4,5mm. Cunhas de abertura foram confeccionadas para simular a distração da osteotomia alta da tíbia. Realizadas falhas na cortical lateral para simular fraturas e fixadas com diferentes tipos de parafusos. Ensaios de torção e compressão axial foram realizados. 04 diferentes grupos foram constituídos. RESULTADOS: As medidas de torção registradas no grupo com cortical íntegra foram superiores àquelas obtidas no grupo com cortical rompida (p<0,001) e estatisticamente equivalentes aos grupos com cortical rompida associado à parafuso de estabilização lateral de compressão ou de posição (p>0,05). As medidas de compressão obtidas no grupo com cortical íntegra foram superiores aos demais grupos (p<0,001). Em torção e compressão não houve diferença estatística entre os tipos de parafuso de estabilização lateral (p>0,05). CONCLUSÃO: A cortical lateral íntegra agrega estabilidade às osteotomias com cunha de abertura medial. Modelo com cortical íntegra evidenciou superioridade biomecânica em rigidez nos ensaios de torção e compressão. Nos ensaios torcionais, os modelos com falha de continuidade cortical com parafusos de estabilização lateral de compressão ou de posição apresentaram equivalência aos modelos com cortical íntegra.

OBJECTIVE: To evaluate the role of lateral tibial cortex integrity in open wedge tibial osteotomy (OWTO). METHODS: Experimental models of polyurethane fibers, simulating tibial models and modified with open wedge osteotomies were fixed with DCP® straight 4.5 mm plates. Four groups were constituted: two with cortical integrity and two with a gap in the lateral tibial cortex. Biomechanical analysis of torsion and axial compression were performed. RESULTS: The measures of twist recorded in the group with cortical integrity were higher than those obtained in the group with noncontinuous cortices (p <0.001). The groups with cortical gap on the lateral side that were fixed with screws had a biomechanical behavior comparable to the group with cortical integrity. Measures of compression obtained in the group with full cortical integrity were greater than those of other groups (p <0.001). In torsion and compression, no statistical difference between lag and position screws on the lateral cortical was demonstrated (p>0.05). CONCLUSION: Integrity of lateral tibial cortex adds stability to open wedge tibial osteotomies. Models with lateral cortical integrity demonstrated superiority in biomechanical stiffness even under torsion or compression. In torsion tests, models with a gap on the lateral cortex, fixed with a lag or position screw to promote lateral stabilization had similar biomechanical behavior to those with lateral cortex integrity.

Container productivity, daily survival rates and dispersal of Aedes aegypti mosquitoes in a high income dengue epidemic neighbourhood of Rio de Janeiro: presumed influence of differential urban structure on mosquito biology

Different urban structures might affect the life history parameters of Aedes aegypti and, consequently, dengue transmission. Container productivity, probability of daily survival (PDS) and dispersal rates were estimated for mosquito populations in a high income neighbourhood of Rio de Janeiro. Results were contrasted with those previously found in a suburban district, as well as those recorded in a slum. After inspecting 1,041 premises, domestic drains and discarded plastic pots were identified as the most productive containers, collectively holding up to 80 percent of the total pupae. In addition, three cohorts of dust-marked Ae. aegypti females were released and recaptured daily using BGS-Traps, sticky ovitraps and backpack aspirators in 50 randomly selected houses; recapture rate ranged from 5-12.2 percent within cohorts. PDS was determined by two models and ranged from 0.607-0.704 (exponential model) and 0.659-0.721 (non-linear model), respectively. Mean distance travelled varied from 57-122 m, with a maximum dispersal of 263 m. Overall, lower infestation indexes and adult female survival were observed in the high income neighbourhood, suggesting a lower dengue transmission risk in comparison to the suburban area and the slum. Since results show that urban structure can influence mosquito biology, specific control strategies might be used in order to achieve cost-effective Ae. aegypti control.

