Enhancing functional recovery following postpartum femoral neuropathy: early neurorehabilitation and multidisciplinary obstetric care.

Postpartum femoral neuropathy has a reported incidence of less than 1% and its total recovery time extends up to 6 months to a year. A multidisciplinary approach is vital to rule out permanent disability and to assure a correct diagnosis and earlier rehabilitation. We report a case of a 37-year-old puerperal woman with a history of intrapartum epidural analgesia, who presented post-labor unilateral lower-limb motor weakness and sensory loss, with functional compromise on independent gait. A multidisciplinary team consisting of an anesthesiologist, a physiatrist, a neurologist, and an obstetrician was then established. In the initial physiatry and neurology assessment, the patient reported pain (numerical rating scale 7/10) over the inguinal ligament, lower limb hypoesthesia, and muscle weakness. Femoral neuropathy was suspected. Magnetic resonance imaging ruled out potential complications related to the anesthetic procedure. The patient was then enrolled in a supervised rehabilitation program and, 3 weeks later, electrodiagnostic studies confirmed the initial suspicion. Two months later, the patient had regained lower-limb active range of motion and no pain nor paresthesia was reported. Our case report describes how an early multimodal rehabilitation program within a multidisciplinary framework allows for sooner neuromotor function improvement and activities of daily living independence.

Pharmacists' approaches to vaccination consultations in Switzerland: a qualitative study comparing the roles of complementary and alternative medicine (CAM) and biomedicine.

BACKGROUND: Many community pharmacies in Switzerland provide complementary and alternative medicine (CAM) approaches in addition to providing biomedical services, and a few pharmacies specialise in CAM. A common perception is that CAM providers are sceptical towards, or opposed to, vaccination. OBJECTIVES: Key objectives of this study are to examine the potential roles of biomedically oriented and CAM-specialised pharmacists regarding vaccine counselling and to better understand the association between vaccine hesitancy and CAM. DESIGN: We conducted semistructured, qualitative interviews. Transcripts were coded and analysed using thematic analysis. Interview questions were related to: type of pharmaceutical care practised, views on CAM and biomedicine, perspectives on vaccination, descriptions of vaccination consultations in community pharmacies and views on vaccination rates. SETTING: Qualitative interviews in three language regions of Switzerland (German, French and Italian). PARTICIPANTS: We interviewed 18 pharmacists (N=11 biomedically oriented, N=7 CAM specialised). RESULTS: Pharmacist participants expressed generally positive attitudes towards vaccination. Biomedically oriented pharmacists mainly advised customers to follow official vaccination recommendations but rarely counselled vaccine-hesitant customers. CAM-specialised pharmacists were not as enthusiastic advocates of the Swiss vaccination recommendations as the biomedically oriented pharmacists we interviewed. Rather, they considered that each customer should receive individualised, nuanced vaccination advice so that customers can reach their own decisions. CAM-specialised pharmacists described how mothers in particular preferred getting a second opinion when they felt insufficiently advised by biomedically oriented paediatricians. CONCLUSIONS: Vaccination counselling in community pharmacies represents an additional option to customers who have unmet vaccination consultation needs and who seek reassurance from healthcare professionals (HCPs) other than physicians. By providing individualised vaccination counselling to vaccine-hesitant customers, CAM-specialised pharmacists are likely meeting specific needs of vaccine-hesitant customers. As such, research and implementation efforts should more systematically involve pharmacists as important actors in vaccination provision. CAM-specialised pharmacists particularly should not be neglected as they are important HCPs who counsel vaccine-hesitant customers.

Comparing Polyurethane and Acellular Dermal Matrix Implant Cover in Prepectoral Breast Reconstruction: Short-term Complications.

