Clinimetric properties of the Perme Intensive Care Unit Mobility Score -a multicenter study for minimum important difference and responsiveness analysis

Background: The use of instruments in clinical practice with measurement properties tested is highly recommended, in order to provide adequate assessment and measurement of outcomes. Objective: To calculate the minimum clinically important difference (MCID) and responsiveness of the Perme Intensive Care Unit Mobility Score (Perme Score). Methods: This retrospective, multicentric study investigated the clinimetric properties of MCID, estimated by constructing the Receiver Operating Characteristic (ROC). Maximizing sensitivity and specificity by Youden's, the ROC curve calibration was performed by the Hosmer and Lemeshow goodness-of-fit test. Additionally, we established the responsiveness, floor and ceiling effects, internal consistency, and predictive validity of the Perme Score. Results: A total of 1.200 adult patients records from four mixed general intensive care units (ICUs) were included. To analyze which difference clinically reflects a relevant evolution we calculated the area under the curve (AUC) of 0.96 (95% CI: 0.95-0.98), and the optimal cut-off value of 7.0 points was established. No substantial floor (8.8%) or ceiling effects (4.9%) were observed at ICU discharge. However, a moderate floor effect was observed at ICU admission (19.3%), in contrast to a very low incidence of ceiling effect (0.6%). The Perme Score at ICU admission was associated with hospital mortality, OR 0.86 (95% CI: 0.82-0.91), and the predictive validity for ICU stay presented a mean ratio of 0.97 (95% CI: 0.96-0.98). Conclusion: Our findings support the establishment of the minimum clinically important difference and responsiveness of the Perme Score as a measure of mobility status in the ICU.

Antecedentes: Se recomienda encarecidamente el uso de instrumentos en la práctica clínica con propiedades de medición probadas, con el fin de proporcionar una evaluación y medición adecuada de los resultados. Objetivo: Calcular la diferencia mínima clínicamente importante (MCID) y la capacidad de respuesta de la puntuación de movilidad de la unidad de cuidados intensivos de Perme (Perme Score). Métodos: Este estudio multicéntrico retrospectivo investigó las propiedades clinimétricas de MCID, estimadas mediante la construcción de la característica operativa del receptor (ROC). Maximizando la sensibilidad y especificidad mediante la prueba de Youden, la calibración de la curva ROC se realizó mediante la prueba de bondad de ajuste de Hosmer y Lemeshow. Además, establecimos la capacidad de respuesta, los efectos suelo y techo, la consistencia interna y la validez predictiva del Perme Score. Resultados: Se incluyeron un total de 1,200 registros de pacientes adultos de cuatro unidades de cuidados intensivos (UCI) generales mixtas. Para analizar qué diferencia refleja clínicamente una evolución relevante calculamos el área bajo la curva (AUC) de 0.96 (95% CI: 0.95-0.98); y se estableció el valor de corte óptimo de 7.0 puntos. No se observaron efectos suelo (8.8%) o techo (4.9%) sustanciales al alta de la UCI. Sin embargo, se observó un efecto suelo moderado al ingreso en la UCI (19.3%), en contraste con una incidencia muy baja del efecto techo (0.6%). El Perme Score al ingreso en UCI se asoció con la mortalidad hospitalaria, OR 0.86 (95% CI: 0.82-0.91), y la validez predictiva de estancia en UCI presentó una relación media de 0.97 (95% CI: 0.96-0.98). Conclusiones: Nuestros hallazgos respaldan el establecimiento de la diferencia mínima clínicamente importante y la capacidad de respuesta de el Perme Score como medida del estado de movilidad en la UCI.

Sports practice after lumbar discectomy in non-professional athletes: a cross-sectional study / Prática esportiva após discectomia lombar em atletas não profissionais: estudo transversal / Práctica deportiva tras discectomía lumbar en atletas no profesionales: un estudio transversal

