First Case Report of Bilateral Parotid Lymphoepithelial Carcinoma.

Background/Aim: The parotid is the largest salivary gland and is located anteriorly to the sternocleidomastoid muscle and laterally to the ramus of the mandible. Neoplasms in this gland are relatively rare, with 80% being benign and 20% malignant, primarily represented by mucoepidermoid carcinoma. In the head and neck region, lymphoepithelial carcinoma (LEC) accounts for 0.4% of malignant salivary gland tumors. Case Report: A 35-year-old man with no previous comorbidities was admitted to a Head and Neck Surgery Specialty Service for a painless right cervical mass of uncertain growth. Extensive diagnostic investigation revealed involvement of the contralateral parotid, associated with systemic lymph node enlargement. Thus, adjuvant radiotherapy was decided by the treating team. Conclusion: This case confirms the heterogeneous features and distinctive behavior that the disease can present, as seen with bilateral parotid LEC.

A validated dilute-and-shoot LC-MS-MS urine screening for the analysis of 95 illicit drugs and medicines: Insights from clinical and forensic Brazilian cases.

Urine toxicological analysis is a relevant tool in both clinical and forensic scenarios, enabling the diagnosis of acute poisonings, elucidation of deaths, verification of substance use in the workplace and identification of drug-facilitated crimes. For these analyses, the dilute-and-shoot technique associated with liquid chromatography coupled with tandem mass spectrometry (LC-MS-MS) is a promising alternative since it has demonstrated satisfactory results and broad applicability. This study developed and validated a comprehensive LC-MS-MS screening method to analyze 95 illicit drugs and medicines in urine samples and application to clinical and forensic Brazilian cases. The dilute-and-shoot protocol was defined through multivariate optimization studies and was set using 100 µL of sample and 300 µL of solvent. The total chromatographic run time was 7.5 min. The method was validated following the recommendations of the ANSI/ASB Standard 036 Guideline. The lower limits of quantification varied from 20 to 100 ng/mL. Within-run and between-run precision coefficient of variations% were <20%, and bias was within ± 20%. Only 4 of the 95 analytes presented significant ionization suppression or enhancement (>25%). As proof of applicability, 839 urine samples from in vivo and postmortem cases were analyzed. In total, 90.9% of the analyzed samples were positive for at least one substance, and 78 of the 95 analytes were detected. The most prevalent substances were lidocaine (40.2%), acetaminophen (38.0%) and benzoylecgonine (31.5%). The developed method proved to be an efficient and simplified alternative for analyzing 95 therapeutic and illicit drugs in urine samples. Additionally, the results obtained from sample analysis are essential for understanding the profile of Brazilian substance use, serving as a valuable database for the promotion of health and safety public policies.

Cork sheet as an efficient biosorbent for forensic toxicology: Application to vitreous humor analysis.

There is an increasing number of people affected worldwide by mental health disorders, such as depression and anxiety. One of the main courses of treatment, along with psychotherapy, is the use of psychoactive medications, like antidepressants and benzodiazepines. Also, the unprescribed use of these substances is a concerning public health issue. Hence, the analysis of psychotropic medications is mandatory in postmortem toxicology and various biological samples can be used for this detection, among them the vitreous humor (VH) stands out. Also, there is a demand for more sustainable and more efficient extraction methodologies according to green chemistry. An example is solid phase microextraction techniques (SPME), which use a solid sorbent and small solvent amounts. Biosorbents are substances of natural origin with sorptive properties, and they have been successfully used in SPME in environmental toxicology for water analysis, mainly. This study aimed to develop a sustainable, fast, cheap and simple SPME methodology using cork sheet strips as a biosorbent, to extract antidepressants, benzodiazepines and others from VH samples by liquid chromatography coupled to tandem mass spectrometry. The extraction was conducted in a 96-well plate using 200 µL of VH and optimization of relevant parameters for extraction was performed. For solvent optimization, two simplex-centroid experiments were planned for extraction and desorption and to evaluate time and pH, a Doehlert design experiment was performed. The analytical method for the determination and quantification of 17 substances was validated. The quantification limits were 5 ng/mL for all analytes and the calibration curves were linear between 5 and 30 ng/mL. This study was able to develop an efficient, cheap, simple and fast microextraction method for 17 analytes in VH, using strips of cork sheet for extraction and a 96-well plate as a container. Furthermore, this approach system could be automated for routine toxicology laboratories.

