ROLE OF ACC DEAMINASE PRODUCING PLANT GROWTH PROMOTING RHIZOBACTERIA IN AMELIORATING THE SALINITY STRESS CONDITIONS: A REVIEW

Salinity in agricultural soil is a severe problem that affects the growth and production in numerous crops all over the world. The country's salt?affected land is estimated to be 6.74 million hectares. According to estimates, approximately 10% more land is becoming salinized each year, and by 2050, nearly half of all arable land will be contaminated by salt. Plants may have bacterial companions that shield them from the negative consequences of salt stress (SS). Plant growth?promoting bacteria (PGPR) can minimize the usage of agrochemicals while also improving plant production, nutrition, and biotic–abiotic stress tolerance. The enzyme 1? aminocyclopropane?1?carboxylic acid deaminase (ACCD) is found in certain bacteria and works by degrading ACC (ethylene precursor in higher plants) into ??ketobutyrate and ammonia (NH ), thereby reducing the ACC levels, thus, inhibits excessive biosynthesis of3 ethylene under numerous stress circumstances. This is one of the most effective methods for inducing plant tolerance to SS. The current review highlighted the recent works of ACCD under SS environment. Further, the relevance of reducing the negative effect of ROS and increasing plant development under SS were also discussed. We propose a path for the community to employ beneficial microorganisms to boost agricultural yield and achieve sustainable development by highlighting plant?microbe interactions in this review.

EXPRESSION OF CD44 AS A CANCER STEM CELL MARKER IN ORAL CANCER: A META-ANALYSIS STUDY

Various researches have shown that Cluster of Differentiation 44 (CD44) is one of the valued markers. As it plays an important role in tumor growth and metastasis but studies also suggest it as a cancer stem cell (CSC) marker in oral cancer (OC). Therefore, we aimed to explore association between the expression of CD44 and clinicopathological characteristics along with the OC prognosis.We conducted literature search through PubMed database (till October 22, 2020) to determine and evaluate the clinical and prognostic significance of CD44 expression in OC patients. According to the inclusion criteria we finalized 9 studies with 867 OC cases. We found the positive expression of CD44 in advanced stages was prominently associated with reduced survival rate. Our analysis suggest that higher tumor expression of CD44 may predict poor survival in end staged OC patient

Acceptance and commitment therapy-based behavioral intervention for insomnia: a pilot randomized controlled trial

Objective: To evaluate a protocol for acceptance and commitment therapy-based behavioral intervention for insomnia (ACT-BBI-I) in adults compared to cognitive behavioral therapy for insomnia (CBT-I). Methods: Forty-five adults with chronic insomnia were randomized to ACT-BBI-I or CBT-I. Both interventions were performed in six weekly group sessions. The common treatment elements in both protocols included stimulus control and sleep restriction. CBT-I is focused on the cognitive restructuring of maladaptive beliefs about sleep and the daytime effects of insomnia. ACT-BBI-I focuses on therapeutic processes of acceptance, availability, values, defusion, and commitment. The results were evaluated through the following instruments: a sleep diary, the Insomnia Severity Index, the Epworth Sleepiness Scale, the Hospital Anxiety and Depression Scale, the Acceptance and Action Questionnaire-II, and the Dysfunctional Beliefs and Attitudes about Sleep scale. Results: Both interventions had a significant positive impact on sleep patterns, insomnia, anxiety, beliefs about sleep, and psychological flexibility. All improvement was maintained at the 6-month follow-up. Conclusion: The results suggest that integrating principles of ACT with behavioral techniques may be useful for treating insomnia. Further research should identify whether the principles of ACT result in added effectiveness compared to behavioral components alone. Clinical trial registration: RBR-7nc5wq

Orienting the superficial inferior epigastric artery (SIEA) pedicle in a stacked SIEA-deep inferior epigastric perforator free flap configuration for unilateral tertiary breast reconstruction