ABSTRACT: Introduction: Most athletes treated for lumbar disc herniation return to play between 3 and 9 months after conservative or surgical treatment. In the last two decades, the general population increased the practice and participation in amateur competitions, being more prone to overload injuries. Objectives: To evaluate sports practice after lumbar discectomy in non-professional athletes. Methods: In the last five years, a digital questionnaire was sent to patients submitted to up to two levels of open discectomy. After signing the informed consent form, the patients were instructed to answer the questionnaire with personal and clinical data related to disc treatment and sports practice after the procedure. Results: Of 182 contacted patients, a hundred answered the questionnaire; 65% practiced regular sports activities before surgery. From patients who practiced sports before surgery, 75.38% returned to sports activities after the procedure. 39.29% returned between 3 and 6 months. Only 12.31% referred to impaired sports performance, while 56.92% performed unaffected, and 21.54% reported improved performance after surgery. Prior sports practice, participation in amateur competitions, and regular core strengthening were significantly associated with sports practice after surgery (P<0,05). Conclusions: From the participants who had already practiced sports before surgery, 75.38% returned after the surgical procedure. Sports practice before surgery, participation in amateur competitions, and regular core strengthening were positively associated with a return to sports practice after lumbar discectomy. The study shows that core strengthening should be encouraged and recommended to all non-professional athletes who intend to return to sports after microdiscectomy surgeries. Level of Evidence: III; Cross-Sectional Retrospective Study.

RESUMO: Introdução: A maioria dos atletas tratados de hérnia de disco lombar volta a jogar em um período entre 3 e 9 meses, após tratamento conservador ou cirúrgico. Nas últimas duas décadas, a população em geral aumentou a prática e participação em competições amadoras; sendo mais propenso a lesões por uso excessivo. Objetivos: Avaliar a prática esportiva após discectomia lombar em atletas não profissionais. Métodos: Um questionário digital foi enviado aos pacientes submetidos à discectomia aberta de até 2 níveis, nos últimos cinco anos. Após a assinatura do termo de consentimento livre e esclarecido, os pacientes foram orientados a responder o questionário com dados pessoais e clínicos relacionados ao tratamento e à prática esportiva após o procedimento. Resultados: Dos 182 pacientes contatados, cem responderam ao questionário; destes, 65% praticavam atividades esportivas regulares antes da cirurgia. Dos pacientes que praticavam esportes antes da cirurgia, 75,38% retornaram à atividade esportiva após o procedimento. 39,29% retornaram entre 3 e 6 meses. Apenas 12,31% relataram piora no desempenho esportivo, enquanto para 56,92% o desempenho não foi afetado e 21,54% relataram melhora no desempenho após a cirurgia. A prática esportiva prévia, a participação em competições amadoras e o fortalecimento regular do core foram significativamente associados à prática esportiva após a cirurgia (P<0,05). Conclusões: Dos participantes que já praticavam esportes antes da cirurgia, 75,38% retornaram após o procedimento cirúrgico. A prática esportiva prévia à cirurgia, a participação em competições amadoras e o fortalecimento regular do core foram positivamente associados ao retorno à prática esportiva após a discectomia lombar. O estudo mostra que o fortalecimento do core deve ser incentivado e recomendado para todos os atletas não profissionais que pretendem retornar ao esporte após cirurgias de microdiscectomia. Nível de Evidência III; Estudio Transversal Retrospectivo.

RESUMEN: Introducción: La mayoría de los atletas tratados por hernia de disco lumbar regresan a jugar en un período de entre 3 y 9 meses, luego de un tratamiento conservador o quirúrgico. En las últimas dos décadas, la población en general incrementó la práctica y participación en competencias aficionadas; siendo más propensos a sufrir lesiones por sobrecarga.Objetivos: Evaluar la práctica deportiva posterior a discectomía lumbar en deportistas no profesionales. Métodos: Se envió un cuestionario digital a los pacientes sometidos a discectomía abierta de hasta 2 niveles, en los últimos cinco años. Tras firmar el consentimiento informado, se instruyó a los pacientes para que respondieran el cuestionario con datos personales y clínicos, relacionados con el tratamiento discal y la práctica deportiva posterior al procedimiento. Resultados: De 182 pacientes contactados, cien respondieron el cuestionario; de estos, el 65% practicaba actividades deportivas regulares antes de la cirugía. De los pacientes que practicaban deporte antes de la cirugía, el 75,38% retornó a la actividad deportiva después del procedimiento. El 39,29% volvió entre los 3 y 6 meses. Solo el 12,31 % refirió deterioro del rendimiento deportivo, mientras que para el 56,92 % el rendimiento no se vio afectado y el 21,54 % refirió mejora del rendimiento después de la cirugía. La práctica deportiva previa, la participación en competiciones aficionadas y la realización regular de fortalecimiento del core, se asociaron significativamente con la práctica deportiva tras la cirugía (P<0,05). Conclusiones: De los participantes que ya practicaban deporte antes de la cirugía, el 75,38% regresaron después del procedimiento quirúrgico. La práctica deportiva previa a la cirugía, la participación en competiciones de aficionados y la realización de un fortalecimiento core periódico se asociaron positivamente con la vuelta a la práctica deportiva tras la discectomía lumbar. El estudio muestra que se debe alentar y recomendar el fortalecimiento del core a todos los atletas no profesionales que tengan la intención de volver al deporte después de las cirugías de microdiscectomía. Nivel de Evidencia III; Estudio Retrospectivo Transversal.

