Reprocessamento de Marca-Passos em Países de Língua Portuguesa: Uma Reflexão Clínica / Pacemaker Reuse in Portuguese Speaking Countries: A Clinical Reflection

Resumo Há uma enorme disparidade entre os países de alta renda e outros em termos de acesso a dispositivos médicos cardíacos, como marca-passos e desfibriladores implantáveis. Os custos são uma das principais barreiras ao uso de dispositivos cardíacos nesses países. Existem iniciativas internacionais que visam reduzir essa disparidade, e o reuso de marca-passos tem sido discutido como uma possível alternativa. O conceito de reutilização de marca-passos não é novo; entretanto, estudos recentes têm se mostrado seguros, éticos e eficazes para aqueles que precisam de dispositivos eletrônicos cardíacos implantáveis e não tem como adquiri-los. Parte dos países de língua portuguesa, especialmente na África, precisam de uma resposta imediata que beneficie seus inúmeros pacientes que sofrem de arritmias tratáveis.

Abstract There is a gap between high-income countries and others in terms of access to medical cardiac devices, such as pacemakers and implantable cardioverter defibrillators. Costs are one of the main barriers to the use of cardiac devices in these countries. There are international initiatives that aim to reduce the gap. The reuse of pacemakers has been discussed as a possible alternative to this problem. The concept of reusing pacemakers is not new; however, recent studies have proven to be safe, ethical, and effective for those who need cardiac implantable electronic devices and cannot afford them. Part of the Portuguese-speaking countries, especially in Africa, need an immediate response that benefits their countless patients who suffer from treatable arrhythmias.

Biomechanical evaluation of four surgical techniques for ventral stabilization of the atlantoaxial joint in dogs

ABSTRACT Purpose: This study compared, through biomechanical evaluation under ventral flexion load, four surgical techniques for ventral stabilization of the atlantoaxial joint in dogs. Methods: In total, 28 identical atlantoaxial joint models were created by digital printing from computed tomography images of a dog, and the specimens were divided into four groups of seven. In each group, a different technique for ventral stabilization of the atlantoaxial joint was performed: transarticular lag screws, polyaxial screws, multiple screws and bone cement (polymethylmethacrylate-PMMA), and atlantoaxial plate. After the stabilization technique, biomechanical evaluation was performed under ventral flexion load, both with a predefined constant load and with a gradually increasing load until stabilization failure. Results: All specimens, regardless of stabilization technique, were able to support the predefined load without failing. However, the PMMA method provided significant more rigidity (p ≤ 0.05) and also best resisted the gradual increase in load, supporting a significantly higher maximum force (p ≤ 0.05). There was no statistical difference in flexural strength between the transarticular lag screws and plate groups. The polyaxial screws method was significantly less resistant to loading (p ≤ 0.05) than the other groups. Conclusions: The PMMA technique had biomechanical advantages in ventral atlantoaxial stabilization over the other evaluated methods.

Trabalho, formação e política em debate na pesquisa-intervenção em uma Unidade Básica de Saúde (UBS) de Porto Alegre (RS) / Work, professional development, and politics in debate in an intervention-research in a Basic Health Unit in Porto Alegre (RS)

Este artigo coloca em debate a relação entre trabalho, formação e política a partir de uma experiência de pesquisa-intervenção realizada com trabalhadores de uma Unidade Básica de Saúde do município de Porto Alegre. Iniciamos posicionando a tríade "trabalho-formação-política" esboçando a compreensão que temos dessa relação. A seguir, apresentamos os principais operadores teórico-metodológicos utilizados na pesquisa, destacando o emprego da cartografia e o dispositivo da instrução ao sósia. Por fim, desenvolvemos trechos do material analisado por meio dos operadores conceituais e metodológicos propostos, indicando que a análise da atividade suscita a colocação de problemas aos saberes construídos no trabalho, constituindo outras maneiras de trabalhar em meio a debates que envolvem decisões relacionadas aos impactos do trabalho para os trabalhadores e o território onde atuam. Concluímos, com base na investigação feita, que a construção de saberes ao trabalhar não é somente uma tessitura de si ou de saberes, mas também, e necessariamente, da própria política, visto que viver o/no/pelo trabalho, renormatizando os processos, implica a tessitura dos modos de viver em conjunto

This article discusses the relationship between work, professional development, and politics based on an intervention-research experience conducted with workers of a Basic Health Unit in the city of Porto Alegre. We begin by positioning the "work-education-politics" triad, outlining our understanding of this relationship. Next, we present the main theoretical-methodological operators used in this research, highlighting the use of cartography and the device of the instruction to the double. Finally, we developed excerpts of the analyzed material with the proposed conceptual and methodological operators, indicating that the analysis of the activity leads to posing problems to the knowledge built at work, constituting other ways of working in the midst of debates that involve decisions related to the impacts of the work for the workers and the territory where they work. We conclude, based on the investigation carried out, that the construction of knowledge when working is not only a weaving of itself, or of knowledge, but also, and necessarily, of the policy itself, since living the/in/through work, normalizing the processes again, implies weaving the modes to live together

Influence of Metabolic Syndrome on the Recovery from Idiopathic Sudden Sensorineural Hearing Loss

