Outcomes of urethral meatal preservation ventral urethroplasty for female urethral stricture: a series of cases

Abstract Objective: To present a series of cases with our initial experience and short-term outcomes of a modified vaginal mucosal flap urethroplasty. Methods: Patients diagnosed with urethral stricture and operated by the same operative technique between January 2012 and January 2018 were followed for at least 6 months. Uroflowmetry and clinical outcomes were evaluated. Results: Nineteen patients were included with an average age of 56.4 years, mean preoperative Qmax of 5.3 ml/s, and PVR of 101.4 mL. After 6 months of the procedure, the mean Qmax improved to 14.7 mL/s (p<0.05), PVR decreased to 47.3 mL (p<0.05), and 84.2% of all patients reported improvement in clinical self-reported symptoms. There was an improvement in symptoms such as voiding effort in 84.2% of patients, weak stream (89.5%), and recurrent urinary tract infection (85.7%). The success rate (absence of symptoms and normal Qmax with no significant PVR) of the procedure was 84.2%. Conclusion: The described technique was considered effective for the treatment of female urethra stricture, with a high clinical success rate and an objective improvement of Qmax and decrease in PVR after 6 months of the procedure.

Mapeamento do uso da caderneta de saúde da criança por pais e profissionais: um estudo descritivo / Mapping the use of the child health handbook by parents and professionals: a descriptive study / Mapeo del uso del manual de salud infantil por padres y profesionales: un estudio descriptivo

Objetivo: Identificar o conhecimento dos pais acerca da Caderneta de Saúde da Criança, mapear o preenchimento da Caderneta pelos profissionais e correlacionar o preenchimento da caderneta com a orientação dos pais pelos profissionais de saúde. Métodos: pesquisa quantitativa descritiva, realizada num hospital universitário, através da aplicação de formulário com 22 pais ou responsáveis e análise através de tabelas, gráficos, estatística descritiva e inferencial. Resultados: (77,3%) dos entrevistados alegaram não ter recebido orientação sobre a Caderneta, a maioria das cadernetas não apresentava registro no item de Índice de Massa Corporal tanto como a maioria apresentava preenchimento completo no item de registro de vacinas do calendário básico e as correlações não foram significativas, apresentando independência na maioria. Conclusão: evidenciou-se uma necessidade de orientação dos familiares tanto como capacitação dos profissionais que trabalham com a população infantil e não se verificou dependência entre a maioria das variáveis correlacionadas neste estudo

Objective:To identify parents' knowledge about the Child Health Handbook, map the completion of the booklet by professionals and correlate the completion of the booklet with the guidance of parents by health professionals. Methods: descriptive quantitative research, conducted in a university hospital, through the application of a form with 22 parents or guardians and analysis through tables, graphs, descriptive and inferential statistics. Results: (77.3%) of respondents claimed not to receive guidance on the Passbook, the majority of the handbooks had no record in the Body Mass Index item as much as most completed in the basic calendar vaccine record item and correlations were not significant, presenting independence in the majority. Conclusion: there was a need for guidance from family members as well as training of professionals working with the child population and there was no dependence between most of the correlated variables in this study

Objetivo: Identificar el conocimiento de los padres sobre el Manual de Salud Infantil, mapear la finalización del folleto por profesionales y correlacionar la finalización del folleto con la orientación de los padres por parte de profesionales de la salud. Métodos: investigación cuantitativa descriptiva, realizada en un hospital universitario, mediante la aplicación de un formulario con 22 padres o tutores y análisis a través de tablas, gráficos, estadísticas descriptivas e inferenciales. Resultados: El (77.3%) de los encuestados afirmaron no haber recibido orientación sobre el Manual, la mayoría de los manuales no tenían registros en el ítem del Índice de Masa Corporal tanto como la mayoría había completado en el ítem y las correlaciones del registro básico de la vacuna del calendario no fueron significativas, presentando independencia en la mayoría. Conclusión: era necesaria la orientación de los miembros de la familia, así como la capacitación de profesionales que trabajan con la población infantil y no hubo dependencia entre la mayoría de las variables correlacionadas en este estudio

The first instrument for complex PTSD assessment: psychometric properties of the ICD-11 Trauma Questionnaire

