The use and role of telemedicine in maternal fetal medicine around the world: an up-to-date.

Purpose: The aim of this narrative review is to sumarize data about the use and role of telemedicine in maternal fetal medicine (MFM). Methods: We searched pubmed and scopus to find articles about telemedicine in MFM by using the terms telmedicine or telehealth and maternal fetal medicine. Results: Telehealth has been widely used for several medical specialties. During the coronavirus disease 2019 (COVID-19) pandemic, telehealth has gained investment and further research. Even though telemedicine in MFM has not been frequently applied, from 2020 onwards it has increased in both implementation and acceptance worldwide. The need to screen the patients in overloaded centers in a pandemic scenario required telemedicine in MFM, which has exhibited consistently good results concerning health and budget. The aim of this study was to review the telehealth programs and research focused on MFM around the world. Few studies have been applied to MFM and even fewer in developing and undeveloped countries. The majority of studies were concentrated in the USA and in Europe. Conclusion: Further research is needed, especially in non-developed countries, to comprehend the potential role of telemedicine in MFM for improving the life quality of the patients, health professionals, and to be cost-efficient.

Selective Laser Melting and Mechanical Properties of Stainless Steels.

Metal additive manufacturing (AM) has been evolving in response to industrial and social challenges. However, new materials are hindered in these technologies due to the complexity of direct additive manufacturing technologies, particularly selective laser melting (SLM). Stainless steel (SS) 316L, due to its very low carbon content, has been used as a standard powder in SLM, highlighting the role of alloying elements present in steels. However, reliable research on the chemical impact of carbon content in steel alloys has been rarely conducted, despite being the most prevalent element in steel. Considering the temperatures involved in the SLM process, the laser-powder interaction can lead to a significant carbon decrease, whatever the processing atmosphere. In the present study, four stainless steels with increasing carbon content-AISI 316L, 630 (17-4PH), 420 and 440C-were processed under the same SLM parameters. In addition to roughness and surface topography, the relationship with the microstructure (including grain size and orientation), defects and mechanical properties (hardness and tensile strength) were established, highlighting the role of carbon. It was shown that the production by SLM of stainless steels with similar packing densities and different carbon contents does not oblige the changing of processing parameters. Moreover, alterations in material response in stainless steels produced under the same volumetric energy density mainly result from microstructural evolution during the process.

O cuidado às Pessoas Vivendo com HIV/Aids na Atenção Primária à Saúde na cidade do Rio de Janeiro: uma avaliação de implantação / Care for People Living With HIV/AIDS in Primary Health Care in the city of Rio de Janeiro: an implementation evaluation

RESUMO Objetivou-se realizar uma avaliação de implantação do modelo descentralizado de cuidado às Pessoas Vivendo com HIV/Aids (PVHA) no Município do Rio de Janeiro (MRJ) mediante análise do contexto que propiciou a intervenção e análise do grau de implantação ao fim do período estudado (2013-2016). Nesses anos, substituiu-se a atenção centrada no infectologista pelo manejo focado na Atenção Primária à Saúde (APS), no contexto de fortalecimento da Estratégia Saúde da Família. A pesquisa utilizou entrevistas com gestores e análise de dados secundários para estudar o contexto gerencial da saúde no MRJ e sua influência sobre a construção do modelo descentralizado, assim como as características desse modelo e o grau de sua implantação. A análise de contexto evidenciou a influência das normativas nacionais sobre a reforma da APS no município, e desta sobre a proposta de cuidado descentralizado, bem como as tensões entre atores do processo, especialmente gestores, médicos da APS, infectologistas e PVHA. Como características do modelo descentralizado, destacaram-se ampliação de acesso, promoção da integralidade e coordenação do cuidado. Quanto ao grau de implantação, concluiu-se que esta havia progredido heterogeneamente, avançando mais nas áreas de prevenção, diagnóstico e assistência farmacêutica, e menos em atenção integral e coordenação do cuidado.

ABSTRACT This article aimed to evaluate the implementation of a decentralized care model for People Living With HIV/AIDS (PLWHA) in the city of Rio de Janeiro, by analyzing the context that enabled it and the degree of its implementation at the end of the time frame studied (2013-2016). During this period, infectologist-centered HIV/AIDS care was replaced by one centered in Primary Health Care (PHC), in the context of strengthening the Family Health Strategy. By interviewing administrators and analyzing secondary data, we studied the process from city health managers' viewpoint, described its main characteristics and the degree to which decentralization measures were implemented. As a result, we observed how national guidelines influenced the implementation of changes in the municipal PHC structure, especially in the restructuring of HIV care, and the tensions among key players (administrators, PHC doctors, infectologists, and PLWHA). Among the characteristics of the new model, increasing healthcare access, enhancing integrality and coordination of care were features most commonly cited in the interviews. Finally, the degree of implementation of the decentralization policy was found to be heterogeneous, being more advanced in the fields of prevention, diagnosis and access to medication, and less in comprehensive care and coordination of care.

