Correlation between quality of life and the clinical results of patients with leprosy with drop foot after tendon transfer / Avaliação de pacientes com hanseníase pós transposição tendínea para pé caído e sua correlação com a qualidade de vida

ABSTRACT Objective: To evaluate the functional results of surgically correcting drop foot in patients with leprosy and compare their SALSA, Social Participation, and AOFAS score. Methods: Overall, 22 patients were subjected to posterior tibial tendon transfer via the subcutaneous route to the foot dorsum with an average follow-up of 56 months (min 12, max 70). In our sample, 15 of the enrolled patients were men and seven, women, aged between 20 and 73 years old who were operated on from January 2014 to December 2017. The Pearson's correlation test (r) was used to measure the correlation among those scales. A p < 0.05 was considered significant between the pre- and pos-operative AOFAS scale scores. Results: Pre-operative average AOFAS score was 59.6 (min 35, max 74) and 77.2 postoperative (min 36, max 97) (p < 0.0001), postoperative Salsa and Social Participation scale, 30.6 and 22.5, respectively. Statistical analysis suggests a strong positive correlation between AOFAS and Salsa scales (r = −0.83) and AOFAS and social participation (r = −0.78). Average dorsiflexion was 5.4 degrees. Conclusion: The surgical correction of drop foot positively affects the quality of life and social participation of patients with leprosy. Level of Evidence III, Retrospective Study.

RESUMO Objetivo: Avaliar o resultado funcional da cirurgia de correção de pé caído em pacientes hansênicos e comparar as escalas Screening of Activity Limitation and Safety Awareness (SALSA) e de Participação social pós-operatórias com o escore da American Orthopaedic Foot and Ankle Society (AOFAS). Métodos: Avaliamos 22 pacientes submetidos à transposição do tibial posterior para o dorso do pé com mínimo de seguimento de 12 e máximo de 131 meses operados entre janeiro de 2013 e dezembro de 2017. Utilizamos o coeficiente de Pearson (r) para medir o grau de correlação entre as escalas funcionais e consideramos o valor de p < 0,05 na análise dos valores pré e pós-operatórios da AOFAS. Resultados: A média da AOFAS foi de 59,6 no pré-op (mín 35, máx 74) e 77,2 no pós-op (mín 36, máx 97) (p < 0,0001) e das escalas SALSA e participação social de 30,6 e 22,5 no pós-operatório. A análise estatística demonstrou correlação positiva forte (r = −0,83) com as escalas SALSA e de participação social (r = −0,78) quando comparadas ao AOFAS. O grau de dorsiflexão atingido foi de 5,4 graus em média. Linha de pesquisa: Evidência clínica e organizacional, modelos assistenciais, educacionais e avaliação de qualidade em APS - Pós-graduação em Clínica Médica da Faculdade de Medicina da UFRJ. Conclusão: A melhora da função através da correção cirúrgica do pé caído possui correlação direta na melhora da qualidade de vida dos pacientes portadores de hanseníase. Nível de Evidência III, Estudo Retrospectivo.

Lateral Sesamoid Position Relative to the Second Metatarsal in Feet with and without Hallux Valgus / Posição do sesamoide lateral em relação ao segundo metatarso em pés com e sem hálux valgo

Abstract Objective To determine if the sesamoids migrate laterally in the feet with hallux valgus or if they only appear to move, maintaining their relationship with the other forefoot structures. Methods Anteroposterior radiographs of 80 patients (94 feet, all weight-bearing), from the period between 2015 and 2016, were evaluated. Forty-eight had a valgus hallux angle greater than 15° (hallux valgus group) and 46 presented a hallux valgus angle lower than 15° (control group). The distances from the firstmetatarsus head and the lateral sesamoid bone to the secondmetatarsus axis weremeasured. Subsequently, the coefficients of these distances were determined by the length of the second metatarsus to adjust it for different foot sizes. Results Both the absolute and the relativemeasures from the firstmetatarsus head to the second metatarsus axis were significantly different between the groups, with a positive correlationwith hallux valgus and intermetatarsal angles. However, neither the absolute nor the relative distance of the lateral sesamoid bone to the second metatarsus was different between the groups, as they did not correlate with hallux valgus or intermetatarsal angles. Conclusion Despite the medial deviation of the first metatarsus in hallux valgus, the sesamoid bone maintains its relationship with the second metatarsus in the transverse plane. This apparent lateral displacement may lead to misinterpretation of these radiographs. This fact is of paramount importance in the pre-, intra-, and postoperative period of patients with hallux valgus.