Sedentary time play a moderator role in the relationship between physical fitness and brain-derived neurotrophic factor in children. A pilot study.

Aim: Despite some advances, there are many controversies concerning brain-derived neurotrophic factor (BDNF) and its relationships with variables related to physical fitness and sedentary time, especially in children. The aim of the study was to explore the moderating role of sedentary time on the association between physical fitness and BDNF. Therefore, this study will add to the perspective of understanding how much time children may spend being sedentary with no deleterious influence on the positive association between physical fitness and BDNF. Methods: This cross-sectional study included 44 children aged between 6 and 11 years (9.02 ± 1.43) from a public school in Porto Alegre, Brazil. Cardiorespiratory fitness (CRF) was determined by the 6-min walk/run test, and muscular strength was determined through the lower limb strength test (LLS). Sedentary time was assessed through accelerometers, and blood samples were collected to determine serum BDNF levels (z score). Moderation analysis was performed using the PROCESS macro adjusted for sex, age, somatic maturation, waist circumference, and socioeconomic level. Results: Sedentary time moderates the relationship between CRF and BDNF, such that children should spend less than 511 minutes per day sedentary to achieve the benefits of CRF in BDNF concentrations. Conclusion: Sedentary time plays a significant moderating role in the relationship between CRF and BDNF. Therefore, to promote brain health in children, both increasing physical fitness and reducing sedentary time might be encouraged.

Bioanalytical method for simultaneous determination of benzodiazepines in vitreous humor using liquid chromatography-tandem mass spectrometry.

The use of vitreous humor (VH) in forensic casework has been growing in the last years due to numerous advantages. Several compounds can be evaluated in this matrix, including benzodiazepines whose determination is essential due to their great availability and potential of dependance and misuse. Postmortem toxicological analyses are required to determine the influence of benzodiazepines in deaths. However, most of the analytical methods which determine these drugs in VH are laborious and time consuming. This article describes a simple method based on protein precipitation for the determination of eight benzodiazepines in VH samples. Samples were prepared through a protein precipitation method and analyzed by liquid chromatography tandem mass spectrometry. Solvent choice and sample and solvent volumes for precipitation were optimized using chemometric approaches. The method was validated for selectivity, lower limit of quantification (LLOQ), linearity, carryover, precision, bias, matrix effect and dilution integrity. In order to verify the applicability, 62 vitreous humor samples were analyzed. LLOQs were 1 ng/mL and calibration curves were linear from 1 to 25 ng/mL (r2 > 0,99) for all analytes. Bias, precision and dilution integrity results were satisfactory according to proper guidelines. Ionization suppression was significant with values ranging from 8 to 37%. Two samples from real cases were positive for diazepam with the following concentrations: 6.80 ng/mL and 47.68 ng/mL, approximately 10 times lower than those found in peripheral blood. The procedure described here can be used as a straightforward and low cost method for the quantitation of multiple benzodiazepines in VH.

Effects of resistance training on the glycemic control of people with type 1 diabetes: a systematic review and meta-analysis.

Resistance training has shown the potential to contribute to better glycemic control in people with Type 1 Diabetes (T1D), however, there are contradictory results in this regard and a need to clarify the effects of isolated resistance training on glycemic control in T1D. The aim was to verify the effects of resistance training on the glycemic control of people with T1D. Original articles were selected, randomized and non-randomized clinical trials that aimed to verify chronic responses, through the concentrations of glycated hemoglobin (HbA1c), to a structured program of resistance exercise in the glycemia of patients with T1D. The following databases were searched; MEDLINE, PubMed, Web of Science, Scopus, ScienceDirect, LILACS, and SciELO. Five studies were included in the review. A reduction in HbA1c was observed (SMD = -0.568 ± 0.165 [95% CI = -0.891 to -0.246]; p = 0.001; I2 = 82%) in patients undergoing resistance training, when compared to the control group (SMD = 1.006 ± 0.181 [95% CI = 0.653 to 1.360]; p <0.001). Two studies, with children and adolescents and longer interventions, demonstrated a significant reduction in HbA1c, increased strength, and an improved lipid profile. Resistance training was efficient for assisting in glycemic control in people with T1D and should be incorporated in treatment plans.

Expression of EMT-Related Genes CAMK2N1 and WNT5A is increased in Locally Invasive and Metastatic Prostate Cancer.