Implant covering with an interface material is the standard in prepectoral breast reconstruction. Acellular dermal matrix (ADM) is frequently used, but it is expensive and associated with complications. Alternatively, we have been using integrated devices consisting of a silicone implant coated with polyurethane (PU) foam. We aimed to compare both techniques in terms of acute complications. Methods: The authors retrospectively reviewed patients undergoing prepectoral direct-to-implant reconstruction from June 2018 to January 2022. Two cohorts were defined based on the interface material used: ADM versus PU. Total drainage volume, time to drain removal, and acute complications (hematoma, seroma, infection, and explantation) were analyzed. Results: Forty-four breast reconstructions were performed in 35 patients (10 bilateral); implants were covered with ADM in 23 cases and with PU foam in 21. Median total drainage volume (500 versus 515 cc for ADM and PU, respectively) and time to drain removal (9 versus 8 days) were not affected by the interface material used, but seromas and infections occurred exclusively in the ADM cohort (seromas in four of 23 of cases, P = 0.109; infections in three of 23 cases, P = 0.234). Overall complications occurred more often in cases reconstructed with ADM, but the difference was nonsignificant (P = 0.245). Conclusions: The use of interface materials is generally considered a prerequisite for state-of-the-art prepectoral breast reconstruction for a variety of reasons, including the prevention of capsular contracture. In this study, PU coating tended to be associated with fewer short-term complications than ADM, including seroma and infection.

Therapeutic Reduction Mammoplasty: Experience of a Single Institute.

INTRODUCTION: Breast cancer is the most common malignancy in women worldwide as reported by the World Health Organization. The concept of oncoplastic breast surgery appeared as an extension of breast-conserving surgery, applying breast reduction techniques with more acceptable aesthetic and functional outcomes. The purpose of the present study was to describe the breast cancer population of a single institute submitted to lumpectomy and bilateral immediate breast reduction or mastopexy and its complications. MATERIAL AND METHODS: This is a retrospective observational study including patients submitted to lumpectomy and immediate bilateral breast reduction or mastopexy. Patients and tumour characteristics, surgical technique, complications, follow-up period, and recurrence data were obtained and analyzed. RESULTS: A total of 49 patients were submitted to lumpectomy and bilateral breast therapeutic reduction/mastopexy, with a mean age of 56.47 ±8.58 years and a mean body mass index of 28.68kg/m2 ±3.94 kg/m² between January 2019 and December 2021. Invasive tumours of no specific type, associated or not, with carcinoma intraductal in situ were the most common histological type corresponding to almost 80% of the cases with T1 stage corresponding to more than half of the cases. Sixteen percent of the patients had early minor complications with wound dehiscence associated with wound delayed healing, corresponding to 75% of the cases. Body mass index had a statistical difference between groups (p=0,006, t-test). CONCLUSIONS: The low rates of minor and major complications show that immediate therapeutic breast reduction can be a suitable approach in selected cases.

Developing a Card Game for Assessment and Intervention in the Person and the Family in Palliative Care: "Pallium Game".

Communication between the multidisciplinary team, the person, and the family in palliative and end-of-life situations implies, in most situations, a high negative emotional burden. Therefore, innovative strategies are needed to reduce it. The goal of this study is to describe the various stages of development and validation of a collaborative card game for people in palliative care and their families. Phase one is an exploratory study, Phase two is a Delphi study, and Phase three is a multiple case study. Participants for phases 2 and 3 were recruited using a convenience sampling method. The results demonstrate in an organized and structured way the different phases required to build a collaborative card game. The use of the game was found to be useful and effective. Four categories emerged from the content analysis of the open-ended responses: usability, evaluation tool, communication and therapeutic relationship, and meaning when using the game. A collaborative game in palliative care helps to create a space for individuals and families to express feelings and experiences, meeting the myriad of physical, psychosocial, and spiritual needs. The "Pallium game" is a useful and impactful approach to discussing sensitive topics in palliative care.

"Vaccination needs to be easy for the people, right ?": a qualitative study of the roles of physicians and pharmacists regarding vaccination in Switzerland.