Resumo Objetivo Determinar se os sesamoides migramlateralmente nos pés comhálux valgo ou se apenas aparentam deslocar-se, mantendo sua relação com as demais estruturas do antepé. Métodos Foram avaliadas radiografias na incidência anteroposterior com carga dos pés de 80 pacientes (94 pés) entre o período de 2015 e 2016. Dessas, 48 tinham ângulo de hálux valgo maior do que 15º (grupo hálux valgo) e 46 tinham ângulo de hálux valgo menor do que 15º (grupo controle). Foram medidas as distâncias da cabeça do primeiro metatarso e do sesamoide lateral ao eixo do segundo metatarso. Posteriormente, forammedidos os coeficientes dessas distâncias pelo comprimento do segundo metatarso, a fim de se ajustarem aos diferentes tamanhos de pés. Resultados Tanto a medida absoluta quanto a medida relativa da cabeça do primeiro metatarso ao segundo metatarso foram significativamente diferentes nos dois grupos, tiveram correlação positiva com os ângulos de hálux valgo e intermetatarsal. Contudo, nem a distância absoluta nem a relativa do sesamoide lateral ao segundo metatarso foram diferentes nos dois grupos, bem como não se correlacionaram com os ângulos de hálux valgo e inter-metatarsal. Conclusão Apesar do desvio medial do primeiro metatarso no hálux valgo, o sesamoide mantém sua relação com o segundo metatarso no plano transverso. Esse aparente deslocamento lateral pode levar a interpretação equivocada dessas radiografias. Tal fato é de suma importância no pré-, peri- e pós-operatório dos pacientes com hálux valgo.

Intervening in the acute phase of postradiation carotid blowout syndrome

Introduction: Acute carotid blowout syndrome (aCBS) is a severe complication of head and neck cancer (HNC). It can be defined as a rupture of the extracranial carotid arteries, or one of their branches, that causes life-threatening hemorrhage, and which nowadays can be treated with urgent endovascular intervention. Objective: We retrospectively evaluate the endovascular management of aCBS and its outcome in years of survival. Methods: Retrospectively, we describe our experience with endovascular control of aCBS in patients treated for HNC. We review the characteristics, pathology, endovascular treatment and morbidity and assess the gain in life years. Results: Nine individuals were included in this study. Four patients had been previously diagnosed with laryngeal squamous cell carcinoma (SCC), one with paranasal SCC, one with nasopharyngeal carcinoma and three with oral or maxillary adenocarcinoma. All subjects underwent radiotherapy and surgical excision to different extents. Twelve endovascular procedures were performed for injuries to the internal carotid artery (n = 3; 25%), external carotid artery (n = 1; 7%) or one of their branches (n = 8; 67%). Deconstructive methods were used in nine procedures, and three procedures were mainly reconstructive with deployment of covered stents. Total control of bleeding was achieved in all individuals with no intraprocedural complications. Conclusion: Endovascular therapy is an effective alternative for the management of exsanguinating CBS. In our series, this palliative therapy increased the overall patient survival by an estimated 9 months (AU)

El taller de radio y su aporte a la inclusión social de los usuarios del Centro de Salud Mental Comunitaria "La casa de Ramos Mejía" / The radio workshop and its contributioin to the social inclusion of the Community's Mental Health Center "La casa de Ramos Mejía"

