Famílias ouvintes e filhos surdos: o papel da Libras na comunicação / Hearing families and deaf children: the role of Libras in communication / Familias oyentes y niños sordos: el papel de Lengua de Señas Brasileña em la comunicación

Introdução: A Língua Brasileira de Sinais (Libras) é uma língua de natureza visuo-motora com um sistema linguístico e estrutura gramatical próprio e sua aquisição em tempo oportuno é importante para o desenvolvimento cognitivo e comunicativo da criança surda. As famílias ouvintes de crianças surdas devem se engajar no aprendizado dessa língua, uma vez que na ausência do conhecimento da Libras, podem apresentar dificuldades de comunicação e de relacionamento com seu filho surdo. Objetivo: O objetivo deste estudo foi compreender o papel da Libras na comunicação de familiares ouvintes e seus filhos surdos atendidos em um centro de reabilitação. Métodos: Trata-se de um estudo transversal, de caráter qualitativo. Foi aplicado um roteiro de entrevista semiestruturado com 10 questões abertas a pais ouvintes de crianças surdas que participam de atendimentos em um centro de reabilitação. A análise dos dados foi realizada por meio do método análise de conteúdo. Resultados: Ao todo foram entrevistadas 10 mães de crianças surdas. As idades das mães variaram de 21 a 47 anos. Nove mães afirmaram usar a Libras em casa com seus filhos todos os dias e todas relataram usá-la em atividades cotidianas da criança. Todas as mães afirmaram que o uso da Libras trouxe benefícios para o relacionamento na díade mãe-filho. Conclusão: Os achados revelam um importante papel da Libras tanto na comunicação de familiares ouvintes e seus filhos surdos, como no cotidiano desses lares. (AU)

Introduction: The Brazilian Sign Language (Libras) is a visual-motor language with its linguistic system and grammatical structure and its timely acquisition is important for deaf children's cognitive and communicative development. Deaf children's hearing families should engage in learning this language, since not knowing Libras may lead to communication and relationship difficulties with their deaf children. Objective: This study aimed to understand the role of Libras in the communication between hearing family members and their deaf children treated at a rehabilitation center. Methods: This cross-sectional qualitative study applied a semi-structured interview with 10 open-ended questions to hearing parents of deaf children who receive care at a rehabilitation center. Data were analyzed with the content analysis method. Results: Altogether, 10 mothers of deaf children were interviewed. Their ages ranged from 21 to 47 years. Nine mothers said they used Libras at home with their children every day, and all reported using it in their child's daily activities. All mothers stated that the use of Libras brought benefits to the mother-child relationship. Conclusion: The findings highlight the important role of Libras in the daily lives and communication of hearing family members and their deaf children. (AU)

Introducción: La Lengua de Señas Brasileña (Libras) es una lengua visomotora con sistema lingüístico y estructura gramatical propios y su adquisición oportuna es importante para el desarrollo cognitivo y comunicativo del niño sordo. Las familias oyentes de niños sordos deben involucrarse en el aprendizaje de este idioma, ya que en ausencia del conocimiento de Libras, pueden tener dificultades en la comunicación y las relaciones con su hijo sordo. Objetivo: El objetivo de este estudio fue comprender el papel de Libras en la comunicación de los familiares oyentes y sus hijos sordos atendidos en un centro de rehabilitación auditiva. Métodos: Se trata de un estudio transversal, cualitativo. Se aplicó un guión de entrevista semiestructurada con 10 preguntas abiertas a padres oyentes de niños sordos que participan en el cuidado en un centro de rehabilitación. El análisis de los datos se realizó mediante el método de análisis de contenido. Resultados: En total, se entrevistaron 10 madres de niños sordos. Las edades de las madres oscilaron entre 21 y 47 años. Nueve madres dijeron que usan Libras en casa con sus hijos todos los días y todas informaron que lo usan en las actividades diarias de sus hijos. Todas las madres afirmaron que el uso de Libras trajo beneficios a la relación madre-hijo. Conclusión: Los hallazgos revelan un papel importante de Libra tanto en la comunicación de los miembros oyentes de la familia y sus hijos sordos, como en la vida diaria de estos hogares. (AU)

"Penumbra sign" in knee pain: a case of distal femur osteomyelitis

"Penumbra sign" is a characteristic finding in magnetic resonance imaging (MRI) of Brodie's abscess, a rare variant of subacute osteomyelitis. We aimed to discuss the imaging finding penumbra sign that will help in the diagnosis of osteomyelitis and may be useful to clinicians in differential diagnosis. A 26-year-old male patient presented to the emergency department with complaints of pain and limping in the right knee that did not go away. He had a history of arthroscopic debridement and percutaneous fixation surgery due to osteochondral fragment 3 years ago. There were no additional findings in the patient's vital parameters, physical examination, and medical history. X-ray imaging revealed two screws in the distal femur and a well-defined sclerotic rim surrounding a radiolucent lesion anterior to the screws. MRI revealed a lesion in the distal femoral metaphysis with low-density fluid and hyperintense granulation tissue surrounding it. After surgical abscess drainage and local debridement, bone cement was placed in the resulting cavity. Teicoplanin treatment was started. The patient was discharged and complete recovery was achieved in the second month. The diagnosis of osteomyelitis is often missed or confused with bone tumors in non-traumatic cases presenting with persistent bone pain. MRI imaging is frequently used in differential diagnosis, and detection of characteristic imaging signs such as the penumbra sign accelerates the diagnosis. In this context, emergency department clinicians, in particular, should be cautious and not forget that early treatment can be started by recognizing these signs.