Abstract Introduction Idiopathic sudden sensorineural hearing loss (ISSHL) is a disabling otologic urgency whose ethiopathogenesis is still controversial. Only in recent years metabolic syndrome (MetS) has been implicated as a possible aggravating factor in the prognosis of recovery from ISSHL. Objective To assess whether the preexistence of MetS interferes on hearing recovery levels. Methods Retrospective cohort study composed of adult (> 18 years old) ISSHL patients admitted for treatment between January 2015 and December 2019. To diagnose ISSHL, we used pure-tone audiometry, and identified MetS patients based on the criteria of the United States National Cholesterol Education Program Adult Treatment Panel III (NCEPATP III). The treatment protocol comprised hospitalization for five days for the intravenous administration of dexamethasone, audiometric surveillance, imaging and blood analyses, and, based on recovery, the planning of rescue treatments (intratympanic administration of dexamethasone and/or hyperbaric oxygen). The Siegel criteria were used to evaluate the hearing outcomes. Results The final sample was composed of 81 patients, 48 without MetS (nMetS) and 33 with MetS. Regarding the Siegel recovery category, the nMetS group had significantly better results (p = 0.001), with 44% of complete recoveries against 6% in the MetS, and 58% of the MetS patients had the worst outcome, contrasting with 27% in the nMetS group. The nMetS group had an overall better evolution in terms of hearing recovery and had a significant improvement in the median hearing gain (20.6 dB versus 8.8 dB; p = 0.008). Additionally, the multivariate analysis revealed that the presence of MetS is a significant risk factor for a worse outcome (odds ratio [OR] = 0.30; 95% confidence interval [95%CI] = 0.10-0.85). Conclusion Regardless of age, gender, the initial audiometry threshold, and autoimmunity, MetS is a clear risk factor for a worse outcome regarding the recovery of hearing after ISSHL.

Tinnitus and Otosclerosis: An Exploratory Study about the Prevalence, Features and Impact in Daily Life

Abstract Introduction Tinnitus is experienced by a significant part of the patients suffering from otosclerosis. Objective To assess the prevalence of tinnitus in otosclerosis, its main features, and the impact on the daily life. Methods Patients diagnosed with otosclerosis in 2019 in a tertiary hospital were enrolled in the study. Demographic data were retrieved and, besides a regular audiometric evaluation, the patients underwent acuphenometry to assess the psychoacoustic measurements (pitch and loudness), and the Tinnitus Handicap Inventory (THI). Results In total, 66 patients fulfilled the inclusion criteria, with a female predominance (63.6%; n = 42), and a mean age of 48.7 years. The mean air-bone gap was of 26.3 dB. A total of 72.7% complained of tinnitus; it was mostly unilateral, identified in the low frequencies, namely 500 Hz, with median loudness of 7.5 dB. The median score on the THI score was of 37; most patients had a mild handicap (33.3%, n = 16), followed by those with a severe handicap (22.9%; n = 11). The female gender had a statistically significant association with the presence of tinnitus. The THI scores were higher in middle-aged patients (age groups: 40 to 49 and 50 to 59 years), which was statistically significant. No correlation was found between audiometry results and the prevalence of tinnitus or score on the THI. On the other hand, high-pitched tinnitus, compared to low pitched-tinnitus, was associated with larger air-bone gaps. Conclusion The prevalence of tinnitus in our population was in line with the prevalences reported in the literature. It caused a catastrophic handicap in 22.9% of the patients. High-pitched tinnitus was associated with higher handicap. Nonetheless, the existence of tinnitus and its severity were not associated with the degree of hearing loss.

Bone alignment after minimally invasive plate osteosynthesis of the tibia in dogs / Avaliação do alinhamento ósseo após osteossíntese minimamente invasiva com placa de tíbia em cães

ABSTRACT: This study assessed radiographically changes in tibial alignment in the frontal and sagittal planes in dogs that underwent minimally invasive plate osteosynthesis (MIPO) without the aid of image intensifiers. Radiographs of dogs with complete non-articular tibial fractures submitted to MIPO were included and evaluated, without the aid of a transoperative image intensifier and / or an association of implants. The tibial mechanical angles (mMPTA, mMDTA, mCaPTA and mCrDTA) were measured by three evaluators. The data obtained were compared with results from previously published studies. Twenty-seven animals were included in the study. The mean and standard deviation of the angular changes were as follows: mMPTA, 2.54° ± 3.10 (-1.1º to 8.7º); mMDTA, 0.03º ± 0.16 (-3.44º to 0.79º); mCaPTA, 37º ± 4.29 (-6.23º to 14.87º); and mCrDTA, 8.25° ± 5.53 (-0.2º to 17.28º). There was a negative correlation between "mCaPTA" and "mCrDTA". MIPO of the tibia without using image intensifiers and implant association can potentially cause angular changes, which can lead to clinically relevant deformities after bone healing.

RESUMO: Este estudo teve como objetivo avaliar radiograficamente as alterações no alinhamento da tíbia nos planos frontal e sagital em cães submetidos à osteossíntese minimamente invasiva com placa (MIPO) sem o auxílio de intensificadores de imagem. Foram incluídas e avaliadas radiografias de cães com fraturas completas da tíbia não articulares submetidos a MIPO, sem o auxílio de intensificador de imagem transoperatório e/ou associação de implantes. Os ângulos mecânicos tibiais (mMPTA, mMDTA, mCaPTA e mCrDTA) foram mensurados por três avaliadores. Os dados obtidos pela média de todas as avaliações foram comparados com resultados de estudos previamente publicados. Vinte e sete animais foram incluídos no estudo. A média e desvio padrão das alterações angulares foram os seguintes: mMPTA= 2,54° ± 3,10 (-1,1º a 8,7º); mMDTA= 0,03º ± 0,16 (-3,44º a 0,79º); mCaPTA= 37º ± 4,29 (-6,23º a 14,87º); e mCrDTA= 8,25 ° ± 5,53 (-0,2º a 17,28º). Houve uma correlação negativa entre "mCaPTA" e "mCrDTA". A realização de MIPO em tíbia sem o uso de intensificadores de imagem e associação de implantes pode causar alterações angulares, o que pode levar a deformidades clinicamente relevantes após a cicatrização óssea.

