Removal of phosphorus by modified bentonite:polyvinylidene fluoride membrane-study of adsorption performance and mechanism.

Enhanced phosphorus management, geared towards sustainability, is imperative due to its indispensability for all life forms and its close association with water bodies' eutrophication, primarily stemming from anthropogenic activities. In response to this concern, innovative technologies rooted in the circular economy are emerging, to remove and recover this vital nutrient to global food production. This research undertakes an evaluation of the dead-end filtration performance of a mixed matrix membrane composed of modified bentonite (MB) and polyvinylidene fluoride (PVDF) for efficient phosphorus removal from water media. The MB:PVDF membrane exhibited higher permeability and surface roughness compared to the pristine membrane, showcasing an adsorption capacity (Q) of 23.2 mgP·m-2. Increasing the adsorbent concentration resulted in a higher removal capacity (from 16.9 to 23.2 mgP·m-2) and increased solution flux (from 0.5 to 16.5 L·m-2·h-1) through the membrane. The initial phosphorus concentration demonstrates a positive correlation with the adsorption capacity of the material, while the system pressure positively influences the observed flux. Conversely, the presence of humic acid exerts an adverse impact on both factors. Additionally, the primary mechanism involved in the adsorption process is identified as the formation of inner-sphere complexes.

Source apportionment and health impact assessment of atmospheric particulate matter in the city of São Carlos, Brazil.

In this study, positive matrix factorization method was used for source apportionment of PM10 in the city of São Carlos from 2015 to 2018. The annual mean concentrations of PM10, 15 PAHs, 4 oxy-PAHs, 6 nitro-PAHs, 21 saccharides, and 17 ions in these samples were in the ranges 18.1 ± 6.99 to 25.0 ± 11.3 µg m-3 for PM10, 9.80 × 10-1 ± 2.06 to 2.03 ± 8.54 × 10-1 ng m-3 for ΣPAHs, 83.9 ± 35.7 to 683 ± 521 pg m-3 for Σoxy-PAHs, 1.79 × 10-2 ± 1.23 × 10-1 to 7.12 ± 4.90 ng m-3 for Σnitro-PAHs, 83.3 ± 44.7 to 142 ± 85.9 ng m-3 for Σsaccharides, and 3.80 ± 1.54 to 5.66 ± 4.52 µg m-3 for Σions. For most species, the concentrations were higher in the dry season than in the rainy. This was related not only to the low rainfall and relative humidity characteristic of the dry season but also to an increase in fire spots recorded in the region between April and September every year from 2015 to 2018. A 4-factor solution provided the best description of the dataset, with the four identified sources of PM10 being soil resuspension (28%), biogenic emissions (27%), biomass burning (27%), and vehicle exhaust together with secondary PM (18%). Although the PM10 concentrations were not above the limit established by local legislation, the epidemiological study showed that by reducing PM2.5 concentrations to the level recommended by the WHO, approximately 35 premature deaths per 100,000 population could be avoided annually. The results revealed that biomass burning continues to be one of the main anthropic sources of emissions to the atmosphere in the region, so it needs to be incorporated into the existing guidelines and policies to reduce the concentration of particulate matter to within the limits recommended by the WHO, in order to avoid premature deaths.

Perfil epidemiológico dos casos notificados de sífilis materna e congênita em uma maternidade referência em Belo Horizonte / Epidemiological profile of the reported cases of maternal and congenital syphilis in a reference maternity hospital from Belo Horizonte

Introdução: A sífilis é uma doença infectocontagiosa causada pela bactéria Treponema pallidum, com transmissão predominantemente sexual. Nas gestantes não tratadas ou tratadas de forma inadequada, a infecção ocorre por via transplacentária. Objetivos: Traçar o perfil epidemiológico dos casos de sífilis materna e congênita. Métodos: Estudo transversal, descritivo e quantitativo realizado através do acesso aos casos notificados de sífilis no período de janeiro a junho de 2020, em uma maternidade referência em assistência materno-infantil em Belo Horizonte, Minas Gerais. Resultados: Foram identificados 232 casos notificados de sífilis congênita neste período e a prevalência da doença foi de 4,3%. Entre as gestantes, 69% possuem 20 a 34 anos, 14,65% ensino fundamental completo e 43,1% são de raça parda. Quanto aos casos de transmissão vertical, 87,5% realizaram pré-natal, 23,3% obtiveram diagnóstico de sífilis no momento do parto e em 15,1% houve tratamento concomitante do parceiro. Conclusão: Na maternidade estudada é elevada a prevalência da sífilis congênita. Os resultados demonstram a necessidade de melhoria no controle da sífilis na gestação.