Superficial inferior epigastric artery (SIEA) flaps represent a useful option in autologous breast reconstruction. However, the short-fixed pedicle can limit flap inset options. We present a challenging flap inset successfully addressed by de-epithelialization, turnover, and counterintuitive rotation. A 47-year-old woman underwent left tertiary breast reconstruction with stacked free flaps using right deep inferior epigastric perforator and left SIEA vessels. Antegrade and retrograde anastomoses to the internal mammary (IM) vessels were preferred; additionally, the thoracodorsal vessels were unavailable due to previous latissimus dorsi breast reconstruction. Optimal shaping required repositioning of the lateral ends of the flaps superiorly, which would position the ipsilateral SIEA hemi-flap pedicle lateral to and out of reach of the IM vessels. This problem was overcome by turning the SIEA flap on its long axis, allowing the pedicle to sit medially with the lateral end of the flap positioned superiorly. The de-epithelialized SIEA flap dermis was in direct contact with the chest wall, enabling its fixation. This method of flap inset provides a valuable solution for medializing the SIEA pedicle while maintaining an aesthetically satisfactory orientation. This technique could be used in ipsilateral SIEA flap breast reconstructions that do not require a skin paddle, as with stacked flaps or following nipple-sparing mastectomy.

Implications of abnormal abdominal wall computed tomographic angiography findings on postmastectomy free flap breast reconstruction

Background@#Preoperative computed tomography angiography (CTA) of the abdominal wall vessels is used when planning free flap breast reconstruction (FFBR) because it provides a surgical road map which facilitates flap harvest. However, there are few reports on the effect of abnormal findings on the operative plan. @*Methods@#We conducted a retrospective study of all FFBRs performed at a tertiary referral center over a 6-year period (November 2011 to June 2017). One consultant radiologist reported on the findings. Details on patient demographics, CTA reports, and intraoperative details were collected. @*Results@#Two hundred patients received preoperative CTAs. Fourteen percent of patients (n=28) had abnormal findings. Of these findings, 18% were vascular anomalies; 36% tumorrelated and 46% were “miscellaneous.” In four patients, findings subsequently prevented surgery; they comprised a mesenteric artery aneurysm, absent deep inferior epigastric (DIE) vessels, bilateral occluded DIE arteries, and significant bone metastases. Another patient had no suitable vessels for a free flap and the surgical plan converted to a pedicled transverse rectus abdominis musculocutaneous flap. The remaining incidental findings had no impact on the surgical plan or appropriateness of FFBR. More than one in 10 of those with abnormal findings went on to have further imaging before their operation. @*Conclusions@#CTA in FFBR can have a wider impact than facilitating surgical planning and reducing operative times. Incidental findings can influence the surgical plan, and in some instances, avoid doomed-to-fail and unsafe surgery. It is therefore important that these scans are reported by an experienced radiologist.

Does surgical procedure type impact postoperative pain and recovery in deep inferior epigastric artery perforator flap breast reconstruction?

Background@#The deep inferior epigastric artery perforator (DIEP) flap is the commonest flap used for breast reconstruction after mastectomy. It is performed as a unilateral (based on one [unipedicled] or two [bipedicled] vascular pedicles) or bilateral procedure following unilateral or bilateral mastectomies. No previous studies have comprehensively analyzed analgesia requirements and hospital stay of these three forms of surgical reconstruction. @*Methods@#A 7-year retrospective cohort study (2008–2015) of a single-surgeon’s DIEP-patients was conducted. Patient-reported pain scores, patient-controlled morphine requirements and recovery times were compared using non-parametric statistics and multivariable regression. @*Results@#The study included 135 participants: unilateral unipedicled (n=84), unilateral bipedicled (n=24) and bilateral unipedicled (n=27). Univariate comparison of the three DIEP types showed a significant difference in 12-hour postoperative morphine requirements (P=0.020); bipedicled unilateral patients used significantly less morphine than unipedicled (unilateral) patients at 12 (P=0.005), 24 (P=0.020), and 48 (P=0.046) hours. Multivariable regression comparing these two groups revealed that both reconstruction type and smoking status were significant predictors for 12-hour postoperative morphine usage (P=0.038 and P=0.049, respectively), but only smoking, remained significant at 24 (P=0.010) and 48 (P=0.010) hours. Bilateral reconstruction patients’ mean hospital stay was 2 days longer than either unilateral reconstruction (P<0.001). @*Conclusions@#Although all three forms of DIEP flap breast reconstruction had similar postoperative pain measures, a novel finding of our study was that bipedicled DIEP flap harvest might be associated with lower early postoperative morphine requirements. Bilateral and bipedicled procedures in appropriate patients might therefore be undertaken without significantly increased pain/morbidity compared to unilateral unipedicled reconstructions.