O Homem Que Calculava em Libras: Tradução, Contação de História e Matemática / The Man Who Counted in Libras: Translation, Storytelling and Mathematics

RESUMO: Esta pesquisa teve por objetivo compreender os desafios e as possibilidades de tradução e contação em Língua Brasileira de Sinais (Libras) das histórias presentes no livro O homem que Calculava, do escritor modernista brasileiro Malba Tahan. Tratase de uma investigação qualitativa que se debruçou sobre o processo de tradução audiovisual das histórias presentes no livro, as adaptações feitas em suas narrativas, os recursos de preparação para a produção e edição dos vídeos, a implementação de recursos gráficos e visuais e, por fim, sua divulgação como produto da pesquisa. As análises indicam o potencial didático que emerge na interação entre os envolvidos no processo de tradução das histórias: professores, intérpretes e discentes (surdo e ouvinte), possibilitando formas de expressão artísticas que exploram a visualidade inerente da língua de sinais aliada a recursos gráficos, tomando as narrativas como elemento central para o desenvolvimento criativo ancorado no ensino da Matemática por meio da leitura e da interpretação de histórias.

ABSTRACT: This research aimed to understand the challenges and possibilities of translation and storytelling in the Brazilian Sign Language (known by the acronym LIBRAS) of the stories present in the book O homem que calculava [The man who counted] by the Brazilian modernist writer Malba Tahan. This is a qualitative investigation that focused on the audiovisual translation process of the stories present in the book, on the adaptations made in its narratives, the preparation resources for the production and editing of the videos, the implementation of graphic and visual resources and, finally, its dissemination as a research product. The analyzes indicate the didactic potential that emerges in the interaction between those involved in the process of translating the stories: teachers, interpreters and students (deaf and hearing), enabling forms of artistic expression that explore the inherent visuality of sign language combined with graphic resources, taking the narratives as a central element for the creative development anchored in the teaching of Mathematics through the reading and interpretation of stories.

La Figura del Intérprete en Lengua de Señas Chilena: Estado Actual y Desafíos en el Contexto Escolar / The Figure of the Interpreter in Chilean Sign Language: Current State and Challenges in the School Context

RESUMEN: Los intérpretes en Lengua de Señas Chilena (ILSCh) constituyen un recurso para la inclusión, eliminando barreras de estudiantes sordos que manejan la modalidad visual-gestual para comunicarse. Chile tiene normativa que favorece la participación del ILSCh en distintos ámbitos, y este estudio se centró en los intérpretes en contexto escolar, considerando que existe un desconocimiento de los procesos, implementación, resultados, logros y situación laboral. Las interrogantes del estudio fueron: ¿cuál es el estado actual del ILSCh, las trayectorias formativas, el rol y los desafíos de su quehacer? El objetivo general fue describir la figura del ILSCh y los desafíos que enfrenta en su desempeño laboral en contexto escolar, situados en las regiones Metropolitana y Valparaíso, Chile. El enfoque fue cualitativo, interpretativo, diseño fenomenográfico, descriptivo y transeccional, la muestra intencionada por criterios de 24 intérpretes de nivel escolar. Las técnicas de recogida de información fueron: formulario de identificación, entrevista y grupo focal. Se analizaron las transcripciones con el software Atlas TI. Los resultados muestran la diversidad en la formación, centrada en el vocabulario de la lengua, con mínimas líneas del contexto educativo, desconocimiento del rol, solicitudes de tareas fuera de sus funciones y situaciones laborares sin regulación y diversidad de jefaturas.

ABSTRACT: The interpreters in Chilean Sign Language (ILSCh) constitute a resource for inclusion, eliminating the barriers of deaf students who use the visual-gestural modality to communicate. Chile has regulations that favor the participation of the ILSCh in different áreas, and this study focused on interpreters in the school context, considering that there is a lack of knowledge of the processes, implementation, results, achievements and employment situation. The questions of the study were: What is the current state of the ILSCh, its formative trajectories, its role and the challenges of its work? The general objective was to describe the figure of the ILSCh and the challenges it faces in its work performance in the school context, located in the Metropolitan and Valparaíso regions, Chile. The approach was qualitative, interpretative, phenomenographic, descriptive and transactional design, the sample intentional by criteria of 24 school level interpreters. The information collection techniques were: identification form, interview and focus group. The transcripts were analyzed with the Atlas TI software. The results show the diversity in the training, focused on the vocabulary of the language, with minimal lines of the educational context, lack of knowlegde of the role, requests for tasks outside their functions and work situations without regulation and diversity of leadership.

