IMPACTO-MR: um estudo brasileiro de plataforma nacional para avaliar infecções e multirresistência em unidades de terapia intensiva / IMPACTO-MR: a Brazilian nationwide platform study to assess infections and multidrug resistance in intensive care units

RESUMO Objetivo: Descrever o IMPACTO-MR, um estudo brasileiro de plataforma nacional em unidades de terapia intensiva focado no impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Métodos: Descrevemos a plataforma IMPACTO-MR, seu desenvolvimento, critérios para seleção das unidades de terapia intensiva, caracterização da coleta de dados, objetivos e projetos de pesquisa futuros a serem realizados na plataforma. Resultados: Os dados principais foram coletados por meio do Epimed Monitor System® e consistiram em dados demográficos, dados de comorbidades, estado funcional, escores clínicos, diagnóstico de internação e diagnósticos secundários, dados laboratoriais, clínicos e microbiológicos e suporte de órgãos durante a internação na unidade de terapia intensiva, entre outros. De outubro de 2019 a dezembro de 2020, 33.983 pacientes de 51 unidades de terapia intensiva foram incluídos no banco de dados principal. Conclusão: A plataforma IMPACTO-MR é um banco de dados clínico brasileiro de unidades de terapia intensiva focado na pesquisa do impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Essa plataforma fornece dados para o desenvolvimento e pesquisa de unidades de terapia intensiva individuais e ensaios clínicos observacionais e prospectivos multicêntricos.

ABSTRACT Objective: To describe the IMPACTO-MR, a Brazilian nationwide intensive care unit platform study focused on the impact of health care-associated infections due to multidrug-resistant bacteria. Methods: We described the IMPACTO-MR platform, its development, criteria for intensive care unit selection, characterization of core data collection, objectives, and future research projects to be held within the platform. Results: The core data were collected using the Epimed Monitor System® and consisted of demographic data, comorbidity data, functional status, clinical scores, admission diagnosis and secondary diagnoses, laboratory, clinical, and microbiological data, and organ support during intensive care unit stay, among others. From October 2019 to December 2020, 33,983 patients from 51 intensive care units were included in the core database. Conclusion: The IMPACTO-MR platform is a nationwide Brazilian intensive care unit clinical database focused on researching the impact of health care-associated infections due to multidrug-resistant bacteria. This platform provides data for individual intensive care unit development and research and multicenter observational and prospective trials.

Gonioscopy-assisted transluminal trabeculotomy (GATT) outcomes in eyes with open-angle glaucoma resistant to maximum treatment / Resultados da técnica de trabeculotomia transluminal assistida por gonioscopia em olhos com glaucoma de ângulo aberto resistentes ao tratamento máximo

ABSTRACT Purpose: To report the initial 2 years' learning curve on gonioscopy-assisted transluminal trabeculotomy performed using the thermally blunted suture technique and review the factors that could potentially affect the outcome. Methods: This retrospective study evaluated 100 eyes from 89 participants with glaucoma resistant to maximum clinical treatment, which was defined as having an intraocular pressure >21 mmHg in addition to three or four different hypotensive drugs. Intraocular pressure values at baseline, 1 week, and at 1, 2, 3, 6, 12, and 24 months of follow-up and details regarding the need of antiglaucoma medication and further glaucoma surgery were recorded. Eyes that required further surgical intervention for intraocular pressure control were considered as failure. Results: A total of 51 eyes were subjected to isolated gonioscopy-assisted transluminal trabeculotomy, and 49 eyes were subjected to gonioscopy-assisted transluminal trabeculotomy + cataract extraction at the same surgical time. A statistically significant difference was observed between overall mean follow-up intraocular pressure and mean preoperative intraocular pressure (p<0.001) in all follow-up visits. When the extent of treatment was evaluated, patients with an extension of 360° did not exhibit statistically significantly lower mean intraocular pressure than those with other extensions. Hyphema was the only complication presented in 50 eyes (50%), but all had spontaneous resolution within 4 weeks. A total of 26 eyes (26%) required additional conventional trabeculectomy due to uncontrolled intraocular pressure, especially those who previously underwent vitreoretinal surgery. Conclusions: Gonioscopy-assisted transluminal trabeculotomy, besides being an apparently safe procedure, results in satisfactory success rates even during the surgeon's initial learning curve. The technique was effective in decreasing intraocular pressure and medication burden.