Perthes-Like Disease Masquerading Non-Classical MPS

Abstract Mucopolysaccharidoses (MPS) are inborn errors of metabolism caused by deficient lysosomal enzymes, leading to organomegaly, hip osteonecrosis, coarse facial features, bone deformities, joint stiffness, cardiac and pulmonary symptoms (MPS VI) or hypermobility (MPS IVA). Some patients may present with non-classical forms of the disease in which osteoarticular abnormalities are the initial symptoms of non-classical forms. As orthopedists and surgeons are the specialists most frequently consulted before the diagnosis, it is critical that MPS may be considered as a differential diagnosis for patients with bone dysplasia. Experts in Latin America reviewed medical records focusing on disease onset, first symptoms and the follow-up clinical and surgical outcomes of non-classical MPS VI and IVA patients. All patients displayed orthopedic issues, which worsened over time, followed by cardiac and ophthalmological abnormalities. Our findings enlighten the necessity of including non-classical MPS as possible diagnosis for patients who report osteoarticular abnormalities in absence of inflammation.

Sanfilippo Syndrome: The Tale of a Challenging Diagnosis

Abstract Sanfilippo syndrome or mucopolysaccharidosis III (MPS III), includes a group of four autosomal recessive lysosomal storage disorders caused by deficient activity of enzymes involved in the catabolism of heparan sulfate. The four types of MPS III are recognized in accordance with the deficient enzyme, resulting in the accumulation of heparan sulfate with particularly deleterious effects in the central nervous system. The incidence of MPS III remains to be established in Latin American countries. We describe the journey of a patient with MPS IIIB whom, even in the presence of speech delay and deterioration, behavioral problems and motor incoordination, showed unaltered urinary glycosaminoglycans (GAGs) levels. An investigation for MPS was undertaken and enzyme analysis indicated a deficiency of alpha-N-acetylglucosaminidase, leading to the diagnosis of MPS IIIB. With the correct diagnosis, the patient's symptoms could be properly managed, and the parents received appropriate genetic counseling. The present case report reinforces the need of investigating MPS III in patients with language delay and/or regression, neurological impairment and behavioral alterations, even when urinary GAGs are within normal range. A definitive diagnosis ends the diagnostic journey and enables the medical team and family to provide a better care for the child.

Evaluation of hepatocellular dysfunction and its association with severity in dengue patients