Purpose: Prostate cancer (PCa) varies clinically from very indolent, not requiring therapeutic intervention, to highly aggressive, entailing radical treatment. Currently, stratification of PCa aggressiveness is mostly based on Gleason score, serum PSA and TNM stage, but outcome prediction in an individual basis is suboptimal. Thus, perfecting pre-therapeutic discrimination between indolent and aggressive PCa, avoiding overtreatment is a major challenge. Epithelial to mesenchymal transition (EMT) allows epithelial cells to acquire mesenchymal properties, constituting a critical step in tumor invasion and metastization. Thus, we hypothesized that EMT-related markers might allow for improved assessment of PCa aggressiveness. Methods and Results: Using RealTime ready Custom Panel 384 assay, 93 EMT-related genes were assessed in normal prostate tissues (NPT, n=5), stage pT2a+b-PCa (n=5) and stage pT3b-PCa (n=5), from which CAMK2N1, CD44, KRT14, TGFß3 and WNT5A genes emerged as the most significantly altered. Expression levels were then evaluated in a larger series (16 NPT and 94 PCa) of frozen tissues using quantitative RT-PCR. Globally, CAMK2N1, CD44 and WNT5A displayed higher expression levels at higher stages and less differentiated PCa. CAMK2N1 and WNT5A immunoexpression analysis disclosed significantly lower expression in NPT and increasing proportion of high-expression cases from pT2a+b to pT3b and metastatic PCa. Furthermore, higher CAMK2N1 and WNT5A transcript levels associated with shorter disease-free and disease-specific survival. In multivariable analysis, a trend for WNT5A expression levels to independently predict DFS was disclosed (p=0.056). Conclusions: Globally, our findings suggest an association between PCa aggressiveness and increased expression of CAMK2N1 and WNT5A, reflecting the acquisition of effective EMT characteristics by PCa cells.

Estratégia Saúde da Família rural: uma análise a partir da visão dos movimentos populares do Ceará / Rural Family Health Strategy: an analysis from the perspective of popular movements in Ceará

RESUMO A conquista do direito constitucional à saúde não se efetivou em diversos cenários. A partir dessa realidade, em 2011, foi publicada a Política Nacional de Saúde Integral das Populações do Campo, da Floresta e das Águas (PNSIPCFA). Este artigo objetiva analisar as práticas da Estratégia Saúde da Família (ESF) em territórios rurais no Ceará. Trata-se de estudo qualitativo, descritivo, realizado com 5 movimentos populares, sendo 3 entrevistados de cada um deles, totalizando 15 participantes. Utilizaram-se entrevista semiestruturada e análise do discurso. Os movimentos apontaram que houve expansão da ESF no campo, com avanços no acesso à saúde, apesar de existirem limitações. O Programa Mais Médicos destacou-se como marco relevante. Os movimentos têm o desafio de se apropriarem da PNSIPCFA, e contribuir, juntamente com ESF, para a ampliação da participação popular em saúde e reconhecimento dos saberes e práticas populares, considerando a determinação social da saúde.

ABSTRACT The conquest of the constitutional right to health has not been enforced in various scenarios. Considering this reality, in 2011 the National Policy for Integral Health of Countryside, Forest and Water Populations (PNSIPCFA) was published. This article aims to analyze the practices of the Family Health Strategy (FHS) in agricultural territories in Ceará. This is a qualitative, descriptive study, conducted with five popular movements, with 3 respondents from each movement, totaling 15 participants. Semi-structured interview and discourse analysis were used. The movements pointed out that there was an expansion of the FHS in the Countryside, with advances in access to health, despite some restrictions. The More Doctors Program stood out as a relevant milestone. The movements have the challenge of seizing the PNSIPCFA and contribute, along with the FHS, to the expansion of popular participation in health and recognition of popular knowledge and practices, considering the social determination of health.

LOW-COST SIMULATOR ASSEMBLY FOR 3-DIMENSIONAL VIDEOSURGERY TRAINING.

BACKGROUND: Three-dimensional videosurgery is already a reality worldwide. The trainee program for this procedure should be done initially and preferably in simulators. AIM: Assemble low-cost simulator for three-dimensional videosurgery training. METHODS: The simulator presented here was mounted in two parts, base and glasses. After, several stations can be inserted into the simulator for skills training in videosurgery. RESULTS: It was possible to set up three dimensional (3D) video simulations with low cost. It has proved to be easy to assemble and allows the training surgeon of various video surgical skills. CONCLUSION: This equipment may be used in undergraduate programs and advanced courses for residents and surgeons. The acrylic box allows the visualization of the task executed by the tutor and even by other experienced students.