OBJECTIVE: Vaccination in pharmacies has been a key component of national vaccination strategies to facilitate vaccination access. Qualitative data on the perspectives of professional stakeholders on vaccination in pharmacies and on the professional relations of pharmacists with physicians regarding increasing immunisation rates is limited. We conducted a qualitative study in Switzerland. The main aim was to gain further insight into professional stakeholders' perspectives on vaccination counselling and administration conducted in pharmacies, and to further understand their views on physicians' and pharmacists' roles in increasing immunisation rates. DESIGN: We conducted semistructured qualitative interviews. We coded and analysed transcripts using thematic analysis. SETTING: Face-to-face interviews took place in German-speaking and French-speaking regions of Switzerland. PARTICIPANTS: We interviewed 14 key vaccination stakeholders including health authorities, heads of pharmacy management and professional association boards. All participants had a background in medicine or pharmacy. RESULTS: Three main themes emerged from the qualitative data: (1) Participants viewed pharmacists as competent to provide vaccination counselling and administration based on their university training; (2) interprofessional cooperation between physicians and pharmacists on vaccination topics is limited and should be improved; and (3) pharmacists play an important role in increasing immunisation rates by facilitating vaccination access and through provision of vaccination counselling. CONCLUSION: By providing vaccination counselling and administering vaccines, pharmacists play an important public health role. Healthcare policies and health authorities should encourage more involvement of pharmacists and encourage interprofessional cooperation between physicians and pharmacists in order to improve vaccination counselling and increase immunisation rates.

Colgajo sural medial en la reconstrucción de miembro inferior / Medial sural artery perforator flap in lower extremity reconstruction

Introducción y objetivo: El colgajo de perforante de arterial medial sural (MSAP- medial sural artery perforator) fue descrito con un refinamiento del colgajo gastrocnemio medial. A pesar de su reciente historia, demuestra ventajas e indicaciones, principalmente en la reconstrucción de miembro inferior.Presentamos una serie retrospectiva de pacientes con defectos de tejidos blandos de miembro inferior reconstruidos con colgajo MSAP.Material y método.Presentamos 10 pacientes operados entre 2013 y 2018, 6 hombres y 4 mujeres, con edades entre los 27 y los 86 años.La principal etiología de los defectos fue traumática. Los defectos localizados entre el tercio distal del muslo y el tercio proximal de la pierna fueron cubiertos con colgajos pediculados, y los defectos distales con colgajos libres.Resultados.Las dimensiones medias de los colgajos fueron 6.35 cm de anchura por 10.9 cm de longitude y 9.9 cm de longitude del pedículo. Todos los colgajos menos 1 fueron elevados con una sola perforante.Excepto 1 caso de pérdida parcial del colgajo, no hubo complicaciones a corto plazo. Dos pacientes precisaron cobertura con injerto del área donante y el resto fueron cerrados directamente.El seguimiento medio fue de 22.8 meses y no hubo complicaciones en el área donante. Obtuvimos un cierre estable y estéticamente acceptable en todos los casos.Conclusiones.El colgajo MSAP es un colgajo fasciocutaneo fino y plegable que provee tejido similar al área del defecto con minima morbilidad del área donante.Sus características menos positivas incluyen una potencialmente laboriosa disección intramuscular y la posibilidad de congestion venosa ocasional. A pesar de ello, los buenos resultados y la satisfacción de los pacientes lo convierte en una elección apropiada en casos seleccionados de reconstrucción del miembro inferior. (AU)

Background and objective: The medial sural artery perforator (MSAP) flap was first described as a refinement of the medial gastrocnemius flap. Despite its recent history, it has already proven to have several advantages and indications, namely in lower extremity reconstruction.The authors present a retrospective case series with lower limb soft-tissue defects which were reconstructed with the MSAP flap.Methods.Between 2013 and 2018, 10 patients were operated on: 6 men and 4 women, ranging in age from 27 to 86 years.The main etiology of the defects was traumatic injury. The defects located between the distal third of the thigh and the proximal third of the leg were covered with pediculated flaps while the distal defects were covered with free flaps.Results.The mean flap dimensions were 6.35 cm width, 10.9 cm length, and 9.9 cm pedicle length. All flaps except 1 were raised with a single perforator.Apart from 1 case of partial free-flap loss, there were no short-term complications. Two patients required skin grafting of the donor site while the remaining were closed directly.The mean follow-up time was 22.8 months and there were no donor site complaints. A stable and aesthetically satisfactory coverage was obtained in all cases.Conclusions.The MSAP flap is a thin and pliable fasciocutaneous flap that can provide “like-with-like” tissue with minor donor site morbidity in lower limb reconstruction. Less positive characteristics include a potential laborious intramuscular dissection and occasional venous congestion. Still, the good results and satisfaction of the patients make this a wise choice in selected cases. (AU)