RESUMO Objetivo: Reportar a curva de aprendizado dos 2 anos iniciais da trabeculotomia transluminal assistida por gonioscopia, usando a técnica de sutura termicamente atenuada e revisar os fatores que podem afetar o resultado. Métodos: Este estudo retrospectivo incluiu 100 olhos de 89 participantes com glaucoma resistente ao tratamento clínico máximo, definido como tendo pressão intraocular superior a 21mmHg, além de três ou quatro drogas hipotensoras diferentes. Pressão intraocular inicial, 1 semana, primeiro, segundo, terceiro, sexto, 12 e 24 meses de acompanhamento; necessidade de medicação antiglaucoma; necessidade de mais cirurgias anti-glaucomatosas foram registradas. Olhos que necessitaram de intervenção cirúrgica adicional para o controle da pressão intraocular foram considerados como insucesso. Resultados: Cinquenta e um olhos foram submetidos à trabeculotomia transluminal assistida por gonioscopia isolado e 49 olhos à trabeculotomia transluminal assistida por gonioscopia associado à extração de catarata no mesmo tempo cirúrgico. Houve diferença estatisticamente significativa entre a pressão intraocular média global no acompanhamento e a pressão intraocular média pré-operatória (p<0,001) em todas as visitas do acompanhamento. Ao avaliar a extensão do tratamento, os pacientes com extensão de 360 graus não apresentaram pressão intraocular média menor estatisticamente significativa em comparação com outras extensões. O hifema foi a única complicação presente em 50 olhos (50%), contudo todos tiveram resolução espontânea em quatro semanas. Um total de 26 olhos (26%) teve que ser submetido a trabeculectomia convencional adicional devido à pressão intraocular descontrolada, principalmente aqueles previamente submetidos à cirurgia vitreorretiniana. Conclusões: A trabeculotomia transluminal assistida por gonioscopia, além de ser um procedimento aparentemente seguro, apresenta taxas de sucesso satisfatórias, mesmo durante a curva de aprendizado inicial do cirurgião. A técnica foi efetiva em reduzir a pressão intraocular e uso de medicamentos.

Clinical validation of an in-house quantitative real time PCR assay for cytomegalovirus infection using the 1st WHO International Standard in kidney transplant patients / Validação clínica de um ensaio de PCR in house quantitativo em tempo real para infecção por citomegalovírus usando o 1º Padrão Internacional da OMS em pacientes com transplantados renais

Abstract Introduction: Cytomegalovirus (CMV) is one of the most common agents of infection in solid organ transplant patients, with significant morbidity and mortality. Objective: This study aimed to establish a threshold for initiation of preemptive treatment. In addition, the study compared the performance of antigenemia with qPCR results. Study design: This was a prospective cohort study conducted in 2017 in a single kidney transplant center in Brazil. Clinical validation was performed by comparing in-house qPCR results, against standard of care at that time (Pp65 CMV Antigenemia). ROC curve analysis was performed to determine the ideal threshold for initiation of preemptive therapy based on the qPCR test results. Results: Two hundred and thirty two samples from 30 patients were tested with both antigenemia and qPCR, from which 163 (70.26%) were concordant (Kappa coefficient: 0.435, p<0.001; Spearman correlation: 0.663). PCR allowed for early diagnoses. The median number of days for the first positive result was 50 (range, 24-105) for antigenemia and 42 (range, 24-74) for qPCR (p<0.001). ROC curve analysis revealed that at a threshold of 3,430 IU/mL (Log 3.54), qPCR had a sensitivity of 97.06% and a specificity of 74.24% (AUC 0.92617 ± 0.0185, p<0.001), in the prediction of 10 cells/105 leukocytes by antigenemia and physician's decision to treat. Conclusions: CMV Pp65 antigenemia and CMV qPCR showed fair agreement and a moderate correlation in this study. The in-house qPCR was revealed to be an accurate method to determine CMV DNAemia in kidney transplant patients, resulting in positive results weeks before antigenemia.

Resumo Introdução: Citomegalovírus (CMV) é um dos agentes infecciosos mais comuns em pacientes com transplante de órgãos sólidos, com morbidade e mortalidade significativas. Objetivo: Este estudo visou estabelecer um limite para o início do tratamento preemptivo. Além disso, comparou o desempenho da antigenemia com os resultados da qPCR in house. Desenho do estudo: Este foi um estudo de coorte prospectivo realizado em 2017 em um centro único de transplante renal no Brasil. A validação clínica foi realizada comparando resultados de qPCR in house, com o padrão de atendimento na época (Antigenemia para CMV Pp65). A análise da curva ROC foi realizada para determinar o limite ideal para o início da terapia preemptiva baseado nos resultados do teste qPCR in house. Resultados: 232 amostras de 30 pacientes foram testadas com antigenemia e qPCR, das quais 163 (70,26%) foram concordantes (Coeficiente Kappa: 0,435, p<0,001; Correlação Spearman: 0,663). PCR permitiu diagnósticos precoces. O número médio de dias para o primeiro resultado positivo foi 50 (intervalo, 24-105) para antigenemia e 42 (intervalo, 24-74) para qPCR (p<0,001). A análise da curva ROC revelou que em um limite de 3.430 UI/mL (Log 3,54), qPCR teve sensibilidade de 97,06% e especificidade de 74,24% (AUC 0,92617 ± 0,0185, p<0,001), na previsão de 10 células/10(5) leucócitos por antigenemia e na decisão do médico de tratar. Conclusões: Antigenemia para CMV Pp65 e qPCR para CMV mostraram uma concordância aceitável e uma correlação moderada neste estudo. qPCR in house revelou-se um método preciso para determinar DNAemia do CMV em pacientes transplantados renais, obtendo resultados positivos semanas antes da antigenemia.