Correlation of clinical data and the Alvarado's Score as predictors of acute appendicitis / Correlação de dados clínicos e a escala de Alvarado como preditores da apendicite aguda

ABSTRACT Objective: To correlate the patient's clinical data and the Alvarado's Score as predictors of acute appendicitis. Methods: This is an observational, descriptive and prospective study performed at a public urgency and emergency hospital in the city of Fortaleza, Ceará, between July and December 2016, with 34 patients undergoing open appendectomy with ages between 18 and 70 years. Statistical analysis was performed using the SPSS program. Results: The following statistical correlations were performed: number of days with abdominal pain until the operative event and degree of inflammation according to a macroscopic analysis of the appendix, Alvarado's Score and number of days with abdominal pain until the operative event, Alvarado's Score and degree of inflammation according to a macroscopic analysis of the appendix, number of days with abdominal pain until the operative event, and number of days of hospitalization in the postoperative period, degree of inflammation according to amacroscopic analysis of the appendix, number of days of hospitalization in the postoperative period and Alvarado's Score, and number of days of hospitalization in the postoperative period; the first five correlations were statistically significant (p < 0.05). Conclusion: The use of this Alvarado's Score in health services emerges as a tool for the diagnosis of acute appendicitis.

RESUMO Objetivo: correlacionar os dados clínicos do paciente e a pontuação do Escore de Alvarado como preditores da apendicite aguda. Métodos: Estudo observacional, descritivo e prospectivo realizado em um hospital secundário de urgência e emergência da rede pública na cidade de Fortaleza-Ceará, entre julho a dezembro de 2016, com 34 pacientes submetidos à apendicectomia por via aberta com idade entre 18 e 70 anos. A análise estatística foi realizada utilizando o programa SPSS. Resultados: Foram realizadas as seguintes correlações estatísticas: número de dias com dor abdominal até o ato operatório e grau de inflamação segundo análise macroscópica do apêndice, Escore de Alvarado e número de dias com dor abdominal até o ato operatório, Escore de Alvarado e grau de inflamação segundo análise macroscópica do apêndice, número de dias com dor abdominal até o ato operatório e número de dias de internação no pós operatório, grau de inflamação segundo análise macroscópica do apêndice e número de dias de internação no pós operatório e Escore de Alvarado e número de dias de internação no pós-operatório, sendo as cinco primeiras estatisticamente significantes (p < 0,05). Conclusão: O uso desta escala nos serviços de saúde emerge como uma possibilidade de ferramenta para auxiliar o diagnóstico de apendicite aguda.

Modelo sintético e de baixo custo para treinamento de hernioplastia inguinal aberta / Synthetic and low cost model for open inguinal hernioplasty training

As hérnias inguinais representam 69% dos casos de hérnias abdominais e sua reparação, a hernioplastia, é o procedimento mais realizado em Cirurgia Geral. Tendo em vista esse fato e que simuladores de baixo custo vêm ganhando cada vez mais espaço na graduação Médica devido aos aspectos éticos envolvendo o treinamento com pacientes reais e animais, nosso estudo objetivou a confecção de modelo sintético inédito, reprodutíveis e de baixo custo para o treinamento na técnica de hernioplastia inguinal aberta. Desse modo, com materiais de fácil acesso e preço reduzido, conseguimos construir com R$ 44,12 reais (US$ 14,27) o simulador proposto, podendo ser utilizado em cursos e aulas teórico-práticas com o intuito de demonstrar o procedimento de hernioplastia inguinal. (AU)

Inguinal hernias represent 69% of the cases of abdominal hernias and their repair is the most accomplished procedure in General Surgery. Considering this fact and that low cost simulators have been gaining more space in medical graduation due to the ethical aspects involved in the training of real and animal patients, our study aimed at the creation of a synthetic, unpublished, reproducible and low cost model for the Training in the technique of open inguinal hernioplasty. Thus, with easy-access materials and reduced price, we were able to construct with US$ 14,27 the proposed simulator, being able to be used in courses and theoretical-practical classes with the purpose of demonstrating the inguinal hernioplasty procedure. (AU)