Objective: The ICD-11 Trauma Questionnaire (ITQ) was developed as a joint effort by researchers from several countries to evaluate post-traumatic stress (PTSD) and complex-PTSD (C-PTSD) symptoms. This study is part of a multi-center international collaborative research project that aims to provide psychometric support for this initial instrument in different languages, considering the specific contexts related to complex traumatization. This study verified the psychometric characteristics of the Portuguese version of the ITQ, evaluating symptoms beyond those described the existing literature. Methods: We examined the results of a convenience sample totaling 268 Portuguese and Angolan participants. Two instruments were applied: the ITQ, which evaluates symptoms resulting from a traumatic life event, and the Life Events Checklist (LEC), which evaluates stressful life events. The general characteristics of the scales are described, and reliability analysis and validity studies were performed. Results: Cronbach's alpha varied between 0.84 and 0.88, and the exploratory factorial analysis results were consistent with the concept of C-PTSD, with five components explaining 61.58% of scale variance. Conclusion: The results suggest good psychometric characteristics for the Portuguese version of the ITQ, and thus it can be included in protocols intended evaluating complex traumatic symptoms.

Effects of remote ischemic preconditioning and topical hypothermia in renal ischemia-reperfusion injury in rats

Abstract Purpose: To evaluate whether combining hypothermia and remote ischemic preconditioning (RIPC) results in protection from ischemia-reperfusion (IR). Methods: Thirty-two Wistar rats underwent right nephrectomy and were randomly assigned to four experimental protocols on the left kidney: warm ischemia (group 1), cold ischemia (group 2), RIPC followed by warm ischemia (group 3), and RIPC followed by cold ischemia (group 4). After 240 minutes of reperfusion, histological changes in the left kidney, as well as lipid peroxidation and antioxidant enzyme activity, were analyzed. The right kidney was used as the control. Serum creatinine was collected before and after the procedures. Results: RIPC combined with hypothermia during IR experiments revealed no differences on interventional groups regarding histological changes (p=0.722). Oxidative stress showed no significant variations among the groups. Lower serum creatinine at the end of the procedure was seen in animals exposed to hypothermia (p<0.001). Conclusions: Combination of RIPC and local hypothermia provides no renal protection in IR injury. Hypothermia preserves renal function during ischemic events. Furthermore, RIPC followed by warm IR did not show benefits compared to warm IR alone or controls in our experimental protocol.

Combined effects of melatonin and topical hypothermia on renal ischemia-reperfusion injury in rats

Abstract Purpose: To evaluate whether their combination was more effective than either alone in decreasing renal damage due to ischemia/reperfusion (I/R) injury in rats. Methods: Thirty-two Wistar rats were assigned to four groups. Following right nephrectomy, their left kidneys were subjected to warm ischemia (IR), cold ischemia (TH+IR), intraperitoneal injection of 10 mg/kg melatonin (MEL+IR), or injection of 10 mg/kg melatonin followed by cold ischemia (MEL+TH+IR). Eight randomly assigned right kidneys constituted the control group. After 240 min of reperfusion, left nephrectomy was performed for histopathological evaluation, lipid peroxidation, and measurement of antioxidant enzyme activity. Serum was collected to measure urea and creatinine concentrations. Results: Histopathological damage induced by ischemia and reperfusion was more attenuated in the MEL+TH+IR group than in the MEL+IR and TH+IR groups (p<0.037). Superoxide dismutase activity was significantly higher (p<0.029) and creatinine (p<0.001) and urea (p<0.001) concentrations were significantly lower in the MEL+TH+IR group than in the MEL+IR and TH+IR groups. Conclusion: The combination of melatonin (MEL) and topical hypothermia (TH) better protects against renal I/R injury than does MEL or TH alone.

The effects of local ischemic preconditioning and topical hypothermia in renal ischemia/reperfusion injury in rats

Abstract Purpose: Topical hypothermia and local ischemic preconditioning have been shown to reduce renal ischemia-reperfusion (I/R) injury individually. We examined whether combination of both strategies lessens renal I/R injury. Methods: Post right nephrectomy, 40 male Wistar rats were randomly assigned to five experimental protocols performed in the left kidney: topical hypothermia without ischemia (TH), warm ischemia (IR), ischemic preconditioning followed by warm ischemia (IPC+IR), cold ischemia (TH+IR), and ischemic preconditioning followed by cold ischemia (IPC+TH+IR). Eight randomly assigned right kidneys constituted the control group. After 240 min of reperfusion, the left kidney was retrieved to evaluate histological changes, lipid peroxidation and antioxidant enzymes activity. Serum was collected to evaluate urea and creatinine. Results: IPC+TH+IR group revealed no difference to any other group subjected to ischemia in relation to histological changes, lipid peroxidation and antioxidant enzymes activity. Creatinine was lower in IPC+TH+IR group compared with IPC+IR, but showed no difference compared to TH+IR group. Conclusions: Combination of local ischemic preconditioning (IPC) and topical hypothermia conferred no protection in renal I/R injury. Moreover, local IPC solely followed by warm ischemia impaired renal function more than warm ischemia alone.