Tourniquet use for civilian extremity hemorrhage: systematic review of the literature / Uso de torniquete nas hemorragias de extremidades na população civil: revisão sistemática da literatura

ABSTRACT Introduction: extremity tourniquet (TQ) use has increased in the civilian setting; the beneficial results observed in the military has influenced acceptance by EMS and bystanders. This review aimed to analyze extremity TQ types used in the civilian setting, injury site, indications, and complications. Methods: a systematic review was conducted based on original articles published in PubMed, Embase, and Cochrane following PRISMA guidelines from 2010 to 2019. Data extraction focused on extremity TQ use for hemorrhage control in the civilian setting, demographic data, study type and duration, mechanism of injury, indications for use, injury site, TQ type, TQ time, and complications. Results: of the 1384 articles identified, 14 were selected for review with a total of 3912 civilian victims with extremity hemorrhage and 3522 extremity TQ placements analyzed. The majority of TQs were applied to male (79%) patients, with blunt or penetrating trauma. Among the indications for TQ use were hemorrhagic shock, suspicion of vascular injuries, continued bleeding, and partial or complete traumatic amputations. Upper extremity application was the most common TQ application site (56%), nearly all applied to a single extremity (99%), and only 0,6% required both upper and lower extremity applications. 80% of the applied TQs were commercial devices, and 20% improvised. Conclusions: TQ use in the civilian setting is associated with trauma-related injuries. Most are single-site TQs applied for the most part to male adults with upper extremity injury. Commercial TQs are more commonly employed, time in an urban setting is under 1 hour, with few complications described.

RESUMO Introdução: o uso de torniquete em extremidades (TQ) aumentou no ambiente civil; os resultados benéficos observados nas forças armadas influenciaram a aceitação por equipes de pré-hospitalar (PH) assim como pela população leiga. Esta revisão teve como objetivo analisar os tipos de TQ de extremidades usados em ambiente civil, local da lesão, indicações e complicações. Métodos: revisão sistemática foi conduzida com base em artigos originais publicados no PubMed, Embase e Cochrane seguindo as diretrizes do PRISMA de 2010 a 2019. Extração de dados focada no uso de TQ de extremidade para controle de hemorragia em ambiente civil, dados demográficos, tipo de estudo e duração, mecanismo de lesão, indicações de uso, local da lesão, tipo de TQ, tempo de TQ e complicações. Resultados: dos 1.384 artigos identificados, 14 foram selecionados para revisão com total de 3.912 vítimas civis com hemorragia nas extremidades e 3.522 colocações de extremidades TQ analisadas. A maioria foi aplicado em pacientes do sexo masculino (79%), com trauma contuso ou penetrante. Entre as indicações estavam choque hemorrágico, suspeita de lesões vasculares, sangramento contínuo e amputações traumáticas parciais ou completas. A aplicação na extremidade superior foi o local de aplicação mais comum (56%), quase todos aplicados a uma única extremidade (99%), e apenas 0,6% requereram aplicações nas extremidades superior e inferior. 80% dos TQs aplicados eram dispositivos comerciais e 20% improvisados. Conclusões: o uso de TQ em ambientes civis está associado a traumas. Os TQs comerciais são mais utilizados, com tempo menor que uma hora de uso e poucas complicações.

Bovine digital dermatitis in the Brazilian Amazon biome and topical treatment with Copaifera reticulata oil / Dermatite digital bovina no bioma amazônico brasileiro e tratamento tópico com óleo de Copaifera reticulata

Bovine Digital Dermatitis (BDD) was studied in crossbred dairy cows grazing in Rondon do Pará, in the state of Pará, as well as in Açailândia and Cidelândia, in the state of Maranhão, Brazilian Amazon biome. The digits inspection from the dairy cows during milking was performed in ten farms comprising four visits (August and November 2016; April and July 2017). The cows were kept all year in pastures, and were mechanically milked on concrete floors and the animals were protected against the rains in eight farms, maintaining a daily cleaning, however, it could not be found a concrete floor in pre- or post-milking to ensure milking parlor on three farms. Manual milking on no concrete floors was performed in two farms. No preventive measures against hoof lesions were adopted. The BDD prevalence was 1.3% (22/1664), and no statistical difference among rainy or no rainy season was obtained (p = 0.72). The BDD lesions were classified according to "M system" (M0 = no lesion, M1 = active ulceration <2cm, M2 = active ulceration >2cm, M3 = healing stage, M4 = chronic stage, M4.1 = M4 with active ulceration). Regarding the 22 BDD lesions observed, 22.7% (5/22) were M1 stage, 36.4% (8/22) M2, 22.7% (5/22) M3, 13.6% (3/22) M4 and 4.5 (1/22) M4.1. Hypertrophic hairs at the edges of the lesions caused by fly larvae of genus Cochliomyia spp. as well as alterations on the hoof were also observed. Topical treatment was performed in six BDD lesions with a raw extract from trees of the genus Copaifera reticulata (Copaiba oil) and compared with the treatment of salicylic acid paste in five BDD lesions. The lesions were protected with a bandage for seven days and followed weekly until recovery. The complete therapeutic responses were 83.4% (5/6) and 75% (3/4), respectively, with an average time of seven weeks. The BDD in the Amazon biome occurs in low prevalence, not seasonal, and presents macro and microscopic features similar to BDD lesions from dairy cattle kept in free-stall housing. The treatment with copaiba oil showed similar results to the treatment of salicylic acid paste and can be used in control measures to BDD in the Amazon biome.(AU)