Entre Demografia e Antropologia: povos indígenas no Brasil / Between Demography and Anthropology indigenous peoples in Brazil

Oitavo livro da coleção Saúde dos Povos Indígenas, Entre Demografia e Antropologia: povos indígenas no Brasil apresenta profundas avaliações sobre as dinâmicas populacionais indígenas. A coletânea levanta contribuições que indicam que os escassos dados demográficos de décadas atrás se tornaram mais abundantes, passando a fomentar políticas públicas. Em suas abordagens, a obra passa por pesquisas e conhecimentos multidisciplinares, que vão de questões de migração, mobilidade e dinâmica territorial até a contextualização de dados censitários e a forma como a população indígena é retratada nos censos demográficos do Brasil. A antropóloga Marta Azevedo ressalta a importância de "buscar uma maior participação da população indígena na produção de dados e análises demográficas". Segundo ela, tão estratégico quanto continuar a fomentar a realização de uma demografia indígena é formar demógrafos indígenas no país. O anseio expressado pela autora e organizadora aparece no último capítulo do livro, que é dividido em três partes: Perspectivas a partir do Campo, Dados Censitários em Contexto e Trajetórias, Categorias, Implicações.

Nupcialidade indígena: possibilidades e limitações de análise utilizando os dados do Censo Demográfico de 2010 / Nuptiality of indigenous people: possibilities and limitations of analyses using the Demographic Census of 2010 / Nupcialidad de los indígenas: posibilidades y limitaciones de análisis utilizando datos del Censo Demográfico de 2010

O presente artigo analisa os dados disponíveis na amostra do Censo Demográfico de 2010 a respeito da nupcialidade da população autodeclarada indígena. Se há uma significativa produção antropológica sobre organização social dos povos indígenas no Brasil, o que contempla aspectos referentes a casamentos, pouco se sabe, a partir de uma perspectiva demográfica, sobre a nupcialidade desse segmento da população e como se dão as uniões endogâmicas e exogâmicas considerando os grupos de raça/cor. Assim, tem-se como objetivo apresentar uma análise dos padrões de nupcialidade, utilizando as categorias pesquisadas do quesito raça/cor no Censo Demográfico de 2010, com foco na população indígena. Especificamente se realiza uma análise da idade média à união e ao casamento e das taxas de homogamia por raça/cor, inclusive separando os casais por grupos de idade da mulher, status marital, situação do domicílio e residentes em municípios com Terras Indígenas. Apesar das evidentes limitações dos dados, e com uso de métodos demográficos indiretos, os resultados revelam que, entre todas as categorias de raça/cor, a idade média à união dos indígenas é a menor e suas taxas padronizadas de endogamia por raça/cor são as mais altas.

Abstract This paper analyzes nuptiality data from the Brazilian 2010 Demographic Census, with a focus on indigenous women. There is an extensive anthropological literature about the social organization of indigenous peoples in Brazil and its relation to marriage practices. Concerning the demographic field, however, very little is known about nuptiality in this segment of the population and how it compares with non-indigenous women. The objective is to present an analysis of nuptiality patterns, using the surveyed categories of race/color in the 2010 Census, focusing on indigenous population. The mean age of women at marriage and non formal union by race/color and endogamy and exogamy rates are estimated, showing results stratified by age groups, marital status, place of residence urban or rural, and residents in municipalities with or without Indigenous Lands. Despite the evident data limitation, the results show that indigenous women present the lowest mean age at marriage, as well as the highest endogamy rates by race/color.

