Debridement of axillary necrotizing fasciitis under anesthetic blocks of the serratus plane and supraclavicular brachial plexus: a case report.

The regional techniques for axillary analgesia are well established. However, few studies have investigated surgical anesthesia. In this report, extensive debridement of axillary necrotizing fasciitis, including the posteromedial region of the right arm, performed under exclusive regional anesthesia in a patient with probable difficult airway is described. The procedure was accomplished under a Serratus Plane Block (SPB) and supraclavicular brachial plexus block, guided by ultrasound, and with venous sedation. We observed satisfactory anesthesia 15 minutes after the intervention, efficient intraoperative pain control and within the following 24.Çëhours. Surgical axilla anesthesia is feasible with the described blocks.

Neuraxial block anesthetic technique in a patient with SCN8A encephalopathy: case report.

Mutations in SCN8A gene lead to changes in sodium channels in the brain, which are correlated with severe epileptic syndrome. Due to the rarity, there are few studies that support anesthesia in that population. The present study aims to report alternatives to inhalation anesthesia at epileptic encephalopathy. CASE REPORT: Male, 4 years old, with SCN8A encephalopathy with surgical indication of orchidopexy. Neuroaxis block was performed and dexmedetomidine was used as a pre-anesthetic and sedation. The anestheticsurgical act was uneventful. CONCLUSION: The association of neuraxial block and dexmedetomidine proved to be a viable alternative for surgery in patients with SCN8A encephalopathy.

Electrooxidation of sulfanilamide and its voltammetric determination in pharmaceutical formulation, human urine and serum on glassy carbon electrode / 药物分析学报

For the first time, sulfanilamide (SFD) was determined in otologic solution, human urine and serum by electroanalytical techniques on glassy carbon electrode (GCE). The cyclic voltammetry (CV) experiments showed an irreversible oxidation peak at +1.06 V in 0.1 mol/L BRBS (pH = 2.0) at 50 mV/s. Different vol-tammetric scan rates (from 10 to 250 mV/s) suggested that the oxidation of SFD on the GCE was a diffusion-controlled process. Square-wave voltammetry (SWV) method under optimized conditions showed a linear response to SFD from 5.0 to 74.7μmol/L (R = 0.999) with detection and quantification limits of 0.92 and 3.10μmol/L, respectively. The developed SWV method showed better results for detection limit and linear range than the chronoamperometry method. It has been successfully applied to determine SFD concentration in pharmaceutical formulation, human urine and serum samples with recovery close to 100%.

Decreased Neurotrophic Support is Associated with Cognitive Decline in Non-Demented Subjects.

BACKGROUND: There is evidence of decreased neurotrophic support in Alzheimer's disease (AD), including its prodromal stages, but it is not clear whether this abnormality represents a marker of this process. OBJECTIVE: To determine serum concentrations of a panel of neurotrophic factors (BDNF, NGF, and GDNF) in a cross-section of elderly patients with mild cognitive impairment (MCI) and AD compared to cognitively healthy controls, and to evaluate whether abnormal levels of these factors at baseline predict the transition from MCI to dementia. METHODS: A total of 134 older adults were enrolled in this study. Twenty-six patients with mild to moderate AD, 62 with MCI, and 46 cognitively healthy older adults (controls) were subjected to a clinical evaluation including several cognitive tests. Peripheral blood was drawn and serum levels of BDNF, NGF, and GDNF were measured by enzyme-linked immunosorbent assay. APOE genotyping was performed by PCR assays. RESULTS: Serum concentrations of BDNF, NGF, and GDNF were significantly reduced in cognitively impaired subjects (i.e., MCI and AD) as compared to controls, although only the former two remained statistically different after controlling for age, gender, and cognitive performance (p = 0.05 and p = 0.01, respectively). Lower BDNF and NGF levels were also observed in the sub-sample of MCI patients who progressed to dementia upon follow-up (p = 0.02 and p = 0.002, respectively). CONCLUSION: Abnormalities in neurotrophic systems are observed at early stages of AD and may represent a marker of cognitive deterioration.