Background: Dengue is a mosquito-borne infection that in recent years has become an important disease of international public health concern. Dengue virus infections and illness when symptomatic, that patients tend to present with a significantly wide variety manifestations. The aim of the study was to evaluate liver dysfunction in patients with dengue infections.Methods: The present study was undertaken as an observational cross-sectional study the period June 2017 to December 2018. The details of all patients with serologically proved dengue fever admitted in the hospital were reviewed. Data including routine blood count, liver function test (LFT), prothrombin time (PT), activated partial prothrombin time (APTT), abdominal ultrasonography was studied. Statistical analysis: Data was analyzed using SPSS version 21.0. Difference between proportions was tested by using chi square test. Pearson correlation coefficient was used to measure linear correlation between two continuous variables. A p value <0.05 was consideredstatistically significant.Results: Majority of the study participants were in the age group of 16-30 years (57.5%) and were males (64.5%). Fever, Headache and joint pain were the most common symptoms noted among the study participants. Majority of the study participants were found to have elevated levels of SGOT (75.3%), SGPT (64.2%) levels and lower levels ofserum albumin (68.6%) on evaluation. Statistically significant association was observed between elevated liver enzymes and presence of features of dengue haemorrhagic fever.Conclusions: Considerably high proportion of patients with dengue infection were found to have hepatic dysfunction in the form of deranged liver enzymes.

Phytochemical Screening, Antioxidant Activity and Hypoglycemic Potential of Kenyan Aloe lateritia and Aloe secundiflora Extracts in Alloxan-Induced Diabetic Swiss Albino Mice

The aim of the study was to investigate the phytochemical constitution, antioxidant activity, hypoglycemic potential and safety of Aloe lateritia and Aloe secundiflora. Phytochemical screening was determined using standard procedures and Gas chromatography-mass spectrometry (GC-MS) analysis. 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging activity was determined spectro-photometrically. Hypoglycemic studies involved daily administration of 200 mg/kg of metformin and 300 mg/kg of methanol and aqueous leaves extracts of A. lateritia and A. secundiflora to alloxan-induced diabetic mice for 21 days. The safety of the extracts was experimented using OECD protocol on Acute Oral Toxicity-Acute Toxic Class Method Test no. 423. The results showed the presence of hypoglycemic phytochemicals: - phenols, saponins, alkaloids, flavonoids, tannins, anthraquinones, steroids and carbohydrates in both plants. Analysis by GC-MS determined the presence of phytochemicals in A. lateritia and A. secundiflora already established in other Aloe species. Aloe secundiflora extracts were decided to have higher free radical scavenging activity than A. lateritia extracts. Both A. lateritia and A. secundiflora aqueous and methanol extracts showed significant decreases in FBG levels when compared to the diabetic control group while there was no significant difference between A. secundiflora extracts and metformin-treated group at the end of the experiment (P<0.05). Aloe secundiflora methanol extracts achieved the highest percentage glycemic change among the extracts. All the extracts were not toxic at the tested levels. The hypoglycemic and antioxidant activities established in A. lateritia and A. secundiflora can be linked to the phytochemicals present.

Diagnosis and Management of Classica Homocystinuria in Brazil: A Summary of 72 Late-Diagnosed Patients

Abstract This study described a broad clinical characterization of classical homocystinuria (HCU) in Brazil. This was a cross-sectional, observational study including clinical and biochemical data from 72 patients (60 families) from Brazil (South, n = 13; Southeast, n = 37; Northeast, n = 8; North, n = 1; and Midwest, n = 1). Parental consanguinity was reported in 42% of families. Ocular manifestations were the earliest detected symptom (53% of cases), the main reason for diagnostic suspicion (63% of cases), and the most prevalent manifestation at diagnosis (67% of cases). Pyridoxine responsiveness was observed in 14% of patients. Only 22% of nonresponsive patients on treatment had total homocysteine levels <100 mmol/L. Most commonly used treatment strategies were pyridoxine (93% of patients), folic acid (90%), betaine (74%), vitamin B12 (27%), and low-methionine diet + metabolic formula (17%). Most patients diagnosed with HCU in Brazil are late diagnosed, express a severe phenotype, and poor metabolic control. Milder forms of HCU are likely underrepresented due to underdiagnosis.

