Onfalopagus parasitic fusioned twin: A case report.

INTRODUCTION AND IMPORTANCE: The parasitic fetus is a kind of siamese twin, in which one of the twins is reabsorbed and some parts of the body can remain attached to the other twin. It is a very rare event, with a birth incidence that varies from 0.05 to 1.47 cases per 100,000. CASE PRESENTATION: This paper reports the case of a parasitic twin diagnosed at 34 weeks of gestational age. Preoperative ultrasonography was performed and the absence of communication between vital organs and the parasite was observed, and surgery was scheduled at 10 days of life. A multidisciplinary team performed the surgical procedure and the child was discharged from the intensive care unit after 3 months. CLINICAL DISCUSSION: After diagnosis and birth, it is essential to investigate the anomalies found for future surgical programming, and cases of twins who do not share vital organs, for example, heart or brain, have higher survival rates. The treatment is surgical and the objective of the surgery must be resection of the parasite. CONCLUSION: The diagnosis still in the gestational period is essential to plan the best mode of delivery and neonatal care, as well as define the surgical schedule. The hospital must be tertiary and the presence of a multidisciplinary team is necessary to perform the surgery in order to present the highest success rates.

Monte Carlo simulations of synchrotron X-ray dose affecting root growth during in vivo tomographic imaging.

Synchrotron X-ray computed tomography (XCT) has been increasingly applied to study the in vivo dynamics of root growth and rhizosphere processes. However, minimizing radiation-induced damage to root growth warrants further investigation. Our objective was to develop a robust approach for modeling and evaluating ways to reduce synchrotron X-ray dose effects on root growth during in vivo imaging. Wheat roots growing in soil were exposed to X-rays during XCT experiments resolved in space (3D) plus time (4D). The dose rate and cumulative absorbed dose in roots were modelled using the Monte Carlo code FLUKA for different experimental conditions of polychromatic and quasi-monochromatic X-ray beam configurations. The most impactful factors affecting damage to roots were incident X-ray energy spectrum, stored current in the accelerator machine, position of the root in the soil, and possibly the number of exposures during the 4D XCT experiments. Our results imply that radiation dose during in vivo imaging of plant roots can be diminished by using monochromatic radiation at the highest energy suitable for a given sample thickness and field of view, and by controlling the rotation axis of off-centered roots to increase attenuation of radiation by the soil matrix.

Patterns of genome size variation in caridean shrimps: new estimates for non-gambarelloides Synalpheus species.

Genome size (GS) or DNA nuclear content is considered a useful index for making inferences about evolutionary models and life history in animals, including taxonomic, biogeographical, and ecological scenarios. However, patterns of GS variation and their causes in crustaceans are still poorly understood. This study aimed to describe the GS of five Neotropical Synalpheus non-gambarelloides shrimps (S. apioceros, S. minus, S. brevicarpus, S. fritzmueller, and S. scaphoceris) and compare the C-values of all Caridea infraorder in terms of geography and phylogenetics. All animals were sampled in the coast of São Paulo State, Brazil, and GS was assessed by flow cytometry analysis (FCA). The C-values ranged from 7.89 pg in S. apioceros to 12.24 pg in S. scaphoceris. Caridean shrimps had higher GS than other Decapoda crustaceans. The results reveal a tendency of obtaining larger genomes in species with direct development in Synalpheus shrimps. In addition, a tendency of positive biogeographical (latitudinal) correlation with Caridea infraorder was also observed. This study provides remarkable and new protocol for FCA (using gating strategy for the analysis), which led to the discovery of new information regarding GS of caridean shrimps, especially for Neotropical Synalpheus, which represents the second-largest group in the Caridea infraorder.

Kaposiform hemangioma of jejunum in a newborn: A case report and review of literature.