Análise da composição nutricional de dietas da moda divulgadas por revistas não científicas / Analysis of the nutritional composition of fad diets in nonscientific magazines

Objetivo: Analisar a composi��o nutricional das dietas da moda divulgadas por revistas n�o cient�ficas. M�todos: Foi realizado estudo transversal descritivo de dietas da moda selecionadas em revistas n�o cient�ficas. A composi��o nutricional das dietas foi calculada pelo software AVANUTRI� e comparada com a recomenda��o proposta pelas DRIS (Dietary Reference Intakes) para macronutrientes e fibras alimentares de acordo com valores propostos pela IV Diretriz Brasileira sobre Dislipidemias e Preven��o da Aterosclerose. Para o c�lculo das dietas, foram adotadas como padr�o as recomenda��es para mulheres com 160cm e 61,8kg. Resultados: Foram analisadas 12 dietas publicadas em quatro revistas distintas. O aporte energ�tico oscilou de 720 a 1720kcal/dia. Ao comparar com os macronutrientes, 5 (41,6%) card�pios apresentaram quantidade excessiva de prote�nas; 6 (50%), insufici�ncia de carboidratos; 9 (45%), insufici�ncia de lip�deos; e apenas 2 (10%), quantidade suficiente de fibras. Conclus�o: Os resultados apontam que a maioria das dietas publicadas em revistas n�o cient�ficas apresenta inadequa��es na distribui��o de macronutrientes, o que pode comprometer o estado nutricional dos indiv�duos. Esses dados refor�am a import�ncia de que as dietas sejam individualizadas e acompanhadas por profissional habilitado, um nutricionista.

Objective: To evaluate the nutritional composition of fad diets in non-scientific magazines. Methods: This is a descriptive cross-sectional study of fad diets selected from non-scientific magazines. The nutritional composition of diets was calculated by AVANUTRI� software and compared with DRIS (Dietary Reference Intakes) for macronutrients and fibers according to the values proposed by the IV Brazilian Guidelines on Dyslipidemia and Prevention of Atherosclerosis. Standard recommendations for women of 160cm in height and 61.8kg in weight were adopted to perform the calculation of diets. Results: We analyzed 12 diets published in four different magazines. The energy intake ranged from 720 to 1720kcal/day. Regarding macronutrients, 05 (41.6%) menus presented excessive amount of protein, 06 (50%) showed carbohydrate insufficiency, 09 (45%) presented lipid insufficiency, and only 02 (10%) showed sufficient amount of fibers. Conclusion: The results indicate that most diets published in non-scientific magazines present inadequacies of nutrients, which may compromise the nutritional status of individuals. It is indispensable that diets be individualized and monitored by professional nutritionists.

Varia��o da aplica��o da for�a de palpa��o digital utilizada no exame cl�nico de disfun��o temporomandibular e dor orofacial / Variation of digital palpation pressure used in the clinical examination of TMJ disorders and orofacial pain

Objective: The present research aims to evaluate the calibration of digital palpation pressure as well as to assess the inter-examiner variation and mean pressure used by a sample consisting of 56 professionals of the TMJ disorders and Orofacial Pain area. Methods: Each participant was asked to press a digital balance to approach 1.0 kg and subsequently 0.5 kg without seeing the display, in order to obtain a blind data. The values of 1.0 kg and 0.5 kg are recommended by the Research Diagnostic Criteria for Temporomandibular Disorder in the refined Axis I, the Physical Assessment. Participants were considered calibrated when they applied the correct pressure in at least 4 of the 5 measurement taken; within a 20% variation interval (pressures between 0.4 and 0.6 kg were acceptable for the reference value of 0.5 kg and between 0.8 and 1.2 kg for the reference value of 1.0kg). The t-student test was used to analyze data (p?0.05). Results: 70% of the sample was classified as non- calibrated for the 0.5 kg pressure while 57% were not calibrated for the 1.0 kg pressure. The mean inter-examiner variations, 0.3 kg for the pressure set at 0.5kg and 0.6 kg for the pressure set at 1.0 kg, were considered high. Conclusion: The mean pressures applied by participants (0.7 kg for joint palpation and 1.4 kg for muscle palpation) were also considered high in comparison with those recommended by the Research Diagnostic Criteria for Temporomandibular Disorder, but acceptable according to the tendency of applying higher values of 1.0 - 1.5 kg, as proven by recent study.