Introduction: Syphilis is an infectious contagious disease caused by bacterium Treponema pallidum, with predominantly sexual transmission. In untreated or inadequately treated pregnant women, the infection occurs transplacentally. Purpose: To trace the epidemiological profile of the maternal and congenital syphilis cases. Methods: A cross-sectional, descriptive and quantitative study conducted through access to the syphilis cases reported from January to June 2020, in a maternity hospital that is a reference in maternal and childcare in Belo Horizonte, Minas Gerais. Results: A total of 232 reported cases of congenital syphilis were identified in this period and the prevalence of the disease was 4.3%. Among the pregnant women, 69% are aged between 20 and 34 years old, 14.65% have complete elementary school, and 43.1% are brown-skinned. As for the cases of vertical transmission, 87.5% attended prenatal care, 23.3% were diagnosed with syphilis at the time of delivery and, in 15.1% there was concomitant treatment of the partners. Conclusion: In the maternity hospital under study, the prevalence of congenital syphilis is high. The results show the need for improvement in the control of syphilis during pregnancy

Ovarian cancer staging: What the surgeon needs to know.

Ovarian cancer (OC) is the leading cause of gynecological cancer death, and most cases are diagnosed at advanced stages due to a nonspecific and insidious clinical presentation. Radiologists play a critical role in the decision of which patients are candidates for primary debulking surgery and who may benefit from neoadjuvant chemotherapy. This pictorial review summarizes the dissemination patterns of OC, main imaging findings of metastatic disease, and which findings may alter the treatment plan or predict suboptimal tumor resection.

Impacto de programas de reabilitação respiratória na função respiratória de doentes COVID-19 em fase pós-aguda: uma revisão sistemática da literatura / Impact of respiratory rehabilitation programmes on respiratory function in post-acute COVID-19 patients: a systematic review of the literature

A reabilitação é um processo global e dinâmico que visa a recuperação física e psicológica da pessoa com incapacidade, tendo em vista a sua reintegração social, na qual diversos profissionais de saúde têm um papel fundamental, e nos quais se inclui o Enfermeiro Especialista em Enfermagem de Reabilitação (EEER). Na atual conjuntura da emergência de saúde pública que vivemos, torna-se fundamental desenhar o sistema de saúde de forma a potenciar as competências e intervenções de cada profissional, com o objetivo de tratar pessoas com COVID-19 e prevenir complicações associadas à doença. Objetivo: Determinar os resultados de programas de reabilitação respiratória na função respiratória de doentes COVID-19 em fase pós-aguda. Metodologia: Foi realizada uma revisão sistemática da literatura, identificando estudos científicos publicados sobre a temática em estudo, nas bases de dados Pubmed e Web of Science, tendo em consideração certos critérios de elegibilidade e exclusão definidos, segundo as recomendações de Cochrane e do PRISMA, que permitissem responder à questão de investigação: Qual o efeito de programas de reabilitação respiratória na função respiratória de doentes COVID-19 em fase pós-aguda? Resultados: Foram encontrados dois artigos que evidenciaram os efeitos do programa de reabilitação respiratória em doentes COVID-19 em fase pós-aguda. Os resultados foram visíveis e benéficos na função respiratória, na força muscular, equilíbrio, qualidade de vida e ansiedade, limitou o transtorno de stress pós-traumático, mas não apresentou melhoria no estado depressivo dos idosos nem na capacidade das atividades de vida diárias. Conclusões: Este trabalho de projeto demonstra que a reabilitação respiratória, com treino de exercício, proporciona melhoria significativa na capacidade de exercício em pacientes COVID-19. É também importante referir que quanto mais cedo a reabilitação respiratória for introduzida na fase pós-aguda e quanto maior a duração do programa de reabilitação respiratória, melhor os pacientes recuperaram a sua capacidade física.

Rehabilitation is a global and dynamic process that aims at the physical and psychological recovery of people with disabilities, in view of their social reintegration, in which several health professionals have a fundamental role, and which includes the Specialist Nursing Nurse in Rehabilitation (EEER). In the current conjuncture of the public health emergency that we are experiencing, it is essential to design the health system in order to enhance the skills and interventions of each professional, with the objective of treating people with COVID-19 and preventing complications associated with the disease. Objective - To determine the results of respiratory rehabilitation programs on the respiratory function of COVID-19 patients in the post-acute phase. Methodology - A systematic literature review was carried out, identifying published scientific studies on the subject under study, in the Pubmed and Web of Science databases, as well as the list of bibliographic references of the articles found, taking into account certain eligibility and exclusion criteria, according to the recommendations of Cochrane and PRISMA defined, that would answer the research question: What is the effect of respiratory rehabilitation programs on the respiratory function of COVID-19 patients in the post-acute phase?. Results - Two articles were found that evidenced the effects of the respiratory rehabilitation program in post-acute COVID-19 patients. They were visible and beneficial in respiratory function, muscle strength, balance, quality of life and anxiety, limited posttraumatic stress disorder, but did not showed improvement in the depressed state of the elderly or in the capacity of daily living activities Conclusions ­ This project work demonstrates that respiratory rehabilitation, with exercise training, provides significant improvement in exercise capacity in COVID-19 patients. It is also important to note that the sooner respiratory rehabilitation was introduced in the post-acute phase and the longer the duration of the respiratory rehabilitation program, the better the patients recovered their physical capacity.

