Registro Brasileiro de Cardiologia Intervencionista durante a Pandemia de COVID-19 (RBCI-COVID19) / Brazilian Registry of Interventional Cardiology during the COVID-19 Pandemic (RBCI-COVID19)

Resumo Fundamento No início da pandemia de COVID-19, os pacientes com infarto do miocárdio (IM) demoraram para procurar um hospital por medo de contágio ou dificuldades no acesso aos serviços de saúde. Objetivos Avaliar procedimentos de cardiologia intervencionista realizados durante a pandemia de COVID-19 e implicações na abordagem do IM. Métodos Registro prospectivo de 24 centros de hemodinâmica no Brasil, com pacientes adultos submetidos a procedimentos de cardiologia intervencionista entre 26 de maio e 30 de novembro de 2020. Os desfechos foram complicações cardiovasculares (CV) e não CV, morte e IM. A concomitância de COVID-19 foi confirmada com RT-PCR. Técnicas de machine learning foram usadas com modelos não paramétricos de árvores de classificação. Usou-se análise de correspondência simples com o software R. Adotou-se nível de significância de 5%. Resultados Este estudo incluiu 1.282 pacientes, 435 dos quais (33,9%) apresentaram IM: IM com supra de ST (IMCSST), 239 (54,9%); e IM sem supra de ST(IMSSST), 196 (45.1%). Dos 1.282 pacientes, 29 tiveram complicações CV, 47 tiveram complicações não CV e 31 morreram. O diagnóstico de COVID-19 foi confirmado em 77 pacientes (6%), com 15,58% de mortalidade e 6,49% de complicações não CV. A maioria dos pacientes apresentou significativa doença arterial coronariana (63%). Trombo intracoronariano foi mais frequente na presença de IMCSST (3,4%) e COVID-19 (4%). Tempo porta-mesa superior a 12 horas no IMSSST associou-se a 30,8% de complicações, 25% em pacientes com COVID-19. Conclusões Todos os óbitos foram precedidos por complicações CV ou não CV. A presença de COVID-19 foi associada a óbito e complicações não fatais dos pacientes submetidos a procedimentos de cardiologia intervencionista durante a pandemia.

Abstract Background At the beginning of the COVID-19 pandemic, patients with myocardial infarction (MI) took longer to present to hospitals because of fear of contamination and health care access difficulties. Objectives To assess interventional cardiology procedures performed during the COVID-19 pandemic and its implications for MI approach. Methods Prospective registry of 24 cardiac catheterization laboratories in Brazil, with adult patients undergoing interventional cardiology procedures between May 26 and November 30, 2020. The outcomes were cardiovascular (CV) and non-CV complications, death, and MI. Concomitant COVID-19 was confirmed using RT-PCR. Machine learning techniques were used with nonparametric Classification Trees models, and Simple Correspondence Analysis, with R statistical software package. Significance level adopted of 5%. Results This study included 1282 patients, 435 of whom (33.9%) had MI as follows: ST-segment elevation MI (STEMI), 239 (54.9%); and non-ST-segment elevation MI (NSTEMI), 196 (45.1%). Of the 1282 patients, 29 had CV complications, 47 had non-CV complications, and 31 died. The diagnosis of COVID-19 was confirmed in 77 patients (6%), with 15.58% mortality and non-CV complications in 6.49%. Most patients had significant coronary artery disease (63%), and an intracoronary thrombus was more often found in the presence of STEMI (3.4%) and COVID-19 (4%). A door-to-table time longer than 12 hours in NSTEMI was associated with 30.8% of complications, 25% in COVID-19 patients. Conclusions All deaths were preceded by CV or non-CV complications. The presence of COVID-19 was associated with death and non-fatal complications of patients undergoing interventional cardiology procedures during the pandemic.

Metastasis of Pulmonary Carcinoma to the Breast: Case Report / Metástase de Carcinoma Pulmonar para Mama: Relato de Caso / Metástasis de Carcinoma Pulmonar a la Mama: Informe de Caso

Introduction: Pulmonary carcinoma is the most prevalent cancer in the world, followed by breast cancer. It has high mortality rates in men and women mainly due to its ability to metastasize. Metastases from lung carcinoma to the breast are extremely rare. The first case described occurred in 1965 and since then there are few cases of this condition reported in the world medical literature. Case report: A 59-year-old woman who complained of low back pain in May 2017. The investigation revealed a metastatic site in the fifth vertebra of the lumbar spine with unknown origin. Six months later, a new lesion was found in the ninth vertebra of the thoracic spine. Immunohistochemistry showed positivity for cytokeratin 7 and TTF1 markers, confirming the hypothesis of lung carcinoma as the primary site. In March 2018, the patient evolved with a symptomatic nodule in the right breast on ultrasound and with positivity for TTF1 on immunohistochemical study, confirming the metastasis of lung carcinoma to the breast. Treated for two years until March 2020, when she presented multiple brain metastases. Patient had no therapeutic success and died. Conclusion: The difficulty in diagnosing lung carcinoma metastasis to the breast stands out, surgeons, clinicians and pathologists should consider this diagnosis, although rare.