Presumed unconstrained dispersal of Aedes aegypti in the city of Rio de Janeiro, Brazil / Dispersão de Aedes aegypti em local presumidamente sem barreira limitante ao vôo na cidade do Rio de Janeiro / Dispersión ilimitada de Aedes aegypti en la ciudad de Río de Janeiro, Brasil

OBJECTIVE: To evaluate dispersal of Aedes aegypti females in an area with no container manipulation and no geographic barriers to constrain mosquito flight. METHODS: A mark-release-recapture experiment was conducted in December 2006, in the dengue endemic urban district of Olaria in Rio de Janeiro, Southeastern Brazil, where there is no evident obstacle to the dispersal of Ae. aegypti females. Mosquito traps were installed in 192 houses (96 Adultraps and 96 MosquiTRAPs). RESULTS: A total of 725 dust-marked gravid females were released and recapture rate was 6.3 percent. Ae. aegypti females traveled a mean distance of 288.12 m and their maximum displacement was 690 m; 50 percent and 90 percent of females flew up to 350 m and 500.2 m, respectively. CONCLUSIONS: Dispersal of Ae. aegypti females in Olaria was higher than in areas with physical and geographical barriers. There was no evidence of a preferred direction during mosquito flight, which was considered random or uniform from the release point.

OBJETIVO: Avaliar a dispersão de fêmeas de Aedes aegypti em uma área onde não houve nenhuma interferência quanto à redução de potenciais criadouros e não há barreira geográfica que limite o vôo dos mosquitos. MÉTODOS: Um experimento de marcação-soltura-recaptura foi realizado em dezembro de 2006, no bairro urbano Olaria, endêmico para dengue na cidade do Rio de Janeiro (RJ), onde não há obstáculos evidentes à dispersão de fêmeas de Ae. aegypti. Armadilhas para captura de mosquitos foram instaladas em 192 residências (96 Adultraps e 96 MosquiTraps). RESULTADOS: Foram soltas 725 fêmeas grávidas marcadas com pó fluorescente e a taxa de recaptura foi de 6,3 por cento. Fêmeas de Ae. aegypti dispersaram em média 288,12 m do ponto de soltura e o deslocamento máximo foi de 690 m; 50 por cento e 90 por cento das fêmeas voaram até 350 m e 500,2 m respectivamente. CONCLUSÕES: A dispersão de fêmeas de Ae. aegypti em Olaria foi maior que em áreas com barreiras físicas e/ou geográficas. Não houve evidências de preferência de direção do vôo dos mosquitos, o qual foi considerado randômico ou uniforme a partir do ponto de soltura.

OBJETIVO: Evaluar la dispersión de hembras de Aedes aegypti en un área sin manipulación de recipientes y sin barreras geográficas que limiten el vuelo del mosquito. MÉTODOS: Se realizó un experimento de marcaje y recaptura en diciembre de 2006, en el distrito urbano Olaria, Rio de Janeiro (Sureste de Brasil), área endémica para dengue, donde no hay obstáculo evidente para la dispersión de hembras de Ae. aegypti. Trampas para mosquitos fueron instaladas en 192 casas (96 Adultraps y 96 MosquiTraps). RESULTADOS: Un total de 725 hembras grávidas marcadas con polvo fueron liberadas y recapturadas siendo la tasa de 6,3 por ciento. Las hembras de Ae. Aegypti viajaron una distancia promedio de 288,12 m y su máximo desplazamiento fue de 690 m; 50 por ciento y 90 por ciento de las hembras volaron hasta los 350 m y 500,2 m, respectivamente. CONCLUSIONES: Dispersión de las hembras de Ae. aegypti en Olaria fue mayor que en las áreas con barreras físicas y geográficas. No hube evidencia de una dirección preferida durante el vuelo del mosquito, por lo que se considera aleatorio y uniforme desde el punto de liberación.