Vena Cava Filter Misplacement: A Killer Traveler

ABSTRACT Inferior vena cava filter embolization is not uncommon and can reach 11.8%. However, device migration to the heart is not frequent and occurs in cases after inferior vena cava filter fracture. We present the case of a young woman who was submitted to a routine inferior vena cava filter placement three days before and presented with hemodynamic instability. Since the device was not retrievable, the surgical team opted for an open cardiac surgery under cardiopulmonary bypass to remove the inferior vena cava filter and avoid other further complications.

Effect of the Unilateral Breast Cancer Surgery on the Shoulder Movement: Electromyographic and Motion Analysis / Efecto de la cirugía unilateral del cáncer de mama en el movimiento del hombro: análisis electromiográfico y de movimiento

ABSTRACT After breast cancer surgery, women might develop musculoskeletal impairments that affect movements of the upper limbs and reduce the quality of life. The objective of this research was to analyze the effect of the unilateral breast cancer surgery on the kinematics of the shoulder and the electrical activity of the upper trapezius, middle deltoid and pectoralis major muscles. Eight right-handed female participants, mean age 46.5 ± 5.45 years and mean body mass 71.21 ± 13.33 kg, with unilateral breast cancer surgery, without breast reconstruction and without lymphedema symptoms were included in the research. Flexion-extension and abduction-adduction movements of the shoulder were evaluated with infrared cameras and the electrical activity was measured using surface electromyography. The statistical analysis of the direction angles showed a significant reduction of the flexion-extension and abduction-adduction movements in the affected side in most of the participants (p<0.05). The muscle electrical activity did not present a significant difference between the two sides for the flexion-extension and abduction-adduction movements (p>0.05). The results suggest that the surgical procedure could compromise the range of motion of the affected side. Furthermore, this research contributes to clarify the effect of the surgical procedure in the range of motion of the upper limbs.

RESUMEN Después de la cirugía de cáncer de mama, las mujeres pueden desarrollar deficiencias musculoesqueléticas que afectan los movimientos de las extremidades superiores y reducen la calidad de vida. El objetivo de esta investigación fue analizar el efecto de la cirugía unilateral del cáncer de mama sobre la cinemática del hombro y la actividad eléctrica de los músculos trapecio superior, deltoides medio y pectoral mayor. Se incluyeron ocho participantes diestras, edad promedio 46.5 ± 5.45 años y masa promedio 71.21 ± 13.33 kg, con cirugía de cáncer de mama unilateral, sin reconstrucción mamaria y sin síntomas de linfedema. Los movimientos de flexión-extensión y abducción-aducción del hombro se evaluaron con cámaras infrarrojas y se midió la actividad eléctrica mediante electromiografía de superficie. El análisis estadístico de los ángulos de dirección mostró una reducción significativa del movimiento de flexión-extensión y abducción-aducción en el lado afectado en la mayoría de las participantes (p<0.05). La actividad eléctrica muscular no presentó diferencia significativa entre los dos lados para los movimientos de flexión-extensión y abducción-aducción (p>0.05). Los resultados sugieren que el procedimiento quirúrgico podría comprometer el rango de movimiento del lado afectado. Además, esta investigación contribuye a esclarecer el efecto del procedimiento quirúrgico en el rango de movimiento de los miembros superiores.