Introdução: O carcinoma pulmonar é o câncer mais prevalente no mundo, seguido pelo de mama. Apresenta altas taxas de mortalidade em homens e mulheres, principalmente em virtude da sua capacidade de metastatizar. As metástases do carcinoma de pulmão para a mama são extremamente raras. O primeiro caso descrito ocorreu em 1965 e, desde então, há poucos casos dessa condição relatados na literatura médica mundial. Relato do caso: Mulher, 59 anos, apresentou dor lombar em maio de 2017. A investigação revelou um local metastático na quinta vértebra da coluna lombar sem descobrir sua origem. Seis meses depois, uma nova lesão foi encontrada na nona vértebra da coluna torácica. A imuno-histoquímica mostrou positividade para os marcadores citoqueratina 7 e TTF1, confirmando a hipótese de carcinoma de pulmão como sítio primário. Em março de 2018, a paciente evoluiu com um nódulo sintomático na mama direita ao ultrassom e com positividade para TTF1 no estudo imuno-histoquímico, confirmando tratar-se de metástase de carcinoma de pulmão para a mama. Foi tratada por dois anos até março de 2020, quando apresentou múltiplas metástases cerebrais. A paciente não teve sucesso terapêutico e faleceu. Conclusão: Ressalta-se a dificuldade no diagnóstico de metástase de carcinoma de pulmão para a mama e alertar clínicos, cirurgiões e patologistas para que considerem esse diagnóstico, embora raro.

Introducción: Carcinoma de pulmón es el cáncer más prevalente del mundo, seguido del cáncer de mama. Presenta elevadas tasas de mortalidad en hombres y mujeres, debido principalmente a su capacidad de metástasis. Las metástasis del carcinoma de pulmón hacia la mama son extremadamente raras. El primer caso descrito fue en 1965 y, desde entonces, existen pocos casos de esta afección en la literatura médica de todo el mundo. Informe del caso: Mujer, 59 años, comenzó a experimentar dolor lumbar en mayo de 2017. La investigación reveló un foco metastásico en la quinta vértebra de la columna lumbar sin descubrir su origen. Seis meses después, se encontró una nueva lesión en la novena vértebra de la columna torácica. Inmunohistoquímica mostró positividad para los marcadores citoqueratina 7 y TTF1, confirmando la hipótesis de carcinoma de pulmón como localización primaria. En marzo de 2018, la paciente evolucionó con un nódulo sintomático en la mama derecha en la ecografía y con positividad para TTF1 en el estudio inmunohistoquímico, confirmando que se trataba de una metástasis de carcinoma pulmonar a la mama. Tratada durante dos años hasta marzo de 2020, cuando presentó múltiples metástasis cerebrales. La paciente no tuvo éxito terapéutico y falleció. Conclusión: Destacan la dificultad en el diagnóstico de metástasis de carcinoma pulmonar a la mama y alertar clínicos, cirujanos y patólogos para que consideren este diagnóstico, aunque poco frecuente.

Revolução tecnológica e smartphone: considerações sobre a constituição do sujeito contemporâneo / Revolución tecnológica y smartphone: consideraciones sobre la constitución del sujeto contemporáneo / Technological revolution and smartphone: considerations about the constitution of the contemporary subject

RESUMO. O texto, resultante de estudos teóricos empreendidos à luz da Psicologia Histórico-Cultural entre 2016 e 2020, tem como objetivo recuperar a revolução tecnológica como um recurso para a compreensão da constituição dos sujeitos contemporâneos, partindo da máquina a vapor da Primeira Revolução Industrial, empregada nos meios de produção, até o smartphone, empregado na cotidianidade. O smartphone possui níveis tão altos de compactação, portabilidade e operacionalidade que o tornaram uma das mais avançadas tecnologias da história, revelando o elevado grau de desenvolvimento do psiquismo alcançado pelo gênero humano. Ele, mais do que outras tecnologias digitais de informação e comunicação (TDICs), tem impactado notadamente a constituição dos sujeitos contemporâneos, especialmente suas funções psicológicas cognitivas. Os resultados demonstram que recuperar dialeticamente o percurso histórico das criações tecnológicas é essencial à psicologia, permitindo ampliar o espectro de análise de como os sujeitos se constituem na atualidade. Conclui-se que a revolução microtecnológica deve ser tomada sob um viés crítico e ético, por tudo o que pode impactar nas relações entre os sujeitos e no desenvolvimento dos seus processos psíquicos.

RESUMEN. El texto, resultante de estudios teóricos realizados a la luz de la Psicología Histórico-Cultural entre 2016 y 2020, tiene como objetivo recuperar la revolución tecnológica como un recurso para comprender la constitución de los sujetos contemporáneos, a partir de la máquina de vapor de la Primera Revolución Industrial, empleada en los medios de producción, hasta el smartphone, utilizado en la vida cotidiana. El smartphone tiene niveles tan altos de compacidad, portabilidad y operabilidad que se ha convertido en una de las tecnologías más avanzadas de la historia, revelando el alto grado de desarrollo de la psique alcanzado por la humanidad. Él, más que otras tecnologías digitales de información y comunicación, ha impactado notablemente la constitución de los sujetos contemporáneos, especialmente sus funciones psicológicas cognitivas. Los resultados demuestran que recuperar dialécticamente el camino histórico de las creaciones tecnológicas es esencial para la psicología, lo que permite ampliar el espectro de análisis de cómo se constituyen los sujetos en la actualidad. Concluye que la revolución microtecnológica debe tomarse desde una perspectiva crítica y ética, para todo lo que pueda afectar las relaciones entre los sujetos y el desarrollo de sus procesos psíquicos.

ABSTRACT. The text, resulting from theoretical studies undertaken in the light of Historical-Cultural Psychology between 2016 and 2020, aims to recover the technological revolution as a resource for understanding the constitution of contemporary subjects, starting from the steam engine of the First Industrial Revolution, used in the means of production, even the smartphone, used in everyday life. The smartphone has such high levels of compactness, portability and operability that it has become one of the most advanced technologies in history, revealing the high degree of development of the psyche achieved by mankind. It, more than other digital information and communication technologies, has impacted notably on the constitution of contemporary subjects, especially on their cognitive psychological functions. The results demonstrate that recovering dialectically the historical path of technological creations is essential to Psychology, allowing to expand the spectrum of analysis of how subjects are constituted today. It concludes that the microtechnological revolution must be taken under a critical and ethical bias, due to everything that can impact on the relationships between the subjects and the development of their psychic processes.