Fraturas do planalto tibial / Tibial plateau fractures

As fraturas do planalto tibial são lesões articulares cujos princípios de tratamento envolvem a redução anatômica da superfície articular e a restauração funcional do eixo mecânico do membro inferior. Contribuem para a tomada de decisões no tratamento dessas fraturas o perfil do paciente, as condições do envelope de tecidos moles, a existência de outros traumatismos associados e a infraestrutura disponível para abordagens cirúrgicas. Para as fraturas de alta energia, o tratamento estagiado, seguindo o princípio do controle de danos, tem como prioridade a manutenção do alinhamento do membro enquanto se aguarda a resolução das más condições de tecidos moles. Já nos traumas de baixa energia, desde que os tecidos moles não sejam um fator adverso, o tratamento deve ser realizado em tempo único, com osteossíntese definitiva. Fixação estável e movimento precoce são variáveis diretamente relacionadas com os melhores prognósticos. Desenvolvimentos recentes, como os implantes com estabilidade angular, substitutos ósseos e imagens tridimensionais para controle intraoperatório, deverão contribuir para cirurgias menos invasivas e melhores resultados.

Tibial plateau fractures are joint lesions that require anatomical reduction of joint surface and functional restoration of mechanical axis of a lower limb. Patient profile, soft tissue conditions, presence of associated injuries and the available infrastructure for the treatment all contribute to the decision making about the best treatment for these fractures. High-energy fractures are usually approached in a staged manner respecting the principle of damage control, and are primarily targeted to maintain limb alignment while the resolution unfavorable soft tissue conditions is pending. Low-energy trauma can be managed on a single-stage basis, provided soft tissues are not an adverse factor, with open reduction and internal f-ixation. Stable fixation and early painless joint movement are related to a better prognosis. New developments as locked plates, bone replacements, intraoperative 3D imaging are promising and will certainly contribute for less invasive procedures and better outcomes.

Calculating the survival rate and estimated population density of gravid Aedes aegypti (Diptera, Culicidae) in Rio de Janeiro, Brazil / Determinação da taxa de sobrevivência e estimativa da densidade populacional de fêmeas grávidas de Aedes aegypti (Diptera, Culicidae) no Rio de Janeiro, Brasil

Population size and daily survival rates of disease vectors are important determinants of vectorial capacity. A mark-release-recapture experiment was conducted in a dengue endemic urban neighborhood of Rio de Janeiro, Brazil, to estimate population size, survival rate and vectorial capacity of Aedes aegypti females using back-pack aspirators and gravid sticky traps (MosquiTRAP). Estimations of the gravid female population size were different when using data gathered from just the MosquiTRAP (3,505 individuals) or aspirator (1,470). However Ae. aegypti survival rates and longevity were similar irrespective of the method of capture. Up to 26.3 percent of released females would be able to survive for more than 10 days, the length of time of the extrinsic incubation period. Vectorial capacity value ranged between 0.01567 and 0.4215 and the basic reproductive number (R0) was estimated to be between 0.0695 and 1.88.

O tamanho populacional e a taxa de sobrevivência de vetores de doenças são importantes componentes da capacidade vetorial. Um experimento de marcação-soltura-recaptura foi conduzido numa área urbana endêmica de dengue no Rio de Janeiro, Brasil, para estimar o tamanho populacional, taxa de sobrevivência diária e capacidade vetorial de fêmeas de Aedes aegypti; para tal, usaram-se aspirador costal e armadilha para fêmeas grávidas de Ae. aegypti (MosquiTRAP). Estimativas do tamanho populacional de fêmeas grávidas foram diferentes quando foram analisados dados coletados apenas na MosquiTRAP (3.505 indivíduos) e aspiradores (1.470). Por outro lado, taxas de sobrevivência e longevidade de Ae. aegypti foram semelhantes independentemente do método de captura empregado. Até 26,3 por cento das fêmeas seriam capazes de sobreviver mais do que dez dias, tempo equivalente à duração do período de incubação extrínseco. O cálculo da capacidade vetorial revelou valores entre 0,01567 e 0,4215, e o número básico de reprodução foi estimado entre 0,0695 e 1,88.