Toxicity of the sawdust used for phosphorus recovery in a eutrophic reservoir: experiments with Lactuca sativa and Allium cepa.

Eutrophication is one of the environmental problems arising from the increase of essential nutrient concentrations, mainly phosphorus and nitrogen. In contrast to excess phosphorus, the depletion of phosphate rock deposits used for the production of fertilizers compromises the food supply. Therefore, the development of technologies that propose the recovery of the phosphorus contained in eutrophic environments for its later use for agricultural fertilization purposes is very important to ensure global food security. This work aimed to evaluate the toxic potential of the sawdust (biosorbent previously used for phosphorus adsorption) in order to enable its application in agriculture. For this, toxicity experiments with Lactuca sativa (lettuce) and Allium cepa (onion) seeds were performed. The phytotoxic potential was assessed by means of the seed germination index and physiological parameters such as radicle and hypocotyl growth. Cytotoxicity, genotoxicity, and mutagenicity tests were also performed on onion seeds. From statistical tests, it was possible to affirm that the sawdust did not promote inhibition of seed germination and radicle and hypocotyl growth. No genotoxicity, cytotoxicity and, mutagenicity were observed, which allowed to state that the sawdust is not toxic to the onion species, which reinforces the possibility of application of the biosorbent for soil fertilization purposes. Therefore, the use of sawdust for phosphorus biosorption with the subsequent agricultural application is promising and quite important from a global food security point of view.

Lung radiofrequency ablation: post-procedure imaging patterns and late follow-up.

PURPOSE: To describe expected imaging features on chest computed tomography (CT) after percutaneous radiofrequency ablation (RFA) of lung tumors, and their frequency over time after the procedure. METHODS: In this double-center retrospective study, we reviewed CT scans from patients who underwent RFA for primary or secondary lung tumors. Patients with partial ablation or tumor recurrence during the imaging follow-up were not included. The imaging features were assessed in pre-defined time points: immediate post-procedure, ≤4 weeks, 5-24 weeks, 25-52 weeks and ≥52 weeks. Late follow-up (3 and 5 years after procedure) was assessed clinically in 48 patients. RESULTS: The study population consisted of 69 patients and 144 pulmonary tumors. Six out of 69 (9%) patients had primary lung nodules (stage I) and 63/69 (91 %) had metastatic pulmonary nodules. In a patient-level analysis, immediately after lung RFA, the most common CT features were ground glass opacities (66/69, 96 %), consolidation (56/69, 81 %), and hyperdensity within the nodule (47/69, 68 %). Less than 4 weeks, ground glass opacities (including reversed halo sign) was demonstrated in 20/22 (91 %) patients, while consolidation and pleural thickening were detected in 17/22 patients (77 %). Cavitation, pneumatocele, pneumothorax and pleural effusions were less common features. From 5 weeks onwards, the most common imaging features were parenchymal bands. CONCLUSIONS: Our study demonstrated the expected CT features after lung RFA, a safe and effective minimally invasive treatment for selected patients with primary and secondary lung tumors. Diagnostic and interventional radiologists should be familiar with the expected imaging features immediately after RFA and their change over time in order to avoid misinterpretation and inadequate treatments.

Development of a simple method to quantify fipronil and its intermediates in soil.

A simple and reproducible method was developed and validated for simultaneous quantification of the pesticide fipronil and its intermediates fipronil desulfinyl, fipronil sulfone and fipronil sulfide, in soil. The analytes were extracted by ultrasonic bath and the ratio of solvents (hexane/acetone), number and time of cycles were optimized by Box-Behnken design with a triplicate central point. The optimal extraction conditions were achieved through a response surface analysis. The clean-up step was conducted by cartridges of solid phase extraction (SPE) containing silica (Florisil®) and aluminum oxide. Gas chromatography with electron capture detection (GC-ECD) was employed for separating fipronil and its intermediates with a suitable resolution and runtime of 20 minutes. The best quantification was achieved with 1 : 1 (v/v) acetone/hexane and 2 ultrasound cycles of 15 minutes each. The recovery values were between 81 to 108%, with relative standard deviation (RSD) lower than 6%, with no effect of the used matrix. Analytical curves presented regression coefficients values above 0.9908 for a concentration range from 0.005 to 0.6 µg g-1. Limits of detection (LOD) from 0.002 to 0.006 µg g-1 and limits of quantification (LOQ) from 0.006 to 0.020 µg g-1 were reached for all analytes. This method can be used to monitor and quantify fipronil and its intermediates in soil.