El Centro de Salud Mental Comunitaria "La Casa de Ramos Mejía" se encuentra ubicado en la Localidad de Ramos Mejía, Partido de La Matanza. Funciona de lunes a viernes y cuenta con un equipo interdisciplinario conformado por psicólogos, psiquiatras, trabajadoras sociales, terapistas ocupacionales y un sociólogo. También talleristas y voluntarios que colaboran en actividades educativas, expresivas, comunicacionales, artísticas, deportivas y en espacios de socialización y terapéuticos. Este estudio se propuso identificar y analizar el aporte del taller de radio a la inclusión social de los usuarios, entendiéndola como el acceso a oportunidades para el desarrollo de una mejor calidad de vida y el ejercicio pleno de derechos individuales y sociales. Este trabajo se trata de un estudio de caso cualitativo de tipo exploratorio-descriptivo. Participaron los usuarios que concurren al taller de radio y los trabajadores ­profesionales y talleristas- del Centro. Las técnicas de recolección de datos utilizadas fueron: la observación participante, la entrevista etnográfica y las notas de campo. El aporte del taller de radio a la inclusión social de los usuarios se da principalmente por medio de su empoderamiento, en tanto sujetos de derechos, en su proceso de subjetivación, a través de la promoción de su autonomía y su independencia. Se busca, por un lado, fortalecer los lazos debilitados y restablecer aquellos quebrados, con sus familiares, referentes afectivos, grupos primarios y/o redes vinculares; y, por otro lado, incrementar sus capacidades para el acceso a información y servicios para el ejercicio efectivo de sus derechos individuales y sociales. Tanto el taller de radio como el programa que ahí se realiza no constituyen un fin en sí mismo, sino que son herramientas y el medio para generar un vínculo con la sociedad, buscando la interpelación y la disputa de sentidos(AU)

Localização segura na colocação dos pinos percutâneos no calcâneo / Safe localization for placement of percutaneous pins in the calcaneus

OBJETIVO: Determinar as áreas de risco em seis zonas do calcanhar e quantificar os riscos de lesão das estruturas anatômicas (artéria, veia, nervo e tendão). MÉTODO: Foram utilizados 53 calcâneos de cadáveres divididos em três zonas e subdivididas em duas áreas, superior e inferior, por meio de uma linha longitudinal do calcâneo. O risco de lesão das estruturas anatômicas em relação a cada fio de Kirschner foi determinado pelo sistema de graduação segundo a classificação de Licht. A quantificação do risco total de lesão das estruturas anatômicas na colocação de mais de um fio foi calculada pela lei aditiva das probabilidades e pela lei do produto para eventos independentes. RESULTADOS: O cálculo dos riscos de lesão, segundo a classificação de Licht, demonstrou que o risco de lesão da artéria ou veia na zona IA é mais expressivo (43%) em relação às lesões de nervo e tendão (13 e 0%, respectivamente). CONCLUSÃO: O estudo permitiu identificar as estruturas anatômicas mais vulneráveis e quantificar o risco de lesão no calcanhar.

OBJECTIVE: To determine the areas presenting risk in six zones of the calcaneus, and to quantify the risks of injury to the anatomical structures (artery, vein, nerve and tendon). METHOD: Fifty-three calcaneus from cadavers were used, divided into three zones and each subdivided in two areas (upper and lower) by means of a longitudinal line through the calcaneus. The risk of injury to the anatomical structures in relation to each Kirschner wire was determined using a graded system according to the Licht classification. The total risk of injury to the anatomical structures through placement of more than one wire was quantified using the additive law of probabilities and the product law for independent events. RESULTS: The injury risk calculation according to the Licht classification showed that the highest risk of injury to the artery or vein was in zone IA (43%), in relation to injuries to nerves and tendons (13% and 0%, respectively). CONCLUSION: This study made it possible to identify the most vulnerable anatomical structures and quantify the risk of injury to the calcaneus.