Seasonality, soil attributes and root biomass in cerrado, cerradão and forest environments, western Amazon

The Amazon rainforest region presents a phytophysiognomy that ranges from savannas to cerrados, all of them intimately associated to climate and soil characteristics. Evidence has been given that plant growth and development are affected by soil quality and seasonality, thus making it crucial to understand them and how they are related to each other in order to grasp the dynamics of the whole ecosystem. In this context, the goal of this research was to assess how seasonality, soil attributes, and root system biomass are related in natural cerrado, cerradão, and forest areas in southern Amazonas State, in Brazil. Soil samples were collected during dry (June/2018) and rainy (December/2018) seasons from three different layers 0.00­0.05m; 0.05­0.15m, and 0.15­0.30m deep. In each area ten sampling points were randomly chosen. Two kinds of soil samples were collected: the first using 4.0 cm height by 5.1cm internal-diameter soil sample rings; and the second were intact soil lumps. Physical and Chemical soil attributes assessed were macro-porosity (MaP), micro-porosity (MiP), total porosity (TP), soil density (SD), aggregates texture and stability (GMD and WAR), gravimetric humidity (HG), organic carbon (OC), exchangeable aluminum (Al3+), potential acidity (H+Al), sum of bases (SB), cation exchange capacity (CEC), and root biomass (RB). All data were analysed via Tukey t test and student T test to compare results between seasons and areas. Increasing vegetation density (cerrado < cerradão < forest) was followed by an increment in CEC and OC, showing the importance of these attributes to maintaining biodiversity in environments. In amazon cerrado, rainy season as well a sandier soil textures provided favourable conditions to the growth and development of plants' root system. Soil attributes were little affected by seasonality, that had greater effect on MiP, TP, SD, and OC, leading to lesser values for these variables during rainy season.

Demographic and clinical characteristics of pulmonary arterial hypertension caused by schistosomiasis are indistinguishable from other etiologies

Abstract INTRODUCTION: Pulmonary arterial hypertension (PAH) is a serious pulmonary circulation disease caused by several etiologies, including schistosomiasis. The present study retrospectively evaluated the clinical and hemodynamic characteristics of patients with schistosomal PAH (PAH-Sch) compared to those of non-Sch PAH patients (non-Sch PAH). METHODS: Patients treated at the Pronto-Socorro Cardiológico de Pernambuco and diagnosed by right cardiac catheterization were divided into PAH-Sch and non-Sch PAH groups. Their socio-demographic and clinical characteristics, N-terminal-pro B-type natriuretic peptide (NT-proBNP), and echocardiography and hemodynamic parameters were retrospectively reviewed. RESULTS: Among the included 98 patients (mean age, 45 ± 14 years; 68 women [69.4%]), we found 56 PAH-Sch and 42 non-Sch PAH. The age distribution was heterogeneous in the PAH-Sch group, with patients predominantly ranging from 50-59 (p <0.004). Dyspnea was the most common symptom, reported by 92 patients (93.8%), and commonly present for over two years prior to diagnosis. Clinical symptoms were similar in both groups, with no differences in functional class, pulmonary artery systolic pressure (p = 0.102), 6-minute walk test score (p = 0.234), NT-proBNP serum levels (p = 0.081), or hemodynamic parameters. CONCLUSIONS: Patients with PAH-Sch present clinical, laboratory, and hemodynamic profiles similar to those with PAH resulting from other etiologies of poor prognosis. PAH is an important manifestation of schistosomiasis in endemic regions that is often diagnosed late.

Physical and chemical properties of soils in different physiographic environments in the southern Amazonas region / Atributos físicos e químicos de solos em diferentes ambientes fisiográficos na região sul do Amazonas, Brasil

The Amazon region has a great diversity of landscapes such as forests galleries, natural fields ("Cerrados Amazônicos"), dense forest, these environments made possible the formation of a broad class of soils over time. The aim of this study was to evaluate the physical and chemical properties of soils in different physiographic environments in southern Amazonas, Brazil. Three areas of representative physiographies were selected, all of them in natural conditions: natural field / forest and floodplain / dry land transitions, and corrugated relief areas. Soil samples were collected in layers of 0.0 to 0.20 and 0.80-1.0 m. From the samples collected the following physical analyzes were performed: particle size, bulk density, particle density, total porosity and saturated hydraulic conductivity; and chemical: exchangeable calcium, magnesium, aluminum and potassium available, phosphorus, potential acidity, pH and organic carbon. Based on the results of chemical analysis were calculated the sum of bases and base saturation. The results were submitted to multivariate statistics analysis, at the discretion of the principal component analysis (PCA). From the results it is clear that different physiographic environments studied influence the formation of different soil classes, featuring the diversity of Amazonian soils. The PCA allowed the distinction and formation of differentsimilarity groups, thus enabling to relate the physical and chemical properties with the physiographic formation in which they are inserted.

A região amazônica possui uma grande diversidade de paisagens, como galerias de florestas, campos naturais (Cerrados Amazônicos), floresta densa, possibilitando a formação de uma ampla classe de solos ao longo do tempo. O objetivo deste estudo foi investigar as propriedades físicas e químicas de solos em diferentes ambientes fisiográficos no sul do Amazonas, Brasil. Três áreas de fisiografias representativas foram selecionadas, todas em condições naturais: campo natural / floresta e transições de várzea / terra firme e áreas de relevo corrugado. Amostras de solo foram coletadas em camadas de 0,0 a 0,20 e 0,80-1,0 m. Das amostras coletadas foram realizadas as seguintes análises físicas: tamanho de partícula, densidade do solo, densidade de partículas, porosidade total e condutividade hidráulica saturada; e químico: cálcio trocável, magnésio, alumínio e potássio disponíveis, fósforo, acidez potencial, pH e carbono orgânico. Com base nos resultados da análise química foram calculados a soma das bases e saturação por bases. Os resultados foram submetidos à análise estatística multivariada, a critério da análise de componentes principais (PCA). A partir dos resultados, percebe-se que diferentes ambientes fisiográficos estudados influenciam a formação de diferentes classes de solos, caracterizando a diversidade de solos amazônicos. O PCA permitiu a distinção e formação de diferentes grupos de similaridade, permitindo relacionar as propriedades físico-químicas com a formação fisiográfica em que estão inseridos.