A dermatite digital bovina (DDB) foi estudada em vacas mestiças leiteiras nos municípios de Rondon do Pará no Pará, Açailândia e Cidelândia no Maranhão, bioma amazônico brasileiro. Para tanto, foram realizadas quatro visitas a 10 propriedades, nos meses de agosto e novembro em 2016 e abril e julho em 2017, e realizada a inspeção dos dígitos de 1.664 vacas em lactação durante a ordenha. Nestas propriedades as vacas eram criadas a pasto durante todo o ano e ordenhadas mecanicamente em oito propriedades. As quais, as salas de ordenha tinham piso concretado, com proteção contra as chuvas e era realizada a limpeza diariamente. No entanto, em três dessas propriedades, as salas de pré ou pós ordenha tinham piso não concretado e em duas, a ordenha era manual em piso de chão batido. Em todas elas não havia medidas profiláticas para afecções podais. A prevalência de DDB foi de 1,3% (22/1.664) e não se obteve diferença estatística entre os períodos chuvoso e não chuvoso (P = 0,72). As lesões observadas foram classificadas de acordo com o sistema M (M0-sem lesão; M1-lesão ulcerada <2cm; M2-lesão ulcerada >2cm; M3-lesão em cicatrização; M4-lesão crônica; M4.1- M4 com área ulcerada). De 22 lesões observadas, 22,7% (5/22) apresentavam-se em estágio M1, 36,4% (8/22) em M2, 22,7% (5/22) em M3, 13,6% (3/22) em M4 e 4,5% (1/22) em M4.1. Pelos hipertrofiados nos bordos das lesões, larvas de moscas do gênero Cochliomyia spp. e alterações no tecido córneo também foram observados. Nas lesões de 11 bovinos, em seis, foi realizado o tratamento tópico com extrato bruto de Copaifera reticulata (óleo de copaíba) e em cinco, com a pasta de ácido salicílico a 660mg/g e ambos os tratamentos foram protegidos com bandagem por sete dias. Após, as lesões foram acompanhadas semanalmente até a cura e obteve-se um índice de 83,4% (5/6) e 75% (3/4) de cura com esses tratamentos, respectivamente, com uma média de 7 semanas. Conclui-se que no bioma amazônico a DDB ocorre em baixa prevalência, não sazonal e com características macroscópicas semelhantes às lesões de vacas leiteiras criadas em sistema free stall. O tratamento com o óleo da copaíba apresentou resultados semelhante ao ácido salicílico e pode ser uma alternativa como medida de controle da DDB no bioma amazônico.(AU)

The trauma and acute care surgeon in the COVID-19 pandemic era / O cirurgião de trauma e emergência na era da pandemia de COVID-19

ABSTRACT The World Health Organization recognized in March 2020 the existence of a pandemic for the new coronavirus that appeared in China, in late 2019, and whose disease was named COVID-19. In this context, the SBAIT (Brazilian Society of Integrated Care for Traumatized Patients) conducted a survey with 219 trauma and emergency surgeons regarding the availability of personal protective equipment (PPE) and the role of the surgeon in this pandemic by means of an electronic survey. It was observed that surgeons have been acting under inadequate conditions, with a lack of basic supplies as well as more specific equipment such as N95 masks and facial shields for the care of potential victims who may be contaminated. The latter increases the risk of contamination of professionals, resulting in potential losses in the working teams. Immediate measures must be taken to guarantee access to safety equipment throughout the country, since all trauma victims and/or patients with emergency surgical conditions must be treated as potential carriers of COVID-19.

RESUMO A Organização Mundial de Saúde reconheceu a partir de março de 2020 a existência de uma pandemia do novo coronavírus que surgiu na China no final de 2019, e cuja doença foi denominada COVID-19. Neste contexto, a SBAIT (Sociedade Brasileira de Atendimento Integrado ao Traumatizado) realizou pesquisa com 219 cirurgiões de Trauma e de Urgências e Emergências a respeito de disponibilidade de equipamentos de proteção individual (EPI) e do papel do cirurgião nesta pandemia, por meio de formulário eletrônico. Observou-se que os cirurgiões vêm atuando em condições inadequadas, com falta de insumos básicos assim como equipamentos mais específicos, como máscaras N95 e protetores faciais, para a atenção de potenciais vítimas que estejam contaminadas. Isso eleva o risco de contaminação dos profissionais e causa decorrentes baixas na força de trabalho. Medidas imediatas devem ser adotadas para garantir o acesso aos equipamentos de segurança em todo país uma vez que, todos os pacientes vítimas de trauma e/ou portadores de doenças cirúrgicas de urgência devem ser tratados como potenciais portadores do COVID-19.

Fístula perianal compleja: Tratamiento con plasma rico en plaquetas / Complex perianal fistula: Treatment with platelet-rich plasma

Paciente masculino con diagnóstico de enfermedad inflamatoria intestinal (colitis ulcerosa), corticodependiente, que consulta en nuestro servicio por fístula perianal compleja con extenso compromiso inflamatorio crónico de la región perianal, el cual fue tratado exitosamente con la aplicación local de plasma rico en plaquetas como única terapéutica. Se presentan los beneficios que se podrían obtener mediante la aplicación de plasma rico en plaquetas autólogo en el tratamiento de este tipo de fístulas. De ese modo se evitan los procedimientos quirúrgicos en un terreno inflamatorio crónico que implican altas tasas de complicaciones y recurrencia, afectando la calidad de vida.