El e-learning e impacto en la enseñanza y evaluación de anatomía humana durante la COVID 19: una revisión de la calidad de la literatura / E-learning and impact on the teaching and assessment of human anatomy during COVID 19: a review of the quality of the literature

RESUMEN: El e-learning (aprendizaje electrónico) es el proceso de enseñanza, aprendizaje y evaluación, a través de internet y la tecnología, es decir, está centrado en los métodos de aprendizaje, la expansión y conexión de información, que en el uso de una computadora como un artefacto en el proceso de aprendizaje. El propósito de esta revisión fue identificar estudios que exploraran las tecnologías e-learning y su impacto en el proceso de enseñanza y evaluación de Anatomía Humana, y evaluar la calidad de investigación publicada. Se realizó una revisión sistemática de la literatura en las bases de datos Pudmed (Medline), Ovid (cochrane Central), Ovid (Medline), Scopus, Web of science (clarivate) y Science Direct, incluyendo las palabras claves: Examination, Teaching, COVID-19 medical education, COVID-19, Medical student exams, Anatomy, Students, Medical. Se evaluó la calidad de las investigaciones a través del instrumento de Calidad del Estudio de Investigación de Educación Médica (MERSQI). En total se encontraron 202 artículos de investigación, y al aplicar los criterios de inclusión y exclusión se identificaron un total de 24 artículos; tras leer los artículos, se escogieron cuatro investigaciones que cumplieron con los criterios de síntesis en esta revisión. En general, los resultados mostraron un impacto favorable de las tecnologías e-learning pues facilitó el acceso, la flexibilidad y el ritmo de aprendizaje para cada estudiante, también promovió nuevas formas de enseñanza y evaluación en la disciplina de la Anatomía Humana en estudiantes de medicina durante la pandemia la COVID-19. Así, la educación médica para la ciencia básica en anatomía humana indica una transición a un aprendizaje combinado de lo presencial y virtual a un modelo de aprendizaje mixto (b-learning).

SUMMARY: E-learning (electronic learning) is the process of teaching, learning and evaluation, through the internet and technology, that is, it is focused on learning methods, the expansion and connection of information, which in the use of a computer as an artifact in the learning process. The purpose of this review was to identify studies that explore e-learning technologies and their impact on the teaching and assessment process of Human Anatomy, and to assess the quality of published research. A systematic review of the literature was carried out in the databases Pudmed (Medline), Ovid (Cochrane Central), Ovid (Medline), Scopus, Web of science (clarivate) and Science Direct, including the keywords: Examination, Teaching, COVID-19 medical education, COVID-19, Medical student exams, Anatomy, Students, Medical. Research quality was assessed using the Medical Education Research Study Quality (MERSQI) instrument. In total, 202 research articles were found, and when applying the inclusion and exclusion criteria, a total of 24 articles were identified; After reading the articles, four investigations were chosen that met the synthesis criteria in this review. In general, the results showed a favorable impact of e-learning technologies since it facilitated access, flexibility and learning pace for each student, it also promoted new forms of teaching and evaluation in the discipline of Human Anatomy in medical students. during the Covid-19 pandemic. Thus, medical education for basic science in human anatomy indicates a transition from blended face-to-face and virtual learning to a blended learning model (b-learning).

Perfil e desfechos clínicos de pacientes internados por covid-19 em um hospital do sul do brasil / Perfil y resultados clínicos de pacientes internados por covid-19 en un hospital del sur de brasil / Clinical profile and outcomes of patients hospitalized for covid-19 in a hospital in southern brazil

Objetivo: descrever perfil e desfechos clínicos de pacientes diagnosticados com COVID-19 admitidos em hospital privado na região Sul do Brasil. Método: estudo descritivo, realizado com 110 pacientes com COVID-19 que necessitaram de internação hospitalar entre março e maio de 2020. Foram coletados dados sociodemográficos, perfil clínico, sinais e sintomas e desfechos clínicos. Adotou-se análise descritiva para interpretação dos dados. Resultados: predominou sexo masculino (64,5%). Comorbidade prevalente: Hipertensão Arterial Sistêmica (45,5%). Sinais e sintomas com maior destaque: tosse (53,6%) e dispneia (48,2%). Desfechos clínicos evidenciados: tomografia de tórax com opacidades em vidro fosco (98,2%), suplementação com oxigenoterapia (86,4%), encaminhamento para Unidade de Internação (90,9%). Intercorrências observadas: arritmias cardíacas (18,2%) e hipoxemia (18,2%). Desfecho final predominante foi alta melhorada (90%). Conclusão: a descrição de perfil e desfecho clínico de pacientes com COVID-19 proporcionará o direcionamento de cuidados com fluxos e protocolos assistenciais que garantam qualidade da assistência e segurança na prática clínica.