Comparison of intraoperative nociception and postoperative acute pain after traditional or minimally invasive ovariohysterectomy in dogs

Many variations of ovariohysterectomy techniques have been described, including the traditional one and minimally invasive procedures. Non-laparoscopic Snook hook technique is an alternative for performing minimally invasive ovariohysterectomy. Few studies have been carried out in order to assess pain in animals submitted to minimally invasive surgeries, especially involving one of the most performed surgical procedures in veterinary practice. The aim of this study was to evaluate surgical duration, intraoperative nociception and acute postoperative pain after traditional ovariohysterectomy or minimally invasive non-laparoscopic technique in dogs using Snook hook. The hypothesis is that non-laparoscopic minimally invasive ovariohysterectomy would be faster and less painful than the conventional technique. Thirty dogs were divided into Traditional Group (TG = 15) and Minimally Invasive Group (MIG = 15). Heart rate, respiratory rate, systolic blood pressure, body temperature, oxyhemoglobin saturation, end-tidal carbon dioxide concentration (ETCO2) and end-tidal isoflurane concentration were evaluated before the surgery begins (M0), during incision (M1), clamping of the first ovarian pedicle (M2), second ovarian pedicle (M3), uterine cervix (M4), abdominal suture (M5) and at the end of surgery (M6). The modified Glasgow Pain Scale was used for acute postoperative pain assessment and Visual Analogue Scale (VAS) was used to assess the sensitivity of surgical wound. The level of significance established for all statistical analysis was 5%. Statistical differences were not observed between groups considering total surgical time and postoperative acute pain intensity (P > 0.05), in spite of MIG having shorter duration of surgery. There was no statistical difference between groups considering all intraoperative parameters except respiratory rate (TG < MIG; P < 0.05) and ETCO2 (MIG < TG; P < 0.05) at the moment of traction of the first ovarian pedicle (M2). Pain assessment by VAS showed statistical difference 24h after the end of surgery (TG < MIG) (P < 0.05). Both procedures were similar regarding intraoperative nociception and acute postoperative pain. It is possible that the sensation of pain in both procedures was blocked by the effectiveness of analgesics, once they might cause an inhibition of painful behaviors limiting a possible difference in pain identification. Higher respiratory stress observed in MIG at M2 and higher pain score by VAS noted in MIG 24 h after the end of surgery can be justified by greater traction of ovarian pedicle, due to limited surgical access of minimally invasive technique. Minimally invasive ovariohysterectomy non-laparoscopic seems to be potentially faster, probably due to the smaller size of the abdominal incision, which takes less time to be closed. In the present study, both techniques were performed by an experienced surgeon, providing safe procedures, nevertheless it is important to emphasize that iatrogenic injury can be caused by surgeons non-proficient in the Snook hook technique, considering the limited visualization of anatomical abdominal structures. Data obtained indicate that traditional ovariohysterectomy and non-laparoscopic Snook hook technique promote similar intraoperative nociception and acute postoperative pain, however minimally invasive procedure is potentially faster with less surgical trauma.(AU)

Biomechanical evaluation of a new femoral stem design for total hip replacement in a canine model

ABSTRACT Purpose To evaluate the biomechanical properties of a novel total hip replacement femoral stem. Methods Eight pairs of femurs from dog cadavers were used. The femurs were separated into different groups. A novel femoral stem with a convex proximal portion (Stem B) was biomechanically evaluated and compared to awell-known veterinary collared stem (Stem A). Femoral stems were inserted into the contralateral femurs from the same dog, forming 16 constructs. A flexo-compression load was applied on the axial axis of each sample. Maximum strength, deflection, stiffness, and energy absorption were analysed. Results Group B constructs showed significantly higher values (p ? 0.05) for the variables, except stiffness. The mean maximum strength was 1,347 ± 357 N for Group A and 1,805 ± 123 N for Group B (p ? 0.0069). The mean deflection was5.54 ± 2.63 mm for Group A and 10.03 ± 3.99 mm for Group B (p ? 0.0056). For the energy variable, the force was 6,203 ± 3,488 N/mm for Group A and 12,885 ± 5,056 N/mm for Group B (p ? 0.0054). Stem B had greater maximum strength, deflection, and energy. Conclusions The new stem was effective in neutralizing the impact of axial flexion-compression stresses during biomechanical tests in cadaveric models.

Capital femoral physeal dysplasia in cats submited to ostectomy of the femoral head and neck / Displasia femoral capital em felinos submetidos a ostectomia da cabeça e colo femoral

ABSTRACT: This report described pathological fracture of the femoral head (physeal dysplasia) in four male cats (three mixed breed and one Bengal), with an average age of 16 months, treated by an ostectomy of the femoral head and neck. Three cats were neutered and one entire. All presented with mild intermittent lameness in the pelvic limbs. Displacement of the femoral epiphysis and resorption of the femoral neck were present and excision of the femoral head and remaining neck was performed in all cases. Hstological examination showed mild foci of compaction and trabecular fibrosis with deposition of fibrous connective tissue, permeated by granulation tissues, consistent with the original diagosis. Limb function improved in all patients from 2 to 4 weeks postoperatively. Diagnosis of physeal dysplasia is challenging and treatment is different from acute traumatic fractures. Femoral head and neck excision was considered a good alternative in these patients.

RESUMO: Este trabalho descreve a fratura patológica da cabeça do femur (displasia fiseal) em quatro machos (três raças mistas e um Bengal), com idade média de 16 meses, que foram tratados com ostectomia da cabeça e colo femorais. Três gatos eram castrados e um inteiro. Todos apresentaram leve claudicação intermitente nos membros pélvicos. O deslocamento da epífise femoral e a reabsorção do colo femoral estavam presentes, a excisão da cabeça e colo femoral foi realizada em todos os casos. O exame histológico mostrou focos de compacteção e fibrose trabecular com deposição de tecido conjuntivo fibroso, permeado por tecidos de granulação, consistentes com o suposto diagnóstico. A função dos membros melhorou em todos os paciente entre dois a quatro semanas pós-operatório. O diagnóstico da displasia fiseal pe desafiador e o tratamento é diferente das fraturas traumáticas agudas. A excisão de cabeça e colo femoral é considerada uma boa alternativa nesses pacientes.