A male patient with a diagnosis of steroid dependent inflammatory bowel disease (ulcerative colitis) sought medical care due to complex perianal fistula with extended chronic inflammation of the perianal region that was successfully treated with platelet-rich plasma as a single therapy. The benefits of autologous platelet-rich plasma for the treatment of this type of fistulas are presented. In this way, there is no need to perform surgery in a chronic inflammatory territory with high rate of complications and recurrence affecting patients' quality of life.

Análise comparativa entre dinamometria e equações antropométricas preditoras da força de preensão manual em idosos / Comparative analysis between dynamometry and different anthropometric equations predicting of handgrip strength of elderly

A Força de Preensão Manual (FPM) é uma medida bastante utilizada na prática clínica como um indicador de saúde, por representar a força muscular global. O objetivo deste estudo foi analisar os coeficientes de concordância entre dinamometria e diferentes equações antropométricas preditoras da força de preensão manual em idosos. Trata-se de um estudo transversal baseado nos dados da pesquisa epidemiológica de base populacional e domiciliar. Participaram do estudo 283 (85,8%) idosos, residentes na zona urbana do município de Lafaiete Coutinho, com idade > 60 anos. A força de preensão manual foi mensurada por meio da dinamometria e estimada por diferentes equações antropométricas: Tveter et al., Novaes et al., e Fortes et al. As medidas antropométricas utilizadas no estudo foram: peso e estatura. O coeficiente de Lin e os gráficos de Bland Altman foram usados para observar concordância da FPM entre as equações. A média de idade dos idosos foi de 73,8±8,9 anos, peso corporal 60,11 ± 12,54 Kg, estatura média foi 154,83 ± 9,1 cm e IMC 25,05 ± 4,7 kg/m2 . Para os coeficientes houve moderada concordância nas equações antropométricas de Fortes 0,62 (0,55 ­ 0,68), Novaes 0,60 (0,53 ­ 0,66) e Tveter 0,60 (0,53 ­ 0,65) comparada a dinamometria, respectivamente. As equações antropométricas utilizadas para estimar a força de preensão manual apresentaram moderada concordância com o método padrão ouro (dinamometria)....(AU)

The handgrip strength (HGS) is a measure widely used in clinical practice as a health indicator, to represent the overall muscle strength. The aim this study was to analyze the concordance coefficients between dynamometry and different anthropometric equations predictor handgrip strength of elderly. This is a cross-sectional study that analyzed data from epidemiological research of a home and population-based epidemiological survey. Participated in the study 283 (85,8%) elderly people, living in the urban área of the municipality of Lafaiete Coutinho, aged > 60 years. Handgrip strength was measured using dynamometry and different anthropometric equations: Tveter et al., Novaes et al., and Fortes et al. Anthropometric measurements used in the study were: weight and height. The Lin coefficient and the Bland Altman graphics were used to observe the HGS concordance between the different equations. The mean age of the elderly was 73.8 ± 8.9 years, mean body weight was 60.11 ± 12.54 kg, mean height was 154.83 ± 9.1 cm and BMI 25.05 ± 4.7 kg/m2 . For the coefficients there was moderate concordance in the anthropometric equations of Fortes 0,62 (0,55 ­ 0,68), Novaes 0,60 (0,53 ­ 0,66) e Tveter 0,60 (0,53 ­ 0,65) compared to dynamometry, respectively. The anthropometric equations used to estimate the handgrip strength showed moderate concordance with the gold standard test (dynamometry)....(AU)

Success and Complication Rates After Sacral Neuromodulation for Fecal Incontinence and Constipation: A Single-center Follow-up Study

BACKGROUND/AIMS: The aim of this study was to evaluate the sustainability of sacral neuromodulation (SNM) success in patients with fecal incontinence (FI) and/or constipation. METHODS: This is a retrospective analysis of a prospective database of patients who received SNM therapy for FI and/or constipation between 2006 and 2015. Success rates, complications and reintervention rates were assessed after up to 10 years of follow-up. RESULTS: Electrodes for test stimulation were implanted in 101 patients, of whom 79 (78.2%) received permanent stimulation. The mean follow-up was 4.4 ± 3.0 years. At the end of follow-up, 57 patients (72.2%) were still receiving SNM. The 5-year success rate for FI and isolated constipation was 88.2% (95% confidence interval [CI], 80.1–97.0%) and 31.2% (95% CI, 10.2–95.5%), respectively (P 50% in 76.1% of patients (95% CI, 67.6–86.2%) after 5 years. A lead position at S3 was associated with an improved outcome (P = 0.04). Battery exchange was necessary in 23 patients (29.1%), with a median battery life of 6.2 years. Reinterventions due to complications were necessary in 24 patients (30.4%). For these patients, the 5-year success rate was 89.0% (95% CI, 75.3–100.0%) compared to 78.4% (95% CI, 67.2–91.4%) for patients without reintervention. CONCLUSIONS: SNM offers an effective sustainable treatment for FI. For constipation, lasting success of SNM is limited and is thus not recommended. Reinterventions are necessary but do not impede treatment success.