Relação entre comportamentos de risco para ortorexia nervosa, mídias sociais e dietas em estudantes de nutrição / Relationship between risk behaviors for orthorexia nervosa, social media and diets in nutrition students

O estudo visou identificar comportamentos de risco para ortorexia nervosa e sua relação com as mídias sociais, dietas da moda e período letivo em estudantes de Nutrição de uma Instituição de Ensino Superior em São Paulo. Trata-se de pesquisa transversal envolvendo 285 alunos. O questionário ORTO-15 avaliou comportamentos de risco para ortorexia nervosa e foi associado ao Questionário de Frequência e Uso de Mídias Sociais, aplicados via internet. Utilizou-se a análise de variância ANOVA one-way com post hoc de Fisher e teste t Student independente, adotando nível de significância de 0,05. Constatou-se tal comportamento em 72% da amostra, porém observou-se um declínio ao longo do curso. Aqueles que já fizeram dieta e usavam frequentemente mídias sociais digitais apresentaram escore significativamente menor, favorecendo o desenvolvimento da prática. Estudantes de nutrição revelaram-se um grupo suscetível a comportamentos ortoréxicos, que estão relacionados aos semestres cursados, à prática de realizar dietas e ao uso de mídias sociais. A conscientização dessa prática e a prevenção são necessárias devido aos riscos biopsicossociais.

The study aimed to identify risk behaviors for orthorexia nervosa and their relationship with social media, fad diets and academic term in nutrition students at a higher education institution in São Paulo. The method used was a cross-sectional study involving 285 students. ORTO-15 questionnaire assessed risk behaviors for orthorexia nervosa and was associated with the Frequency and Use of Social Media Questionnaire, applied through internet. ANOVA one-way analysis of variance was used with Fisher's post hoc and Student's t-test, adopting a significance level of 0.05. The orthorexic behavior was found in 72% of the sample, however, a decline was observed over the course. Those who have already dieted and frequently used social media had a significantly lower score, favoring the development of the practice. Nutrition students demonstrated to be a group susceptible to orthorexic behaviors and those behaviors are related to the semesters they are attending, fad diets and social media. Awareness of this practice and prevention are necessary, avoiding biopsychosocial losses.

Treatment of Distal Radio Vicious Consolidation: Corrective Osteotomy Through 3D Printing Prototyping.

Distal radial fractures are very common. Vicious consolidation can occur in up to one third of these fractures, resulting in wrist pain, restricted movement, and, eventually, physical limitation or disability. The treatment of this condition consists in corrective osteotomy, which requires careful preoperative planning due to its three-dimensional complexity, especially in injuries with joint involvement. Recently, prototyping based on three-dimensional (3D) reconstruction of computed tomography (CT) scans has been used for osteotomy planning in a 3D anatomical model. It allows a better understanding of the deformity in a realistic surgical approach, leading to safer, faster, and more predictable procedures. The aim of the present study is to present this technique and show its use in two clinical cases.

The malunion of distal radius fracture: Corrective osteotomy through planning with prototyping in 3D printing.

INTRODUCTION: Distal radius fractures (DRF) are among the most frequent in the body. About one third of these fractures can result in malunion with restriction of movement and pain in the wrist, the treatment in these cases consists of corrective osteotomy of the deformity. Due to its three-dimensional (3D) complexity, careful preoperative planning is a fundamental step in correction. The prototyping from the 3D reconstruction of the computed tomography of the affected wrist, allows the real understanding of the deformity. METHODS: Patients with malunion of the distal radius with indication for surgical treatment, from December 2019, were included in the group of corrective osteotomies through planning with prototyping in 3D printing. The postoperative functional outcome was assessed by the Disabilities of the Arm, Shoulder and Hand Score (DASH) and visual analogue scale (VAS). Radiographic data including radial inclination, volar tilt and joint step were recorded from standard posteroanterior and lateral radiographic views. RESULTS: A total of 9 patients were included. The mean age was 47 years. The average postoperative DASH value of the patients was 24.9 and VAS was 3.6. Radiographically, the palmar tilt had an average improvement of 25.22°, and the radial inclination had an average improvement of 2°. CONCLUSION: Corrective osteotomy through planning with prototyping in 3D printing is an effective method of treating symptomatic distal radius malunions. The possibility of performing the osteotomy in a 3D model, simulating the surgery, making the procedure more predictable.