INTRODUCTION: Kaposiform hemangioendothelioma is a rare tumor, of vascular origin, which predominates in childhood. Although it is frequently a vascular cutaneous anomaly, it is known that some cases can involve bones, mediastinum and retroperitoneum, being even rarer when it occurs in the small intestine, representing only 0.05% of all intestinal neoplasms. PRESENTATION OF CASE: Female patient, 21 days old, born at 38 weeks, is admitted to the hospital due to bilious vomiting, dehydration and major abdominal distension. An X-ray of the acute abdomen suggests type I jejunal atresia. An exploratory laparotomy was performed, with the presence of a stenotic area in the proximal jejunum, which was chosen for resection of the stenotic area and end-to-end terminal anastomosis, with post-pyloric jejunostomy. The presence of kaposiform hemangioma was confirmed by immunohistochemistry, and the patient had no further complications. DISCUSSION: The presence of hemangiomas in childhood is frequent, is but it very rare when it appears in the gastrointestinal location, as reported in the present case. A common presentation is intestinal bleeding, being manifested as anemia or, sometimes, acute and potentially fatal anemia. Other forms of rare presentation include intussusception, perforation and obstruction, the latter being out patient's last manifestation. The diagnosis of this alteration can be difficult, and often performed only in the intraoperative period of an exploratory laparotomy. CONCLUSION: The presence of bilateral vomiting and intestinal obstruction in newborns opens the possibility of a wide range of possible diagnoses, such as the presence of intestinal atresia. Kaposiform intestinal hemangioma is an uncommon cause in these clinical manifestations, but it should be included in the differential diagnosis.

New record of the sponge-dwelling shrimp Typton distinctus Chace, 1972 (Decapoda: Caridea: Palaemonidae) in São Paulo State, Brazil.

Among the Caridea Infraorder, the palaemonid shrimp from the genus Typton Costa, 1844 are commonly found in association with sponges, frequently feeding on the tissues of their hosts ((Duris et al. 2011; Almeida et al. 2014; Pachelle et al. 2015; Soledade et al. 2017). Typton is mostly characterized by morphological features related to their sponge-dwelling lifestyle, as a simple and compressed rostrum, carapace smooth and antennal spines present, antennae extremely reduced and scaphocerite rudimentary. Mandible without palp, incisor process normal, reduced or absent. Second legs unequal, asymmetrical, without molar process on major chela (Bruce, 1972).

Fatores que obstam na comunicação entre pais e filhos adolescentes sobre sexualidade / Factores que dificultan la comunicación entre padres y adolescentes sobrela sexualidad niños / Factors that stand in the way of the communication between parents and teenagers about sexuality

Objetivos: analisar fatores que interferem na comunicação sobre sexualidade entre pais e filhos adolescentes em situação de vulnerabilidade social. Método: utilizou-se a abordagem qualitativa e a dialética como referencial teórico filosófico. No tratamento e avaliação dos dados coletados utilizou-se a Análise de Conteúdo. Resultados: a comunicação no âmbito familiar frequentemente está ausente ou é insuficiente. Certos pais revelaram que apesar dos entraves, abordam o assunto, dando margens a superações. Considerações finais: objetivando superar as dificuldades e contradições entre pais e filhos adolescentes sobre sexualidade, sugerimos o apoio de profissionais de educação e de saúde na utilização de estratégias, que considerem os modos de vida juvenis. A existência de diálogo aberto,democrático, livre de coerções e de preconceitos é essencial para a redução da vulnerabilidade do adolescente intrínseca à comunicação ineficaz sobre sexualidade.

Aim: to analyze factors which interfere in the communication about sexuality between parents and teenagers in situation of social vulnerability. Method: it was used the qualitative approach and the dialectics as philosophical theoretical reference. In the studyand assessment of the collected data we used Content Analysis. Results: the communication within the family is often absent or insufficient. Some parents revealed that despite the obstacles, they broach the subject in order to make easy the overcoming. Final Thoughts: aiming to overcome the difficulties and contradictions between parents and teenagers about sexuality, we suggest the support of professionals in education and health in the useof strategies that consider the juvenile lifestyles. The existence of an open, democratic,free of coercion and prejudice dialogue is essential to the reduction of the adolescents'vulnerability inherent in the ineffective communication about sexuality.