Uncommon Prostate Malignant Neoplasms.

Prostate adenocarcinoma is the most common prostate cancer; however, there are several other malignant neoplasms that radiologists should be familiar with. The histological classification of malignant prostate neoplasms includes epithelial tumors, mesenchymal tumors, neuroendocrine tumors, hematolymphoid tumors, and stromal tumors. Knowledge of the main clinical and prostate magnetic resonance imaging features of uncommon tumors beyond adenocarcinoma is important for radiologists to enlarge their diagnostic ability and guide referring physician regarding the appropriate patient workup.The aim of this review article is to (1) review the main anatomical and histological concepts of the prostate gland and (2) provide an overview of uncommon prostate malignant neoplasms, emphasizing the key clinical, pathological, and imaging findings that may help radiologists in their daily interpretation of prostate magnetic resonance imaging.

Urinary incontinence between 12 and 24 months postpartum: a cross-sectional study nested in a Brazilian cohort from two cities with different socioeconomic characteristics.

INTRODUCTION AND HYPOTHESIS: We aimed to identify the prevalence of urinary incontinence (UI) during the postpartum period (12-24 months) in two cities with different socioeconomic indicators in Brazil (Ribeirão Preto, SP, and São Luís, MA) and to determine associated risk factors. METHODS: A cross-sectional study nested in the Brazilian Ribeirão Preto and São Luís Birth Cohort Studies (BRISA) cohort was conducted in two Brazilian municipalities (Ribeirão Preto, and São Luís). A total of 13,214 women delivered in both cities (2010-2011). We interviewed 3,751 postpartum women in Ribeirão Preto and 3275 in São Luís (2011-2013). Univariate and multivariate analyses were performed to assess factors associated with postpartum UI for each municipality. RESULTS: The prevalence of self-reported UI at 12-24 months postpartum was 16.3% (611 out of 3,751) in Ribeirão Preto and 11.4% (375 out of 3,275) in São Luís (p < 0.001). The univariate analysis performed at Ribeirão Preto showed that women who were obese, who had diabetes or gestational diabetes and who presented with excessive weight gain during gestation presented an association with postpartum UI. However, only weight gain during pregnancy remained strongly associated with UI on multivariate analysis (p = 0.009; OR 1.041 [1.010-1.073]). On the other hand, in São Luís, no risk factors were associated with postpartum UI at univariate and multivariate analysis. CONCLUSIONS: The prevalence of UI was higher in Ribeirão Preto (higher socioeconomic level) than in São Luís. Weight gain during pregnancy was statistically associated with UI in Ribeirão Preto. No independent variables remained associated in the final model with UI in São Luís.

Factors associated with non-adherence to outpatient follow-up of neonatal intensive care discharge.

OBJECTIVE: To analyze the factors associated with non-adherence to the outpatient follow-up of infants discharged from the Neonatal Intensive Care Unit. METHOD: A cross-sectional study that included 596 children who were discharged between October 1, 2014 and September 30, 2015 and who were referred to outpatient follow-up. The data were collected by evaluating the discharge report and attendance to the consultations. RESULTS: Of the 596 children referred for follow-up, 118 (19.80%) did not attend any outpatient care in the 12 months after discharge. Children with gestational age at birth ≥37 weeks (odds ratio 1.97, p=0.013), who were not resuscitated at birth (odds ratio 1.79, p=0.032) and those without continuous use of medications at home (odds ratio 1.69, p=0.046) were more likely to not adhere to outpatient follow-up. CONCLUSION: The expressive number of non-adherence to follow-up indicates the need for actions to ensure care continuity to newborns at risk after hospital discharge. Although the differences pointed out cannot be defined as predictors of non-follow-up, evidence of these variables allows us to recognize risks and seek to reduce factors that influence abandoning follow-up care.

Quality Information about Uterine Fibroids on the Internet.

OBJECTIVE: There are no published studies analyzing the quality of the information for lay women on the Internet regarding uterine fibroids. The accuracy of the provided material is also unknown. Thus, we have performed a cross-sectional study with 381 websites in the English and Brazilian Portuguese languages between May and December 2017. METHODS: Two investigators performed the analysis, and the Cohen kappa coefficient was calculated to analyze the agreement between them. Search terms (uterine fibroids and derivatives) in the English and Brazilian Portuguese languages were used. The accuracy was analyzed by a 10-item checklist created based on the American Society for Reproductive Medicine (ASRM), National Institutes of Health (NIH) and European Menopause and Andropause Society (EMAS) consensuses about uterine fibroids. The item-test correlation and the intraclass coefficient were performed in the 16 questions from the DISCERN instrument, which was designed to measure the quality of health information on the Internet. Analysis of variance (ANOVA) measurements were performed for the independent variables and the DISCERN/accuracy scores. RESULTS: Google was the most used search engine, and uterine fibroid was the search term that generated most of the analyzed material. The median score for accuracy in all websites was 5 out of 10, and the median score of the DISCERN instrument was 38 out of 80. The top-scoring sites in the English language were derived from scientific organizations and federal governments, and they regarded the DISCERN score (The American College of Obstetricians and Gynecologists [ACOG], the Food and Drug Administration [FDA]) and the accuracy criteria (NIH, and FDA). On the other hand, in the Brazilian Portuguese language, the highest scores in both instruments were from magazines or physician's blogs. The Cronbach α test showed a higher correlation (0.77-0.79) between the sites and DISCERN; however, the item-test correlation varied from 0.39 to 0.56. CONCLUSION: There is a need to improve the quality of the information regarding uterine fibroids for lay women.