Gender-related dimensions of childhood adversities in the general population

Objective: Childhood adversities (CAs) comprise a group of negative experiences individuals may suffer in their lifetimes. The goal of the present study was to investigate the cluster discrimination of CAs through psychometric determination of the common attributes of such experiences for men and women. Methods: Parental mental illness, substance misuse, criminality, death, divorce, other parental loss, family violence, physical abuse, sexual abuse, neglect, physical illness, and economic adversity were assessed in a general-population sample (n=5,037). Exploratory and confirmatory factor analysis determined gender-related dimensions of CA. The contribution of each individual adversity was explored through Rasch analysis. Results: Adversities were reported by 53.6% of the sample. A three-factor model of CA dimensions fit the data better for men, and a two-factor model for women. For both genders, the dimension of family maladjustment - encompassing physical abuse, neglect, parental mental disorders, and family violence - was the core cluster of CAs. Women endorsed more CAs than men. Rasch analysis found that sexual abuse, physical illness, parental criminal behavior, parental divorce, and economic adversity were difficult to report in face-to-face interviews. Conclusion: CAs embrace sensitive personal information, clustering of which differed by gender. Acknowledging CAs may have an impact on medical and psychiatric outcomes in adulthood.

Possible effects of clustering structure in the competition between fast emission processes and compound nucleus decay / Posibles efectos de estructura de agrupamiento en la competencia entre los procesos de emisión rápida y desintegración del núcleo compuesto

Abstract The attention to nuclear clustering has been renewed due to the study of weakly bound nuclei at the drip lines. In particular, clustering structural properties in medium-mass systems have been studied by looking at the competition between the evaporation and pre-equilibrium particle emission in central collisions. Although for light nuclei at an excitation energy close to the particle separation value there are experimental evidence of such structure effects, this is still not the case for heavier systems since the determination of pre-formed clusters within nuclear matter is less obvious. Two systems, leading to the same 81Rb* compound nucleus, have been studied at the same beam velocity 16 AMeV: 16O + 65Cu and 19F + 62Ni. The experiment has been performed using the GARFIELD + RCo detection system installed at the Legnaro National Laboratories.Light charged particles energy distributions and multiplicities have been compared with different statistical and dynamical model calculations. From the first comparison between the two systems a difference in the fast α-decay channel has been evidenced, which can be related to the difference in the projectile structure. Recent data analysis results and comparisons with model calculations are presented in this contribution.

Resumen La atención a la agrupación nuclear se ha renovado debido al estudio de núcleos débilmente unidos en las líneas de goteo. En particular, se han estudiado las propiedades estructurales del agrupamiento en sistemas de masa media al observar la competencia entre la evaporación y la emisión de partículas de preequilibrio en colisiones centrales. Aunque para núcleos ligeros a una energía de excitación cercana al valor de separación de la partícula hay evidencia experimental de tales efectos de estructura, este no es el caso para sistemas más pesados ya que la determinación de agrupamientos preformados dentro de la materia nuclear es menos obvia. Se han estudiado dos sistemas, que conducen al mismo núcleo compuesto 81Rb *, a la misma velocidad de haz 16 AMeV: 16O + 65Cu y 19F + 62Ni. El experimento se ha realizado utilizando el sistema de detección GARFIELD + RCo instalado en los Laboratorios Nacionales Legnaro. Las distribuciones de energía y las multiplicidades de partículas de carga ligera se han comparado con diferentes cálculos de modelos estadísticos y dinámicos. Desde la primera comparación entre los dos sistemas, se ha evidenciado una diferencia en el canal de desintegración α rápida, que se puede relacionar con la diferencia en la estructura del proyectil. En esta contribución se presentan los resultados del análisis de datos recientes y las comparaciones con los cálculos del modelo.

Correlations between caregiver psychiatric symptoms and offspring psychopathology in a low-resource setting

Objective: Associations between parental/caregiver depression and adverse child outcomes are well established and have been described through one or more mechanisms: child psychopathology following exposure to a depressed caregiver, child psychopathology exacerbating a caregiver's depression, and caregiver and offspring depression sharing the same etiology. Data from low and middle-income countries is scarce. We examined correlations between common symptoms of mental disorders in caregivers and their offspring's psychopathology in a Brazilian sample. Methods: In this cross-sectional study, adult caregivers were screened for depression during routine home visits by community health workers as part of the Brazilian Family Health Strategy. Caregivers with suspected depression were assessed using the Zung Self-Rating Depression Scale and the Self-Reporting Questionnaire (SRQ-20). Children's symptoms were evaluated using the Strengths and Difficulties Questionnaire (SDQ). Results: The sample included 68 primary caregivers and 110 children aged 6 to 15 years. Higher caregiver scores on the SRQ-20 correlated significantly with psychiatric symptoms in offspring. Conclusion: These results substantiate our hypothesis that child psychopathology correlates with caregivers' psychiatric symptoms. This paper adds to the growing literature on community mental health assessment and can help guide future strategies for reducing the burden of common mental disorders in caregivers and children alike in low and middle-income countries.