Profil histopathologique des pseudotumeurs et tumeurs bénignes des mâchoires à Douala, Cameroun

INTRODUCTION. Les pseudotumeurs et tumeurs benignes des machoires regroupent une diversite histologique de lesions. Leur distribution geographique est heterogene. L'objectif de cette etude etait de ressortir la distribution des types histologiques ainsi que leurs frequences relatives dans deux formations hospitalieres a Douala (Cameroun). MeTHODOLOGIE. Cette etude descriptive retrospective et prospective a ete conduite dans les services d'anatomie pathologique des Hopitaux Laquintinie et General de Douala; sur une periode de 12;3 ans allant de janvier 2003 a avril 2015. Etait inclus tout patient chez qui le diagnostic de pseudotumeur ou tumeur benigne des machoires etait pose a l'examen d'anatomie pathologique et nous avons retenu 52 cas. ReSULTATS. Sur ce total de 52 cas dont 30 femmes et 22 hommes; l'age moyen des patients etait de 31;1 ans; avec un pic de frequence entre 20 et 40 ans. Les pseudotumeurs et tumeurs odontogenes ont represente 63;46 %; et etaient dominees par l'ameloblastome (78;79%) ; ses variantes folliculaire (50%) et plexiforme (26;92%) etaient les plus frequentes. Les pseudotumeurs et tumeurs non odontogenes (36;54%) etaient dominees par les lesions fibro-osseuses avec 52;63%. CONCLUSION. Les pseudotumeurs et tumeurs benignes des machoires sont des pathologies rencontrees dans notre milieu. L'ameloblastome domine par ses variantes folliculaire et plexiforme ainsi que la dysplasie fibreuse sont les types histologiques predominants

Prostate laser vaporization is safe and effective in elderly men

There are few data on the safety and efficacy of laser photoselective vaporization [LVP] in elderly men. We compared the safety and efficacy of LVP for the treatment of symptomatic benign prostatic hyperplasia [BPH] in men >/= 75 years, who we defined as elderly, to those <75 years. Safety and efficacy outcomes in elderly men undergoing LVP for lower urinary tract symptoms secondary to BPH from 2005 to 2012 were compared with men <75 years. Differences between-groups in demographics, perioperative outcomes, complications, and postoperative changes in International Prostate Symptom Score [I-PSS] were calculated. Of 202 patients, 49 [24%] were elderly [range: 75-95 years] and 153 [76%] were <75 years. Preoperatively, elderly men were more likely to have heart disease [35% vs. 20%, P = 0.03], gross hematuria [6.1% vs. 0.7%, P = 0.05], urinary retention [57% vs. 41%, P = 0.07], and take anti-coagulants [61% vs. 35%, P = 0.002]. Elderly men had a longer median length of stay [1 day vs. 0 day, P = 0.001]. There were no significant between-group differences in transfusion frequency [4.4% vs. 0.7%, P = 0.14] or Clavien III complications [2% vs. 2.6%, P = 1.0]. One month postsurgery, elderly patients reported smaller median decreases in I-PSS [5.5 vs. 9, P = 0.02] and urinary bother [1 point vs. 2, P = 0.03] compared with preoperative values. At till 9 months follow-up, there were no significant between-group differences in median I-PSS or urinary bother scores. Despite a higher prevalence of preoperative comorbidity and urinary retention, elderly LVP patients experienced perioperative safety and shorter term efficacy outcomes comparable to younger men