Obstrucción intestinal secundario a vólvulo de sigmoides en un paciente joven Reporte de un caso / Intestinal Obstruction Secondary to Sigmoid Volvulus in a Young Patient. Case report

Resumen El vólvulo de sigmoides ocurre como resultado de una torsión del eje mesentérico colónico, cuenta con una etiología multifactorial y controvertida, de fisiopatología no clara aún. Presenta un cuadro clínico de inicio inespecífico y posteriores signos y síntomas de oclusión intestinal; su diagnóstico se establece mediante tomografía computarizada, con una sensibilidad y especificidad mayor al 90%. El manejo dependerá de la condición clínica del paciente. Caso clínico: Hombre de 29 años con antecedente de síndrome de Asperger. Refirió que desde 7 días previos a su ingreso presentó dolor tipo cólico difuso, asociado a distensión abdominal e intolerancia a la vía oral. Acudió a valoración hospitalaria donde se realizóa tomografía computarizada con niveles hidroaéreos, torsión de arteria mesentérica inferior de aspecto de torbellino. Se realizó laparotomía exploradora a través de la cual se encontró sigmoides dilatado y volvulado, con perforación en la unión rectosigmoidea; se realizó sigmoidectomía con colorectoanastomosis. Al quinto día presentó datos de respuesta inflamatoria con abdomen agudo, por lo que ingresó a laparotomía exploradora donde se encontró dehiscencia de anastomosis; se realizó procedimiento de Hartmann. El paciente presentó choque séptico y falleció a las 24 horas del postquirúrgico. Discusión: La presentación de vólvulo sigmoides generalmente se presenta en personas mayores de 70 años, pocos casos se describen en personas jóvenes y están relacionados con enfermedad de dismotilidad intestinal. El paciente no contaba con factores predisponentes, el diagnóstico se estableció con imágenes características de la enfermedad, como la imagen en torbellino, se decidió manejo quirúrgico con la realización de resección con colorectoanastomosis. Conclusión: La oclusión intestinal por vólvulo sigmoides es una patología infrecuente en jóvenes y de clínica inespecífica. Ante un paciente que presente datos de oclusión intestinal deberá ser abordado de manera apropiada, sobre todo en pacientes en quienes hayan debutado con una clínica insidiosa y persistente de dolor abdominal secundario a oclusión intestinal, sean jóvenes con o sin factores de riesgo.

Abstract Sigmoid volvulus occurs due to a torsion of the colonic mesenteric axis, it has a multifactorial and controversial etiology, and its pathophysiology is not yet clear. Presenting a clinical picture of non-specific onset and later signs and symptoms of intestinal occlusion, its diagnosis is established with computed tomography with a sensitivity and specificity greater than 90%. Management will depend on the clinical condition of the patient. Clinical case: A 29-year-old man with a history of Asperger syndrome. He referred 7 days prior to admission with diffuse cramping pain, associated with abdominal distension and oral intolerance. He went to the hospital for evaluation where a computed tomography was performed with air-fluid levels, torsion of the inferior mesenteric artery with a whirlwind appearance. Exploratory laparotomy was performed, finding a dilated and volvulated sigmoid with perforation at the rectosigmoid junction. A sigmoidectomy with colorectal anastomosis was performed. On the fifth day, he presented data of inflammatory response with acute abdomen, entering exploratory laparotomy finding anastomosis dehiscence, Hartmann procedure was performed. The patient presented septic shock, died 24 hours after surgery. Discussion: The presentation of sigmoid volvulus generally occurs in people older than 70 years, few cases are described in young people and are related to intestinal dysmotility disease, the patient did not have predisposing factors, the diagnosis is established with characteristic images of the disease such as whirlwind image, surgical management is decided by performing resection with colorectal anastomosis. Conclusion: Intestinal occlusion due to sigmoid volvulus is an infrequent pathology in young people and with non-specific symptoms. When faced with a patient presenting evidence of intestinal occlusion, this should be appropriately addressed, especially in patients who have debuted with insidious and persistent symptoms of abdominal pain secondary to intestinal occlusion, whether they are young with or without risk factors.

Assessing the validity of flap motility sign in predicting the extent of anterior capsular tears in phacoemulsification

Capsulorhexis is an integral step of cataract surgery, and continuous curvilinear capsulorhexis is crucial during phacoemulsification to prevent intraoperative complications. However, sometimes during phacoemulsification in complicated and hard cataract cases, rhexis extension may occur, resulting in posterior capsular rent, nucleus drop, cortex drop, and aphakia. It may not always be possible to continue with phacoemulsification in all cases. In this perspective, the authors describe a novel flap motility sign (FMS) to predict the extent of anterior capsular tear during phacoemulsification. A total of 21,678 patients underwent phacoemulsification for three years, from July 2016 to June 2019. One hundred and twenty-one patients had an anterior capsular tear. There were 102 cases (84.3%) with pre-equatorial tears and 19 cases (15.70%) with postequatorial tears. All pre-equatorial flaps were everted and fluttering, and all postequatorial flaps were inverted and nonfluttering. Posterior capsule rupture (PCR) was observed in all 19 cases of postequatorial flaps (100%). No PCR was observed in patients with fluttering and everted flaps (0%). In-the-bag and scleral-fixated intraocular lens implantations succeeded in pre-equatorial and postequatorial tears, respectively. There was no case of a nucleus drop. This study validates FMS as a predictor for identifying the extent of anterior capsular tears, thereby determining the endpoint of safe phacoemulsification and the site for intraocular lens implantation. Pre-equatorial tears allow for the continuation of safe phacoemulsification and in-the-bag intraocular implantation. Postequatorial tears necessitate timely conversion to small-incision cataract surgery or extracapsular cataract extraction.