Ovarian dysgerminoma causing multifocal metastases in young bitch / Disgerminoma ovariano causando metástases multifocais em cadela jovem

The ovarian neoplasias are unusual in canine species, mainly originated from germinative cells. Among these, dysgerminoma is a rare neoplasm in bitches, predominantly affecting senile and small and medium breeds. They are large, rounded, smooth surface, painless and firm in consistency. The clinical signs commonly demonstrated by patients with this neoplasia are abdominal distension and secondary signs of hyperestrogenism. The diagnosis should be based on the association of history, clinical signs, radiographic, ultrasonographic, cytological, histopathological and immunohistochemical exams. The treatment is the surgical castration and metastases are uncommon. Due to the rarity in bitches, specifically the young animals, this study aimed to describe a case of left ovarian dysgerminoma, of considerable size and adherence in adjacent organs, in a Brazilian Fila, whose showed considerable increase in abdominal volume and progressive weight loss. The diagnosis was confirmed by means of complementary x-ray, ultrasound, histopathological and immunohistochemical tests. Even with the recommended surgical treatment (castration), the patient demonstrated severe respiratory symptoms and increased abdominal volume after two months, and the complementary exams suggested pulmonary and multifocal metastases and the tutor chose euthanasia. As presented by the results, although rare in bitches, dysgerminoma should be included in the differential of ovarian neoplasias, including the young ones.

As neoplasias ovarianas são de ocorrência incomum na espécie canina, principalmente as originadas de células germinativas. Dentre estas, o disgerminoma é uma neoplasia rara em cadelas, acometendo predominantemente fêmeas senis e de raças pequenas e médias. Apresentam-se como massas grandes, arredondadas, de superfície lisa, indolores e de consistência firme. Os sinais clínicos comumente demonstrados por pacientes com este tipo neoplásico incluem distensão abdominal e sinais secundários de hiperestrogenismo. O diagnóstico deve ser baseado na associação do histórico, sinais clínicos, exames radiográficos, ultrassonográficos, citológicos, histopatológicos e imunohistoquímicos. O tratamento de escolha é a castração cirúrgica, sendo que as metástases são incomuns. Perante a raridade em cadelas, em específico as jovens, este relato teve como propósito discorrer um caso de disgerminoma ovariano esquerdo, de tamanho considerável e aderência em órgãos adjacentes, em uma Fila Brasileira, cuja sintomatologia incluiu considerável aumento de volume abdominal e emagrecimento progressivo. O diagnóstico foi confirmado por meio de exames complementares de raios-x, ultrassom, histopatológico e imunohistoquímicos. Mesmo com a instituição dotratamento cirúrgico preconizado (castração), a paciente demonstrou grave sintomatologia respiratória e aumento de volume abdominal após dois meses e, como os exames complementares foram sugestivos de metástases pulmonares e multifocais, o tutor optou pela eutanásia. Diante dos resultados, pode-se admitir que apesar de raro em cadelas, o disgerminoma deve ser incluído no diferencial das neoplasias ovarianas, incluindo as jovens.

Acetabular ventroversion using the sacroiliac wedge, with or without pelvic osteotomies in dogs: an ex vivo study / Ventroversão acetabular associada ou não a osteotomias pélvicas por meio da utilização de cunha sacroilíaca em cães: estudo ex-vivo

Canine hip dysplasia (CHD) is a common condition observed in the surgical clinics for small animals. Among the surgical techniques for management of CHD, triple pelvic osteotomy and sacroiliac wedge promote acetabular lateral axial rotation (ventroversion), increasing acetabular coverage and joint stability. The present study aimed to evaluate radiographically, by measuring the Norberg angle (NA) and the acetabular coverage percentage (ACP), the acetabular ventroversion induced by the sacroiliac wedge technique, with or without pelvic osteotomies; we also checked the feasibility of wedges made of polyamide with an angulation of 20° and 30°. The software used to measure NA and ACP was AutoCAD® 2009. Pelves from 10 canine corpses were evaluated radiographically at four time-points: M0 (Control Group), M1 (wedges of 20° and 30°), M2 and M3 (wedges associated with bilateral pubis and ischium osteotomies, respectively). There was no significant increase in the acetabular ventroversion at M1, M2, and M3. The polyamide sacroiliac wedge technique proved to be feasible, stable, and easy to apply. Further, the software proved to be efficient and easy to use for NA and ACP measurements. In the present study, even in the cases of non-dysplasic adult canine corpses, it was concluded that the sacroiliac wedge technique does not require to be accompanied by pubis and ischial osteotomies because they did not significantly increase the NA and ACP.(AU)

A displasia coxofemoral (DCF) é afecção comum na clínica cirúrgica de pequenos animais. Entre as técnicas cirúrgicas para controle da DCF, a osteotomia pélvica tripla (OPT) e a cunha sacroilíaca (CSI), promovem rotação lateral acetabular no eixo axial (ventroversão), aumentando a cobertura acetabular e a estabilidade da articulação. Desta forma, o presente estudo objetivou avaliar radiograficamente, por meio da aferição do ângulo de Norberg (NA) e da porcentagem de cobertura acetabular (PCA), a ventroversão acetabular induzida pela técnica da cunha sacroilíaca, associada ou não às osteotomias pélvicas, além de verificar a exequibilidade das cunhas confeccionadas de poliamida com angulação de 20ο e 30ο. O software utilizado para aferir o AN e o PCA foi o AutoCAD® 2009. Dez pelves de cadáveres caninos foram avaliadas radiograficamente em quatro momentos: MO (Grupo Controle), M1 (cunhas de 20ο e 30ο), M2 e M3 (cunhas associadas à osteotomia bilateral do púbis e ísquio, respectivamente). Não houve aumento significativo da ventroversão em M1, M2 e M3. A técnica de cunha sacroilíaca de poliamida mostrou-se exequível, estável e de fácil aplicação. Não obstante, o software utilizado mostrou-se eficiente e de fácil utilização nas aferições do AN e PCA. Neste estudo, mesmo tratando-se de cadáveres de cães adultos e de maioria não displásicos, concluiu-se que a utilização da técnica de cunha sacroilíaca não necessita de associação à ostectomia púbica e a osteotomia do ísquio por não promoverem aumento significativo do AN e da PCA.(AU)