Coronary Angioplasty with Stent in Woman with Active Vaginal Bleeding

Uterine leiomyoma and coronary artery disease are two common diseases in women. However, the association of uterine bleeding caused by leiomyoma with unstable coronary syndrome is not frequent. Here we describe a case of a patient with active vaginal bleeding and unstable angina who underwent a unique approach by performing percutaneous procedures. The report demonstrates that new interventional options can be used to control active bleeding in patients in need of coronary angioplasty

Orientações da Sociedade Brasileira de Hérnia (SBH) para o manejo das hérnias inguinocrurais em adultos / Guidelines of the Brazilian Hernia Society (BHS) for the management of inguinocrural hernias in adults

RESUMO As hérnias inguinais são um problema frequente e o seu reparo representa a cirurgia mais comumente realizada por cirurgiões gerais. Nos últimos anos, novos princípios, produtos e técnicas têm mudado a rotina dos cirurgiões que precisam reciclar conhecimentos e aperfeiçoar novas habilidades. Além disso, antigos conceitos sobre indicação cirúrgica e riscos de complicações vêm sendo reavaliados. Visando criar um guia de orientações sobre o manejo das hérnias inguinais em pacientes adultos, a Sociedade Brasileira de Hérnias reuniu um grupo de experts com objetivo de revisar diversos tópicos, como indicação cirúrgica, manejo perioperatório, técnicas cirúrgicas, complicações e orientações pós-operatórias.

ABSTRACT Inguinal hernias are a frequent problem and their repair is the most commonly performed procedure by general surgeons. In the last years, new principles, products and techniques have changed the routine of surgeons, who need to recycle knowledge and perfect new skills. In addition, old concepts regarding surgical indication and risk of complications have been reevaluated. In order to create a guideline for the management of inguinal hernias in adult patients, the Brazilian Hernia Society assembled a group of experts to review various topics, such as surgical indication, perioperative management, surgical techniques, complications and postoperative guidance.

Antiplasmodial and antileishmanial activities of compounds from Piper tuberculatum Jacq fruits

Abstract INTRODUCTION This study assessed the activity of compounds from Piper tuberculatum against Plasmodium falciparum and Leishmania guyanensis. METHODS The effects of compounds from P. tuberculatum fruits on P. falciparum and L. guyanensis promastigote growth in vitro were determined. Hemolytic action and cytotoxicity in HepG2 and J774 cells were measured. RESULTS Three compounds showed strong antiplasmodial activity and one compound showed strong antileishmanial activity. Two compounds were non-toxic to HepG2 cells and all were toxic to J774 cells. The compounds showed no hemolytic activity. CONCLUSIONS The tested compounds from P. tuberculatum exhibited antiparasitic and cytotoxic effects.

First results of the Brazilian Registry of Percutaneous Left Atrial Appendage Closure / Primeiros Resultados do Registro Brasileiro de Oclusão Percutânea do Apêndice Atrial Esquerdo

Abstract Background: Left atrial appendage closure (LAAC) is an effective alternative to oral anticoagulation (OA) for the prevention of stroke in patients with non-valvular atrial fibrillation (NVAF). Objective: To present the immediate results and late outcomes of patients submitted to LAAC and included in the Brazilian Registry of Percutaneous Left Atrial Appendage Closure. Methods: 91 patients with NVAF, high stroke risk (CHA2DS2VASc score = 4.5 ± 1.5) and restrictions to OAC (HAS-BLED score = 3.6 ± 1.0) underwent 92 LAAC procedures using either the Amplatzer cardiac plug or the Watchman device in 11 centers in Brazil, between late 2010 and mid 2016. Results: Ninety-six devices were used (1.04 device/procedure, including an additional non-dedicated device), with a procedural success rate of 97.8%. Associated procedures were performed in 8.7% of the patients. Complete LAAC was obtained in 93.3% of the successful cases. In cases of incomplete closure, no residual leak was larger than 2.5 mm. One patient needed simultaneous implantation of 2 devices. There were 7 periprocedural major (5 pericardial effusions requiring pericardiocentesis, 1 non-dedicated device embolization and 1 coronary air embolism without sequelae) and 4 minor complications. After 128.6 patient-years of follow-up there were 3 deaths unrelated to the procedure, 2 major bleedings (one of them in a patient with an unsuccessful LAAC), thrombus formation over the device in 2 cases (both resolved after resuming OAC for 3 months) and 2 strokes (2.2%). Conclusions: In this multicenter, real world registry, that included patients with NVAF and high thromboembolic and bleeding risks, LAAC effectively prevented stroke and bleeding when compared to the expected rates based on CHA2DS2VASc and HASBLED scores for this population. Complications rate of the procedure was acceptable considering the beginning of the learning curve of most of the involved operators.