El estudio de los efectos de la modalidad lingüística en el léxico mental / The study of the effects of linguistic modality on the mental lexicon

Resumen El estudio se cuestiona sobre un abordaje fructífero en el estudio de los efectos de la modalidad lingüística (de señas versus oral) en la organización de la memoria semántica. Para responder la pregunta de investigación, un aspecto central es definir criterios y procedimientos capaces de distinguir entre los factores transportados por la modalidad lingüística de los que le son propios. Entre los primeros, se encuentran la edad de exposición a la lengua natural y su distribución funcional, etaria o geográfica. Entre los aspectos propios de la modalidad se incluyen la iconicidad y el grado de concreción/abstracción de las piezas léxicas. Se sugiere centrarse en el uso de dicho gradiente para evocar dominios conceptuales. Si lo concreto/abstracto es un continuo, entonces hay que preguntarse qué forma de organización es predominante en el léxico mental de las poblaciones señantes u oyentes y qué factores modulan el perfil de esa organización.

Abstract The efforts to understand the relationship of the meaning of a lexical piece to the object to which it refers, the relationship between the lexical pieces and the concepts, and the understanding of the meanings shared between two speakers who use the same lexical pieces have all constituted major problems for the semantic memory models. According to contemporary literature, perceptual-motor, linguistic, and social information have different weights in the formation of concepts, whether concrete or abstract, stored in the aforementioned memory. Regardless of the models developed so far, it is interesting to note that semantic knowledge is represented by various ways of relating the concepts and the types of relationships between them. In this context, studies in sign languages and comparative studies between spoken and sign languages are scarce. Thus, little is known about the effect of linguistic modality on the semantic networks. After all, the theory on semantic networks and norms for the production of features has been grounded on theories of language and its processing adjusted to spoken languages. As the incorporation of the sign language and the Deaf population has shown in other psycholinguistic and linguistic topics, the importance of including these languages and populations, and comparatives with spoken languages, might increase the explanatory power of the theory to account for the universal and contextual aspects of language and its processing. In this effort, there is a latent risk: the linguistic modality can be only a vehicle for more well-known or studied cross-modal variables (e. g., age of acquisition, functional distribution of language, size of the available lexicon, etc.). If it is considered that languages are not stored together, but similar processes can occur in them, it is essential to find out what may be a singular feature of each modality (spoken versus sign) that might ground differentiated processes. Considering the high iconicity of the sign languages and the possibility of a high concreteness of the lexical pieces in the sign language as distinctive features -not collapsible into well-known variables such as the aforementioned-, this article suggests a careful approach to avoid the aforementioned risk in the study of the effects of the linguistic modality (sign versus oral) in the organization of semantic memory. Since perceptual-motor and social information are the main sources of iconicity, a balanced instrument is necessary in the evocation of perceptual-motor, social, and linguistic information. Repeated free word association tasks seem like an appropriate paradigm for a suggested approach. The reasons for this are that, by not censoring the types of response, then free association tasks allow capturing all kinds of concepts (concrete or abstract), all kinds of semantic relationships/organization (paradigmatic versus thematic) and all kinds of processes (comparison versus interaction). This type of task therefore makes it possible to collect meanings related to linguistic information and non-linguistic experience because affective and experiential information is accessible by doing the task in different repetitions. The approach and the tool are exemplified by an ongoing comparative study between Deaf signing and hearing populations. The partial findings of this study also serve to focus on the expected effects of the difference in iconicity and the level of concreteness/abstractness of the lexical pieces of each linguistic modality; namely, the differences between an abstract and a concrete conceptualization of the conceptual domains. Taxonomic and introspective labels might appear as indicative of paradigmatic relationships, of a taxonomic organization, and of underlying comparison processes. On the other hand, the situational and entity labels, indicative of syntagmatic relationships, of a thematic organization and of underlying interaction processes, might suggest a predominantly concrete organization.

THE ‘FEEDING BRONCHUS SIGN‘ IN CAVITARY LUNG LESIONS, ITS EVALUATION WITH COMPUTED TOMOGRAPHY AND A GUARDED OPINION REGARDING PHYSIOTHERAPY

BACKGROUND Bronchiectasis and cavitation are key features of acute and chronic pulmonary infections. Cavitary lesions may carry unfavourable prognosis with regard to complete restoration of pulmonary function in few patients. OBJECTIVES To evaluate type and site of bronchiectasis, its relation with cavity formation on computed tomography and providing an insight to sorting out subjects suited for physiotherapy. A radiological sign-“Feeding bronchus sign” has been discussed with reference to bronchiectasis, its origin, natural course and a suggestion of guarded future management and rehabilitation. METHODS Total 150 chest CT scans with presence of cavity and bronchiectasis were retrospectively reviewed and followed up for type, site of bronchiectasis, signs of active infection, site of cavity and presence of “feeding bronchus sign”. Final diagnosis was confirmed by sputum sample, acid-fast bacillus test or culture or polymerase chain reaction. RESULTS Out of 150 cases, 70 (46%) had chronic and 80 (53%) had active infection. 33 (22%) had solitary and 117 (78%) had multiple cavities. 37 (34.6 %) patients had cylindrical, 11 (7.3 %) had varicose, 27 (18%) had cystic bronchiectasis, 23 (15.3%) had cylindrical and varicose, 19 (12.6%) had cylindrical and cystic and 33 (22%) had all three types. “Feeding bronchus sign” was observed in 102 (68%) patients. Radiological evidence of disease progression was seen in 21 patients, improvement in 19 and no change in 17 on follow-up CT. CONCLUSION Patients with positive “Feeding bronchus sign” are at risk for increased disease transmission and secondary opportunistic infections. Improvement and maintenance of quality of life is ultimate goal of management. Apart from antibiotics, pulmonary rehabilitation also plays an important role in cavitary lung disease