Biocompatibility of polyamide 12 intramedullary rod after humeral consolidation in white Plymouth Rock birds / Biocompatibilidade de haste intramedular bloqueada de poliamida 12 após consolidação óssea umeral em aves Plymouth Rock branca

Technological and tissue engineering have enabled available, biologically inert, and low cost materials to be considered as viable alternatives in the surgical treatment of long bone fractures in birds. The aim of this study was to microscopically analyse osteotomized humerus of birds following the insertion of solid laser-sintered polyamide 12 rods in order to detect foreign body reaction and, thus, verify the bioinert property of the material in the bone fracture environment. Polyamide 12 intramedullary rods were inserted into the osteotomized humerus of 10 birds (white Plymouth Rock) and blocked using 2mm diameter cortical screws of varying lengths. The birds were operated at 60 days of age and monitored post-operatively for three months. Animals were euthanized at 150 days old and samples of the operated humerus collected for immunohistochemistry, light and scanning electron microscopy analysis. Results show bone consolidation without rejection of the implant and absence of inflammatory cells. Vascular Endothelial Growth Factor (VEGF) was expressed in the endothelial cells of the blood vessels at the site of the newly formed bone surrounding the implant, indicative of local angiogenesis. There was no bone growth on the surface of the rod; however, the implant did not interfere with the circumjacent bone repair. Thus, the findings of this study corroborate with the literature in characterizing polyamide as a bioinert material and, under the studied conditions, it can be concluded that polyamide 12 intramedullary rod is biocompatible and provides adequate bone consolidation in humeral fractures with no signs of rejection.(AU)

Com o desenvolvimento tecnológico e crescimento da engenharia de tecidos, o uso de materiais disponíveis, bioinertes e debaixo custo pode ser alternativa viável para o tratamento cirúrgico de fraturas em ossos longos nas aves. O objetivo do estudo foi realizar avaliação microscópica óssea após a implantação de haste maciça de poliamida, implantada em úmeros osteotomizados de galinhas para detectar reação do tipo corpo estranho, verificando a propriedade "bioinerte" do material no ambiente de fratura óssea. Foram utilizados 10 galos (Plymouth rock branca) e implantou-se a haste perfazendo o bloqueio das mesmas com parafusos corticais de 2 mm de diâmetro com comprimentos de acordo com a necessidade. As aves foram operadas aos 60 dias de vida e o acompanhamento pós-operatório ocorreu por três meses. Após a eutanásia, foram realizadas coletas do úmero operado (local de consolidação óssea) paraexame histopatológico, imuno-histoquímico e de microscopia eletrônica de varredura. Os resultados demonstraram consolidação óssea, sem presença de rejeição do material, com ausência de células inflamatórias. A neoformação óssea ao redor do implante expressou VEGF (fator de crescimento endotelial vascular) nas células endoteliais dos vasos sanguíneos caracterizando angiogênese no local. Na região de interface de tecido ósseo com a poliamida não foram observadas micro fraturas. Não houve crescimento ósseo na superfície da haste, porém a mesma não atrapalhou o reparo ósseo circunjacente. Assim, esse estudo corrobora com a literatura caracterizando a poliamida como um material bioinerte, e nas condições estudadas pode-se concluir que o uso da haste intramedular de poliamida 12 proporcionou consolidação óssea nesse modelo biológico nesse tipo de fratura, não havendo indícios de induzir rejeição.(AU)

Prospective clinical assessment of tibial tuberosity advancement for the treatment of cranial cruciate ligament rupture in dogs

Abstract Purpose: To evaluate clinically dogs that underwent tibial tuberosity advancement (TTA) six months previously. Methods: Dogs of various breeds, gender, weight, and age that had CCL rupture and underwent TTA for treatment were included in this study. Parapatellar arthrotomy was performed in all patients to assess the joint for a ruptured ligament and meniscal injury before the TTA. The appropriate cage for the TTA was chosen with planning surgery. The surgical procedure was performed according to the literature, using a modified Maquet technique. Six months after surgery, lameness during walking; muscular atrophy; crepitation, cranial drawer and tibial compression tests and quality of life based on owner's evaluation were assessed. Results: Postoperative complications were observed in only one knee (4.76%), with a surgical site seroma. The mean lameness score at walking was 0.29 (± 0.64). The mean score regarding muscular atrophy was 0.95 (± 1.56). The mean score of the cranial drawer test, in a range from 0 to 5, was 1.52 (± 1.54). The owners rated the dog's quality of life as excellent in 44%, good in 30%, and moderate in 17%. Conclusion: This clinical study supports the affirmation that patients who undergo TTA for treatment of CCL rupture have an acceptable response.