Analysis of the effects of topical renal hypothermia on lung tissue after kidney ischemia and reperfusion in rats

PURPOSE: To evaluate whether topical renal hypothermia (TRH) at different levels of temperature has protective effects on lung tissue after renal I/R, through an analysis of organ histology and inflammatory markers in lung tissue. METHODS: Twenty-eight male Wistar rats were randomly allocated across four groups and subjected to renal ischemia at different levels of topical renal temperature: normothermia (no cooling, 37°C), mild hypothermia (26°C), moderate hypothermia (15°C), and deep hypothermia (4°C). To induce I/R, the vessels supplying the left kidney of each animal were clamped for 40 minutes, followed by reperfusion. After four hours, another procedure was performed to harvest the tissues of interest. TNF-α, IL-1β and myeloperoxidase activity were measured in lung tissue. Histological analysis was performed in hematoxylin and eosin-stained lung specimens. RESULTS: Induction of renal I/R under deep topical hypothermia resulted in a significant decrease in lung concentrations of TNF-α compared with normothermic I/R (p<0.05). A trend toward significant correlation was found between lung IL-1β concentration and intensity of hypothermia (Spearman r=−0.37; p=0.055). No difference was found in myeloperoxidase activity or histologic injury between groups. CONCLUSION: Topical renal hypothermia reduces activation of the inflammatory cascade in the lung parenchyma. However, tissue-protective effects were not observed. .

Oxidative stress evaluation of ischemia and reperfusion in kidneys under various degrees of hypothermia in rats

PURPOSE:To design an animal model of ischemia-reperfusion (I/R) in kidneys and evaluate the role that predetermined ranges of local hypothermia plays on markers of stress-oxydative as well as on histologic sections. METHODS: Twenty eight male rats Wistar, under general anesthesia, undergone right nephrectomy (G0, control group) followed by left kidney ischemia during 40 min. Four temperatures groups were designed, with seven animals randomized for each group: normothermic (G1, ±37ºC), mild hypothermia (G2, 26ºC), moderate hypothermia (G3, 15ºC) and deep hypothermia (G4, 4ºC). Left kidney temperature was assessed with an intraparenchymal probe. Left nephrectomy was performed after 240 min of reperfusion. After I/R a blood sample was obtained for f2-IP. Half of each kidney was sent to pathological evaluation and half to analyze CAT, SOD, TBARS, NO3, NO2. RESULTS:Histopathology showed that all kidneys under I/R were significantly more injured than the G0 (p<0.001). TBARS had increased levels in all I/R groups compared with the G0 (p<0.001). CAT had a significant difference (p<0.03) between G1 and G4. Finally, no difference was found on SOD, NO3, NO2 nor on f2-IP. CONCLUSION: This model of I/R was efficient to produce oxidative-stress in the kidney, showing that 4ºC offered significant decrease in free radicals production, although tissue protection was not observed.

Transplante renal em pacientes HIV positivos: relato de dois casos da experiência inicial do Hospital de Clínicas de Porto Alegre / Kidney transplantation in HIV positive patients: two case reports from Hospital de Clínicas de Porto Alegre initial experience

Recentemente, o transplante renal passou a ser uma modalidade terapêutica aceita para o tratamento de pacientes renais crônicos terminais infectados pelo HIV. Para tal, há necessidade de estabilidade de parâmetros clínicos e laboratoriais relacionados à infecção pelo HIV e do uso de terapia antiretroviral de elevada eficiência. Neste relato, apresentamos os dois primeiros casos no Brasil de pacientes portadores de infecção pelo HIV transplantados com órgãos de doadores falecidos realizados com sucesso em nossa instituição. As interações entre os imunossupressores e as drogas antiretrovirais, as coinfecções, o perfil de risco cardiovascular e a elevada incidência de rejeição aguda permanecem os maiores problemas a serem equacionados nestes pacientes.

Recently kidney transplantation has become an accepted treatment modality for the treatment of HIV infected patients with end-stage renal diseases. For such treatment it is required stability of clinical and laboratory parameters related to HIV infection and the use of highly active antiretroviral therapy. In this report we present the first two cases in Brazil of patients with HIV infection transplanted with organs from deceased donors performed successfully in our institution. The interactions between immunosuppressive and antiretroviral drugs, the co-infections, cardiovascular risk profile and the high incidence of acute rejection remain the major problems to be dealt with in these patients.