Objetivos: analizar los factores que interfieren en la comunicación acerca dela sexualidad entre padres e hijos adolescentes en situación de vulnerabilidad social.Método: fue utilizado el abordaje cualitativo y la dialéctica como referencial teóricofilosófico. Para el tratamiento y evaluación de los datos recogidos usamos análisis decontenido. Resultados: la comunicación en el ámbito familiar a menudo está ausente o es insuficiente. Algunos padres revelaron que pesar de los obstáculos, abordan el tema,dando margen a las superaciones. Consideraciones finales: con el objetivo de superar las dificultades y contradicciones entre padres e hijos adolescentes acerca de la sexualidad,sugerimos el apoyo de profesionales de educación y de salud en el uso de estrategias que consideren los modos de vida juveniles. La existencia de diálogo abierto, democrático,libre de coerción y de prejuicios es indispensable para reducir la vulnerabilidad adolescente intrínseca a la comunicación ineficaz sobre sexualidad.

Anafilaxia: conhecimento médico sobre o manejo em anafilaxia: estudo em urgentistas na cidade de Petrópolis - RJ / Anaphylaxis: medical knowledge about anaphylaxis: a study carried out in emergency doctors in the city of Petropolis

Objetivo: Avaliar o conhecimento médico no manejo da anafilaxia nas emergências dos hospitais de Petrópolis. verificar ações imediatas não medicamentosas, analisar a conduta farmacológica, identificar o conhecimento médico frente a uma anafilaxia refratária à adrenalina em pacientes em uso de beta-bloqueador, verificar o conhecimento médico em relação à reação bifásica da anafilaxia. Métodos: Estudo transversal descritivo. Foi aplicado um questionário aos médicos das principais emergências de pediatria e clínica médica dos sete hospitais de Petrópolis (quatro particulares e três públicos). Resultados: Nas emergências, nesta época, havia cerca de 170 médicos. 52 médicos concordaram em participar da pesquisa, logo o nosso universo é de 30,6% dos médicos que trabalham nas emergências de Petrópolis. Dos 52 médicos analisados, 50% já atenderam um choque anafilático. Em relação às medidas não farmacológicas, a desobstrução das VAS foi a conduta mais mencionada (76,9%). Na conduta (76.9%). e farmacológica, a adrenalina foi citada como primeira escolha em 63,4%, sendo a via subcutânea a mais utilizada. O local da administração da adrenalina não foi respondido por 52% dos médicos. O segundo medicamento de escolha mais menciona do foi o corticóide. O glucagon só foi citado por um médico como alternativa terapêutica no paciente em uso contínuo de beta bloqueador que foi refratário ao tratamento. Conclusão: A anafilaxia demanda pronto reconhecimento e rápido atendimento. É necessária educação continuada sobre o tema nos setores de emergência da cidade de Petrópolis.

Objective: To evaluate the medical knowledge in dealing with anaphylaxis in the emergency room of Hospitals in Petropolis. To verify non-medicine prompt actions, to analyze the pharmacological intervention, to identify the medical knowledge in relation to a refractory anaphylactic shock to adrenaline in patients on beta blockers treatment and toverify the medical knowledge in relation to biphasic reaction to anaphylaxis. Methods: Descriptive cross-sectional study. A questionnaire was sent out to the attending physicians and pediatricians of the main emergency rooms of the seven hospitals in Petropolis (4 private and 3 public). Results: There were about 170 doctors working in emergency rooms by the time of the study and 52 doctors agreed to take part in the survey, so we had 30.6% of the doctors who work in the emergencies in Petropolis. From the 52 interviewed, 50% have already treated an anaphylactic shock. In relation to the non-pharmacological measures, patency of the upper airways was the most mentioned one (76.9%). In the pharmacological intervention, the adrenaline was cited as the first choice in 63.4% of the cases, being the subcutaneous via the most used. The place where the adrenaline was administrated was not answered by 52% of the doctors. The second choice was the steroid. Glugacon was mentioned by only one doctor as a therapeutic alternative in the patient who uses beta blockers continuously and was refractory to the treatment. 75% of the doctors did not know anything about the biphasic reaction. Conclusion: Anaphylaxis demands prompt recognition and quick treatment. Continuing medical education about the subject in emergency rooms in Petropolis is necessary.