Low-cost simulator assembly for 3-dimensional videosurgery training / Montagem de simulador de baixo custo para treinamento de videocirurgia em três dimensões

ABSTRACT Background: Three-dimensional videosurgery is already a reality worldwide. The trainee program for this procedure should be done initially and preferably in simulators. Aim: Assemble low-cost simulator for three-dimensional videosurgery training. Methods: The simulator presented here was mounted in two parts, base and glasses. After, several stations can be inserted into the simulator for skills training in videosurgery. Results: It was possible to set up three dimensional (3D) video simulations with low cost. It has proved to be easy to assemble and allows the training surgeon of various video surgical skills. Conclusion: This equipment may be used in undergraduate programs and advanced courses for residents and surgeons. The acrylic box allows the visualization of the task executed by the tutor and even by other experienced students.

RESUMO Racional: A videocirurgia em três dimensões já é realidade no cenário atual. O treinamento dessa habilidade deve ser feito inicialmente e preferencialmente em simuladores. Objetivo: Montar simulador de baixo custo para treinamento de videocirurgia em três dimensões. Métodos: O simulador aqui apresentado foi montado em duas partes, base e óculos. Após montagem, podem ser inseridas estações diversas no simulador para treinamento de habilidades em videocirurgia. Resultados: Foi possível montar simuladores de videocirurgia em 3D com custo baixo. Ele apresentou-se ser de fácil montagem permitindo o treinamento de várias habilidades videocirúrgicas. Conclusão: Este equipamento pode ser utilizado tanto em cursos básicos para a graduação quanto para avançados destinados a residentes e cirurgiões. A caixa de acrílico permite a visualização da tarefa executada pelo orientador/tutor e por outros alunos.

Educação popular e educação permanente em saúde: diálogos na formação de Agentes Comunitários de Saúde de um município do interior do Ceará / Popular education and continuing education in health: dialogues in the formation of Community Health Agents of a municipality in the interior of Ceará

A construção da formação em saúde se dá em meio a paradigmas e linhas de fuga, na medida em que visualizamos um modelo hegemônico de formação em contato com uma diversidade de mecanismos de subversão dessa hegemonia, produzindo alto grau de singularidade com múltiplos modos de aprender e ensinar. Constitui objetivo do trabalho relatar a experiência de edificação de um Círculo de Cultura por parte do autor e dos Agentes Comunitários de Saúde de um município do interior do Ceará, utilizando os alicerces da pedagogia do oprimido em um processo de educação permanente em saúde. Realizou-se no município serrano de Pacoti. A experiência contou com a participação de 23 profissionais, todos os Agentes Comunitários de Saúde atuantes naquele período no município em questão. A experiência foi vivenciada no período de agosto a dezembro de 2015. A experiência do Círculo de Cultura, após o período de imersão foi dividida em duas etapas, sendo elas: (1) O Encontro Inicial e (2) as Oficinas de Formação. Experiências como as aqui descritas atuam de modo a questionar instituídos. Apresentamos a experiência de diálogo entre Educação Popular e Educação Permanente como alternativa pedagógica para as ações de formação em saúde dos profissionais Agentes Comunitários de Saúde, agregando potencialidades do cotidiano dos serviços de saúde no intuito de avançar no sentido de um cuidado de qualidade, implicado com a realidade social dos educandos e dos usuários do sistema de saúde.

The construction of health training occurs in the midst of paradigms and lines of flight, as we visualize a hegemonic model of formation in contact with a diversity of mechanisms of subversion of this hegemony, producing a high degree of singularity with multiple ways of learning and teach. It is the objective of this work to report the experience of building a Culture Circle by the author and the Community Health Agents of a municipality in the interior of Ceará, using the foundations of the pedagogy of the oppressed in a process of permanent education in health. It was carried out in the mountain municipality of Pacoti. The experience counted on the participation of 23 professionals, all the Community Health Agents acting in that period in the municipality in question. The experience of the Círculo de Cultura, aGer the period of immersion, was divided into two stages: (1) The Initial Meeting and (2) the Training Workshops. Experiments such as those described here act in a way to question instituted. We present the experience of dialogue between Popular Education and Permanent Education as a pedagogical alternative for the health training actions of the professionals Community Health Agents, adding potential of daily health services in order to move towards quality care, implicated with the social reality of learners and users of the health system.

Identification of somatic TERT promoter mutations in familial nonmedullary thyroid carcinomas.