Objetivo: describir perfil y resultados clínicos de pacientes diagnosticados con COVID-19 admitidos en hospital privado en la región Sur de Brasil. Método: estudio descriptivo, realizado con 110 pacientes con COVID-19 que necesitaron de internación hospitalaria entre marzo y mayo de 2020. Se recogieron datos sociodemográficos, perfil clínico, signos y síntomas y resultados clínicos. Se adoptó análisis descriptivo para interpretación de los datos. Resultados: predominó sexo masculino (64,5%). Comorbilidad prevalente: Hipertensión Arterial Sistémica (45,5%). Signos y síntomas con mayor destaque: tos (53,6%) y disnea (48,2%). Resultados clínicos evidenciados: tomografía de tórax con opacidades en vidrio esmerilado (98,2%), suplementación con oxigenoterapia (86,4%), encaminamiento para Unidad de Internación (90,9%). Complicaciones observadas: arritmias cardíacas (18,2%) e hipoxemia (18,2%). Resultado final predominante fue alta mejorada (90%). Conclusión: la descripción de perfil y resultado clínico de pacientes con COVID-19 proporcionará la orientación de cuidados con flujos y protocolos asistenciales que garanticen calidad de la asistencia y seguridad en la práctica clínica.

Objective: to describe the clinical profile and outcomes of patients diagnosed with COVID-19 admitted to a private hospital in southern Brazil. Method: descriptive study, conducted with 110 patients with COVID-19 who required hospitalization between March and May 2020. Sociodemographic data, clinical profile, signs and symptoms, and clinical outcomes were collected. Descriptive analysis was adopted for data interpretation. Results: male predominated (64.5%). Prevalent comorbidity: Systemic Arterial Hypertension (45.5%). Signs and symptoms with greater prominence: cough (53.6%) and dyspnea (48.2%). Clinical outcomes evidenced: chest tomography with ground-glass opacities (98.2%), supplementation with oxygen therapy (86.4%), referral to the Hospitalization Unit (90.9%). Observed complications: cardiac arrhythmias (18.2%) and hypoxemia (18.2%). Predominant outcome was improved discharge (90%). Conclusion: the description of the clinical profile and outcome of patients with COVID-19 will provide the direction of care with care flows and protocols that guarantee quality of care and safety in clinical practice.

Las tecnologías e-learning y TIC en el aprendizaje a largo plazo de la anatomía humana en estudiantes del área de la salud: una revisión de la literatura / E-learning and TIC technologies in long-term learning of human anatomy of health students: a review of the literature

RESUMEN: Los propósitos de esta revisión literaria fueron, identificar estudios que explorarenlas tecnologías e-learning y TIC y su impacto en el aprendizaje a largo plazo, y evaluar la calidad de los estudios en esta aérea. Se realizaron búsquedas en las bases de datos PubMed (Medline), Ovid (cochrane Central), Ovid (Medline), Ovid (Global Health), Scopus, Web of Science (clarivate) y Science Direct, incluyendo las palabras clave: Education Distance, eLearning, Learning, Learning Curve, Long Term Memory, active learning, Repetion Anatomy, Anatomy Cross-Sectional, Anatomy Regional, Students Health Occupations y Medical education. Tres evaluadores de forma independiente evaluaron la calidad de las investigaciones utilizando el instrumento de Calidad del Estudio de Investigación de Educación Médica (MERSQI). El total de resultados inicialmente fueron 557 artículos de investigación, al aplicar los criterios de inclusión y exclusión por los evaluadores se identificaron un total de 25 artículos. Posterior a la revisión de los artículos se incluyeron 2 investigaciones que cumplieron con los criterios de síntesis en esteestudio. En conclusión, la incorporación de las tecnologías e - learning y TIC permitió evaluar el aprendizaje a largo plazo, aporto motivación y aumento en las habilidades del conocimiento, además de ser una herramienta para el proceso de Enseñanza - aprendizaje -evaluación, sin embargo, se necesitan investigaciones que evalúen cuidadosamente el impacto de los factores preponderantes del aprendizaje largo plazo, mientras se utilizan las tecnologías e-learning y TIC.