OBJETIVOS: Não existem estudos publicados analisando a qualidade de informação para mulheres leigas na internet sobre o leiomioma uterino. A acurácia do material existente também não é conhecida. Portanto, realizamos um estudo transversal envolvendo 381 sites em língua inglesa e portuguesa de maio a dezembro de 2017. MéTODOS: Dois pesquisadores fizeram a análise, e o coeficiente kappa de Cohen foi calculado para analisar a concordância entre ambos. Termos de pesquisa (leiomioma uterino e derivados) em inglês e português foram usados. A acurácia foi analisada por meio de uma lista de 10 itens criados após a fusão de consensos da Sociedade Americana de Medicina da Reprodução (ASRM, na sigla em inglês), dos Institutos Nacionais de Saúde (NIH, na sigla em inglês) e da Sociedade Europeia de Menopausa e Andropausa (EMAS, na sigla em inglês) sobre leiomioma uterino. A correlação item­teste e o coeficiente intraclasse foram realizados nas 16 questões do questionário DISCERN, um instrumento desenvolvido para medir a qualidade da informação de saúde disponível na internet. O método de análise de variância (ANOVA, na sigla em inglês) foi utilizado para as variáveis independentes e as pontuações de acurácia e do DISCERN. RESULTADOS: O Google foi a ferramenta mais utilizada, e o leiomioma uterino foi o termo de busca que gerou a maior parte do material analisado. A pontuação média para a acurácia dos websites foi 5/10, e do questionário DISCERN, 38/80. Os sites de língua inglesa com maior pontuação foram os de organizações científicas e de governos federais, tanto no questionário DISCERN (Faculdade Americana de Obstetrícia e Ginecologia [ACOG, na sigla em inglês], Administração de Alimentos e Medicamentos [FDA, na sigla em inglês]) quanto na acurácia (NIH e FDA). Entretanto, em língua portuguesa, os sites com as maiores pontuações em ambos os instrumentos foram de revistas ou blogs médicos. O teste α de Cronbach evidenciou maior correlação entre os sites e o DISCERN (0,77­0,79); contudo, a correlação item­teste variou de 0,39 a 0,56. CONCLUSãO: Há necessidade de melhorar a qualidade da informação sobre o leiomioma uterino para mulheres leigas.

Quality information about uterine fibroids on the internet / Qualidade da informação presente na Internet sobre Leiomioma uterino

Abstract Objective There are no published studies analyzing the quality of the information for lay women on the Internet regarding uterine fibroids. The accuracy of the provided material is also unknown. Thus, we have performed a cross-sectional study with 381 websites in the English and Brazilian Portuguese languages between May and December 2017. Methods Two investigators performed the analysis, and the Cohen kappa coefficient was calculated to analyze the agreement between them. Search terms (uterine fibroids and derivatives) in the English and Brazilian Portuguese languages were used. The accuracywas analyzed by a 10-itemchecklist created based on the American Society for Reproductive Medicine (ASRM), National Institutes of Health (NIH) and European Menopause and Andropause Society (EMAS) consensuses about uterine fibroids. The item-test correlation and the intraclass coefficient were performed in the 16 questions from the DISCERN instrument, which was designed to measure the quality of health information on the Internet. Analysis of variance (ANOVA) measurements were performed for the independent variables and the DISCERN/accuracy scores. Results Google was the most used search engine, and uterine fibroid was the search term that generatedmost of the analyzed material. The median score for accuracy in all websites was 5 out of 10, and the median score of the DISCERN instrument was 38 out of 80. The top-scoring sites in the English language were derived from scientific organizations and federal governments, and they regarded the DISCERN score (The American College of Obstetricians and Gynecologists [ACOG], the Food and Drug Administration [FDA]) and the accuracy criteria (NIH, and FDA). On the other hand, in the Brazilian Portuguese language, the highest scores in both instruments were from magazines or physician's blogs. The Cronbach α test showed a higher correlation (0.77-0.79) between the sites and DISCERN; however, the item-test correlation varied from 0.39 to 0.56. Conclusion There is a need to improve the quality of the information regarding uterine fibroids for lay women.