OBJECTIVE: The genes causing familial nonmedullary thyroid carcinoma (FNMTC) identified to date are only involved in a small fraction of the families. Recently, somatic mutations in TERT promoter region and in EIF1AX gene were reported in thyroid tumours of undefined familial status. The aim of this study was to investigate the role of TERT and EIF1AX mutations in familial thyroid tumours. DESIGN: The promoter region of TERT was sequenced in leucocyte DNA of the probands from 75 FNMTC families. In thyroid tumours from 54 familial cases, we assessed somatic TERT promoter, RAS and BRAF hotspot mutations, and the whole EIF1AX gene. RESULTS: No potentially pathogenic germline variants were identified in TERT in the 75 FNMTC families' probands. In the 54 carcinomas, we identified five cases (9%) with hotspot somatic TERT promoter mutations. BRAF mutations were found in 41% of the tumours. All TERT-positive samples were also positive for BRAF p.Val600Glu, and this co-occurrence was found to be statistically significant (P=.008). RAS mutations were detected in four tumours wild-type for TERT (7%). Evaluation of tumour mutation data together with the patients' clinicopathological features revealed a significant correlation between TERT plus BRAF mutations and advanced tumour stage (T4) (P=.020). No mutations were identified in EIF1AX. CONCLUSIONS: The results of this study suggest that TERT promoter and EIF1AX mutations are not frequently involved in FNMTC aetiology. However, we show for the first time that TERT alterations are associated with familial thyroid tumour progression. Our data also suggest that TERT mutations are more often found in concomitance with BRAF mutations in advanced stages of FNMTC.

MiR-193b promoter methylation accurately detects prostate cancer in urine sediments and miR-34b/c or miR-129-2 promoter methylation define subsets of clinically aggressive tumors.

BACKGROUND: Contemporary challenges of prostate cancer (PCa) include overdiagnosis and overtreatment, entailing the need for novel clinical tools to improve risk stratification and therapy selection. PCa diagnosis and prognostication might be perfected using epigenetic biomarkers, among which aberrant DNA methylation of microRNA promoters has not been systematically explored. Herein, we identified aberrantly methylated microRNAs promoters in PCa and assessed its diagnostic and prognostic biomarker potential. METHODS: Using HumanMethylation450 BeadChip-based analysis differentially methylated CpGs in microRNA promoters were identified. Promoter methylation of six microRNAs (miR-34b/c, miR-129-2, miR-152, miR-193b, miR-663a and miR-1258) was analyzed by qMSP in three sets (180 prostatectomies, 95 urine sediments and 74 prostate biopsies). Biomarkers' diagnostic (validity estimates) and prognostic [disease-free (DFS) and disease-specific survival (DSS)] performance was assessed. RESULTS: Significantly higher promoter methylation levels in PCa were confirmed for six candidate microRNAs. Except for miR-152, all displayed AUC values higher than 0.90, with miR-1258 and miR-193b disclosing the best performance (AUC = 0.99 and AUC = 0.96, respectively). In urine samples, miR-193b showed the best performance (91.6% sensitivity, 95.7% specificity, AUC = 0.96). Moreover, higher miR-129-2 independently predicted for shorter DSS and miR-34b/c methylation levels independently predicted for shorter DFS and DSS. CONCLUSIONS: Quantitative miR-193b, miR-129-2 and miR-34b/c promoter methylation might be clinically useful PCa biomarkers for non-invasive detection/diagnosis and prognostication, both in tissue and urine samples.

Assessment of Physical Therapy Strategies for Recovery of Urinary Continence after Prostatectomy

Introduction: Urinary incontinence is a complication of radical prostatectomy. Pelvic floor exercises can facilitate recovery of continence after surgery; however, there is not sufficient evidence that physical therapy with biofeedback training is effective, particularly with respect to providing a faster recovery. Objective: To analyze the application of physical therapy techniques in the recovery of urinary incontinence after prostatectomy. Methodology: A randomized clinical trial was conducted from April to October 2015 with patients undergoing radical prostatectomy up to three months after surgery at the Santa Casa de Misericordia in Northeastern Brazil. The physical therapy intervention consisted of up to eight individual sessions. Patients were randomized into the intervention group, which performed exercises and received biofeedback training, and the control group, which performed exercises alone. Participants were assessed before, during and after treatment. The initial assessment included a structured instrument addressing sociodemographic and urological data. Frequencies were calculated for all variables and comparisons were checked by the Mann-Whitney test and for correlation significance. Results: The study included 13 patients aged 54-74 years, the majority undergoing retropubic surgery with mild urinary incontinence [11 (84.6%)]. There was a significant difference in the outcome of the pad test before (p=0.070) and after (p=0.015) treatment between the groups, but the reduction of urinary loss and the time to recovery of continence were equivalent for both groups. Conclusion: Both interventions provided improvement in the degree of incontinence within two months of treatment.