Neural compression-induced neuralgias: clinical evaluation of the effect of nucleotides associated with vitamin B12

The use of a combination of uridine triphosphate (UTP), cytidine monophosphate (CMP), and hydroxocobalamin was evaluated in a double-blind, randomized study in the treatment of neuralgia due to degenerative orthopedic alterations with neural compression. Following informed consent, 80 patients were randomized to a 30 day treatment period. The subjects received a thrice-daily oral treatment regimen of either the combination treatment (Group A: total daily dose of 9mg UTP, 15mg CMP, 6 mg hydroxocobalamin) or vitamin B12 alone (Group B: total daily dose of 6 mg hydroxocobalamin). Efficacy measures evaluated global patient condition from the perspective of the subject and the investigating physician pain ? measured by a visual-analog scale and functionality, using a patient-response questionnaire. The safety evaluation took into account physical evaluations and laboratory tests performed at each visit to the study center as well as the incidence and severity of adverse events. At the end of the 30-day treatment period, there were reductions in the pain scale scores in both groups, however there was a significantly larger reduction in the scores of the Group A patients. The Patient Global Evaluation scores improved in both groups but showed greater improvement in Group A, while the Physician Global Evaluation improved significantly only in Group A. A similar finding was observed in the scores of the Patient Functionality Questionnaire. Based on the findings of this clinical trial, we conclude that the combination of UTP, CMP, and vitamin B12 has a positive effect on pain and functionality improvement in the treatment of degenerative orthopedic alterations with neural compression, in the study population evaluated.

Evaluation of the safety and efficacy of an injectable B-vitamin combination in acute neuralgias

A clinical trial evaluating the safety and efficacy of the use of an intramuscular combination of vitamins B1, B6, and B12 in the treatment of the signs and symptoms of trigeminal and plantar neuralgia was performed. Patients were submitted to a 9-day, open-label treatment period with three administrations of the study medication, and underwent a series of clinical and laboratory evaluations prior to the first treatment dose and at each of the three following visits to the study center. The incidence of adverse events and the use of concomitant medications was monitored at each study visit, when efficacy evaluations were also performed, including a 100mm VAS pain assessment and global and satisfaction surveys completed by the patients and investigating physician. Additionally, at the end of the treatment period, the patients were evaluated on their willingness to continue treatment with the study medication.

Safety and efficacy of a B-vitamin combination in the treatment of osteoarthritis-related pain / Segurança e eficácia da associação das vitaminas B1, B6, B12 na analgesia da osteoartrite

We evaluated the safety and efficacy of the use of an oral combination of vitamins B1, B6, and B12 in the treatment of osteoarthritis-related pain and loss of mobility. A 14-day, open-label treatment period was adopted for patients presenting osteoarthritis of the knee or hip. Patients underwent a series of clinical and laboratory evaluations prior to the first treatment dose, following 7 days of treatment, and at the end of the 14-day drug administration period. The incidence of adverse events and use of concomitant medication was also monitored at each study visit. At each study visit, osteoarthritis evaluations were performed, including a 100mm VAS pain assessment, and global and satisfaction surveys completed by both patients and investigating physician. At the conclusion of the study, an additional assessment was performed to evaluate the patient's willingness to continue treatment with the B-vitamin combination.Clinical safety was evaluated by comparing the differences between the pretreatment, mid-study, and end-of-study clinical and laboratory evaluations as well as the incidence and severity of any adverse events. A comparison between the patient and physician assessments at each study visit was used to evaluate efficacy.A total of 54 patients were treated with the study medication. A clinically significant change was observed from pretreatment to end-of-study efficacy evaluations, including those for pain, mobility, and global osteoarthritis condition. The physician's evaluation of global patient condition and treatment satisfaction evaluation also presented a clinically significant change from pretreatment to the final study evaluation. No clinically significant changes in the patients clinical and laboratory evaluations were observed during the study.Based on the results of this clinical study, we conclude that the combination of cyanocobalamin, thiamine mononitrate and pyridoxine chlorihydrate at the concentrations employed is safe and effective in the treatment of the pain and loss of mobility associated with osteoarthritis.