Resumo Fundamento: A oclusão percutânea do apêndice atrial esquerdo (OAAE) é uma alternativa eficaz à anticoagulação oral (ACO) para a prevenção de acidente vascular cerebral (AVC) em pacientes com fibrilação atrial não-valvular (FANV). Objetivo: Apresentar os resultados imediatos e o seguimento tardio de pacientes submetidos a OAAE e incluídos no Registro Brasileiro de Oclusão Percutânea do Apêndice Atrial Esquerdo. Métodos: 91 pacientes com FANV, alto risco de AVC (escore CHA2DS2VASc = 4,5 ± 1,5) e restrição à AO (escore HAS-BLED = 3,6 ± 1,0) foram submetidos a 92 procedimentos de OAAE com as próteses Amplatzer Cardiac Plug e Watchman em 11 centros do Brasil, entre o final de 2010 e a metade de 2016. Resultados: Utilizaram-se 96 próteses no total (1,04 próteses/procedimento, incluindo-se o uso de 1 prótese não-dedicada adicional em um dos casos), obtendo-se sucesso em 97,8% dos procedimentos. Realizaram-se procedimentos associados à OAAE em 8,7% dos pacientes. Observou-se oclusão total do AAE em 93,3% dos casos com sucesso, e nos casos de oclusão incompleta, nenhum leak foi > 2,5 mm. Um paciente necessitou do implante simultâneo de 2 próteses. Houve 7 complicações maiores periprocedimento (5 derrames pericárdicos necessitando pericardiocentese, 1 embolização da prótese não-dedicada e 1 embolia aérea coronariana sem sequelas) e 4 menores. No seguimento de 128,6 pacientes-ano, houve 3 óbitos não relacionados ao procedimento, 2 sangramentos maiores (um deles em um dos casos de insucesso da OAAE), formação de trombo sobre a prótese em 2 casos (tratados com sucesso com reinstituição da ACO por 3 meses), e 2 AVCs (2,2%). Conclusões: Neste registro multicêntrico de mundo real, que incluiu pacientes com FANV e alto risco de sangramento e de eventos tromboembólicos, a OAAE foi eficaz na prevenção de AVC e sangramento quando comparada às taxas de AVC previstas pelos escores CHA2DS2VASc e HASBLED para esta população. O índice de complicações do procedimento foi aceitável, considerando se tratar do início da curva de aprendizado da maioria dos operadores envolvidos.

Incidencia de lesiones en la práctica deportiva del motocross / Incidence of injuries in the sport practice of motocross

Antecedentes: Estudiar la incidencia de lesiones que involucran a atletas profesionales de Motocross de diferentes categorías en niveles de carreras estatales, nacionales e internacionales y evaluar las le-siones más comunes dentro de los atletas de Motocross y las áreas más frecuentemente afectadas por la práctica del deporte. Métodos: El estudio incluyó un cuestionario respondido por 45 atletas entre 16 y 46 años de edad, hombres y mujeres, de diferentes nacionalidades y lugares de nacimiento, en carreras para el Campeonato de Motocross de Brasil. Resultados: Las fracturas son las lesiones más comunes entre los corredores de Motocross (17.55 %), seguido de dislocaciones (13.05%). Los hom-bros y las rodillas son los sitios anatómicos más afectados. Las pruebas de chi- cuadrado mostraron que el diagnóstico tiene una relevancia significativa sobre la influencia y la definición del tratamiento de las lesiones (p = 0.001). El diagnóstico tuvo significación estadística en relación con el regreso de los corredores a los deportes con el mismo nivel físico anterior a la lesión (p = 0.001). Conclusión: Los hombros fueron los más afectados por las lesiones y las fracturas la lesión más común en la práctica de Motocross y debido a su naturaleza de alto impacto, el Motocross tiene una alta tasa de lesiones.

Background: To study the incidence of injuries involving professional Motocross athletes from diffe-rent categories in state, national and international racing levels and to evaluate the most common inju-ries within Motocross athletes and the most frequently affected areas by the sport's practice. Methods: The study included a questionnaire answered by 45 athletes aged between 16 and 46 years old, male and female, of different nationalities and places of birth, racing for the Brazilian Motocross Champion-ship. Results: Fractures are the most common injuries among Motocross racers (17.55%), followed by dislocations (13.05%). The shoulders and knees are the most affected anatomical sites. The chi- square tests showed that the diagnosis has significant relevance over the influence and definition of the inju-ries' treatment (p=0.001).The diagnosis had statistical significance in relation to the racers' return to sports with the same physical level prior to the injury (p=0.001). Conclusion: The shoulders were the most affected by injuries and the fractures the most common lesion in Motocross practice and because of its high impact nature, Motocross has a high rate of injuries.

Herniorrafia inguinal convencional com tela autofixante versus videolaparoscópica totalmente extraperitoneal com tela de polipropileno: resultados no pós-operatório precoce / Conventional inguinal hernia repair with self-fixating mesh versus totally extraperitoneal laparoscopic repair with polypropylene mesh: early postoperative results

RESUMO Objetivo: avaliar o resultado no pós-operatório precoce do tratamento da hérnia inguinal pela técnica convencional com tela autofixante versus videolaparoscópica totalmente extraperitoneal com uso da tela de polipropileno. Foram comparados, sobretudo, dor, tempo cirúrgico e complicações precoces. Métodos: estudo prospectivo, de série de casos, realizado na Clínica Cirúrgica A, do Hospital Universitário Gaffrée e Guinle (HUGG), no qual 80 casos consecutivos foram estudados. Apenas pacientes com hérnia inguinal unilateral, não recidivada e operadas em caráter eletivo foram incluídas no estudo. Os pacientes foram divididos em dois grupos, de 40 pacientes cada; grupo AF (técnica convencional com uso de tela autofixante) e grupo VL (técnica videolaparoscópica com uso de tela de polipropileno). Os pacientes foram acompanhados até o 45º dia de pós-operatório. Resultados: dos 80 pacientes operados no estudo, 98,7% pertenciam ao sexo masculino e a maioria era portadora de hérnia inguinal direita indireta (Nyhus II). Não houve diferença entre os grupos estudados no que diz respeito à dor e tempo operatório. No entanto, ocorreram mais complicações (seroma e hematoma) no grupo da cirurgia aberta. Conclusão: as duas operações realizadas se mostraram factíveis, seguras e estão relacionadas à mínima dor pós operatório e a um baixo tempo cirúrgico.