Signo de la cruz en una paciente peruana con ataxia espinocerebelosa tipo 2: reporte de un caso / Hot cross bun sign in a Peruvian patient with spinocerebellar ataxia type 2: A case report

RESUMEN La ataxia espinocerebelosa tipo 2 (SCA2) es una enfermedad neurodegenerativa hereditaria autosómica dominante, causada por una expansión anormal del trinucleótido CAG en el gen ATXN2. La SCA2 se presenta habitualmente en la edad adulta, con ataxia progresiva asociada a neuropatía periférica, alteración de movimientos oculares, parkinsonismo, entre otros síntomas. Exámenes auxiliares aplicables incluyen pruebas bioquímicas, neuroimágenes, como resonancia magnética cerebral, y estudio genético molecular. Describimos, por primera vez en la población peruana, el caso de una mujer de mediana edad con diagnóstico confirmado de SCA2, cuya resonancia magnética cerebral muestra el signo de la cruz (o hot cross bun sign).

ABSTRACT Spinocerebellar ataxia type 2 (SCA2) is an autosomal dominant inherited neurodegenerative disease, caused by an abnormal CAG trinucleotide expansion in the ATXN2 gene. SCA2 usually occurs in adulthood, with progressive ataxia associated with peripheral neuropathy, impaired eye movements, parkinsonism, and other symptoms. Auxiliary exams include biochemical tests, neuroimaging such as brain MRI, and a molecular genetic study. We describe, for the first time in the Peruvian population, the case of a middle-aged woman with a confirmed diagnosis of SCA2, whose brain MRI shows the "Hot Cross Bun Sign".

Pulmonary Hydatid without Liver Involvement: A Case Series

Pulmonary hydatid is not a rare disease. But raising a suspicion for its diagnosis is limited. There are limited approaches for the diagnosis and treatment of the same. We present here four cases of pulmonary hydatid, without liver involvement, with emphasis on how it was misdiagnosed and received multiple treatment and landed into complications. Most of our cases presented with cough, sputum and hemoptysis. For these nonspecific signs and symptoms, patient is generally treated on a different line of diagnosis. Two of the cases were already treated for abscess and fungal infection. One of the patients was on antitubercular treatment. One of our cases was secondarily infected with aspergilloma. One of the cases was referred to oncologist to start chemotherapy. Interestingly, to raise a suspicion, none of our cases had liver involvement. A detailed history revealed expectoration of white salty material in sputum, living with sheep and dog and expectorating grape-like vesicles in sputum. History helped us to put hydatid as one of our differentials. Echinococcal serology was positive in three cases. Only three cases had on-table appearance of hydatid cyst. All four cases underwent surgical management for complete cure. There is need for strong suspicion and a detailed history and proper set of investigations help in timely diagnosis and management of pulmonary hydatid disease.

Estratégias de comunicação dos profissionais de saúde com pessoas com deficiência auditiva: revisão integrativa / Communication strategies employed by health professionals with hearing impaired people: an integrative review / Estrategias de comunicación de los profesionales de la salud con las personas con discapacidad auditiva: revisión integradora

RESUMO Objetivo: identificar estudos na literatura científica sobre a comunicação dos profissionais de saúde entre pessoas com deficiência auditiva na prestação do cuidado. Método: revisão integrativa realizada em fevereiro/2021, em 14 bases de dados e busca manual, sem recorte temporal, nos idiomas português, inglês, espanhol, através dos descritores Pessoas com Deficiência Auditiva e Profissionais de Saúde e suas variações, sem delimitação de contexto. A análise dos resultados deu-se pela organização em grupos temáticos conforme sua frequência. Resultados: 16 estudos foram selecionados, destacando-se os resultados: uso da escrita e mímica como principais estratégias de comunicação; falta de qualificação dos profissionais para uma comunicação efetiva, sendo o uso de LIBRAS a forma menos utilizada; e, sentimento de insegurança, bloqueio, incapacidade que profissionais vivenciam na comunicação com pessoas com deficiência auditiva. Conclusão: é necessário investir na qualificação dos profissionais de saúde em LIBRAS tornando a comunicação mais eficaz, contribuindo para a melhoria da prática assistencial.

ABSTRACT Objective: to identify studies in the scientific literature on the communication between health professionals and hearing impaired people during care provision. Method: an integrative review carried out in February 2021 in 14 databases and with manual search, without time frame, in Portuguese, English, Spanish and through the Hearing Impaired People and Health Professionals descriptors and their variations, without context delimitation. The results were analyzed by organizing them into thematic groups according to their frequency. Results: a total of 16 studies were selected, with the following results standing out: use of writing and mimicry as main communication strategies; non-qualification of the professionals for effective communication, with the use of LIBRAS as the least used means; and feelings of insecurity, blockage and disability experienced by the professionals in communicating with hearing impaired people. Conclusion: it is necessary to invest in health professionals' qualification in LIBRAS, making communication more effective and contributing to improvements in the care practice.

RESUMEN Objetivo: identificar estudios en la literatura científica sobre la comunicación entre los profesionales de la salud y las personas con deficiencia auditiva en la prestación de cuidados. Método: revisión integradora realizada en febrero de 2021, en 14 bases de datos y búsqueda manual, sin recorte temporal, en portugués, inglés y español, a través de los descriptores Personas con discapacidad auditiva y Profesionales de la Salud y sus variantes, sin delimitación de contexto. El análisis de los resultados se realizó organizándolos en grupos temáticos en función de la frecuencia. Resultados: Se seleccionaron 16 estudios, se destacaron los resultados: uso de la escritura y la mímica como principales estrategias de comunicación; falta de cualificación de los profesionales para lograr una comunicación efectiva, el LIBRAS es la forma menos utilizada; y, sentimiento de inseguridad, bloqueo, incapacidad que experimentan los profesionales en la comunicación con personas con deficiencia auditiva. Conclusión: es necesario invertir en la capacitación de los profesionales de la salud en LIBRAS para que haya una comunicación más efectiva que contribuya a mejorar la práctica asistencial.