Description and post-operative evaluation of tie-in technique in tibial osteosynthesis in dogs / Descrição e avaliação pós-operatória de técnica de osteossíntese com tie-in em tíbia

The aim of this study was to describe and analyse the adaptability and functionality of tie-in configuration in tibial osteosynthesis in dogs. Twenty dogs with tibial fracture were included in this study. An orifice was made on the proximal tibial fragment, on the medial side, close to the tibial crest. The drill piece was angled at 45º and projected into the same orifice on the distal sense of the bone. Others orifices made with the aid of a low rotation drill and drill piece with diameter smaller than the chosen implant. After 10 days post-operative, the animals were evaluated. X-ray analysis was performed at the time of clinical examination; immediate post-operative period; and at 30, 60, 90, and 120 days post-surgery. A questionnaire was given to the owners to provide details on the post-operative period. There were no trans-operative complications or suture dehiscence up to the day of suture removal. Partial development of bone callus was observed in 20 dogs within a mean period of 76 days. Three animals showed bone consolidation within 35 days, nine by 60 days, three by 90 days, and 5 by 120 days post-operative. Dynamization was carried out in 9 animals. The surgical access to the tibial medullary canal through the orifice at the proximal medial face, by the tibial tuberosity, enables the insertion of IMP without risks to articular and peri-articular lesions in the knee in dogs.(AU)

O objetivo deste trabalho foi descrever e analisar a funcionalidade da configuração tie-in na ostessíntese de tíbia em cães. Foram usados 21 cães com fratura de tíbia da rotina clinica do hospital veterinário. Somente a primeira cortical (Sis) foi perfurada, em seguida a broca foi inclinada a 45o e projetada no mesmo orifício no sentido distal do osso. foram confeccionados outros orifícios com auxílio de furadeira de baixa rotação e broca cujo diâmetro era menor que o implante escolhido. Os procedimentos radiográficos foram realizados no momento do atendimento clínico, no período pós-operatório imediato e aos 30, 60, 90 e 120 dias pós-cirúrgico. Não houve nenhuma complicação transoperatória, tão pouco deiscência de sutura até o momento da retirada dos pontos de cútis. A formação parcial de calo ósseo foi evidenciada em 20 cães com tempo médio de 76 dias. Três cães obtiveram consolidação óssea em 35 dias, nove aos 60 dias, três aos 90 dias e cinco aos 120 dias de pós-operatório. Dinamizações foram realizadas em nove animais. Após a confirmação radiográfica de consolidação óssea, os implantes dos 20 animais foram totalmente removidos. Concluiu-se que o acesso cirúrgico ao canal medular da tíbia canina por meio de orifício na face medial proximal, junto à tuberosidade da tíbia, permite a inserção do PIM sem risco de lesões articulares e periarticulares no joelho.(AU)

Prevalence and etiology of dental trauma in schoolchildren aged 6 to 12 years

Aim: To investigate the prevalence and etiological factors of dental trauma in school-age children aged 6 to 12 years. Methods: A study was developed in children and adolescents between the ages of 6 and 12 of both genders enrolled in 3 municipal public schools. An oral examination of the permanent or deciduous incisors was performed, if they were still present in the oral cavity, to evaluate the presence of dental trauma, need for treatment and sequels, and the method of examination and classification of dental trauma of O'Brien. Results: The prevalence of dental trauma was 4.03% (n=29). The most verified traumas were enamel crack / enamel fracture and enamel / dentin fracture without pulp exposure. It was observed that the most affected teeth were the permanent upper central incisors and the age at which trauma was most observed was 11 years, the main etiological factor was fall from a height, in 65.3% of schoolchildren (n=19). Conclusion: The prevalence of dental trauma was 4.03%, with no statistically significant difference between genders. The permanent right upper central incisor was the most affected, occurring predominantly at home and at school. The dissemination of information about dental trauma and emergency protocols to parents and teachers need to be encouraged

Mechanical flexural ex vivo study of osteotomized swine femurs stabilized with two types of polyamide 12 rods / Estudo mecânico de flexão, ex-vivo, de fêmures suínos osteotomizados, estabilizados com dois tipos de haste de poliamida 12

ABSTRACT: Long bone fractures are commonly in surgery routine and several bone imobilization techniques are currently available. Technological progress has enabled to use low cost materials in surgical procedures. Thus, the aim of this study was to evaluate the applicability of polyamide 12 rods, solid and hollow in swine femurs, comparing them through flexion strength. This study had as second aim to fix the locking errors, commom place in interlocking nails, once polyamide 12 allows perforation in any direction by orthopaedic screw. Six groups were used: G1 - eight whole swine femurs; G2 - eight whole swine femurs with drilled medullary canal; G3 - two solid polyamide 12 rods; G4 - two hollow polyamide 12 rods; G5 - eight osteotomized drilled swine femurs with a solid polyamide 12 rod implanted in the medullary canal and locked by four 316L stainless steel screws; and G6 - similar to G5 but using hollow rods instead of solid ones. No significant differences were observed for the modulus of rupture between solid and hollow rods, demonstrating that both rods had similar performances. These results led to the speculation that the addition of other polymers to the hollow rods could increase their strength and thus the bone-implant system. Furthermore, the comparison between G1, G5 and G6 could be analyzed using the finite element method in future. New polymeric materials may be developed based on the data from this study, strengthening the bone-implant system and making possible screws to be placed in any direction, nullifying the detrimental forces on the fracture site.

RESUMO: Fraturas em ossos longos são comumente encontradas na rotina cirúrgica e várias técnicas de imobilização óssea estão disponíveis. Com o avanço tecnológico, tornou-se viável utilizar materiais de baixo custo nos procedimentos, portanto esse estudo objetivou avaliar a aplicabilidade de hastes de poliamida 12, sólidas e vazadas, implantadas em fêmures suínos, comparando-as segundo as forças de flexão e aos erros de bloqueio, corriqueiros nesse implante, uma vez que a poliamida 12 permite sua perfuração em qualquer direção por meio de parafusos ortopédicos. Seis grupos foram usados: G1 - oito fêmures suínos íntegros; G2 - oito fêmures suínos, fresados intramedularmente; G3 - duas hastes maciças de poliamida 12; G4 - duas hastes vazadas de poliamida 12; G5 - oito fêmures suínos osteotomizados e fresados, com haste de poliamida 12 maciça implantada no canal medular e bloqueada com quatro parafusos de aço inoxidável 316L e G6 - diferente de G5 apenas por utilizar hastes vazadas. Não foram observadas diferenças significativas no módulo de ruptura entre hastes sólidas e vazadas, demonstrando que ambas apresentaram o mesmo desempenho. Estes resultados levaram à especulação de que adicionar outros polímeros às hastes vazadas aumentaria sua força e, portanto, do sistema osso-implante. Além disso, a comparação entre G1, G5 e G6 poderia no futuro ser analisada utilizando o método dos elementos finitos. Novos polímeros podem ser desenvolvidos baseando-se nos dados deste estudo, reforçando o sistema osso-implante e também possibilitando o uso de perfurações para o bloqueio no transoperatório em qualquer direção, anulando as forças deletérias atuantes no sítio de fratura.