ABSTRACT Objective: to evaluate the early postoperative results of inguinal hernia repair by the conventional technique with self-fixating mesh versus laparoscopic totally extraperitoneal repair with polypropylene mesh. We compared pain, surgical time and early complications. Methods: this is a prospective, case-series study of 80 consecutive patients treated in the surgical clinic of the Gaffrée e Guinle University Hospital (HUGG). We included patients with unilateral inguinal hernia, not relapsed and operated only on an elective basis. We divided patients into two groups of 40 patients each, SF group (conventional technique using self-fixating mesh) and LP group (laparoscopic technique with polypropylene mesh). We followed patients up until the 45th postoperative day. Results: of the 80 patients, 98.7% were male and the majority had indirect right inguinal hernias (Nyhus II). There was no difference between the groups studied in respect to pain and operative time. However, more complications occurred (seroma and hematoma) in the open surgery group. Conclusion: both operations have proved feasible, safe and with minimal postoperative pain and a low operating time.

Transcolonic Perirectal NOTES Access (PNA): A feasibility study with survival in swine model

ABSTRACT Transrectal access still has some unsolved issues such as spatial orientation, infection, access and site closure. This study presents a simple technique to perform transcolonic access with survival in a swine model series. A new technique for NOTES perirectal access to perform retroperitoneoscopy, peritoneoscopy, liver and lymphnode biopsies was performed in 6 pigs, using Totally NOTES technique. The specimens were extracted transanally. The flexible endoscope was inserted through a posterior transmural incision and the retrorectal space. Cultures of bacteria were documented for the retroperitoneal space and intra abdominal cavity after 14 days. Rectal site was closed using non-absorbable sutures. There was no bowel cleansing, nor preoperative fasting. The procedures were performed in 6 pigs through transcolonic natural orifice access using available endoscopic flexible instruments. All animals survived 14 days without complications, and cultures were negative. Histopathologic examination of the rectal closure site showed adequate healing of suture line and no micro abscesses. The results of feasibility and safety of experimental Transcolonic NOTES potentially brings new frontiers and future wider applications for minimally invasive surgery. The treatment of colorectal, abdominal and retroperitoneal diseases through a flexible Perirectal NOTES Access (PNA) is a promising new approach.

Robotic Transversus Abdominis Release (TAR): is it possible to offer minimally invasive surgery for abdominal wall complex defects? / Transversus Abdominis Release (TAR) Robótico: é possível oferecer cirurgia minimamente invasiva para os defeitos complexos da parede abdominal?

ABSTRACT We describe the preliminary national experience and the early results of the use of robotic surgery to perform the posterior separation of abdominal wall components by the Transversus Abdominis Release (TAR) technique for the correction of complex defects of the abdominal wall. We performed the procedures between 04/2/2015 and 06/15/2015 and the follow-up time was up to six months, with a minimum of two months. The mean surgical time was five hours and 40 minutes. Two patients required laparoscopic re-intervention, since one developed hernia by peritoneal migration of the mesh and one had mesh extrusion. The procedure proved to be technically feasible, with a still long surgical time. Considering the potential advantages of robotic surgery and those related to TAR and the results obtained when these two techniques are associated, we conclude that they seem to be a good option for the correction of complex abdominal wall defects.

RESUMO Descrevemos a experiência preliminar nacional na utilização da cirurgia robótica para realizar a separação posterior de componentes da parede abdominal pela técnica transversus abdominis release (TAR) na correção de defeitos complexos da parede abdominal e seus resultados precoces. As cirurgias foram realizadas entre 02/04/2015 e 15/06/2015 e o tempo de acompanhamento dos resultados foi de até seis meses, com tempo mínimo de dois meses. O tempo cirúrgico médio foi de cinco horas e 40 minutos. Dois pacientes necessitaram reintervenção por laparoscopia, pois um desenvolveu hérnia por migração peritoneal da tela e um teve escape da tela. A cirurgia provou ser factível do ponto de vista técnico, com um tempo cirúrgico ainda elevado. Tendo em vista as vantagens potenciais da cirurgia robótica e aquelas relacionadas ao TAR e os resultados obtidos ao se associar essas duas técnicas, conclui-se que elas parecem ser uma boa opção para a correção de defeitos complexos da parede abdominal.

Introduzindo a história da fisioterapia na evolução do futebol brasileiro e europeu / Introducing the historic evolution of physical therapy in Brazilian football

Introdução: Podemos entender que o processo de evolução da fisioterapia no futebol brasileiro favoreceu a introjeção da fisioterapia esportiva como aliada na aceleração da recuperação do atleta. A fisioterapia é indubitavelmente um recurso terapêutico de primeira linha para o tratamento, habilitação e recuperação de atletas, principalmente de jogadores de futebol. Objetivo: Estabelecer uma periodização, relacionando o futebol brasileiro e a aplicação da fisioterapia esportiva nas suas atividades. Material e métodos: Através da metodologia descritiva e relacional com um levantamento bibliográfico e entrevista com fisioterapeutas na qual foi utilizado um questionário com perguntas fechadas elaborado pelos pesquisadores. As respostas foram relacionadas aos blocos de conteúdos e períodos de evolução da fisioterapia no futebol brasileiro e posterior análise dos resultados utilizando a estatística descritiva. Resultados: Foram entrevistados 33 fisioterapeutas que atuam na área desportiva. Conclusão. Com esta pesquisa se tornou evidente o fato de que a fisioterapia está consolidada no cenário futebolístico nacional. O estudo possibilita inclusões no referendo histórico relacionando à periodização da evolução da fisioterapia esportiva no futebol brasileiro. (AU)