Logbooks online em treinamento de cirurgia de urgência/emergência / Online Logbooks in emergency surgery training

Objetivo: Descrever a utilização de logbooks em treinamento em Cirurgia de Urgência/Emergência de um hospital secundário de Fortaleza, Ceará, Brasil. Síntese dos dados: Após cada plantão de 12 horas, os extensionistas da liga de Cirurgia Geral preenchiam um logbook online com os procedimentos realizados, auxiliados ou observados, bem como podiam relatar intercorrências acontecidas durante o plantão. Este material era disponibilizado para o orientador da liga com o intuito de supervisionar o treinamento. Conclusão: Logbooks conseguem demonstrar a importância de treinamentos práticos, bem como analisar quando esses não estão proporcionando um ambiente de prática satisfatório para o extensionista. Ademais, podem ser preenchidos via Internet, permitindo armazenamento ilimitado, evitando gastos de papel e proporcionando acompanhamento imediato. (AU)

Objective: This paper aims to describe the use of logbooks in Emergency and Urgency Surgery training at a secondary hospital in Northeast of Brazil. Data Synthesis: After reach 12-hours work, students of the General Surgery Extension Program recorded an online logbook, describing procedures that were observed on call, as well as Reporting occurrence during this time. This material was made Available to the instructor and feedback was provided after training. Conclusion: Logbooks can demonstrate the importance of surgery undergraduated training and provide Information about learning environment of the trainees. In addition, logbooks can be filled in a web based, allowing unlimited storage, providing immediate follow-up and feedback to the student. (AU)

Electrochemical treatment of shrimp farming effluent: role of electrocatalytic material.

This study investigated the electrochemical oxidation of organic matter present in shrimp farming effluent using three types of electrocatalytic materials: Ti/Ru0.34Ti0.66O2, Ti/Pt, and boron-doped diamond (BDD). An electrochemical cell with 300 mL under stirring agitation was used by applying 20, 40, and 60 mA cm-2. A Ti/Ru0.34Ti0.66O2 anode showed a reduction of chemical oxygen demand (COD) about 84 % after 1 h of electrolysis, while at the same time, 71 % of COD decay was achieved at Ti/Pt. Conversely, only 71 % of COD was removed after 2 h with a BDD anode. Regarding the temperature effect, BDD showed better performances than those achieved for Ti/Ru0.34Ti0.66O2 and Ti/Pt anodes during an electrochemical treatment of a shrimp farming effluent, obtaining 72 % of COD removal by applying 20 mA cm-2 at 40 °C after 15 min. Energy consumption and cost were estimated in order to established the engineering applicability of this alternative process.

TOTAL COST OF HOSPITALIZATION OF PATIENTS UNDERGOING ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY RELATED TO NUTRITIONAL STATUS.

BACKGROUND: In the Western world, the population developed an overweight profile. The morbidly obese generate higher cost to the health system. However, there is a gap in this approach with regard to individuals above the eutrofic pattern, who are not considered as morbidly obese. AIM: To correlate nutritional status according to BMI with the costs of laparoscopic cholecystectomy in a public hospital. METHOD: Data were collected from medical records about: nutritional risk assessment, nutricional state and hospital cost in patients undergoing elective laparoscopic cholecystectomy. RESULTS: Were enrolled 814 procedures. Average age was 39.15 (±12.16) years; 47 subjects (78.3%) were women. The cost was on average R$ 6,167.32 (±1830.85) to 4.06 (±2.76) days of hospitalization; 41 (68.4%) presented some degree of overweight; mean BMI was 28.07 (±5.41) kg/m²; six (10%) individuals presented nutritional risk ≥3. There was a weak correlation (r=0.2) and not significant (p <0.08) between the cost of hospitalization of the sample and length of stay; however, in individuals with normal BMI, the correlation was strong (r=0,57) and significant (p<0.01). CONCLUSION: Overweight showed no correlation between cost and length of stay. However, overweight individuals had higher cost of hospitalization than those who had no complications, but with no correlation with nutritional status. Compared to those with normal BMI, there was a strong and statistically significant correlation with the cost of hospital stay, stressing that there is normal distribution involving adequate nutritional status and success of the surgical procedure with the consequent impact on the cost of hospitalization.