Validation of a Korean Version of the Insomnia Severity Index

BACKGROUND AND PURPOSE: The purposes of this study were to standardize and validate a Korean version of the Insomnia Severity Index (ISI-K), and to evaluate its clinical usefulness. METHODS: We translated the ISI into Korean and then translated it back into English to check its accuracy. The 614 patients with sleep disorders who were enrolled in this study comprised 169 with primary insomnia, 133 with comorbid insomnia, and 312 with obstructive sleep apnea. All subjects underwent one night of polysomnography (PSG) and completed the Korean versions of both the Pittsburgh Sleep Quality Index (PSQI-K) and the Epworth Sleepiness Scale, as well as the ISI-K. The ISI-K was compared to these sleep scales and various PSG sleep parameters. RESULTS: The internal consistency the ISI-K total score was confirmed by a Cronbach's alpha of 0.92, and the item-to-total-score correlations (item-total correlations) ranged from 0.65 to 0.84, suggesting adequate reliability. The correlation between the ISI-K total score and PSQI-K was 0.84, which suggested adequate convergent validity. Low-to-moderate correlations were obtained between the ISI-K total score and PSG-defined sleep parameters: 0.22 for sleep onset latency, 0.38 for wake after sleep onset, and 0.46 for sleep efficiency. A cutoff score of 15.5 on the ISI-K was optimal for discriminating patients with insomnia. The test-retest scores over a 4-week interval with 34 subjects yielded a correlation coefficient of 0.86, suggesting excellent temporal stability. CONCLUSIONS: The findings of this study show that the ISI-K is a reliable and valid instrument for assessing the severity of insomnia in a Korean population.

Evaluation of clinical and functional abnormalities in Pompe disease: Case Report / Avaliação das anomalias clínico-funcionais na doença de Pompe: Relato de Caso

The patient was a 15 year-old girl who turned out at the Physical Therapy Clinic presenting progressiv escoliosis and angle of 50º Coob by X-Ray. She complained of back pain, headache and weakness of shoulder and pelvic girdle. Physical therapy evaluation came across features of delayed motor development and undernourishment, together with generalized muscle weakness (grade = 4) which was observed by the Kendall test. Lung vital capacity was 40.5%. Clinical Changes: studies of the enzymes with acid alpha-glucosidase assay kits used on filter paper and leukocytes showed low enzyme activity, suggesting a late form of the Pompe disease. The molecular studies proved that the patient had amutation associated with late-onset Pompe disease. Acid alpha-glucosidase enzyme assay studies performed in skin fibroblasts showed a reduction of the enzymatic activity of the acid alpha-glucosidase, confirming the previous results. On account of the results, Pompe disease induced important changes inclinical and functional, as well as metabolic changes, decreased strength and muscle action potentially, biomechanical changes in the spine and changes in respiratory capacity. Furthermore, this case of Pompe disease illustrates the importance of adequate physical therapy evaluation as it can be the starting point of investigation of serious conditions such as late onset Pompe disease

Paciente do sexo feminino com 15 anos, apresentou-se na Clínica de Fisioterapia, devido à presença de escoliose progressiva com ângulo de Coob de 50º pelo Raio-X. Apresentou queixa de dor na coluna e na cabeça, fraqueza de cintura escapular e pélvica. Na avaliação fisioterapêutica observou-se um quadro semelhante ao atraso do desenvolvimento motor e desnutrição, com fraqueza muscular generalizada(grau = 4) observada pelo teste de Kendall. Na função pulmonar a capacidade vital apresentou com 40,5%. Estudos enzimáticos com dosagem da alfa-glicosidade ácida em papel-filtro e leucócitos evidenciaram baixa atividade enzimática, sugestivo de forma tardia da doença de Pompe. No estudo molecular, comprovou-se que a paciente possuía mutação associada à forma tardia da doença; estudos enzimáticos da alfa-glicosidase ácida em fibroblastos cultivados a partir de biópsia de pele evidenciaram redução da atividade enzimática da alfa-glicosidase ácida, confirmando estudos enzimáticos prévios. Perante os resultados, a doença de Pompe apresentou alterações clínicas e funcionais importantes como alteração do metabolismo, diminuição de força e do potencial de ação da musculatura, alterações biomecânicas na coluna e na capacidade respiratória. Adicionalmente, o caso ilustra a importância da avaliação fisioterapêutica adequada, pois ele pode ser o ponto de partida da investigação de doenças graves como o presente caso

Quality of life in patients with Charcot-Marie-Tooth disease type 1A / Análise da qualidade de vida de pacientes com a doença de Charcot-Marie-Tooth tipo 1A