Objetivo: Avaliar a calibra��o da for�a de palpa��o digital, bem como determinar a varia��o intra-examinador e a for�a m�dia aplicada por uma amostra composta de 56 profissionais que atuam na especialidade de disfun��o temporomandibular e dor orofacial. M�todos: Foi solicitado a cada participante que pressionasse o centro de uma balan�a digital, sem visualizar o display, o valor que acreditasse ser correspondente � 1,0 kg e, posteriormente, a 0,5 kg, recomendados pelo protocolo de exame f�sico do Eixo I do Consortium, the Research Diagnostic Criteria for Temporomandibular Disorders. Foram considerados calibrados aqueles que aplicassem a for�a correta, aceitando-se uma varia��o de 20% (entre 0,4 e 0,6 kg para o menor valor e 0,8 a 1.2 kg para o maior valor), em 4 das 5 aferi��es realizadas. Na an�lise dos dados foi utilizado o teste t de Student (p?0,05). Resultados: 70% da amostra foi classificada como n�o calibrada para a for�a de 0,5 kg e 57% n�o calibrada para 1,0 kg. A varia��o m�dia intraexaminador de 0,3 kg para o peso de 0,5 kg e 0,6 kg para o de 1,0 kg foram consideradas altas. Conclus�o: A for�a m�dia aplicada pelos participantes (0,7 kg para palpa��o articular e 1.4 kg para palpa��o muscular) foi maior que o recomendado pelo Consortium, the Research Diagnostic Criteria for Temporomandibular Disorders, entretanto encontra-se de acordo com a tend�ncia em aplicar valores mais altos entre 1,0 e 1,5 kg, validado em estudo recente.

A role for root morphology and related candidate genes in P acquisition efficiency in maize.

Phosphorus (P) is an essential nutrient for plants and is acquired from the rhizosphere solution as inorganic phosphate. P is one of the least available mineral nutrients, particularly in highly weathered, tropical soils, and can substantially limit plant growth. The aim of this work was to study a possible effect of root morphology and the expression pattern of related candidate genes on P efficiency in maize. Our field phenotyping results under low and high P conditions enabled us to identify two contrasting genotypes for P acquisition efficiency that were used for the root traits studies. Root morphology was assessed in a paper pouch system to investigate root traits that could be involved in P acquisition efficiency. The genes, Rtcs, Bk2 and Rth3, which are known to be involved in root morphology, showed higher expression in the P efficient line relative to the P inefficient line. Overall, root traits showed high heritability and a low coefficient of variation. Principal component analysis revealed that out of the 24 root traits analysed, only four root traits were needed to adequately represent the diversity among genotypes. The information generated by this study will be useful for establishing early selection strategies for P efficiency in maize, which are needed to support subsequent molecular and physiological studies.

In-situ monitoring of the structure of a goethite-based catalyst during methane oxidation by X-ray absorption near-edge structure (XANES) spectroscopy assisted by chemometric methods.

A goethite-based catalyst was evaluated using in-situ X-ray absorption near-edge structure (XANES) spectroscopy during methane oxidation under increasing reaction temperature. Determination of rank by median absolute deviation (DRMAD), evolving factor analysis (EFA), and multivariate curve resolution (MCR) were used to detect the species present in the catalyst during the reaction and determine their concentration profiles and their pure spectra. The reactants and reaction products were monitored on-line by mass spectrometer. The goethite-based catalyst was active for methane oxidation, with CO(2) and H(2)O as the main products. DRMAD and EFA were useful to determine the number of chemical species present in the catalyst structure during reactions. The catalyst presented phase transition during the reaction from goethite to maghemite according to XANES spectra determined by MCR. On the other hand, it was verified that the catalyst presented phase transition from goethite to wüstite in the process in the absence of the oxidant (O(2)).