Comparative Evaluation of Coracoid Graft Dimensions in the Latarjet Surgery for Anterior Glenohumeral Instability.

Objectives The aim of the present study was to describe the dimensions of the coracoid grafts in our Latarjet surgeries and compare them with the results described in the literature. In addition, the feasibility of the 7-millimeter rule was verified. Methods Individuals with anterior glenohumeral instability with or without bone loss participated in the present study. The dimensions of 31 coracoid process grafts of patients who were submitted to the Latarjet surgical technique were measured with an analogical caliper and recorded for posterior analysis. Results The dimensions of the coracoid graft did not show statistically significant differences related to gender. The graft width obtained from our sample presented similarities with the dimensions reported in the literature. However, the length and thickness were smaller when compared to the reference study (Young et al, 2013). 15 The 7-millimeter rule was considered feasible regarding the graft dimensions obtained from our sample. Conclusion The coracoid graft dimensions were similar to the dimensions described in the literature regarding width, but the same was not found for length and thickness; and the 7-millimeter rule was feasible regarding the graft dimensions obtained from our sample.

Comparative Evaluation of Coracoid Graft Dimensions in the Latarjet Surgery for Anterior Glenohumeral Instability / Avaliação comparativa das dimensões do enxerto do coracoide na cirurgia de Latarjet para instabilidade glenoumeral anterior

Abstract Objectives The aim of the present study was to describe the dimensions of the coracoid grafts in our Latarjet surgeries and compare them with the results described in the literature. In addition, the feasibility of the 7-millimeter rule was verified. Methods Individuals with anterior glenohumeral instability with or without bone loss participated in the present study. The dimensions of 31 coracoid process grafts of patients who were submitted to the Latarjet surgical technique were measured with an analogical caliper and recorded for posterior analysis. Results The dimensions of the coracoid graft did not show statistically significant differences related to gender. The graft width obtained from our sample presented similarities with the dimensions reported in the literature. However, the length and thickness were smaller when compared to the reference study (Young et al, 2013).15 The 7-millimeter rule was considered feasible regarding the graft dimensions obtained from our sample. Conclusion The coracoid graft dimensions were similar to the dimensions described in the literature regarding width, but the same was not found for length and thickness; and the 7-millimeter rule was feasible regarding the graft dimensions obtained from our sample.

Resumo Objetivo O objetivo deste estudo foi descrever as dimensões do processo coracoide em nossas cirurgias de Latarjet e compará-las com os resultados descritos na literatura. Além disso, a viabilidade da regra dos 7 milímetros foi verificada. Métodos Indivíduos com instabilidade glenoumeral anterior com ou sem erosão óssea participaram deste estudo. As dimensões de 31 enxertos de processo coracoide de pacientes operados pela técnica de Latarjet foram mensuradas com um paquímetro analógico e registradas para análise posterior. Resultados As dimensões do processo coracoide não demonstraram diferença estatisticamente significativa de acordo com o sexo. A largura do enxerto obtida em nossa amostra apresentou semelhança com as dimensões descritas na literatura. No entanto, o comprimento e a espessura foram um pouco menores quando comparados com o estudo de referência (Young et al, 2013).15 A regra dos 7 milímetros foi considerada viável com as dimensões do enxerto obtidas em nossa amostra. Conclusão As dimensões do enxerto do coracoide foram similares às descritas na literatura em relação à largura, mas o mesmo não foi encontrado quanto ao comprimento e espessura; e a regra dos 7 milímetros demonstrou viabilidade com as dimensões do enxerto obtidas em nossa amostra.

Bony Histiocytic Sarcoma of the Scapula: Case Report.

Case report of a pediatric patient with a diagnosis of bony histiocytic sarcoma of the scapula, submitted to oncologic resection (Tikhoff-Linberg type II surgery), who returned to previous activities and was disease-free after 24 months of follow-up.

Bony Histiocytic Sarcoma of the Scapula: Case Report / Sarcoma histiocítico ósseo em escápula: relato de caso

Abstract Case report of a pediatric patient with a diagnosis of bony histiocytic sarcoma of the scapula, submitted to oncologic resection (Tikhoff-Linberg type II surgery), who returned to previous activities and was disease-free after 24 months of follow-up.