We assessed the functional impairment in Charcot-Marie-Tooth resulting from 17p11.2-p12 duplication (CMT1A) patients using the Short-Form Health Survey (SF-36), which is a quality of life questionnaire. Twenty-five patients of both genders aged ≥10 years with a positive molecular diagnosis of CMT1A were selected. Age- and gender-matched Control Group (without family history of neuropathy), and the sociodemographic and professional conditions similar to the patients' group were selected to compare the SF-36 results between them. The results showed that the majority quality of life impairments in CMT1A patients occurred in the social and emotional domains. Functional capacity also tended to be significantly affected; other indicators of physical impairment were preserved. In conclusion, social and emotional aspects are mostly neglected in the assistance provided to CMT1A Brazilian patients, and they should be better understood in order to offer global health assistance with adequate quality of life as a result.

Avaliou-se o comprometimento funcional de pacientes com Charcot-Marie-Tooth provenientes da duplicação 17p11.2-p12 (CMT1A), utilizando o SF-36, que é um questionário para medir a qualidade de vida. Vinte e cinco pacientes de ambos os sexos com idades ≥10 anos e diagnóstico molecular de CMT1A foram selecionados. Idade, sexo, condições sociodemográficas e profissionais foram pareados com o Grupo Controle (sem histórico familiar de neuropatia). Os resultados mostraram que o maior impacto da CMT1A na qualidade de vida ocorreu nos domínios social e emocional dos pacientes avaliados. A capacidade funcional também tende a ser significativamente afetada, enquanto outros indicadores de deficiência física foram preservados. Por fim, os aspectos sociais e emocionais dos pacientes acometidos por CMT1A costumam ser negligenciados na assistência médica prestada aos pacientes brasileiros, e devem ser melhor compreendidos a fim de oferecer uma assistência global à saúde, resultando em adequada qualidade de vida.

Indocyanine Green Videoangiography for Confirmation of Bypass Graft Patency

OBJECTIVE: The aim of the study is to determine the efficacy of indocyanine green (ICG) videoangiography for confirmation of vascular anastomosis patency in both extracranial-intracranial and intracranial-intracranial bypasses. METHODS: Intraoperative ICG videoangiography was used as a surgical adjunct for 56 bypasses in 47 patients to assay the patency of intracranial vascular anastomosis. These patients underwent a bypass for cerebral ischemia in 31 instances and as an adjunct to intracranial aneurysm surgery in 25. After completion of the bypass, ICG was administered to assess the patency of the graft. The findings on ICG videoangiography were then compared to intraoperative and/or postoperative imaging. RESULTS: ICG provided an excellent visualization of all cerebral arteries and grafts at the time of surgery. Four grafts were determined to be suboptimal and were revised at the time of surgery. Findings on ICG videoangiography correlated with intraoperative and/or postoperative imaging. CONCLUSION: ICG videoangiography is rapid, effective, and reliable in determining the intraoperative patency of bypass grafts. It provides intraoperative information allowing revision to reduce the incidence of technical errors that may lead to early graft thrombosis.

Erros inatos do metabolismo confirmados no Hospital das Clínicas de Ribeirão Preto-SP no período de 2000 a 2008 / Inborn errors of metabolism in the Hospital of Clinics of Ribeirão Preto - SP from 2000 to 2008