Reply letter utilization by secondary level specialists in a municipality in Brazil: a qualitative study.

OBJECTIVES: To identify obstacles impeding the use of the reply letter by secondary level specialists in the municipality of Camaragibe, Pernambuco, Brazil, and to highlight possible solutions for improving communication at the interface between secondary level specialist care and primary care. METHODS: Conducted in 2003, this qualitative study used semistructured interviews with 10 randomly selected secondary level specialists. The following specialties were represented: neurology, obstetrics, gynecology, psychiatry, otolaryngology, and colposcopy. Interviews were semistructured, using an interview guide, based on the following seven categories: (1) profile of the specialist, (2) description of outpatient clinic services, (3) professional satisfaction, (4) assessment of the municipal health services, (5) assessment of the Family Health Program (Programa Saúde da Família), (6) description of the referral process, and (7) reply letter utilization. RESULTS: Most of the specialists understood the importance of the reply letter and that this form of communication with the generalist would ensure continuity of care, avoid duplication of efforts or disorganized patient management, and would provide the generalist with the professional support required. However, the study found that most of the specialists do not routinely use the reply letter. In general, the specialists have their own criteria to reply or not to a referral, for example, whether the generalist "deserved" a reply, whether the patient will remain under their care, or whether the patient has a significant pathology. Reasons for low reply letter utilization rates among specialists were categorized into four broad themes: (1) workplace organization, (2) communication inhibition, (3) professional isolation, and (4) medical education. CONCLUSIONS: Despite a general understanding of its importance, specialists in Camaragibe had difficulty adopting the reply letter as a form of communication at the interface between primary and secondary care levels. The reply letter can be effective in improving communication at the interface, but the broad cultural, historical, and organizational features of secondary level specialists need to be considered in order to improve reply letter utilization.

Reply letter utilization by secondary level specialists in a municipality in Brazil: a qualitative study

OBJECTIVES: To identify obstacles impeding the use of the reply letter by secondary level specialists in the municipality of Camaragibe, Pernambuco, Brazil, and to highlight possible solutions for improving communication at the interface between secondary level specialist care and primary care. METHODS: Conducted in 2003, this qualitative study used semistructured interviews with 10 randomly selected secondary level specialists. The following specialties were represented: neurology, obstetrics, gynecology, psychiatry, otolaryngology, and colposcopy. Interviews were semistructured, using an interview guide, based on the following seven categories: (1) profile of the specialist, (2) description of outpatient clinic services, (3) professional satisfaction, (4) assessment of the municipal health services, (5) assessment of the Family Health Program (Programa Saúde da Família), (6) description of the referral process, and (7) reply letter utilization. RESULTS: Most of the specialists understood the importance of the reply letter and that this form of communication with the generalist would ensure continuity of care, avoid duplication of efforts or disorganized patient management, and would provide the generalist with the professional support required. However, the study found that most of the specialists do not routinely use the reply letter. In general, the specialists have their own criteria to reply or not to a referral, for example, whether the generalist "deserved" a reply, whether the patient will remain under their care, or whether the patient has a significant pathology. Reasons for low reply letter utilization rates among specialists were categorized into four broad themes: (1) workplace organization, (2) communication inhibition, (3) professional isolation, and (4) medical education. CONCLUSIONS: Despite a general understanding of its importance, specialists in Camaragibe had difficulty adopting the reply letter as a form of communication...