RACIONAL: No mundo ocidental, a população desenvolveu um perfil de excesso de peso corporal. Os obesos mórbidos geram custo mais alto para o sistema de saúde. Entretanto, observa-se um hiato no tocante aos indivíduos acima do eutrofismo, mas não considerados obesos mórbidos. OBJETIVO: Correlacionar estado nutricional, segundo o IMC, com custo de internação de colecistectomias videolaparoscópicas. MÉTODO: Coleta de dados dos prontuários sobre: avaliação de risco nutricional, estado nutricional e custo de internação de pacientes submetidos à colecistectomia videolaparoscópica eletiva no período de janeiro de 2012 a dezembro de 2014. RESULTADOS: Foram analisados 814 procedimentos. A idade média foi de 39,15 (±12,16) anos; 47 (78,3%) eram mulheres. O custo de internação foi, em média, de R$ 6.167,32 (±1.830,85) para 4,06 (±2,76) dias de internação. Quarenta e um (68,4%) pacientes apresentavam algum grau de sobrepeso; o IMC médio foi 28,07 (±5,41) kg/m²; seis (10%) indivíduos apresentavam risco nutricional ≥3. Houve correlação fraca (r=0,2) e não significativa (p<0,08) entre o custo de hospitalização e o tempo de permanência. No entanto, em indivíduos com IMC normal, a correlação foi forte (r=0,57) e significante (p<0,01). CONCLUSÃO: Sobrepeso não demonstrou correlação entre custo e tempo de internação. Entretanto, os indivíduos com sobrepeso apresentaram custo maior de internação em relação aos que não tiveram intercorrência, mas sem correlação com o estado nutricional. Em relação aos com IMC normal, houve correlação forte e estatisticamente significante com o custo para tempo de internação, reforçando que há provável distribuição normal envolvendo estado nutricional adequado e sucesso do procedimento cirúrgico com consequente impacto no custo de internação.

Male breast cancer: Looking for better prognostic subgroups.

PURPOSE: Male Breast Cancer (MBC) remains a poor understood disease. Prognostic factors are not well established and specific prognostic subgroups are warranted. PATIENTS/METHODS: Retrospectively revision of 111 cases treated in the same Cancer Center. Blinded-central pathological revision with immunohistochemical (IHQ) analysis for estrogen (ER), progesterone (PR) and androgen (AR) receptors, HER2, ki67 and p53 was done. Cox regression model was used for uni/multivariate survival analysis. Two classifications of Female Breast Cancer (FBC) subgroups (based in ER, PR, HER2, 2000 classification, and in ER, PR, HER2, ki67, 2013 classification) were used to achieve their prognostic value in MBC patients. Hierarchical clustering was performed to define subgroups based on the six-IHQ panel. RESULTS: According to FBC classifications, the majority of tumors were luminal: A (89.2%; 60.0%) and B (7.2%; 35.8%). Triple negative phenotype was infrequent (2.7%; 3.2%) and HER2 enriched, non-luminal, was rare (≤1% in both). In multivariate analysis the poor prognostic factors were: size >2 cm (HR:1.8; 95%CI:1.0-3.4 years, p = 0.049), absence of ER (HR:4.9; 95%CI:1.7-14.3 years, p = 0.004) and presence of distant metastasis (HR:5.3; 95%CI:2.2-3.1 years, p < 0.001). FBC subtypes were independent prognostic factors (p = 0.009, p = 0.046), but when analyzed only luminal groups, prognosis did not differ regardless the classification used (p > 0.20). Clustering defined different subgroups, that have prognostic value in multivariate analysis (p = 0.005), with better survival in ER/PR+, AR-, HER2-and ki67/p53 low group (median: 11.5 years; 95%CI: 6.2-16.8 years) and worst in PR-group (median:4.5 years; 95%CI: 1.6-7.8 years). CONCLUSION: FBC subtypes do not give the same prognostic information in MBC even in luminal groups. Two subgroups with distinct prognosis were identified in a common six-IHQ panel. Future studies must achieve their real prognostic value in these patients.