Os Erros Inatos do Metabolismo (EIM) vêm sendo cada vez mais identificados nos últimos anos. A preocupação com o diagnóstico precoce decorre do foco na prevenção de deficiências, especialmente a mental. Este estudo descritivo teve por objetivo verificar diagnósticos confirmados e modalidades de tratamento utilizadas de janeiro de 2000 a dezembro de 2008. Método: foi realizada busca ativa de casos confirmados nos serviços que atendem esse tipo doença: neurologia (neuropediatria e doençasneuromusculares), pediatria (serviço de gastrologia e hepatologia) e genética clínica, além de levantamento no Serviço de Arquivo Médico do HCFMRP-USP. Foram confirmados 165 pacientes com EIM, com idades de um dia a 22 anos (mediana de um ano); 50 casos foram defeitos na síntese ou catabolismo de moléculas complexas, 65 no metabolismo intermediário, e 50 na produção ou utilização de energia. O tratamento foi instituído para 12 dos 50 pacientes do grupo I sendo reposição enzimática em 11 e transplante de medula óssea em um; todos do grupo II e III receberam orientação nutricional; 60 do grupo II receberam fórmula dietética industrializada; dos 50 do grupo III, 43 com mitocondriopatias receberam L-carnitina e coenzimas e aqueles com glicogenose, orientação sobre aporte de carbohidratos. A formação de novos recursos humanos, integração com a Rede EIM Brasil e linhas de pesquisa na área são prioridades para melhorar a acuidade na detecção e tratamento de erros inatos do metabolismo.

Inborn Errors of Metabolism have been increasingly identified in recent years. The early diagnosis focuses on prevention of disabilities, especially mental retardation. This descriptive study aims to verify confirmed diagnosis and treatment modalities in HCFMRP-USP cases from January of 2000 to December of 2008. A total of 165 patients with ages ranging from one day to 22 years (median one year) were detected. Fifty patients had synthesis or catabolism of complex molecules (group I), 65 intermediary metabolism (group II), and 50 had production or use of energy (group III) defects. Among the patients of group I, 11 had enzyme replacement therapy, and one bone marrow transplantation; for group II and III, inaddition to daily nutritional guidance for all of the patients, 60 from group II received industrialized diets; from group III, 43 with mitochondrial diseases received L-carnitine and coenzymes, and those with glycogenosis were focused mainly on the intake of carbohydrates. New human resources, integration with the Network EIM Brazil and lines of research in the area are priorities for improving the accuracy in the detection and treatment of inborn errors of metabolism.

Upper Pole versus Lower Pole Access for Percutaneous Nephrolithotomy (PCNL) in Patients with Multiple Renal Calculi

Abstract Upper Pole versus Lower Pole Access for Percutaneous Nephrolithotomy (PCNL) in Patients with Multiple Renal Calculi Wisoot              Kangchareonsombat      MD* Patric                Villacuna                            MD** Vincent             G  Bird                                MD** Charles             M  Lynne                            MD** Raymond         J   Leveillec                       MD**   * Department of Surgery, VMA Medical College and Vajira Hospital ** Department of Surgery, University of Miami School of Medicine, USA  Objective: To compare the results of percutaneous nephrolithotomy (PCNL) between upper pole and lower pole access. Study design: Cross-sectional study. Subjects: Eighty four renal units in 78 patients with multiple stones and total stone size  2 cm without staghorn calculi          who underwent PCNL at University of Miami School of Medicine, during 1999-2003 were selected. The accesses were divided in 2 groups; first, upper pole access in 57 renal units and second, lower pole access in 27 renal units. Methods: Hospital records, operative reports were retrospectively reviewed. Estimated blood loss, length of hospital stay, number of procedures (for stone free status) and complications were analyzed and compared. Main outcome measures: Estimated blood loss, length of hospital stay, number of procedures and complications. Results: The estimated blood loss (ml), length of hospital stay (hr) and number of procedures in groups 1 and 2 were 133/111 ml., 39/38 hrs., and 1.5/1.7 time respectively with p-value   0.05. There were 3 complications in group 1; consisted of pneumothorax, pulmonary edema and febrile UTL. In group 2, febrile UTI was the sole complication. Conclusion: The estimated blood loss, length of hospital stay and number of procedures were not different statistically significance. Moreover, very few complications occur in both accesses. Then, PCNL via upper and lower pole were safe and effective. Key words: percutaneous nephrolithotomy, upper pole access, lower pole access  Vajira Med J 2006 ; 50 : 21 - 25