Description of six autochthonous cases of canine visceral leishmaniasis diagnosed in Pedregulho (São Paulo, Brazil) / Descrição de seis casos autóctones de leishmaniose visceral canina, diagnosticados em Pedregulho (São Paulo, Brasil)

Visceral leishmaniasis is an infectious disease of chronic, emerging and zoonotic nature that presents various degrees of severity. In Brazil, this illness is caused by Leishmania infantum (Leishmania chagasi), which is transmitted by the bite of the sand fly Lutzomyia longipalpis, and dogs are its main reservoir. Given the increasing spread of this disease across Brazil, the aim of this study was to report on six cases of canine visceral leishmaniasis, diagnosed in June 2013, in the city of Pedregulho, State of São Paulo, considered to be a non-endemic area and free of phlebotomine sand flies. The diagnosis was based on clinical signs of the patients and additional tests (serological and parasitological). It was concluded that the diagnosis of leishmaniasis is complex because the clinical signs are similar to other systemic diseases, thus justifying the importance of parasitological test of bone marrow, considered "gold standard", in the confirmation of the disease. In addition, the area was not, until now, considered risk place, despite notification.

A leishmaniose visceral é uma doença infecciosa de caráter crônico, emergente e zoonótico, apresentando variados graus de severidade. No Brasil, tal enfermidade é causada pela Leishmania infantum (Leishmania chagasi), a qual é transmitida pela picada de flebótomo Lutzomyia longipalpis, tendo o cão como o principal reservatório. Perante a crescente distribuição da doença no território brasileiro, o objetivo do presente trabalho é relatar seis casos de leishmaniose visceral canina, diagnosticados em Junho de 2013, no município de Pedregulho, Estado de São Paulo, considerado área não endêmica e livre de flebotomíneos. O diagnóstico foi baseado nos sinais clínicos dos pacientes e exames complementares (sorológicos e parasitológicos). Concluiu-se que o diagnóstico da leishmaniose é complexo pelo fato dos sinais clínicos serem semelhantes a outras enfermidades sistêmicas, justificando assim a importância do teste parasitológico de medula óssea, considerado padrão ouro na confirmação da doença. Além disso, a área não foi, até o presente momento, considerada local de risco, apesar da notificação.

Endodontics pastes formulated with copaiba oil: action on oral microbiota and dentin bridge formation in dogs / Pastas endodônticas formuladas com óleo de copaíba: ação na microbiota bucal e formação de ponte dentinária em cães

This study analysed the effect of pastes formulated with calcium hydroxide P.A. and different vehicles (saline solution - paste A and Copaifera langsdorffii Desfon oil - paste B) on oral microorganisms and dentin bridge formation in dogs. The antimicrobial action of the pastes and their components was analysed by the minimum inhibitory concentration in agar gel technique. The components were diluted and tested on fifteen standard strains of microorganisms associated with endodontic diseases. The microorganisms were cultivated and after incubation data was analysed using One-Way ANOVA and Turkey's test (P≤0.05). Four superior incisors of ten animals were used to evaluate dentin bridge formation. Two incisors were capped with paste A (GA) and two with paste B (GB). After 90 days, the teeth were extracted for histological analysis and the degree of dentin bridge formation evaluated. Data was analysed by the Kruskal-Wallis test (P<0.05). The pastes and their components were classified in the following decreasing order of antimicrobial action: calcium hydroxide P.A., paste A, paste B and Copaifera langsdorffii Desfon oil. Calcium hydroxide P.A. showed significantly higher antimicrobial action than the pastes or their vehicles. No significant difference was observed between the two pastes in dentin bridge formation. Based on the microorganisms studied, it can be concluded that the pastes analysed showed similar antimicrobial potential but differed significantly from their individual components. No significant difference was observed in dentin bridge formation between the different pastes tested.

Foi avaliada a ação de pastas formuladas com hidróxido de cálcio P.A. e diferentes veículos (solução fisiológica - pasta A e óleo de Copaifera langsdorffii Desfon - pasta B) sobre microrganismos bucais e formação de ponte dentinária em cães. A ação antimicrobiana das pastas e de seus componentes individuais foi avaliada pela técnica da concentração inibitória mínima pela diluição em ágar. Os materiais foram diluídos e avaliados contra quinze cepas padrão de microrganismos relacionados a doenças endodônticas. Os microrganismos foram cultivados e, após a incubação, os dados foram analisados (Anova One-Way, Tukey, P≤0,05). Para a avaliação da formação de ponte dentinária, quatro incisivos superiores de dez animais foram tratados, sendo dois capeados com pasta A (GA) e dois com a pasta B (GB). Após 90 dias, os dentes foram extraídos para obtenção de cortes histológicos, com o objetivo de se avaliar o grau de formação de ponte dentinária. Os dados obtidos foram submetidos à análise estatística (Kruskal-Wallis, P<0,05). Segundo a ação antimicrobiana, os materiais foram classificados em ordem decrescente: hidróxido de cálcio P.A., pasta A, pasta B e óleo de Copaifera langsdorffii Desfon, com diferenças estatisticamente significantes entre o hidróxido de cálcio P.A., as pastas e os veículos. Ao final do estudo, observou-se que as duas pastas avaliadas foram semelhantes quanto à formação de ponte dentinária. Considerando-se os microrganismos selecionados, conclui-se que as pastas avaliadas foram semelhantes entre si em termos de potencial antimicrobiano, diferindo dos componentes individuais. Em relação à formação de ponte dentinária, não foram observadas diferenças significantes entre os dentes tratados com as diferentes pastas.