SUMMARY: The objective of this review was to identify studies that explore e-learning and ICT technologies and their impact on long-term learning, and to evaluate the quality of studies in this area. Searches were carried out in databases PubMed (Medline), Ovid (Cochrane Central), Ovid (Medline), Ovid (Global Health), Scopus, Web of Science (clarivate) and Science Direct, including keywords: Education Distance, e-Learning, Learning , Learning Curve, Long Term Memory, Active Learning, Repetition Anatomy, Anatomy Cross-Sectional, Anatomy Regional, Students Health Occupations and Medical education. Three evaluators independently assessed the quality of the studies using the Medical Education Research Study Quality (MERSQI) instrument. The to- tal results were initially 557 research articles, and after applying inclusion and exclusion criteria, a total of 25 articles were identified. Following a review of the articles, 2 studies were included that met the synthesis criteria in this study. In conclusion, integrating e-learning and ICT technologies facilitate the evaluation of long- term learning, provide motivation and increase knowledge skills, in addition to being a tool for the Teaching-learning-evaluation process. However, further research is needed to evaluate the impact of the preponderant factors of long-term learning, while using e- learning and ICT technologies.

Sangrado uterino anormal: Es la iatrogenia más frecuente de lo que comúnmente conocemos? / Abnormal uterine bleeding: Is iatrogenic more common than usually known?

Este es un artículo de revisión en el cual se expone la clasificación de la hemorragia uterina anormal de acuerdo a su curso clínico y su etiología según lo expuesto por la FIGO inicialmente en 2011 y revisado en 2018 con el sistema PALM-COEIN. Se desglosa cada una de las causas y se describe la manera cómo impacta el sangrado y la calidad de la vida de la mujer. Se hace énfasis en la importancia de enfocar el tratamiento de acuerdo a la causa subyacente para de esa manera evitar una posible iatrogenia.

This is a review article in which the classification of abnormal uterine bleeding is exposed according to its clinical course and etiology as presented by FIGO in 2011 and reviewed in 2018 with the PALM-COEIN system. Each of the causes is broken down and described the way they impact bleeding and quality of life. Emphasis is done in the importance of focusing treatment according to the underlying cause, and avoid possible iatrogenia.

Heyde syndrome treated by conventional aortic valve replacement

Abstract Heyde syndrome manifests as aortic stenosis associated with gastrointestinal bleeding. We describe the case of a 64-year-old man who came to the emergency room due to acute heart failure and intermittent gastrointestinal bleeding. Treatment involves initial correction of anemia and heart failure followed by aortic valve replacement. The prosthesis used depends on the characteristics of each patient and valve replacement allows the resolution of bleeding in most cases. Gastrointestinal bleeding in patients with aortic stenosis is associated with severity of the valve obstruction. A mechanical prosthesis was used with no recurrent bleeding even with the need for lifelong anticoagulation therapy.

Comparative study of electrical stimulation of the heart with vdd and ddd pacemakers as to the evolution to atrial fibrillation

Abstract Introduction: The pacemaker implantation VDD is considered simpler, faster, less expensive and causes fewer complications compared to DDD. However, the VDD pacemaker has not been widely used in many centers, perhaps for fear of dysfunction of the sinus node and the reduction of atrial sensitivity by the pacemaker during follow-up after implantation. Objective: To compare patients with DDD and VDD pacemakers regarding the evolution of chronic atrial fibrillation (AF) and length of stay outside this postoperative arrhythmia. Methods: It was included 158 patients with dual chamber pacemakers, 48 DDD and 110 VDD. Follow-up period: between January 1, 1999 and December 31, 2015. The mean follow-up of patients with DDD was 5.35 years and the VDD, 4.74 years. The percentage of each group (DDD and VDD) which evolved to AF during follow-up was assessed. Also, it was made an actuarial study with the respective curves indicating the time free from AF for each group. Patients were classified according to the diagnosis that led to pacemaker implantation and the degree of heart failure. Results: The percentage of patients who developed AF was higher in DDD group (10.42%) than in VDD group (6.36%), but without statistical significance. Patients with DDD and VDD remained free of AF for similar period. Conclusion: Considering the results, the VDD pacemaker continues to be a good option to the DDD for routine use in cases properly indicated.