Introduction: We can understand that the process of physical therapy evolution in Brazilian soccer favored the introduction of sports physiotherapy as an acceleration of athlete recovery. Physical therapy is undoubtedly a first-class therapeutic resource for the treatment, habilitation and recovery of athletes, especially soccer players. Objective: To establish a periodization, relating Brazilian soccer and the application of sports physical therapy in its activities. Methods: Through the descriptive and relational methodology with a bibliographical survey and interview with physiotherapists in which a questionnaire with closed questions elaborated by the researchers was used. The answers were related to the blocks of contents and periods of physical therapy evolution in Brazilian soccer and later analysis of the results using the descriptive statistics. Results: We interviewed 33 physiotherapists who work in sports area. Conclusion: With this research it became evident the fact that physical therapy is consolidated in the national soccer scene. The study allows inclusion in the historical referendum relating to the periodization of the evolution of sports physical therapy in Brazilian soccer. (AU)

O educador físico e o Parangolé como dispositivo inventivo para a promoção da saúde do escolar: estudo sociopoético / The physical educator and the Parangolé as an inventive device for the promotion of school health: sociopoetic study

Essa pesquisa tem como objeto a prática do educador físico na promoção da saúde do escolar intermediada pela arte. Buscou, utilizando a criatividade, durante os espaços de Educação Física, levantar questões sobre a ação do educador físico na promoção da saúde do escolar. Uma discussão das possibilidades de trabalho corporal através dos conceitos artísticos de Hélio Oiticica, em especial o Parangolé, à luz de Paulo Freire e sob as diretrizes dos Parâmetros Curriculares Nacionais da Educação Física. As questões norteadoras do estudo são: Como incentivar o potencial criativo das crianças através do trabalho com a arte tendo em vista o papel do educador físico na promoção da saúde na escola? Como ocorre a desterritorialização pelo escolar na promoção de saúde durante as aulas de Educação Física? Tem como objetivo geral propiciar a experimentação artística nos espaços de Educação Física escolar na direção do fomento da saúde. E como objetivos específicos discutir as possibilidades criativas no processo de ensino-aprendizagem com alunos do ensino fundamental durante os espaços de Educação Física na direção da promoção da saúde e criar, por meio da produção de dados Sociopoética, um dispositivo inspirado na obra Parangolé de Hélio Oiticica, capaz de potencializar o incremento da saúde escolar. Trata-se de um estudo Sociopoético, com um grupo-pesquisador composto por 12 crianças do ensino fundamental, realizado numa escola municipal do Rio de Janeiro, com aprovação no CEP segundo parecer 1.886.048. Apresentou como resultados três categorias: 1-Você ajuda, eu vou. Você briga, eu travo; 2- Sentimentos: medo de errar, vontade de acertar; 3- Arte e liberdade: podemos aprender, brincando. Concluiu-se que a arte e a inventividade são elementos imprescindíveis para o processo de ensino-aprendizagem, e que a estreita relação docente-discente, intermediada pelo diálogo, é transformadora. Como produto propôs um dispositivo artístico intitulado Parangolé Filosófico, que trata da apresentação de produtos de experimentações estéticas promovidas por docentes do ensino fundamental

This research has as its object the practice of the physical educator in promoting the health of the scholar intermediated by art. He sought, through creativity, during the Physical Education spaces, to raise questions about the action of the physical educator in promoting the health of the scholar. A discussion of the possibilities of corporal work through the artistic concepts of Hélio Oiticica, especially the Parangolé, in the light of Paulo Freire and the guidelines of the National Curricular Parameters of Physical Education. The guiding questions of the study are: How to encourage the creative potential of children through working with art in view of the role of the physical educator in promoting health in school? How does the deterritorialization by the student in health promotion during the Physical Education classes occur? The general objective is to promote an artistic experimentation in the Physical Education spaces at the direction of health promotion. As specific objectives to discuss the creative possibilities in the teaching-learning process with elementary school students during the Physical Education spaces in the direction of health promotion and create a device inspired by the work Parangolé, by Hélio Oiticica, through the production of a Sociopoetic data able to potentiate the promotion of school health. It is about a Sociopoetic study, with a researcher group composed of 12 elementary school children, carried out in a municipal school in Rio de Janeiro, with approval in the CEP according to opinion 1,886,048. As results three categories were presented: 1- You help, I will. You fight, I brake. 2- Feelings: fear of making mistakes, will to answer correctly. 3- Art and freedom: we can learn by playing. The study concluded that art and inventiveness are essential elements for the teaching-learning process, and that the close teacher-student relationship, mediated by dialogue, is transformative. And as a product, it was proposed an artistic device called Parangolé Filosófico, which deals with the presentation of products of aesthetic experiments promoted by elementary school teachers

O riso como estratégia de resistência ao poder punitivo / Laughter as a strategy of resistance to the punitive power / La risa como estrategia de resistencia al poder punitivo

O artigo é resultado de análises teóricas de uma pesquisa de doutorado em formato de um ensaio, na interface das contribuições da Filosofia, Psicologia e Sociedade, para problematizar o riso, a vingança e a justiça. As práticas punitivas, os saberes médicos e jurídicos que as sustentam são colocadas em questão. Também são abordadas as intervenções do riso, na política da verdade, a qual atravessa subjetividades ressentidas, ávidas em julgar, vigiar e punir. Interrogar a relação entre ordem médica e lei, no castigo, em defesa da sociedade é uma importante contribuição desse texto teórico, o qual faz do riso uma arma política em que a ironia e o trágico colocam em questão a justiça como juízo. A crítica à sujeição da pena como vingança face à ruptura com o pacto social é colocada em suspensão. Nesse sentido, é proposta uma linha reflexiva, ainda que provisória, de um problema que me parece essencial no pensamento de Nietzsche e Foucault: os laços entre riso e punição.