Relação entre a biometria ultrassonográfica ocular e os parâmetros morfométricos do crânio, idade, peso e gênero em gatos domésticos / Relation between opfthalmic ultrasound biometry and the morphometric parameters of the skull, age, weight and gender in domestic cats

O exame ultrassonográfico ocular é indispensável no pré-operatório de procedimentos cirúrgicos intraoculares como a facectomia, além de ser uma ferramenta complementar ao exame oftalmológico, em casos de perda da transparência dos meios ópticos. A inexistência de estudos acerca de padrões de normalidades para as medidas do bulbo ocular e de suas estruturas internas nos gatos, cujos valores possibilitam o monitoramento de enfermidades e auxiliam em procedimentos cirúrgicos motivaram este estudo. Utilizaram-se 40 gatos, adultos, machos e fêmeas, livres de enfermidades sistêmica e oftalmológica. Destes, 22 eram da raça persa (grupo braquicefálico - GB) e 18 sem raça definida (grupo não braquicefálico - GNB). A biometria ultrassonográfica ocular transcorneana foi realizada, em modo-B∕A, com o transdutor microlinear de 9 MHz e as medidas D1 (profundidade da câmara anterior), D2 (diâmetro do cristalino), D3 (profundidade da câmara vítrea) e D4 (diâmetro axial do bulbo ocular) aferidas. Ainda, mensuraram-se as distâncias fronto-occipital e bizigomática e o peso desses animais. Os dados obtidos foram analisados pelo teste-t pareado, seguindo-se as análises de variância e covariância, além da regressão linear múltipla relacionando-se as medidas de D1, D2, D3 e D4 às medidas bizigomática e fronto-occipital, como também à idade, ao peso e ao gênero. Obteve-se como resultado a média de D1, D2, D3 e D4, assim como dos diâmetros bizigomático e fronto-occipital, idade e peso, verificando-se diferenças significativas para D4 nas fêmeas de GB. Houve, pela análise de regressão linear, influência do peso, idade e diâmetro fronto-occipital sobre D1, D2 e D4 nos gatos do GB, e dos diâmetros bizigomático sobre D1, D3 e D4 nos gatos do GNB. Conclui-se que houve diferença no diâmetro axial do bulbo ocular nas fêmeas do GB, e que o peso, a idade e os diâmetros cranianos influenciam a biometria ocular dos gatos braquicefálicos e não braquicefálicos.

Ocular ultrasonography is a helpful ophthalmic examination, performed on the absence of transparency in ocular means and frequently requested prior intraocular surgery. Unfortunately, the lack of studies upon ultrasonografic images of the normal feline eye, difficults the evaluation of its biometry and its inner structures in many ophthalmic diseases and also before surgery. The objective of this study was to evaluate the ocular biometry and the morphometric parameters of the cranium of 40 healthy adult cats, including 22 Persian cats (Brachycephalic group - BG) and 18 Mixed-breed cats (Noun brachycephalic group - NBG). B/A-mode ultrasonographic biometry, utilizing a 9 MHz probe, was performed for depth of the anterior chamber (D1), lens axial length (D2), depth of the vitreous chamber (D3) and axial length of the globe (D4). Morphometric parameters of the cranium were obtained for bizygomatic (BZ) and occipital frontal (OF) diameters. Data was collected and statistical analysis, including "t" paired tests, variance and covariance analysis and multiple linear regressions was performed for every obtained measure and also for animal ages, weigh and gender. Statistic relevant values were observed in D4 parameter for female cats of BG. Multiple linear regression indicated some influence of the weigh, age and OF in D1, D2 and D4 of PG; and of BZ in D1, D3 and D4 of NBG. Besides that, it was observed that biometry was also influenced by weigh, age and morphometric parameters of their craniums in both groups.

Uso da acepromazina, dexmedetomidina e xilazina na sedação em cães: alterações hematológicas e bioquímicas

Foram avaliados os efeitos hematológicos e bioquímicos mediante a sedação com acepromazina, dexmedetomidina ou xilazina em cães. Para tanto, os animais foram distribuídos aleatoriamente em 3 tratamentos denominados GA (acepromazina 0,1 mg/kg), GD (dexmedetomidina 0,01 mg/kg) e GX (xilazina 1 mg/kg) por via i.m. Os parâmetros verificados foram eritrócitos totais, hematócrito (Ht), hemoglobina (Hb), leucócitos totais, proteínas totais, alanina transferase, aspartato transferase, albumina, fosfatase alcalina, gama-glutamil transferase, creatinina e uréia plasmática. Os dados foram coletados nos momentos T0 a T480, sendo T0 previamente a aplicação dos fármacos e o restante dos momentos 15, 30, 60, 120, 240 e 480 minutos após a aplicação dos agentes. Foi observada redução dos eritrócitos totais em todos os momentos comparados ao basal no GA. Houve redução dos valores da Hb e do Ht durante todos os momentos de avaliação comparativamente a T0 no grupo GA e GX. Houve redução significativa dos leucócitos totais nos momentos T30, T60, T120 e T240 no GA comparativamente ao momento T0; já nos grupos GD e GX os valores médios foram inferiores ao T0 nos tempos T30 e T120, respectivamente. Não foram verificadas diferenças estatisticamente significativas nas variáveis bioquímicas analisadas entre os tempos e grupos.