Effectiveness analysis of percutaneous parallel screw fixation via posterolateral "safe zone" for Hawkins type Ⅰ- Ⅲ talar neck fractures / 中国修复重建外科杂志

OBJECTIVE@#To explore the effectiveness of the percutaneous parallel screw fixation via the posterolateral "safe zone" for Hawkins type Ⅰ-Ⅲ talar neck fractures.@*METHODS@#A retrospective analysis was conducted on the clinical data from 35 patients who met the selection criteria of talar neck fractures between January 2019 and June 2021. According to the surgical method, they were divided into a study group (14 cases, using percutaneous posterolateral "safe zone" parallel screw fixation) and a control group (21 cases, using traditional open reduction and anterior cross screw internal fixation). There was no significant difference in gender, age, affected side, Hawkins classification, and time from injury to operation between the two groups ( P>0.05). The operation time, bone healing time, complications, and Hawkins sign were recorded, and the improvement of pain and ankle-foot function were evaluated by visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score at last follow-up. The overall quality of life was assessed by the short form of 12-item health survey (SF-12), which was divided into physical and psychological scores; and the satisfaction of patients was evaluated by the 5-point Likert scale.@*RESULTS@#The operation time in the study group was significantly shorter than that in the control group ( P<0.05). All patients werefollowed up 13-35 months, with an average of 20.6 months; there was no significant difference in the follow-up time between the two groups ( P>0.05). The time of bone healing in the study group was shorter than that in the control group, and the positive rate of Hawkins sign (83.33%) was higher than that in the control group (33.33%), and the differences were significant ( P<0.05). In the control group, there were 2 cases of incision delayed healing, 7 cases of avascular necrosis of bone, 3 cases of joint degeneration, 1 case of bone nonunion, and 3 cases of internal fixation irritation; while in the study group, there were only 2 cases of joint degeneration, and there was a significant difference in the incidence of complications between the two groups ( P<0.05). At last follow-up, there was no significant difference in VAS score between the two groups ( P>0.05), but the SF-12 physical and psychological scores, AOFAS ankle and hindfoot scores, and patients' satisfaction in the study group were significantly better than those in the control group ( P<0.05).@*CONCLUSION@#The treatment of Hawkins type Ⅰ-Ⅲ talar neck fractures with percutaneous parallel screw fixation via the posterolateral "safe zone" can achieve better effectiveness than traditional open surgery, with the advantages of less trauma, fewer complications, faster recovery, and higher patient satisfaction.

Urticaria pigmentosa in a 9‐month‐old male: case report

@#Urticaria pigmentosa (UP) is the most common form of cutaneous mastocytosis in children. It can be diagnosed clinically, based on the appearance of numerous brownish macules and papules that are symmetrically distributed, mostly on the trunk and the extremities. Skin biopsy is helpful in establishing the diagnosis. Treatment options generally include antihistamines and/or topical corticosteroids. In most cases, pediatric UP tends to disappear spontaneously before puberty. We present the case of a 9-month-old male with a history of multiple brownish patches and plaques, which started when he was four months old. He was diagnosed with UP based on clinical and histopathologic findings, and was prescribed oral antihistamines and emollients for symptomatic treatment.

Step-by-step instructions for detecting whirlpool sign in adnexal torsion / Journal of Rural Medicine

Objective: Adnexal torsion is a common gynecological emergency whose prompt diagnosis is essential because a delay may lead to ovarian dysfunction. Although the whirlpool sign is reliable for diagnosing ovarian cyst torsion, technical difficulties hinder its use by sonographers. Here we developed a systematic approach to visualizing this sign by focusing on the fact that torsion arises from the space between the uterus and the pelvic wall. One must determine the origin of the torsion via transverse imaging of the uterus and follow the twisted ligaments to the ovarian cyst.Patients and Methods: Two women aged 56 (Case 1) and 28 years (Case 2) visited our hospital with lower abdominal pain. Transvaginal ultrasonography showed a 7-cm right ovarian cyst in Case 1 and a 5-cm cyst in the Douglas pouch in Case 2; normal bilateral ovaries and the whirlpool sign were detected in both cases. Under laparoscopic guidance in Cases 1 and 2, an ovarian cyst and a paraovarian cyst were confirmed and removed.Results: Our step-by-step method allowed us to identify the whirlpool sign and confirm adnexal torsion, leading to prompt surgery in both cases.Conclusion: Using a systematic procedure helps less experienced practitioners detect the whirlpool sign.

The Role of Non-Contrast CT in the Diagnosis of a Rare Cause of Small Bowel Obstruction Due to Bezoar

@#Contrast Enhanced CT Abdomen is usually used to investigate the source of the small bowel obstruction. A 13-year old girl presented with signs of small bowel obstruction and was complicated with acute renal injury. Non-contrast CT Abdomen showed findings consistent with bezoar, and the findings are similar to the features seen in a contrast study. This case shows that both the plain and the contrast CT abdomen give similar findings of bezoar, one not inferior to the other.