This article is a result of theoretical analyses from a doctoral research, in essay format, which brings contributions of Philosophy, Psychology and Society to discuss laughter, revenge and justice. Punitive practices, in addition to the medical and juridical knowledge that sustains them, are called into question. It addresses interventions of laughter in the politics of truth, which crosses resentful subjectivities eager to judge, monitor and punish. Interrogating the relationship between medical order and law as to punishment in defense of society is an important contribution of this theoretical text, which makes laughter a political weapon through which irony and tragedy call into question justice as judgment. The criticism of subjection to penalties as revenge due to a break with the social contract is suspended. In this sense, this study proposes a reflection, albeit provisional, on a problem that seems to be essential in Nietzsche's and Foucault's thoughts: the ties between laughter and punishment.

El artículo es el resultado de un análisis teórico, una investigación doctoral, en la forma de un ensayo, en la interfaz de las contribuciones de Filosofía, Psicología y Sociedad para discutir la risa, de la venganza y la justicia. Prácticas punitivas y el conocimiento médico y legal que las sustentan se ponga en duda. También las medidas de la risa se abordan a política de la verdad, que se ejecutan por intermedio de subjetividades resentidos; deseosos de juzgar, controlar y sancionar. Interrogar la relación entre la ley y el orden médica, en el castigo, en defensa de la sociedad, es una contribución importante de este texto teórico, lo que hace la risa un arma política en la ironía y la trágica en duda la justicia y el juicio, y el juicio. La crítica del sujeto de la oración como una venganza en contra de la ruptura con el pacto social se suspende. En este sentido, se propone una línea de reflexión, aunque sea provisional, un problema que me parece esencial en el pensamiento de Nietzsche y Foucault: las relaciones entre la risa y el castigo.

Screening of the in vitro antileishmanial activities of compounds and secondary metabolites isolated from Maytenus guianensis Klotzsch ex Reissek (Celastraceae) chichuá Amazon

Abstract INTRODUCTION Maytenus guianensis is a member of the Celastraceae family that is used in traditional medicine, particularly for its anti-parasitic and anti-cancer effects. To explore the ethnopharmacological potential of this plant, the present study was designed to screen the in vitro antileishmanial activities of extracts and compounds isolated from M. guianensis. METHODS Maytenus guianensis stems and leaves were extracted in acetone, followed by the preparation of eluates and isolation of secondary metabolites using chromatography on a glass column with silica gel as the fixed phase. The chemical components were identified using spectroscopic methods, including one- and two-dimensional nuclear magnetic resonance of hydrogen-1 and carbon-13, mass spectroscopy, and infrared spectroscopy. The anti-Leishmania amazonensis activities of these eluates and compounds were evaluated by direct promastigote counting and viability assays. RESULTS It was found that the hexane bark eluate produced the strongest anti-L. amazonensis effect, with 90-100% inhibition of the promastigote form. The isolated metabolite that produced the best result was tingenone B, followed by a compound formed by the union of tingenone and tingenone B (80-90% inhibition). CONCLUSIONS Maytenus guianensis shows anti-parasite activity that warrants further investigation to determine the mechanisms underlying this antileishmanial effect and to evaluate the pharmacological potential of these eluates and isolated secondary metabolites, while minimizing any adverse effects.

Evaluation of the antiplasmodial and leishmanicidal potential of Myrciaria dubia (Myrtaceae) extract

Abstract INTRODUCTION: Malaria and leishmaniasis are prevalent in tropical regions, which have environmental characteristics that are highly favorable to protozoa and vectors of these diseases; the transmission of these infections in sub-tropical regions, although recognized, represents only a small fraction of cases. Plants are constantly being used in the search for and acquisition of new drugs, and many compounds derived from them have been used to combat various diseases. In this study, we evaluated the action of the dichloromethanolic extract of Myrciaria dubia leaves against the protozoa Plasmodium falciparum, Leishmania amazonensis, Leishmania braziliensis, and Leishmania chagasi through bioassays. METHODS The extract from M. dubia was tested for its anti-P. falciparum activity in an anti-histidine-rich protein II immunosorbent assay. The antileishmanial assays were performed using the resazurin method, while cytotoxicity against human hepatoma (HepG2) strain was determined using the colorimetric MTT [3-(4, 5-dimethyl-2- thiazolyl)-2, 5-diphenyl-2H tetrazolium bromide] method. RESULTS The M. dubia extract presented a half-maximal inhibitory concentration equal to 2.35 (1.05)μg/mL for P. falciparum, 190.73 (6.41) μg/mL for L. amazonensis, and greater than equal to 200µg/mL for L. chagasi and L. braziliensis strains. The cytotoxic concentration for 50% of the cells was above 500μg/mL for HepG2, indicating no toxicity and greater selectivity against parasites. CONCLUSIONS The results obtained indicate the presence of antiplasmodial and leishmanicidal bioactive compounds in the dichloromethanolic extracts of M. dubia leaves, and point towards future studies to elucidate the mechanism of action for each physiological effect.

Paracoccidioidomycosis due to small forms of Paracoccidioides. A report of 12 cases and review of the literature

Paracoccidioidomycosis (PCM) is a systemic mycosis with a geographic distribution limited to Latin America. PCM is caused by species in the genus Paracoccidioides, which usually appear in tissues as large yeasts, 5 to 30 µm in size. The daughter cells are attached to the parent cell by a narrow neck. Sometimes smaller forms occur (1 to 4 µm). These can be confused with other fungi, such as Histoplasma capsulatum and unencapsulated Cryptococcus variants. Twelve cases of PCM were reported with small forms of Paracoccidioides. The aim of this paper is to focus on the possibility of differential diagnosis with other systemic mycoses