Resumo Objetivos Não existem estudos publicados analisando a qualidade de informação para mulheres leigas na internet sobre o leiomioma uterino. A acurácia do material existente também não é conhecida. Portanto, realizamos um estudo transversal envolvendo 381 sites em língua inglesa e portuguesa de maio a dezembro de 2017. Métodos Dois pesquisadores fizeram a análise, e o coeficiente kappa de Cohen foi calculado para analisar a concordância entreambos. Termos de pesquisa (leiomioma uterino e derivados)eminglês e português foramusados. A acurácia foi analisada por meio de uma lista de 10 itens criados após a fusão de consensos da Sociedade Americana de Medicina da Reprodução (ASRM, na siglaeminglês), dos InstitutosNacionais de Saúde (NIH, na siglaem inglês) e da Sociedade Europeia de Menopausa e Andropausa (EMAS, na sigla em inglês) sobre leiomioma uterino. A correlação item-teste e o coeficiente intraclasse foram realizados nas 16 questões do questionário DISCERN, um instrumento desenvolvido para medir a qualidade da informação de saúde disponível na internet. O método de análise de variância (ANOVA, na sigla em inglês) foi utilizado para as variáveis independentes e as pontuações de acurácia e do DISCERN. Resultados O Google foi a ferramenta mais utilizada, e o leiomioma uterino foi o termo de busca que gerou a maior parte do material analisado. A pontuação média para a acurácia dos websites foi 5/10, e do questionário DISCERN, 38/80. Os sites de língua inglesa commaior pontuação foram os de organizações científicas e de governos federais, tanto no questionário DISCERN (Faculdade Americana de Obstetrícia e Ginecologia [ACOG, na sigla em inglês], Administração de Alimentos e Medicamentos [FDA, na sigla em inglês]) quanto na acurácia (NIH e FDA). Entretanto, em língua portuguesa, os sites com as maiores pontuações em ambos os instrumentos foram de revistas ou blogs médicos. O teste α de Cronbach evidenciou maior correlação entre os sites e o DISCERN (0,77-0,79); contudo, a correlação item-teste variou de 0,39 a 0,56. Conclusão Há necessidade demelhorar a qualidade da informação sobre o leiomioma uterino para mulheres leigas.

Torsion of a giant antimesenteric lipoma of the sigmoid: a rare cause of acute abdomen.

Lipomas of the gastrointestinal tract are uncommon benign tumors of mature adipocytes and may occur in any portion along the gut. Depending on location they may have a variety of clinical presentations and even simulate malignant neoplasms. We report a case of a 58-year-old woman who presented with acute pelvic pain. An emergency sonogram detected a hyperechogenic mass in the left adnexal region, with no vascularization on Doppler. A computed tomography confirmed the hypothesis of a fat containing tumor with signals of torsion. The patient underwent laparoscopy which depicted a mass over the antimesenteric side of the sigmoid with signs of ischemia and twisted vascular pedicle. The lesion was resected, and the microscopy confirmed the diagnosis of lipoma. The multidisciplinary team in the emergency room must be aware of these possible complications in order to optimize patient care.

Ropivacaine use in transnasal sphenopalatine ganglion block for post dural puncture headache in obstetric patients - case series / Uso de ropivacaína em bloqueio do gânglio esfenopalatino via transnasal para cefaleia pós-punção dural em pacientes obstétricas - série de casos

Abstract Purpose Sphenopalatine ganglion block is widely accepted in chronic pain; however it has been underestimated in post dural puncture headache treatment. The ganglion block does not restore normal cerebrospinal fluid dynamics but effectively reduces symptoms associated with resultant hypotension. When correctly applied it may avoid performance of epidural blood patch. The transnasal approach is a simple and minimally invasive technique. In the cases presented, we attempted to perform and report the ganglion block effectiveness and duration, using ropivacaine. Clinical features We present four obstetrics patients with post dural puncture headache, after epidural or combined techniques, with Tuohy needle 18G that underwent a safe and successful sphenopalatine ganglion block. We performed the block 24-48 h after dural puncture, with 4 mL of ropivacaine 0.75% in each nostril. In three cases pain recurred within 12-48 h, although less intense. In one patient a second block was performed with complete relief and without further recurrence. In the other two patients a blood patch was performed without success. All patients were asymptomatic within 7 days. Conclusion The average duration of analgesic effect of the block remains poorly defined. In the cases reported, blocking with ropivacaine was a simple, safe and effective technique, with immediate and sustained pain relief for at least 12-24 h.