Consistency between iodine-unstained area and tumor pathological size of endoscopic submucosal dissection specimen in superficial esophageal cancer / 中华消化内镜杂志

Objective:To investigate the consistency between the iodine-unstained area and the pathological size of endoscopic submucosal dissection (ESD) specimens of superficial esophageal cancer.Methods:A retrospective study was performed on data of 32 patients with superficial esophageal cancer who accepted ESD from May 2019 to April 2020 in the First Affiliated Hospital, Zhejiang University School of Medicine. The maximum transverse diameter and maximum longitudinal diameter of the iodine-unstained area were compared with the tumor pathological area. A size difference no more than 0.5 cm was considered as conformity, any difference between 0.5 and 1.0 cm was considered as non-conformity, and any difference no less than 1.0 cm was considered as serious non-conformity. At the same time, pink sign after spraying Lugo solution and the consistency of pink sign area with the iodine free area were observed.Results:A total of 32 patients with 33 lesions were enrolled in this study, including 23 males and 9 females and the age of the patients was 59.5±7.3 years. There were 19 (57.6%) lesions whose size of iodine-unstained area was consistent with the tumor pathological area. These 19 lesions were all positive for the pink sign, and the pink sign area overlapped with the iodine-unstained area. In addition, 4 (12.1%) iodine-unstained areas of the lesions did not match the size of the pathological area, and 10 (30.3%) iodine-unstained areas of the lesions were seriously inconsistent with the size of the pathological area. These 14 (42.4%) lesions were all positive for pink sign, and the pink sign area was significantly smaller than the iodine-unstained area. Among the 14 discordant lesions, 2 lesions underwent ESD according to the iodine-unstained area, which resulted in excessive resection and postoperative stenosis.Conclusion:Determining the extent of superficial esophageal cancer by iodine-unstained areas before ESD may lead to excessive resection of the lesions, which is related to the fact that the iodine-unstained areas of the lesions are sometimes significantly larger than the pink sign areas. Therefore, in order to achieve precise treatment, endoscopists can choose the iodine-unstained area with positive pink sign as the first choice for resection.

Research progress of ultra-high field strength 7.0 T magnetic resonance imaging in multiple sclerosis / 中华神经科杂志

Multiple sclerosis (MS) is one of the demyelinating diseases of the central nervous system, and its pathogenesis is still unclear. Magnetic resonance imaging (MRI) is an effective tool for the diagnosis and monitoring of MS, and the identification of MS lesions is increasingly updated with the development of technology. In recent years, 7.0 T ultra-high field MRI has been widely used in MS. This review will make an overview of the research progress of 7.0 T ultra-high field MRI in MS in recent years.

Quantitative susceptibility mapping of the substantia nigra subregions in relapsing-remitting multiple sclerosis patients / 中华放射学杂志

Objective:To investigate the distribution of iron deposition in the substantia nigral (SN) subregions on quantitative susceptibility mapping (QSM) and the change of swallow tail sign (STS) in patients with relapsing-remitting multiple sclerosis (RRMS) of different disease stages.Methods:The clinical and imaging data of 53 patients with RRMS (case group) diagnosed at the First Hospital of Chongqing Medical University from November 2019 to December 2021 were retrospectively analyzed. The case group was divided into 0-5 years subgroup, 6-10 years subgroup, and >10 years subgroup according to the disease duration; another 37 age-and gender-matched healthy volunteers were recruited as the control group during the same period. All subjects underwent MRI and QSM reconstruction. First, the SN was divided into four subregions: rostral anterior-SN (aSNr), rostral posterior-SN (pSNr), caudal anterior-SN (aSNc), and caudal posterior-SN (pSNc) on the QSM, and the quantitative susceptibility value (QSV) of each subregion was measured, and then the STS of the SN was observed and scored on the susceptibility weighted imaging (SWI) generated by post-processing. ANOVA was used to compare the differences in the QSV of each subregion of SN among the groups, and the probability of abnormal STS was compared using the χ 2 test. Spearman′s test was used to analyze the correlation between the QSV of each subregion of SN and the STS score. Results:The differences in QSV of aSNr, pSNr, aSNc, and pSNc were statistically significant among the 0-5 years subgroup, 6-10 years subgroup,>10 years subgroup of RRMS patients and the control group ( P<0.05). The QSV of aSNr, pSNr, and aSNc in 0-5 years subgroup was higher than those in the control group ( P was 0.039, 0.008, 0.039, respectively). The QSV of aSNr, aSNc, and pSNc in the 6-10 years subgroup were higher than those in the 0-5 years subgroup ( P was <0.001, 0.020, 0.015, respectively). The QSV of the aSNc, pSNc in >10 years subgroup were lower than those in the 6-10 years subgroup ( P=0.037, 0.006). The QSV of aSNr, pSNr in >10 years subgroup were higher than those in the control group ( P was <0.001, 0.001). There were 7 cases of abnormal STS in the 0-5 years subgroup, 11 cases in the 6-10 years subgroup, 12 cases in >10 years subgroup, and 9 cases in the control subgroup, and there was a statistically significant difference in the probability of abnormal STS among the subgroups of the RRMS patients and the control subgroup (χ 2=16.20, P=0.011). Both the scores of STS in the 6-10 years subgroup and >10 years group were positively correlated with the QSV in pSNc ( r s=0.65, P=0.006; r s=0.48, P=0.045). Conclusions:In RRMS patients, SN iron deposition is concentrated on aSNr, pSNr, and aSNc in the 0-5 years subgroup and on aSNr, aSNc and pSNc in the 6-10 years subgroup. The QSVs of all SN subregions have a downward trend in >10 years subgroup compared with that in the 6-10 years subgroup. Both the QSVs of the pSNc in the 6-10 years group and >10 years group are positively related to STS scores. These help explore the potential progression pattern of SN iron deposition in RRMS patients and the cause of abnormal STS in RRMS patients.