Valores de normalidade para o questionário Rhinoplasty Outcome Evaluation (ROE) / Normal values for the Rhinoplasty Outcome Evaluation (ROE) questionnaire

O Rhinoplasty Outcome Evaluation (ROE) é um questionário de fácil aplicação, que abrange os principais a spectos que influenciam na satisfação do paciente em relação à rinoplastia. Porém, não há, ainda, critérios de normalidade para este questionário. OBJETIVO: Realizar a tradução e adaptação cultural do questionário Rhinoplasty Outcome Evaluation para o Português Brasileiro e estabelecer um parâmetro de normalidade. CASUÍSTICA E MÉTODO: Tradução e adaptação cultural do questionário para Português Brasileiro. Estudo transversal com a aplicação do ROE em 62 pacientes em pré-operatório de rinoplastia ou rinosseptoplastia (Casos) e 100 voluntários sem desejo de cirurgia nasal (Controles). Análise da sensibilidade e especificidade das possíveis notas de corte. Resultados: A média dos escores dos Casos foi de 6,6 ou 27,5% (DP 3,18; mín 0; máx 15) e dos controles, 17,94 ou 74,75% (DP 3,91; mín 7; máx 24). O melhor valor mínimo para normalidade foi de 12 ou 50%, com sensibilidade de 95,16% e especificidade de 95%. CONCLUSÃO: No escore de zero a 24 do ROE em Português Brasileiro, encontramos o valor 12 como limite mínimo de normalidade, com índices de sensibilidade e especificidade de 95,16% e 95%, respectivamente.

Rhinoplasty Outcome Evaluation (ROE) is an easy-to-use questionnaire that allows comprehensive assessment of rhinoplasty-related patient satisfaction. However, normal values for this questionnaire are not known. OBJECTIVE: To translate and cross-culture adapt the Rhinoplasty Outcome Evaluation questionnaire to Brazilian Portuguese and to establish normality parameters. MATERIALS AND METHODS: Cross-sectional study with ROE administration to 62 patients waiting for rhinoplasty or septorhinoplasty (Cases) and 100 volunteer subjects without desire or need for nasal surgery (Controls). Assessment of possible sensitivity and specificity cutoffs. RESULTS: The cases' mean score was 6.6 or 27.5% (SD 3.18; min 0; max 15) and controls' mean score was 17.94 or 74.75% (SD 3.91; min 7; max 24). The best cutoff was 12 or 50%, with 95.16% sensitivity and 95% specificity. CONCLUSION: At the zero-to-24 score of the Brazilian Portuguese ROE, we found 12 as the best cutoff, with 95.16% of sensitivity and 95% of specificity.

Caudal septoplasty: efficacy of a surgical technique-preliminnary report / Septoplastia caudal - eficácia de uma técnica cirúrgica: resultados preliminares

Although not being the most frequent nasal septal deviations, those of the caudal septum account for many complaints. The correction of such defects has always been the subject of much controversy, and several different operative techniques have been described. AIM: To assess the efficacy of a surgical technique for correcting caudal septal deviations. MATERIALS AND METHODS: Prospective study with preliminary reports of 10 patients who answered a standardized, specific questionnaire (the Nasal Obstruction Symptom Evaluation, or NOSE), underwent acoustic rhinometry and had their noses photographed. Caudal deviations were then corrected through a surgical technique whereby the entire deviated portion is removed and a straight cartilage segment is placed between the medial crura of the alar cartilages, through a retrograde approach, to support the nasal tip. Sixty days after all patients were reassessed. RESULTS: As for the NOSE questionnaire, mean pre-operative and post-operative scores were 82.39 and 7.39 respectively (p<0.001). Pre-operative acoustic rhinometry showed mean minimum cross-sectional area (MCA) values of 0.352 and 0.431 cm2, whereas mean post-operative values were 0.657 and 0.711 cm2(p<0.0001). CONCLUSIONS: The study results prove, both subjectively (patient satisfaction as measured with a standardized questionnaire) and objectively (acoustic rhinometry findings), that the proposed technique for correction of caudal septal deviation is safe and effective.