Resumo Justificativa e objetivo O bloqueio do gânglio esfenopalatino é amplamente aceito em dor crônica; porém, esse bloqueio tem sido subestimado no tratamento de cefaleia pós-punção dural. O bloqueio do gânglio não restaura a dinâmica normal do líquido cefalorraquidiano, mas reduz de modo eficaz os sintomas associados à hipotensão resultante. Quando aplicado corretamente, pode evitar a realização de tampão sanguíneo epidural. A abordagem transnasal é uma técnica simples e minimamente invasiva. Nos casos apresentados, tentamos realizar o bloqueio do gânglio e relatar sua eficácia e duração usando ropivacaína. Características clínicas Apresentamos quatro pacientes de obstetrícia com cefaleia pós-punção dural, após técnica epidural ou técnicas combinadas, com agulha Tuohy (18 G), que foram submetidas ao bloqueio do gânglio esfenopalatino de forma segura e bem-sucedida. Realizamos o bloqueio após 24 a 48 horas da punção dural, com 4 mL de ropivacaína a 0,75% em cada narina. Em três casos, a dor voltou em 1-48 horas, embora menos intensa. Em uma paciente, um segundo bloqueio foi realizado com alívio completo e sem recorrência. Nas outras duas pacientes, um tampão sanguíneo foi feito sem sucesso. Todas as pacientes estavam assintomáticas dentro de sete dias. Conclusão A duração média do efeito analgésico do bloqueio continua mal definida. Nos casos relatados, o bloqueio com ropivacaína foi uma técnica simples, segura e eficaz, com alívio imediato e prolongado da dor durante pelo menos 12-24 horas.

Equilibrium and kinetic studies of the adsorption of antibiotics from aqueous solutions onto powdered zeolites.

The performances of two FAU-type zeolites with different SiO2/Al2O3 ratios were evaluated for the removal of antibiotics of three different classes, namely azithromycin, ofloxacin, and sulfamethoxazole, from aqueous solutions. Commercial zeolites were used, without any previous treatment. Use of a small adsorbent dosage resulted in fast antibiotic adsorption that followed pseudo-second order kinetics. The removals of azithromycin and sulfamethoxazole were highly pH-dependent, with low removal percentages observed under acid (pH 2.5-4.5) and basic (pH 8.5-10.5) conditions, respectively. The Freundlich isotherm model provided the best fits to the adsorption data. The adsorption mechanisms appeared to involve both electrostatic and H-bonding interactions. Using an antibiotics mixture, percentage removals of azithromycin and ofloxacin onto the zeolites of up to 79% were obtained. Both materials presented good adsorption (>50%) of azithromycin and ofloxacin from a real sample of effluent wastewater. The results showed that zeolites with FAU structure can be used as effective adsorbents for the removal of antibiotics with different physicochemical properties, including molecules with large volumes, such as azithromycin.

[Ropivacaine use in transnasal sphenopalatine ganglion block for post dural puncture headache in obstetric patients - case series]. / Uso de ropivacaína em bloqueio do gânglio esfenopalatino via transnasal para cefaleia pós­punção dural em pacientes obstétricas ­ série de casos.

PURPOSE: Sphenopalatine ganglion block is widely accepted in chronic pain; however it has been underestimated in post dural puncture headache treatment. The ganglion block does not restore normal cerebrospinal fluid dynamics but effectively reduces symptoms associated with resultant hypotension. When correctly applied it may avoid performance of epidural blood patch. The transnasal approach is a simple and minimally invasive technique. In the cases presented, we attempted to perform and report the ganglion block effectiveness and duration, using ropivacaine. CLINICAL FEATURES: We present four obstetrics patients with post dural puncture headache, after epidural or combined techniques, with Tuohy needle 18G that underwent a safe and successful sphenopalatine ganglion block. We performed the block 24-48h after dural puncture, with 4mL of ropivacaine 0.75% in each nostril. In three cases pain recurred within 12-48h, although less intense. In one patient a second block was performed with complete relief and without further recurrence. In the other two patients a blood patch was performed without success. All patients were asymptomatic within 7 days. CONCLUSION: The average duration of analgesic effect of the block remains poorly defined. In the cases reported, blocking with ropivacaine was a simple, safe and effective technique, with immediate and sustained pain relief for at least 12-24h.

Spatio-temporal evaluation of emerging contaminants and their partitioning along a Brazilian watershed.

The occurrence, partitioning, and spatio-temporal distribution of seven pharmaceuticals for human use, three steroid hormones and one personal care product were determined in surface water, suspended particulate matter (SPM), and sediment of Piraí Creek and Jundiaí River (Jundiaí River Basin, São Paulo, Brazil). The maximum average detected concentrations of the compounds in the Piraí River samples were < 30 ng L-1, except for caffeine (222 ng L-1). In Jundiaí River samples, most of the compounds were frequently detected, wherein caffeine had the highest concentration, with maximum average concentrations of 14,050 ng L-1, followed by atenolol (431 ng L-1), ibuprofen (268 ng L-1) and diclofenac (214 ng L-1). Atenolol, propranolol, estrone, and triclosan were the contaminants most frequently detected in sediment and SPM samples. Triclosan had the highest average proportion of SPM as opposed to in the aqueous phase (> 75%). Contaminants with acid functional groups showed, in general, a lower tendency to bind to particulate matter and sediments. In addition, hydrophobicity had an important effect on their environmental partitioning. The spatial distribution of contaminants along the Jundiaí River was mainly affected by the higher concentration of contaminants in water samples collected downstream from a sewage treatment plant (STP). The results obtained here clearly showed the importance of the analysis of some contaminants in the whole water, meaning both dissolved and particulate compartments in the water, and that the partitioning is ruled by a set of parameters associated to the physicochemical characteristics of contaminants and the matrix properties of the studied, which need be considered in an integrated approach to understand the fate of emerging chemical contaminants in aquatic environments.