Correlation between the quartering method of nerve root subsidence sign and the cross-sectional area of the narrow segment thecal sac in patients with lumbar spinal stenosis / 中国医师杂志

Objective:To study the correlation between the quartering of nerve root subsidence sign (NRS) and the cross-sectional area (CSA) of the narrow segment thecal sac in patients with lumbar spinal stenosis (LSS).Methods:The data of 203 LSS patients in the Fourth People′s Hospital of Hengshui from January 2020 to December 2021 were retrospectively analyzed. All patients underwent MRI cross sectional scanning. The patients were divided into positive type a group ( n=62), positive type b group ( n=32), positive type c group ( n=51), and negative group ( n=58) by NRS quartering method. The minimum CSA, median sagittal diameter (PAD), and lateral recess sagittal diameter of each group were compared. The correlation between NRS quartering classification and the minimum CSA and related indicators of lumbar spinal stenosis was analyzed. Results:The minimum CSA, PAD, and sagittal diameter of the lateral recess in the positive a group, positive b group, and positive c group were all smaller than those in the negative group, while the Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI) were higher than those in the negative group; The minimum CSA, PAD, and sagittal diameter of the lateral recess in the positive b type and positive c type groups were smaller than those in the positive a type group, while the VAS score and ODI index were higher than those in the positive a type group; The minimum CSA, PAD, and sagittal diameter of the lateral recess in the positive c type group were smaller than those in the positive b type group; The VAS score and ODI index were higher than those of the positive b type group; The differences were statistically significant (all P<0.05). 203 patients were divided into 54 normal cases, 58 mild stenosis cases, 49 moderate stenosis cases, and 42 severe stenosis cases based on the minimum CSA. The coincidence rate between negative NRS and minimal CSA diagnosis as normal was 94.44%(51/54), the coincidence rate between positive type a and minimal CSA diagnosis as mild stenosis was 84.48%(49/58), the coincidence rate between positive type b and minimal CSA diagnosis as moderate stenosis was 53.06%(26/49), and the coincidence rate between positive type c and minimal CSA diagnosis as severe stenosis was 90.48%(38/42). Using the kappa consistency test, the kappa value for quantitative diagnosis of minimum CSA stenosis in NRS and LSS patients was 0.743, indicating good consistency. The kappa values for quantitative diagnosis of NRS, sagittal diameter of lateral recess, and PAD stenosis were 0.271 and 0.335, with poor consistency. NRS typing was negatively correlated with CSA and PAD ( r=-0.723, -0.581, all P<0.001), and positively correlated with VAS score and ODI index ( r=0.473, 0.640, all P<0.001). Conclusions:The NRS quartering method has a good consistency in diagnosing the severity of LSS patients and the minimum CSA of stenosis segments, suggesting that the NRS quartering method can better reflect the degree of Spinal stenosis, which can not only be used as an auxiliary indicator for qualitative diagnosis of LSS, but also has a high value in quantitative diagnosis.

Changes of peripheral perfusion index in very low birth weight infants with late-onset sepsis / 中国小儿急救医学

Objective:To analyze the changes of peripheral perfusion index (PPI) with late-onset sepsis (LOS) in very low birth weight infants during hospitalization.Methods:Very low birth weight infants admitted to the neonatal intensive care unit of Children′s Hospital of Fudan University from August 1, 2021 to August 31, 2022 were consecutively included.Infants with admission age ≥three days and unstable circulation, or positive blood culture within three days after birth were excluded.From the day of admission, the PPI values of the right hand and either foot of the infants were measured with Masimo SET Radical-7 everyday while whether LOS occurred during hospitalization was observed.The mean PPI curve of very and extremely low birth weight infants without LOS was plotted.For those with LOS confirmed by blood culture, the PPI change trajectory three days before and after the occurrence of LOS was drawn, and the change trend of PPI before the occurrence of LOS was analyzed by trend chi-square test.Non-parametric test was used to analyze the effect of LOS on pre- and post-ductal PPI values.Results:A total of 107 very low birth weight infants were included in the final analysis.Among them, there were 11 infants confirmed as LOS by blood culture, 37 infants diagnosed as clinical LOS, and 59 infants without LOS.Pre-and post-ductal PPI values of very low birth weight infants without LOS were 2.06±1.30 and 1.72±0.92, respectively; those with clinical LOS were 1.90±0.94 and 1.58±0.83, respectively; those with LOS confirmed by blood culture were 1.92±1.11 and 1.62±0.82, respectively.For infants with LOS confirmed by blood culture, the pre-and post-ductal PPI values showed a continuous downward trend during three days before the onset of disease, with the lowest PPI values on the first day before the diagnosis of blood culture.The downtrend of pre-ductal PPI was statistically significant ( χtrend2=5.57, P<0.05). Conclusion:The PPI value of very low birth weight infants show a downward trend when LOS occurs.It should be observed dynamically in clinical practice, which is helpful to suspect or identify LOS as early as possible.