Metabolic Control in Patients With Phenylketonuria Pre- and Post-Sapropterin Loading Test

Abstract In Portugal, tetrahydrobiopterin (BH4)-responsive patients with phenylketonuria (PKU) are identified using a loading test (LT). Phenylalanine/natural protein (Phe/NP) intake is increased to elevate blood Phe prior to the LT. In a longitudinal retrospective study, the impact of Phe/NP titration post-LT in 58 patients (19.6 + 8.2 years) with PKU during 4 study periods (SPs) was examined. In SP1 (2010-2013), patients were diet treated only; in SP2 (2014), the Phe/NP titration was followed by the LT in SP3 (2015). In SP4 (2016), patients received diet treatment only (n » 49) or BH4 þdiet (n » 9). The median percentage blood Phe within the target range was higher in SP1 versus SP4 (64 [28-85] vs 45 [0-66]; P < .001). Our results suggest that transient Phe/NP titration, associated with a deliberate increase in NP, may adversely affect metabolic control. Controlled studies are necessary to examine the longer term impact of temporary increased NP with BH4 LT in non-BH4-responsive patients.

Estudo clínico e epidemiológico em cães com fraturas e luxações vertebrais toracolombares / Clinical and epidemiological study in dogs with thoracolumbar vertebrae fractures and luxations

Fraturas e luxações vertebrais (FLV) estão dentre as principais afecções que acometem a coluna vertebral em cães, com elevado risco de danos permanentes às estruturas neurais. Objetivou-se estudar as características e implicações associadas às FLV toracolombares em 37 cães, visando auxiliar uma melhor abordagem clínica em pacientes com esta afecção. As FLV foram mais comuns em machos não castrados com acesso a rua. Dentre a etiologia, 32 cães foram acometidos por acidente automobilístico. 14 cães apresentaram lesões não neurológicas em outros sistemas orgânicos. A presença de fraturas instáveis foi a alteração radiográfica mais comum. Em 16,2% dos animais, observaram-se lesões vertebrais fora do foco principal. O tempo até o atendimento neurológico inicial variou de um a 720 dias, no qual a maioria foi encaminhada sem imobilização externa. Houve diferença estatisticamente significante quanto à recuperação neurológica ao se comparar os graus de deslocamento de 0 a 25% e de 76 a 100%.(AU)

Vertebral fractures and luxations (VFL) are one of the most common and severe neurological issues found in clinical practice, with an elevated risk of permanent damage to the spinal cord. Our objective was to study the characteristics and implications associated with thoracolumbar VFL in 37 dogs, aiming assist a better clinical approach to patients with this disease. The VFL were more common in intact males with access to the street. Regarding etiology, 32 dogs were involved in car accidents. Of the dogs included in this research, 14 had non-neurological issues in other systems. The presence of unstable fractures was the most common radiographic change. In 16.2% of the dogs, vertebral lesions were observed outside the main site. Mean time until initial neurologic exam varied between one and 720 days, and most dogs were referred without external coaptation. There was a significant difference in recovery of the dogs when comparing a degree of dislocation of 0 to 25% and 76 to 100%.(AU)

Morfologia comparada do aparelho respiratório de capivaras (Hydrochoerus hydrochoeris) / Comparative morphology of the respiratory organs of capybaras (Hydrochoerus hydrochoeris)

A capivara (Hydrochoerus hydrochoeris), um roedor silvestre típico no continente Sul-americano, é utilizada como fonte de alimento em toda a sua região de ocorrência, sendo um importante componente na dieta de povo indígena e população rural do Brasil. O conhecimento da morfologia fornece bases para outras áreas de atuação, bem coamo, para o manejo biológico de animais silvestres. Devido à escassez na literatura de estudos anatômicos e morfológicos do aparelho respiratório da capivara, o objetivo deste trabalho é analisar os órgãos deste aparelho, macro e microscopicamente, para que possamos adquirir melhor conhecimento básico e compará-lo com o de animais da mesma subordem (Histricomorfos) e com outras espécies de mamíferos. Vimos que o aparelho respiratório da capivara é formado pelas narinas, fossas nasais, cavidade nasal, seios paranasais, faringe, laringe, traqueia e pulmões. O nariz se localiza em plano nasal com as narinas dispostas lateralmente. A maior parte da cavidade nasal está ocupada pelas conchas nasais, que se apresentam como estruturas em formato de espiral, com seus respectivos meatos. A laringe está delimitada por suas cartilagens e está em comunicação com a traqueia. A traqueia é um tubo cartilaginoso flexível e membranoso, com anéis incompletos em formato de "C", que se bifurca em sua parte terminal, formando a carina traqueal. Os pulmões apresentam-se em pares, direito (com quatro lobos) e esquerdo (com dois lobos), localizados na cavidade torácica. As árvores brônquicas são formadas pelo brônquio primário e por uma sequência intrapulmonar que inclui brônquios intrapulmonares, bronquíolos, bronquíolos terminais e bronquíolos respiratórios.(AU)