Efecto a largo plazo de la presión positiva automática en la vía aérea sobre la proteína C / Long Term Effect of Autoadjusting Positive Airway Pressure on C-Reactive Protein and Interleukin-6 in Men With Obstructive Sleep Apnoea Syndrome

IntroducciónLa apnea obstructiva del sueño (AOS) se ha vinculado de forma creciente con las enfermedades cardiovasculares. Los procesos inflamatorios asociados a la AOS pueden contribuir a esta morbilidad. Algunos estudios han señalado que las concentraciones séricas de proteína C reactiva de alta sensibilidad (PCR-as) y de interleucina-6 (IL-6) están aumentadas en estos pacientes. El objetivo principal del estudio has sido investigar la repercusión a corto y largo plazo del tratamiento de presión positiva automática en la vía aérea (APAP) sobre las concentraciones séricas de PCR-as e IL-6 en pacientes con AOS clasificada entre moderada y grave. Como objetivo secundario, nos propusimos evaluar las concentraciones basales de PCR-as e IL-6 en los pacientes con AOS y su posible relación con la gravedad de dicho síndrome, independientemente de los factores de confusión, y comparar las concentraciones de PCR-as en los afectados de AOS con los de una población de control procedente de la comunidad.Pacientes y métodosSe trata de un estudio prospectivo que ha incluido a 98 pacientes varones con AOS de moderada a grave, confirmada mediante un estudio domiciliario del sueño. Las neoplasias malignas y las enfermedades inflamatorias crónicas fueron criterios de exclusión. Se evaluaron las concentraciones séricas de PCR-as y de IL-6 antes de la APAP, a los 9 días y a los 6 meses del tratamiento. Los controles de la comunidad (n=103), que se seleccionaron mediante llamadas telefónicas aleatorias, se emparejaron por edad e índice de masa corporal (IMC) con el grupo de pacientes con objeto de comparar las concentraciones de PCR-as al inicio del estudio(AU)

ResultadosLa población estudiada presentaba una media (± desviación estándar) de edad de 55,3±10,7 años, un IMC medio de 33,2±5,0kg/m2, un índice medio de apneas-hipopneas de 51,7±21,3/h y un índice de desaturación de 86,3±5,3/h. El cumplimiento del tratamiento con APAP fue bueno, con un uso de un 91,27±20,45% de los días y de 5,76±1,59h/noche.Al inicio del estudio, los valores séricos medios de PCR-as e IL-6 fueron de 0,52±0,53 y 17,7±22,5μg/l, respectivamente. Los de PCR-as se correlacionaban de forma significativa con el índice de apneas-hipopneas, el índice de desaturación y la saturación de oxígeno mínima durante la noche, y los de IL-6 estaban correlacionados de forma significativa y negativa con la saturación de oxígeno mínima durante la noche. Al ajustar por los factores de confusión encontrados en el estudio, todas estas relaciones perdieron significación.La PCR-as se encontraba significativamente elevada en los pacientes respecto a los controles (p=0,002). Al considerar las categorías de estratificación del riesgo cardiovascular mediante la PCR-as, en el grupo de pacientes era significativamente mayor el número de personas con riesgo elevado de episodios cardiovasculares en comparación con el grupo control (p=0,002).Tras el ajuste por IMC e hipertensión arterial, el grupo de pacientes presentaba un riesgo moderado casi 2 veces superior y un riesgo importante más de 2 veces superior de desarrollar episodios cardiovasculares en comparación con el grupo de control(AU)

Background and objectivesObstructive sleep apnoea (OSA) has been increasingly linked to cardiovascular disease. Inflammatory processes associated with OSA may contribute to this morbidity. Some studies have reported serum levels of high sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) to be increased in these patients. Primary objective: investigate the impact of short and long-term autoadjusting positive airway pressure (APAP) therapy on IL-6 and hs-CRP serum levels in patients with moderate to severe obstructive sleep apnoea. Secundary Objective: evaluate the basal hs-CRP and IL-6 levels in OSA patients and its possible relation to OSA severity, independently of confounders and compare the hs-CRP levels in OSA patients with those in community controls.Patients and methodsThis is a prospective study including 98 male patients with moderate to severe OSA confirmed by domiciliary sleep study. Malignancy and chronic inflammatory diseases were exclusion criteria. hs-CRP and IL-6 serum levels were evaluated before APAP, 9 days and 6 months after therapy. Community controls (n=103) were selected using random digit dialling, and matched by age and body mass index (BMI) for comparison of hs-CRP levels at baseline(AU)