Mosquito traps designed to capture Aedes aegypti (Diptera: Culicidae) females: preliminary comparison of Adultrap, MosquiTRAP and backpack aspirator efficiency in a dengue-endemic area of Brazil

In this report, the efficiency of Adultrap under field conditions is compared to a CDC backpack aspirator and to MosquiTRAP. An urban dengue-endemic area of Rio de Janeiro was selected to evaluate the efficiency of mosquito traps in capturing Aedes aegypti females. Adultrap and aspirator captured similar numbers of Ae. aegypti females, with the former showing high specificity to gravid individuals (93.6 percent). A subsequent mark-release-recapture experiment was conducted to evaluate Adultrap and MosquiTRAP efficiency concomitantly. With a 6.34 percent recapture rate, MosquiTRAP captured a higher mean number of female Ae. aegypti per trap than Adultrap (Ç2 = 14.26; df = 1; p < 0,05). However, some MosquiTRAPs (28.12 percent) contained immature Ae. aegypti after 18 days of exposure in the field and could be pointed as an oviposition site for female mosquitoes. Both trapping methods, designed to collect gravid Ae. aegypti females, seem to be efficient, reliable and may aid routine Ae. aegypti surveillance.

Efeitos mecânicos causados pela variação da inclinação do parafuso excêntrico no orifício da placa de autocompressão / Mechanical effects caused by the variation of the load screw inclination in the orifice of the dynamic compression plate

OBJETIVO: Avaliar os efeitos mecânicos da inclinação do parafuso excêntrico sobre a compressão axial com placa. MÉTODOS: Corpos de prova artificiais simulando fragmentos de osso diafisário foram fixados com placa DCP® de 4,5mm de sete orifícios. Uma célula de carga registrou as forças de compressão axial no intervalo entre os fragmentos. Guias de perfuração excêntrica com inclinações em relação ao plano longitudinal e transversal da placa foram confeccionados para o experimento. A compressão foi medida em dois diferentes sítios do foco de fratura virtual. De acordo com a magnitude da inclinação e sua direção em relação ao orifício da placa, oito diferentes grupos foram constituídos. Os ensaios mecânicos registraram a força máxima e a força máxima efetiva. RESULTADOS: A inclinação do parafuso em direção contrária à da rampa de deslizamento do orifício da placa foi acompanhada de diminuição nos valores médios de força máxima e força máxima efetiva de compressão 0º > 10ºi (p < 0,001), 0º > 20ºi (p < 0,001), 0º > 25ºi (p < 0,001). CONCLUSÃO: Em modelo experimental, utilizando-se placas do tipo DCP® não pré-tensionadas, a inclinação na inserção de parafusos excêntricos promoveu alterações nos valores médios da força de compressão axial. Houve diferenças significativas (p < 0,05) para menos na compressão axial obtida na cortical subjacente à placa, quando da inserção de parafusos inclinados no plano longitudinal com direção oposta à da rampa de deslizamento do orifício DCP®.

OBJECTIVE: To evaluate the mechanical effects of sloping the load screw on the axial compression with a dynamic plate. METHODS: Artificial parts simulating shaft fragments were fixated with a 4.5 mm, 7 orifice DCP® plate. A load cell recorded axial compression loads in the space between fragments. Eccentric perforation guides with inclinations to the longitudinal and transversal plan of the plate were made for the experiment. Compression was measured in two different sites of the virtual fracture focus. Eight different groups were formed according to the magnitude of inclination and its direction based on the plate orifice. Mechanical assays recorded maximum load and effective maximum load. RESULTS: Screw inclination contrary to the plate orifice sliding slope was related to decreased mean values of maximum compression load and maximum effective compression load 0º > 10ºi (p < 0,001), 0 > 20ºi (p < 0,001), 0º > 25ºi (p < 0,001). CONCLUSION: In an experimental model, using non pre-stressed DCP® plates, the inclination upon inserting load screws brought about changes in the mean values of axial compression load. There significant differences (p < 0,05) to lower axial compression obtained in the cortical adjacent to the plate when the screws were inserted in inclination with the longitudinal plane in the opposite direction of the sliding slope of the DCP® orifice.