Fixação percutânea com parafuso iliossacral na lesão traumática do anel pélvico / Percutaneous fixation with iliosacral screw for traumatic injury of the pelvic ring

Os autores apresentam os resultados de 12 pacientes tratados com a técnica de fixação percutânea com parafuso iliosacral nas lesÒes posteriores do anel pélvico. Foram tratados por essa técnica, com o paciente em decúbito dorsal e após redução fechada da lesão, sob visualização do intensificador de imagem, nove casos de luxação sacroilíaca e três de fratura do sacro. Dois pacientes evoluíram com dor na região sacroilíaca. Não ocorreram complicaçÒes neurovasculares ou infecciosas relacionadas com a técnica de fixação percutânea empregada nas lesÒes posteriores do anel pélvico. Houve um caso de infecção relacionada com a osteossíntese de sínfise pubiana. A fixação percutânea com parafuso iliossacral é alternativa de tratamento para as lesÒes verticalmente instáveis da pelve, desde que haja conhecimento pleno da anatomia e condiçÒes de interpretação correta das incidências radiográficas específicas, reduzindo assim os riscos inerentes ao método

Tratamiento endovascular de remanentes aneurismáticos / Endovascular treatment of partially clipped aneurysms

El pinzado ("clipado") parcial de un aneurisma ocurre en aproximadamente el 4 porciento de las intervenciones quirúrgicas. Debido al riesgo de crecimiento y ruptura del remanente aneurismático, se reconoce la necesidad de una intervención quirúrgica. Sin embargo, este procedimiento puede resultar técnicamente complejo y con un elevado índice de complicaciones . En este artículo describimos nuestra experiencia con 9 pacientes portadores de remanentes aneurismático postclipado tratados por vía endovascular. Cinco pacientes (88.9 porciento) se localizaron en la circulación anterior. La angiografía de control postoperatorio mostró la oclusión total del remanente aneurismático en 8 casos (88.9 porciento). El clipado parcial del cuello o cuerpo aneurismático puede permitir la colocación estable de coils. El clip puede limitar la adecuada visualización angiográfica del cuello aneurismático. No se presentaron complicaciones neurológicas asociadas al procedimiento ni hemorragias durante o posteriormente a la embolización. Concluimos que el tratamiento endovascular de remanentes aneurismáticos puede ser efetuado con seguridad y eficacia. Se identifican tipos de clipado que favorecen el tratamiento endovascular.

Tratamiento empirico anti-toxoplasma en SIDA y Chagas cerebral: relato de dos casos, revision de la bibliografia y propuesta de un algoritmo / Empirical anti-toxoplasma therapy in cerebral AIDS and Chagas invasion: presentation of 2 cases, bibliography review and proposal of an algorithm

El Tripanosoma cruzi, agente causal de la tripanosomiasis americana o enfermedad de Chagas es endémico en extensas áreas de América del Sur y Central, y existen numerosas comunicaciones documentando la invasión del sistema nervioso central por T. cruzi en pacientes con SIDA. Presentamos dos casos que ilustran claramente que el compromiso neurológico causado por T. cruzi resulta frecuentemente indistinguible de la toxoplasmosis del sistema nervioso central. Como el tratamiento precoz del Chagas neurológico ha sido asociado con una mayor sobrevida, y esta enfermedad es fácilmente diagnosticable mediante la identificación del agente en líquido cefalorraquídeo, proponemos que se realice sistemáticamente el estudio serológico de anticuerpos anti- T. cruzi en todos los pacientes con SIDA y diagnóstico presuntivo de toxoplasmosis cerebral. En aquellos pacientes que sean reactivos para Chagas debería realizarse además el estudio sistemático del líquido cefalorraquídeo. O dicho en otras palabras, la imposibilidad para diferenciar clinicamente el compromiso neurológico por T. cruzi del causado por Toxoplasma gondii hace necesatio replantear el abordaje diagnóstico y terapéutico de las lesiones focales agudas del sistema nervioso central en pacientes con SIDA residentes o procedentes de áreas endémicas de Chagas.

An automated system for detection and analysis of locomotor behavior in crustaceans

An efficient and simple system in presented for the analysis of crustacean locomotor behavior. The system is composed by six dual-compartment actographic chambers with photocoupling circuit for movement detection, and a device for acquisition and analysis of cata. Such device is made by a digital interface which feeds in to a microcomputer with disc unit and printer. Information is processed in real time during the experiment, with a simultaneous printout and storage in a floppy disc