Resumo Relato de caso de paciente pediátrico com diagnóstico de sarcoma histiocítico ósseo em escápula, submetido à ressecção oncológica (cirurgia de Tikhoff-Linberg tipo II), com retorno às atividades prévias e livre de doença após 24 meses de seguimento.

Analysis of the characteristics of patients with open tibial fractures of Gustilo and Anderson type III.

OBJECTIVE: To analyze the characteristics of patients with Gustilo-Anderson Type III open tibial fractures treated at a tertiary care hospital in São Paulo between January 2013 and August 2014. METHODS: This was a cross-sectional retrospective study. The following data were gathered from the electronic medical records: age; gender; diagnosis; trauma mechanism; comorbidities; associated fractures; Gustilo and Anderson, Tscherne and AO classifications; treatment (initial and definitive); presence of compartment syndrome; primary and secondary amputations; MESS (Mangled Extremity Severity Score) index; mortality rate; and infection rate. RESULTS: 116 patients were included: 81% with fracture type IIIA, 12% IIIB and 7% IIIC; 85% males; mean age 32.3 years; and 57% victims of motorcycle accidents. Tibial shaft fractures were significantly more prevalent (67%). Eight patients were subjected to amputation: one primary case and seven secondary cases. Types IIIC (75%) and IIIB (25%) predominated among the patients subjected to secondary amputation. The MESS index was greater than 7 in 88% of the amputees and in 5% of the limb salvage group. CONCLUSION: The profile of patients with open tibial fracture of Gustilo and Anderson Type III mainly involved young male individuals who were victims of motorcycle accidents. The tibial shaft was the segment most affected. Only 7% of the patients underwent amputation. Given the current controversy in the literature about amputation or salvage of severely injured lower limbs, it becomes necessary to carry out prospective studies to support clinical decisions.

OBJETIVO: Analisar as características dos indivíduos com fratura exposta de tíbia tipo III de Gustillo e Anderson, tratados em um hospital de nível terciário em São Paulo, entre janeiro de 2013 e agosto de 2014. MÉTODOS: Estudo transversal retrospectivo. Foram coletados dos prontuários eletrônicos: idade, gênero, diagnóstico, mecanismo de trauma, comorbidades, fraturas associadas, classificações de acordo com Gustillo e Anderson, Tscherne e AO, tratamento (inicial e definitivo), presença de síndrome compartimental, amputações primárias e secundárias, índice de MESS, índices de mortalidade e infeção. RESULTADOS: Foram incluídos 116 pacientes, 81% com fratura tipo IIIA, 12% IIIB e 7% IIIC, 85% do gênero masculino, média de 32,3 anos e 57% vítimas de acidente de motocicleta. A fratura da diáfise da tíbia foi significativamente mais prevalente (67%). Oito pacientes foram submetidos à amputação, uma primária e sete secundárias. Houve predomínio dos tipos IIIC (75%) e IIIB (25%) entre os pacientes com amputação secundária. O índice de MESS obteve pontuação maior do que 7 em 88% dos amputados e em 5% dos pacientes com o membro salvo. CONCLUSÃO: O perfil dos pacientes com fratura exposta de tíbia de tíbia tipo III de Gustilo e Anderson envolveu principalmente indivíduos jovens do gênero masculino, vítimas de acidentes de motocicleta. A diáfise da tíbia foi o segmento mais acometido. Apenas 7% dos pacientes foram submetidos à amputação. Diante da controvérsia existente na literatura sobre a amputação ou o salvamento do membro inferior gravemente lesionado, tornam-se necessários mais estudos prospectivos para apoiar a escolha clínica.

Analysis of the characteristics of patients with open tibial fractures of Gustilo and Anderson type III / Análise das características dos pacientes com fratura exposta de tíbia grau III de Gustilo e Anderson