OBJETIVOS: Identificar los obstáculos que impiden a los especialistas del nivel secundario de salud utilizar las cartas de respuesta en el municipio de Camaragibe, Pernambuco, Brasil, y presentar algunas posibles soluciones para mejorar la comunicación en la interfase entre los especialistas del nivel secundario y los de atención primaria. MÉTODOS: Para este estudio cualitativo se realizaron entrevistas semiestructuradas en 2003 a diez especialistas de nivel secundario de salud, seleccionados aleatoriamente, de las siguientes especialidades: neurología, obstetricia, ginecología, psiquiatría, otorrinolaringología y colposcopia. Las entrevistas se realizaron mediante una guía basada en las siguientes categorías: 1) perfil del especialista; 2) descripción de los servicios clínicos ambulatorios; 3) satisfacción profesional; 4) evaluación de los servicios de salud municipales; 5) evaluación del Programa de Salud Familiar (Programa de Saúde da Familia); 6) descripción del proceso de referencia de pacientes; y 7) uso de las cartas de respuesta. RESULTADOS: La mayor parte de los especialistas comprendían la importancia de las cartas de respuesta y que esta forma de comunicación con los médicos generales podría garantizar la continuidad de la atención, evitaría la duplicación de esfuerzos o la atención desorganizada del paciente, y brindaría al médico general el respaldo profesional necesario. No obstante, según el estudio, la mayoría de los especialistas no utilizan las cartas de respuesta habitualmente. En general, los especialistas tienen sus propios criterios para responder o no a las notas de referencia, por ejemplo, si el médico general "merece" una respuesta, si el paciente permanecerá bajo su cuidado o si el paciente tiene una enfermedad que lo justifica. Las razones para la baja tasa de utilización de las cartas de respuesta por parte de los especialistas se clasificaron en los siguientes grandes temas: 1) organización del trabajo; 2)cohibición...

Estudo do lavado broncoalveolar em pacientes com comprometimento pulmonar na leptospirose / Study of bronchoalveolar lavage in leptospirosis patients with pulmonary involvement

INTRODUÇAO: O comprometimento pulmonar é freqüente na leptospirose e caracteriza-se por hemoptise, dispnéia e infiltrados pulmonares bilaterais no radiograma de tórax. Esses achados podem ser compatíveis com hemorragia alveolar, previamente descrita por alguns autores em autópsias e em lavado broncoalveolar. OBJETIVO: Avaliar a presença de hemorragia alveolar, diagnosticada por meio do lavado broncoalveolar, em pacientes portadores de leptospirose com alterações pulmonares, enfatizando-se a importância do método para o diagnóstico precoce da complicação. MÉTODO: Sete pacientes com leptospirose foram submetidos à broncoscopia com lavado broncoalveolar. Todos apresentavam sinais e/ou sintomas respiratórios, e/ou infiltrados no radiograma de tórax, e/ou hipoxemia. A hemorragia alveolar foi definida pelos seguintes achados no lavado: porcentagem de siderófagos e"20 por cento, escore de Golde > 100, e/ou presença de líquido hemorrágico. Foram realizados exame direto e cultura para Leptospiras, com o uso de meios específicos. O diagnóstico da doença foi confirmado por soroaglutinação microscópica para leptospirose. RESULTADOS: O aspecto da broncoscopia foi normal em 5 pacientes, mostrou sangramento na árvore brônquica em 1 caso e sinais inflamatórios em outro. O aspecto do lavado foi hemorrágico em todos os pacientes, configurando o quadro de hemorragia alveolar. A pesquisa direta e a cultura para Leptospiras foram negativas. CONCLUSAO: A leptospirose deve ser considerada no diagnóstico diferencial das hemorragias alveolares.O lavado broncoalveolar mostrou-se um método eficaz para a detecção de hemorragia alveolar na leptospirose, servindo para orientar a terapêutica imediata, com a finalidade de prevenir sua evolução, caracterizada pela presença de hemoptises maciças e insuficiência respiratória.