Diversidade de Euglossini (Hymenoptera: Apidae) em áreas de cerrado do Triângulo Mineiro, MG / Diversity of Euglossini (Hymenoptera: Apidae) in cerrado areas of Triângulo Mineiro, MG

A tribo Euglossini é composta por abelhas típicas de matas tropicais úmidas, mas poucos estudos têm sido feitos estimando parâmetros ecológicos desse grupo em outras fitofisionomias. O objetivo deste trabalho foi estudar a diversidade de Euglossini em áreas de cerrado sentido restrito, próximas ao município de Uberlândia-MG. Foram realizadas coletas na Reserva Ecológica do Clube Caça e Pesca Itororó (CCPIU) e na Estação Ecológica do Panga (EEP),entre outubro de 2003 e setembro de 2004. No total foram coletadas 213 abelhas pertencentes a nove espécies. Eulaema (Apeulaema) nigrita, Euglossa (Euglossa) melanotricha e Euglossa (Glossura) imperialis foram as espécies mais abundantes. Verificou-se uma baixa similaridade de espécies entre as duas áreas (PS=0,409).

Euglossini are typical bees of humid tropical forest, but few studies have been made estimating ecological parameters of this group in the others phytophysionomics. This work aimed to study the diversity of the Euglossini in cerrado areas, near of Uberlândia city-MG. Collections were carried out in the Ecological Reserve of the Club Caça e Pesca Itororó (CCPIU) and in the Ecological Station of the Panga (EEP), from October of 2003 to Septemberof 2004. A total of 213 bees of nine species were collected. Eulaema (Apeulaema) nigrita, Euglossa (Euglossa) melanotricha and Euglossa (Glossura) imperialis were the most abundant species. A low similarity of species was verified between the two areas (PS=0,409).

Variation in Aedes aegypti(Diptera: Culicidae) container productivity in a slum and a suburban district of Rio de Janeiro during dry and wet seasons

Seasonal variation in container productivity and infestation levels by Aedes aegypti were evaluated in two areas with distinct levels of urbanization degrees in Rio de Janeiro, a slum and a suburban neighborhood. The four most productive containers can generate up to 90 percent of total pupae. Large and open-mouthed containers, such as water tanks and metal drums, located outdoors were the most productive in both areas, with up to 47.49 percent of total Ae. aegypti pupae collected in the shaded sites in the suburban area. Water-tanks were identified as key containers in both areas during both the dry and rainy seasons. Container productivity varied according to seasons and urbanization degree. However, the mean number of pupae per house was higher in the suburban area, but not varied between seasons within each area (P > 0.05). High infestation indexes were observed for both localities, with a house index of 20.5-21.14 in the suburban and of 9.56-11.22 in the urban area. This report gives potential support to a more focused and cost-effective Ae. aegypti control in Rio de Janeiro.

Field evaluation of effectiveness of the BG-Sentinel, a new trap for capturing adult Aedes aegypti (Diptera: Culicidae)

In recent years, the development of new tools to gather field information about vector ecological parameters has increased. This report evaluated the BG-Sentinel Trap (BGS-Trap), a promising new attempt to improve collection of the dengue vector, Aedes aegypti. The efficacy of the BGS-Trap was compared with the CDC backpack aspirator, one of the commonest used methods for capturing adult mosquitoes. BGS-Traps captured significantly more Ae. aegypti males (chi2 = 21.774, df = 1, P < 0.05) and females (chi2 = 56.007, df = 1, P < 0.05) than CDC aspirator during all days of field collection. However, CDC aspirator was significantly more efficient to capture Culex quinquefasciatus males (chi2 = 5.681, df = 1, P < 0.05) and females (chi2 = 6.553, df = 1, P < 0.05). BGS-Traps captured host-seeking females (varying between 68.75 to 89.8 percent) in detriment of females in other behavioral and physiological stages. BGS-Traps proved to be efficient and can be used for monitoring adult mosquito populations.