OBJECTIVE: To analyze the characteristics of patients with Gustilo-Anderson Type III open tibial fractures treated at a tertiary care hospital in São Paulo between January 2013 and August 2014. METHODS: This was a cross-sectional retrospective study. The following data were gathered from the electronic medical records: age; gender; diagnosis; trauma mechanism; comorbidities; associated fractures; Gustilo and Anderson, Tscherne and AO classifications; treatment (initial and definitive); presence of compartment syndrome; primary and secondary amputations; MESS (Mangled Extremity Severity Score) index; mortality rate; and infection rate. RESULTS: 116 patients were included: 81% with fracture type IIIA, 12% IIIB and 7% IIIC; 85% males; mean age 32.3 years; and 57% victims of motorcycle accidents. Tibial shaft fractures were significantly more prevalent (67%). Eight patients were subjected to amputation: one primary case and seven secondary cases. Types IIIC (75%) and IIIB (25%) predominated among the patients subjected to secondary amputation. The MESS index was greater than 7 in 88% of the amputees and in 5% of the limb salvage group. CONCLUSION: The profile of patients with open tibial fracture of Gustilo and Anderson Type III mainly involved young male individuals who were victims of motorcycle accidents. The tibial shaft was the segment most affected. Only 7% of the patients underwent amputation. Given the current controversy in the literature about amputation or salvage of severely injured lower limbs, it becomes necessary to carry out prospective studies to support clinical decisions.

OBJETIVO: Analisar as características dos indivíduos com fratura exposta de tíbia tipo III de Gustillo e Anderson, tratados em um hospital de nível terciário em São Paulo, entre janeiro de 2013 e agosto de 2014. MÉTODOS: Estudo transversal retrospectivo. Foram coletados dos prontuários eletrônicos: idade, gênero, diagnóstico, mecanismo de trauma, comorbidades, fraturas associadas, classificações de acordo com Gustillo e Anderson, Tscherne e AO, tratamento (inicial e definitivo), presença de síndrome compartimental, amputações primárias e secundárias, índice de MESS, índices de mortalidade e infeção. RESULTADOS: Foram incluídos 116 pacientes, 81% com fratura tipo IIIA, 12% IIIB e 7% IIIC, 85% do gênero masculino, média de 32,3 anos e 57% vítimas de acidente de motocicleta. A fratura da diáfise da tíbia foi significativamente mais prevalente (67%). Oito pacientes foram submetidos à amputação, uma primária e sete secundárias. Houve predomínio dos tipos IIIC (75%) e IIIB (25%) entre os pacientes com amputação secundária. O índice de MESS obteve pontuação maior do que 7 em 88% dos amputados e em 5% dos pacientes com o membro salvo. CONCLUSÃO: O perfil dos pacientes com fratura exposta de tíbia de tíbia tipo III de Gustilo e Anderson envolveu principalmente indivíduos jovens do gênero masculino, vítimas de acidentes de motocicleta. A diáfise da tíbia foi o segmento mais acometido. Apenas 7% dos pacientes foram submetidos à amputação. Diante da controvérsia existente na literatura sobre a amputação ou o salvamento do membro inferior gravemente lesionado, tornam-se necessários mais estudos prospectivos para apoiar a escolha clínica.

Association between intratumoral lymphatic microvessel density (LMVD) and clinicopathologic features in endometrial cancer: a retrospective cohort study.

BACKGROUND: Lymph node metastasis in endometrial cancer significantly decreases survival rate. Few data on the influence of intratumoral lymphatic microvessel density (LMVD) on survival in endometrial cancer are available. Our aim was to assess the intratumoral LMVD of endometrial carcinomas and to investigate its association with classical pathological factors, lymph node metastasis and survival. METHODS: Fifty-seven patients with endometrial carcinoma diagnosed between 2000 and 2008 underwent complete surgical staging and evaluation of intratumoral LMVD and other histologic variables. Lymphatic microvessels were identified by immunohistochemical staining using monoclonal antibody against human podoplanin (clone D2-40) and evaluated by counting the number of immunostained lymphatic vessels in 10 hot spot areas at 400× magnification. The LMVD was expressed by the mean number of vessels in these 10 hot spot microscopic fields. We next investigated the association of LMVD with the clinicopathologic findings and prognosis. RESULTS: The mean number of lymphatic vessels counted in all cases ranged between 0 and 4.7. The median value of mean LMVD was 0.5, and defined the cut-off for low and high LMVD. We identified low intratumoral LMVD in 27 (47.4%) patients and high LMVD in 30 (52.6%) patients. High intratumoral LMVD was associated with lesser miometrial and adnaexal infiltration, lesser cervical and peritoneal involvement, and fewer fatal cases. Although there was lower lymph node involvement among cases with high LMVD, the difference did not reach significance. No association was seen between LMVD and FIGO staging, histological type, or vascular invasion. On the other hand, low intratumoral LMVD was associated with poor outcome. Seventy-five percent of deaths occurred in patients with low intratumoral LMVD. CONCLUSION: Our results show association of high intratumoral LMVD with features related to more localized disease and better outcome. We discuss the role of lymphangiogenesis as an early event in the endometrial carcinogenesis.