ResultsThe studied population had a mean age of 55.3±10.7 years, mean BMI 33.2±5.0kg/m2, mean apnoea-hypopnoea index 51.7±21.3/h and mean desaturation index 86.3±5.3/h. The APAP compliance was good: 91.27&%#x000B1;20.45 days usage and 5.76±1.59h/night of usage.Mean basal hs-CRP and IL-6 serum values were 0.52±0.53μg/l and 17.7±22.5μg/l, respectively. CRP levels at baseline correlated significantly with apnoea-hypopnoea index, desaturation index and minimum nocturnal oxygen saturation. IL-6 levels at baseline correlated significantly and negatively with minimum nocturnal oxygen saturation. When adjusting for confounding factors found in this study, all these relations lost significance.CRP is significantly increased in patients when compared to controls (p=0.002) and when considering hs-CRP cardiovascular risk stratified categories, cases had significantly more patients at high risk of cardiovascular events than controls (p=0.002).After adjustment for BMI and arterial hypertension, cases had an almost twofold moderate risk of cardiovascular events and more than a twofold severe risk of cardiovascular events when compared to controls(AU)

Prevalência de sintomas respiratórios e condiçöes clínicas associadas à asma em escolares de 6 a 14 anos no Rio de Janeiro / Prevalence of respiratory synptoms and asthma in school children in Rio de Janeiro

OBJETIVO: Avaliar a prevalência de sintomas respiratórios e condiçöes clínicas associadas à asma brônquica e broncoespasmo induzido por exercício (BIE) em duas populaçöes de escolares de instituiçöes públicas e privadas. MÉTODO: Realizado inquérito transversal em 2941 escolares de 6 a 14 anos, sendo 1591 da rede municipal pública (RPb) e 1350 da rede particular (RPt), matriculados nas classes de alfabetizaçäo e primeiro grau de escolas da zona oeste do Rio de Janeiro. Para as entrevistas foi empregado o formulário "ATS-DLD-78-C" modificado. RESULTADO: Segundo a seqüência de perguntas do formulário, houve referência a chiado em 842 (28,6 por cento) entrevistados; BIE em 684 (23,3 por cento); internaçöes hospitalares por problemas respiratórios em 342 (11,6 por cento); uso prévio de broncodilatadores (BD) em 1072 (36,5 por cento); bronquiolite em 40 (1,4 por cento); pneumonia em 185 (6,3 por cento); diagnóstico médico de asma brônquica em 779 (26,5 por cento); rinite em 1088 (37 por cento); atopia familiar em 1794 (61 por cento) e imunoterapia em 577 (19,6 por cento). A comparaçäo estatística entre os dois grupos de escolas mostrou maior freqüência de BIE, hospitalizaçäo e pneumonia na RPb (26,3 por cento, 15,9 por cento e 7,2 por cento, respectivamente). Na RPt foi maior a freqüência de história familiar de atopia e emprego de imunoterapia (63,7 por cento e 23,6 por cento, respectivamente). Aplicando-se a pontuaçäo estabelecida pelo formulário, o diagnóstico de asma ocorreu em 638 (21,7 por cento) escolares, sendo 55 por cento da RPb e 45 por cento da RPt. A distribuiçäo dos casos de asma pelas escolas evidenciou que 354 (22 por cento) eram da RPb e 284 (21 por cento) da RPt (n.s.). CONCLUSÄO: A prevalência de asma foi elevada entre escolares da RPt e da RPb, sem diferença estatística entre ambas. Os quadros de BIE também foram muito prevalentes na amostra estudada, com maior freqüência na RPb