Resumen Este artículo analiza los datos de nupcialidad del Censo Demográfico brasileño de 2010, con especial atención a las mujeres indígenas. Hay una extensa literatura antropológica sobre la organización social de los pueblos indígenas en Brasil y su relación con las prácticas matrimoniales. Cuando se trata de la demografía, sin embargo, se sabe muy poco acerca de la nupcialidad en este segmento de la población y cómo se compara con las mujeres no indígenas. El objetivo es presentar un análisis de los patrones de nupcialidad, utilizando las categorías de auto declaradas de raza/color de la piel en el Censo de 2010, centrándose en la población indígena. Se calcula la edad media a la unión formal y consensual y, también, las tasas de endogamia y exogamia por raza/color, con los resultados estratificados por grupos de edad, situación conyugal, área de residencia (rural o urbana) y domicilio en municipalidades con Tierras Indígenas. A pesar de las evidentes limitaciones de los datos, y el uso de métodos demográficos indirectos, los resultados muestran que, entre todas las categorías de raza/color, la edad media al matrimonio de los indígenas es la más baja y sus tasas estandarizadas de endogamia por raza/color son los más altas.

Demografia dos povos indígenas no Brasil / Demography of the indians peoples in Brazil

Esta obra de caráter interdisciplinar reúne estudos atuais sobre a demografia indígena no Brasil. O fato de ser interdisciplinar é enriquecedor, uma vez que admite a necessidade de diálogo e correlação entre os diferentes campos do saber, como a demografia, a antropologia e a epidemiologia, que tratam de um assunto para dizer no mínimo desconhecido da maioria da população leiga: onde estão e quem são os índios do Brasil? É a partir dessa tentativa de diálogo que os autores procuraram reunir nesta obra artigos que versam sobre diferentes temas como fecundidade, comportamento reprodutivo e mortalidade de populações indígenas.

Capítulo 1. Demografia dos povos indígenas no Brasil: um panorama crítico / Demography of the indians peoples in Brazil: a critical panoramic

São ainda muito pouco conhecidas as mais diversas dimensões da dinâmica demográfica - seja natalidade, mortalidade ou migração - dos povos indígenas no Brasil contemporâneo. Se essa assertiva se aplica plenamente ao conjunto dos povos indígenas, torna-se ainda mais contundente em face da diversidade dessas sociedades. São mais de 200 povos, falantes de aproximadamente 180 línguas, distribuídos em praticamente todo o território nacional, em áreas rurais e urbanas, com características sociais e culturais, bem como com trajetórias históricas, econômicas e políticas, as mais diversas. Quanto à população total dos povos indígenas no país, a depender da fonte, soma entre 350 e 715 mil pessoas, mas não ultrapassando 0,5 % da população nacional...

Capitulo 2. Povos indígenas no Alto Rio Negro: um estudo de caso de nupcialidade / Indians peoples in the Alto Rio Negro: a study of nuptiality case

Introdução: Diversos estudos sobre a demografia dos povos indígenas no Brasil relacionam componentes demográficos à estrutura social desses povos, como o de Pagliaro (2002), sobre os Kaiabi do Parque Indígena do Xingu, onde a autora relaciona os tipos de casamentos existentes com a organização social e a migração do grupo para o Xingu, demonstrando que muitas vezes constrangimentos demográficos podem causar rearranjos nos sistemas tradicionais de escolhas matrimoniais. Ao descrever os casamentos realizados entre homens kaiabi e mulheres juruna, suiá, trumai e txicão nos primeiros anos de permanência do grupo no Parque Indígena do Xingu, a autora avalia " ...