The capybara, a wild rodent typical of the South American continent, is a source of food in all regions of its occurrence and is an important component in the diet of indigenous people and the rural population of Brazil. Knowledge of morphology is basic for the biological management of wild animals. Due to the scarcity of literature on morphological and anatomical studies of the respiratory tract of capybara, the aim of this study is to analyze the organs of this apparatus, macro and microscopically, so we can acquire better basic knowledge and compare it with that of animals of the same suborder (Histricomorpha) and with other species of mammals. We have seen that the respiratory tract of capybara is formed through the nostrils, nasal, nasal cavity, paranasal sinuses, phisarynx, larynx, trachea and lungs. The nose is located in nasal plan with nostrils arranged laterally. The largest part of the nasal cavity of the capybara is occupied by the turbinates, which performe as spiral-shaped structures, with their respective meati. The larynx is bounded by cartilage and in communication with the trachea. The trachea is a flexible cartilaginous and membranous tube, with incomplete rings in the shape of a "C", which is bifurcated in its terminal part, forming the tracheal carina. The lungs of capybaras are in pairs, right (with four lobes) and left (with two lobes), located in the chest cavity. The bronchial tree of capybara is formed by primary bronchi and by a sequence that includes intrapulmonary bronchi, bronchioles, terminal bronchioles, and respiratory bronchioles.(AU)

Evolution to permanent or transient conditions in children with positive neonatal TSH screening tests in Sergipe, Brazil

ABSTRACT Objectives To assess the evolution to permanent or transient conditions in children with positive neonatal TSH tests in Sergipe, Brazil, from 2004 to 2010. Subjects and methods Out of 193,794 screened newborns, 713 presented a neonatal TSH level higher than the local cutoff (5.2 µU/mL). From the confirmatory serum TSH values, the children were diagnosed with initial congenital hypothyroidism (CH) or suspect CH. From the evolution, they were classified as permanent CH, hyperthyrotropinemia, or transient TSH elevation. The mean incidence of each final condition was calculated for the total period of time. Results The initial diagnosis included 37 CH (18.1%) and 167 suspect CH (81.9%) cases. The final diagnosis included 46 cases of permanent CH (22.5%), 56 of hyperthyrotropinemia (27.5%), and 102 of transient TSH elevation (50.0%). Out of the 37 cases of initial CH, 23 (62.2%) had permanent CH, nine (24.3%) had hyperthyrotropinemia, and five (13.5%) had transient TSH elevation. Out of the 167 suspect CH cases, 23 (13.8%) had permanent CH, 47 (28.1%) had hyperthyrotropinemia and 97 (58.1%) had transient TSH elevation. The mean incidence after the follow up was 1:4,166 for permanent CH, 1:3,448 for hyperthyrotropinemia, and 1:1,887 for transient TSH elevation. Eighty-six percent of the children with an initial diagnosis of CH and 41.9% with suspect CH had a permanent condition (CH or hyperthyrotropinemia). Conclusions The follow-up of children with an initial diagnosis of CH or suspect CH is necessary to determine whether the disorder is permanent because predicting the evolution of the condition is difficult.

Avaliação da precisão de dois localizadores foraminais na determinação do limite apical: estudo in vitro / Evaluation of the accuracy of two apex locators in determining apical limit: an in vitro study

O objetivo do presente estudo foi comparar in vitro a precisão de dois localizadores foraminais: Endus (Gnatus, Ribeirão Preto, SP, Brasil) e Root ZX (J. Morita, Tokyo, Japão). Material e Método: Trinta e dois dentes caninos permanentes humanos foram selecionados para o estudo. Após a realização da abertura coronária e preparo do terço cervical e médio, procedeu-se à determinação do comprimento real do dente pelo método visual, com introdução de um instrumento tipo K #10 até ser visto na saída foraminal sob magnificação de 16x com microscópio óptico de luz (DF Vasconcelos, São Paulo, Brasil). Para medição eletrônica, os dentes foram inseridos em um molde de alginato e as medidas realizadas com os dois localizadores foraminais até a saída do forame apical (0,0mm). Resultados: Os resultados evidenciaram um índice de precisão de 96,8% e 91,6% para os localizadores Gnatus e Root ZX, respectivamente. Conclusão: Ambos os localizadores apicais eletrônicos testados apresentaram alto índice de precisão na determinação do limite apical.

The aim of this study was to compare in vitro the precision of two locators foraminal: Endus (Gnatus, Ribeirão Preto, SP, Brazil) and Root ZX (J. Morita, Tokyo, Japan). Methods: Thirty-two canine teeth permanent humans were selected for the study, and, after effectuate the coronary opening and preparation of the cervical and middle third, proceeded to the determination of the real length of the tooth by the visual method, introducing an instrument file K #10 until be seen in foraminal exit under magnification of 16x optical light microscope (DF Vasconcelos, São Paulo, Brazil). For electronic measurement, the teeth were embedded in an alginate mold and electronic measurements with the two locators foraminal to the actual output of the apical foramen (0,0mm). Results: The results showed a 96.8% and 91.6% accuracy rates for the locators Gnatus and Root ZX, respectively. Conclusion: Both electronic apex locators tested presented high index of precision in the precise of determination in the apical limit.