Os desvios situados na parte caudal do septo nasal, apesar de não serem os mais frequentes, são causadores de muitas queixas, e sua correção sempre gerou muitas controvérsias. OBJETIVO: Avaliar, com resultados preliminares, a eficácia de uma técnica cirúrgica para correção dos desvios caudais do septo nasal. MATERIAL E MÉTODO: Ensaio Clínico prospectivo com 10 pacientes que responderam a um questionário padronizado - Nasal Obstruction Symptom Evaluation (NOSE) -, foram submetidos ao exame de Rinometria Acústica e fotografados. Tiveram, então, os desvios caudais corrigidos cirurgicamente por uma técnica na qual toda a porção do desvio é retirada e uma parte sem desvios da cartilagem é recolocada entre as cruras mediais das cartilagens alares por via retrógrada para a sustentação da ponta nasal. Apos 60 dias os pacientes foram reavaliados. RESULTADOS: Quanto ao Questionário NOSE a média dos valores pré-operatórios foi de 82,39 e a média no pós-operatório foi de 7,39 (p < 0,001). Quanto aos resultados da Rinometria Acústica a média dos valores da área de secção transversa mínima ou MCA no pré-operatório foi de 0,352 e 0,431cm2. No pós-operatório a média dos valores foi de 0,657 e 0,711 cm2,(p < 0,0001). CONCLUSÕES: Apesar de serem ainda resultados iniciais, estes mostram que a técnica apresentada para correção dos desvios caudais do septo nasal é eficaz.

Análisis experimental del desgaste entre UHMWPE y acero inoxidable 316l empleados en la manufactura de prótesis coxofemorales / Experimental wear analysis of UHMWPE and stainless 316l used in the manufacturing of coxofemoral prosthesis

La causa más común de falla en prótesis coxofemorales es el aflojamiento entre los componentes que conforman el sistema, de manera específica la copa acetabular y la cabeza femoral. En esta investigación se presenta un análisis tribológico del desgaste en los componentes mencionados, ya que cuando las superficies en contacto se desgastan, la funcionalidad mecánica del sistema se compromete, debido al cambio de geometría de los mismos, dando como resultado un juego mecánico entre la copa y la cabeza. Los materiales considerados en este estudio son el polietileno de ultra elevado peso molecular (UHMWPE, por sus siglas en inglés) para la copa acetabular, y acero inoxidable 316L para la cabeza femoral. Esta combinación de materiales representa hoy en día la recomendación más usual por parte de los cirujanos para pacientes de la tercera edad. La tasa anual de desgaste se determinó de manera experimental y se cuantificó la cantidad de material desprendido durante el contacto. Se establecieron las condiciones de carga de forma analítica, considerando las que actúan sobre la cabeza femoral a lo largo del área de desgaste durante la marcha humana. Posteriormente, se realizó el análisis experimental de desgaste utilizando una máquina tribológica de configuración perno-sobre-disco (pin-on-disk), diseñada de manera específica para este estudio. Las pruebas para determinar la pérdida volumétrica de los componentes se realizaron bajo tres condiciones de operación: en seco, lubricada con agua destilada y lubricada con suero bovino. El marco experimental considerado consistió en pernos de UHMWPE sobre discos de acero inoxidable 316l simulando el desgaste equivalente a diez años de uso de la prótesis. Finalmente, de los resultados obtenidos se puede establecer que el desgaste y la cantidad de partículas desprendidas disminuyen considerablemente cuando se utiliza suero bovino como lubricante para replicar las condiciones reales de operación del sistema...

The most common cause of failure in coxofemoral prostheses is the loosening between the components of the system, namely the acetabular cup and the femoral head. In this work a tribologic analysis of wear suffered in the components is presented, due to when the surfaces in contact are worn, the mechanical function of the system is compromised as the wearing implies a change in the geometry of the components, thus in their dimensions, resulting on a looseness between the cup and the head. The materials considered in this study are Ultra High Molecular Weight Polyethylene (UHMWPE) for the cup and 316L Stainless Steel for the femoral head, which represent the surgeons choice for elderly patients. The annual wearing rate between these components was experimentally determined, as well as the amount of debris produced during contact. Firstly, the loading conditions were determined analytically considering those acting on the femoral head taking into consideration the wearing area during human walk. Secondly, the experimental analysis consisted in wearing tests using a tribology pin-on-disk machine, specifically built for this study. The tests to determine the volumetric loss of the components were performed under three different operational conditions: dry, lubricated with bovine serum and lubricated with destilated water. The experimental set up consisted on UHMWPE pins and 316L Stainless steel discs simulating the equivalent wear of ten years of usage of the prostheses. Lastly, the obtained results proved that using the bovine serum as lubricant the wear and debris of the components was significantly reduced when compared with other cases, being the dry scenario where more damage was produced. It is important to point out that the bovine serum was chosen to simulate the synovial fluid in which the system is embedded.