Factors associated with non-adherence to outpatient follow-up of neonatal intensive care discharge / Fatores associados à não adesão ao seguimento ambulatorial de egressos de terapia intensiva neonatal / Factores asociados a la no adhesión al seguimiento ambulatorio de egresados de terapia intensiva neonatal

ABSTRACT Objective: To analyze the factors associated with non-adherence to the outpatient follow-up of infants discharged from the Neonatal Intensive Care Unit. Method: A cross-sectional study that included 596 children who were discharged between October 1, 2014 and September 30, 2015 and who were referred to outpatient follow-up. The data were collected by evaluating the discharge report and attendance to the consultations. Results: Of the 596 children referred for follow-up, 118 (19.80%) did not attend any outpatient care in the 12 months after discharge. Children with gestational age at birth ≥37 weeks (odds ratio 1.97, p=0.013), who were not resuscitated at birth (odds ratio 1.79, p=0.032) and those without continuous use of medications at home (odds ratio 1.69, p=0.046) were more likely to not adhere to outpatient follow-up. Conclusion: The expressive number of non-adherence to follow-up indicates the need for actions to ensure care continuity to newborns at risk after hospital discharge. Although the differences pointed out cannot be defined as predictors of non-follow-up, evidence of these variables allows us to recognize risks and seek to reduce factors that influence abandoning follow-up care.

RESUMO Objetivo: Analisar os fatores associados à não adesão ao seguimento ambulatorial de crianças egressas da Unidade de Terapia Intensiva Neonatal. Método: Estudo transversal, que incluiu 596 crianças que receberam alta entre 1º de outubro de 2014 e 30 de setembro de 2015 e foram encaminhadas para o seguimento ambulatorial. Os dados foram coletados por meio de avaliação do relatório de alta e acompanhamento da assiduidade às consultas. Resultados: Das 596 crianças encaminhadas ao seguimento, 118 (19,80%) não compareceram a nenhum atendimento ambulatorial nos 12 meses após a alta. Crianças com idade gestacional ao nascimento ≥37 semanas (odds ratio 1,97, p=0,013), que não foram reanimadas ao nascimento (odds ratio 1,79, p=0,032) e sem uso contínuo de medicamentos no domicílio (odds ratio 1,69, p=0,046) tiveram maiores chances de não aderirem ao seguimento ambulatorial. Conclusão: O número expressivo de não adesão ao seguimento indica a necessidade de ações para garantir a continuidade da assistência ao recém-nascido de risco após a alta hospitalar. Ainda que as diferenças identificadas não permitam ser definidas como preditoras do não seguimento, evidenciar essas variáveis permite-nos reconhecer riscos e buscar reduzir os fatores que influenciam o abandono do seguimento.

RESUMEN Objetivo: Analizar los factores asociados a la no adhesión al seguimiento ambulatorio de niños egresados de la Unidad de Terapia Intensiva Neonatal. Método: Estudio transversal, que incluyó a 596 niños que recibieron alta entre el 1 de octubre de 2014 y el 30 de septiembre de 2015 y fueron derivados para el seguimiento ambulatorio. Los datos fueron recolectados por medio de evaluación del informe de alta y seguimiento de la asistencia a las consultas. Resultados: De los 596 niños encaminados al seguimiento, 118 (19,80%) no asistieron a ninguna atención ambulatoria en los 12 meses después del alta. Los niños con edad gestacional al nacer ≥37 semanas (odds ratio 1,97, p=0,013), que no fueron reanimados al nacer (odds ratio 1,79, p=0,032) y sin uso continuo de medicamentos a domicilio (odds ratio 1), 69, p=0,046) tuvieron mayores posibilidades de no adherir al seguimiento ambulatorio. Conclusión: El número expresivo de no adhesión al seguimiento indica la necesidad de acciones para garantizar la continuidad de la asistencia al recién nacido de riesgo después del alta hospitalaria. Aunque las diferencias identificadas no permitan ser definidas como predictores del no seguimiento, evidenciar esas variables nos permite reconocer riesgos y buscar reducir los factores que influyen en el abandono del seguimiento.