Avaliação da sustentabilidade ambiental do uso de esgoto doméstico tratado na piscicultura / Environmental sustainability evaluation of the treated sewage use in aquaculture

Este trabalho teve como objetivo avaliar a sustentabilidade ambiental do uso de esgoto doméstico tratado na piscicultura por meio do Índice de Sustentabilidade Ambiental para Reúso em Piscicultura (ISA RP), do Índice de Qualidade de Água para Reúso em Piscicultura (IQA RP) e do custo ambiental (entropia). Observou-se, por meio do custo ambiental, que a piscicultura convencional causou a deterioração da qualidade da água que foi utilizada. Constatou-se que o sistema de piscicultura utilizando esgoto tratado, sem usar aeração, não causou efeito deletério significante à qualidade da água de reúso (efluente da estação de tratamento de esgoto - ETE). O sistema de piscicultura usando esgoto tratado, com aeração, resultou na melhoria de sua qualidade, quando comparado com o efluente da estação de tratamento, significando que essa prática resultou em um polimento no líquido utilizado. Ambos os sistemas de reúso de águas mostraram-se ambientalmente sustentáveis, o que indica a potencialidade do uso de esgoto doméstico tratado como fonte de água e alimento natural para a piscicultura.

This work aimed to evaluate the environmental sustainability of the treated sewage reuse on aquaculture by using the Environmental Sustainability Index of Aquaculture Reuse (ESI AR), Water Quality Index of Aquaculture Reuse (WQI AR) and environmental cost (entropy). For conventional aquaculture, a water quality deterioration of the fish tanks was observed by the environmental cost. When treated sewage was used in tanks without external aeration, it was not verified a remarkable water quality deterioration. However, for the tanks externally aerated and fed with treated sewage there was a water quality improvement, in other words a polishing step was taking place. All the systems analyzed showed to be environmentally sustainable, which indicates that the treated sewage can be considered a good water source for aquaculture.

Adaptation of an evaluation method of 5 alpha-reductase type 1 and type 2 enzyme activities in prostate tissue

Objectives: We are proposing the adaptation of a method for the assessment of the activity of 5 alpha-reductase type 1 and type 2 isoenzymes in human prostate tissue to be used in studies of the relationship of enzymatic activity and cancer. Material and Methods: We have been developing a method, based on Thomas et al., 2003 which consists of collecting human prostate samples and performing 5 alpha-reductase activity assessment. We are proposing a method based on samples obtained from prostate biopsies, according to a pilot study developed by Oliveira et al. 2006. We have obtained two samples of the same prostate area, and our idea is to send one of these samples for pathological examination and another for 5 alpha-reductase evaluation. Herein we have showed the feasibility of this assay. Through a thin layer chromatography with 14C-testosterone and NADPH (nicotinamide adenine dinucleotide phosphate) cofactor, we have obtained radioactive spots which were detected by autoradiography. The areas associated with testosterone and its metabolite DHT (dihydrotestosterone) were scrapped and counted with a scintillation chamber. Results: We believe that it is possible to demonstrate the activity of 5 alpha-reductase through the adaptation of this biochemistry method. Conclusions: This method is feasible and can be utilized to assess 5 alpha-reductase type 1 and type 2 activity in prostate tissue samples.

Influência do lazer no desempenho acadêmico em estudantes de Medicina / Influence of leisure time on academic performance of medical students

Estudos prévios sugerem que o tempo de lazer diminui progressivamente durante o curso médico, e que a reduçäo de qualidade de vida pode se refletir na reduçäo do desempenho curricular. Näo há relatos de associaçäo entre a quantidade de lazer e a performance acadêmica. Para avaliar essa associaçäo, foi realizdo estudo de corte transversal controlado, onde se aferiram as horas semanais de lazer e o escore de desempenho acadêmico de 77 estudantes da Faculdade de Medicina da Universidade Federal do Rio Grande do Sul. Observou-se ausência de associaçäo entre lazer e desempenho (risco relativo de 1,1 e P=0,9553). Houve uma discreta correlaçäo positiva entre a valorizaçäo do conceito e as horas semanais de lazer (r=-0,23 +/-0,22). Estes resultados permitem concluir que näo foi observada associaçäo entre horas semanais de lazer e desempenho