Capitulo 8. Perfil demográfico e socioeconômico das pessoas que se autodeclaram 'indigenas' nos censos demográficos de 1991 e 2000 / Demographic and socioeconomic profile of the people who if declaredly 'indigene' in the demographic census of 1991 and 2000

Introdução: Há uma notável carência de dados demográficos sobre as populações indígenas no Brasil. Em face da diversidade histórica, social e cultural dos povos indígenas, que somam mais de 200 etnias, falantes de 180 línguas diferentes, é praticamente nulo o que se conhece não somente acerca de sua estrutura populacional, como também dos níveis e padrões de fecundidade, mortalidade e migração, dentre outros aspectos da dinâmica demográfica (Silva, 1994; Ricardo, 1996; Azevedo, 2000; Santos & Coimbra Jr., 2003; Pagliaro et al., neste volume). Se os dados são escassos para os indígenas residentes em terras oficialmente reconhecidas pelo Estado brasileiro, são ainda menos conhecidas as características demográficas dos que vivem em áreas urbanas.

Capitulo 9. dinâmica demográfica dos Mucajaí Yanomami: uma entrevista com John Early / The demographic dynamics of the Mucajaí Yanomami: interview John Early

Apresentação: Durante o seminário Demografia dos Povos Indígenas no Brasil', realizado na Universidade Federal de São Paulo em novembro de 2003, promovido pelo Comit ê de Demografia dos Povos Indígenas, da Associação Brasileira de Estudos Populacionais (Abep), contou-se com a presença do Dr. John D. Early, antropólogo e demógrafo, professor aposentado do Departamento de Antropologia da Florida Atlantic University, Flórida, Estados Unidos. Juntamente com John Peters, John Early é autor de dois importantes livros sobre a demografia dos Yanomami, a saber: The Population Dynamics of the Mucajai Yanomama (Academic Press, 1990) e The Xilixana Yanomami ofthe Amazon (University Press of Florida, 2000). Esses livros, publicados nos Estados Unidos, infelizmente não foram traduzidos para o português . Além dessas duas obras, John Early escreveu trabalhos em que analisou variados aspectos da demografia de povos nativos na Guatemala e nas Filipinas . No semin ário em São Paulo, John Early apresentou um panorama geral de seus estudos demográficos sobre os Yanomami. Tais investigações estão seguramente entre as mais detalhadas e sofisticadas - para não mencionar o período de tempo abrangido - análises existentes sobre a demografia...

Platelets activated by transient coronary occlusion exacerbate ischemia-reperfusion injury in rat hearts.

Platelets (Plt) accumulate in reperfused myocardium but their effect on myocardial necrosis has not been established. We tested the hypothesis that the effect of Plt depends on their activation status. Pig Plt were obtained before 48 min of coronary occlusion (pre-CO-Plt), 10 min after reperfusion (R-Plt), or after a 60-min sham operation (sham-Plt). Plt were infused into isolated rat hearts (n = 124) and subsequently submitted to 60 min of ischemia and 60 min of reperfusion. P-selectin expression was higher (P = 0.02) in R-Plt than in pre-CO-Plt or sham-Plt. Lactate dehydrogenase (LDH) release during reperfusion was similar in hearts receiving pre-CO-Plt, sham-Plt, or no Plt, but R-Plt increased LDH release by 60% (P = 0.004). Activation of pre-CO-Plt with thrombin increased P-selectin expression and LDH release (P < 0.001), and these results were unaffected by tirofiban. There was a close correlation between P-selectin expression and LDH release (r = 0.84; P < 0.001), and myocardial Plt accumulation (r = 0.85; P < 0.001). We conclude that the deleterious effect of Plt on reperfused myocardium depends on their activation status as represented by P-selectin expression, which is enhanced by ischemia-reperfusion.

Estudo dos aspectos éticos dos transplantes na América Latina / Study of ethic aspects of transplant in Latin America

Respeitando recomendaçöes da OMS, foi feito estudo retrospectivo comparativo das legislaçöes de 16 Países da América Latina, a saber: Argentina, Bolívia, Brasil, Colômbia, Costa Rica, Chile, Cuba, Equador, Guatemala, Honduras, México, Panamá, Paraguai, Peru, República Dominicana e Venezuela, do período de 1963 a 1992, enfatizando-se os aspectos éticos referentes a doaçäo, determinaçäo da morte, conflito de interesses, seleçäo do receptor, comercializaçäo e intercâmbio internacional de órgäos.