Identification and bioinformatic analysis of invA gene of Salmonella in free range chicken / Identificação e análise bioinformática do gene invA de Salmonella em frango caipira

Salmonella is a serious cause of the health issues in human and animal worldwide. Salmonella has been isolated from different biological samples and it considers as the key role in induction of inflammation of gastrointestinal tract which in turn cause diarrhoea in different species. To further understand the involvement of Salmonella in contaminating and infecting fresh eggs and meat of free-range chicken. This study aimed to establish the microbiological and molecular detections of Salmonella in the cloaca of the free-range chicken and to identify predicted biological functions using Kyoto Encyclopedia of Gene and Genomic (KEGG) pathways and protein-protein interaction. Cloacal swabs were collected from free range chicken raised in the local farm in Duhok city. The isolates were cultured and biochemical test performed using XLD and TSI, respectively. Molecular detection and functional annotation of invA gene was carried out using Conventional PCR and bioinformatics approaches. The present study found that Salmonella was detected in 36 out of 86 samples using microbiological methods. To confirm these findings, invA gene was utilised and 9 out of 36 Salmonella isolates have shown a positive signal of invA by agarose gel. In addition, bioinformatic analysis revealed that invA gene was mainly associated with bacterial secretion processes as well as their KEGG terms and Protein-Protein Interaction were involved in bacterial invasion and secretion pathways. These findings suggested that invA gene plays important role in regulating colonization and invasion processes of Salmonella within the gut host in the free range chicken.

A salmonela é uma causa séria de problemas de saúde em humanos e animais em todo o mundo. Salmonella tem sido isolada de diferentes amostras biológicas e é considerada como o principal papel na indução da inflamação do trato gastrointestinal que por sua vez causa diarreia em diferentes espécies. Compreender melhor o envolvimento da Salmonella na contaminação e infecção de ovos frescos e carne de frango caipira. Este estudo teve como objetivo estabelecer as detecções microbiológicas e moleculares de Salmonella na cloaca da galinha caipira e identificar as funções biológicas previstas usando as vias da Enciclopédia de Gene e Genômica de Kyoto (KEGG) e interação proteína-proteína. Suabes cloacais foram coletados de galinhas criadas ao ar livre em fazenda local na cidade de Duhok. Os isolados foram cultivados e o teste bioquímico realizado com XLD e TSI, respectivamente. A detecção molecular e anotação funcional do gene invA foi realizada usando PCR convencional e abordagens de bioinformática. O presente estudo descobriu que Salmonella foi detectada em 36 das 86 amostras usando métodos microbiológicos. Para confirmar esses achados, o gene invA foi utilizado e 9 dos 36 isolados de Salmonella mostraram um sinal positivo de invA pelo gel de agarose. Além disso, a análise bioinformática revelou que o gene invA estava associado principalmente a processos de secreção bacteriana, assim como seus termos KEGG e interação proteína-proteína estavam envolvidos na invasão bacteriana e nas vias de secreção. Esses achados sugeriram que o gene invA desempenha um papel importante na regulação dos processos de colonização e invasão de Salmonella dentro do hospedeiro intestinal na galinha caipira.

[Quality of life in institutionalized older adults with moderate to severe major neurocognitive disorder: Effect of Doll therapy]. / Calidad de vida en adultos mayores con trastorno neurocognitivo mayor moderado a grave institucionalizados: efecto de la Doll Therapy.

BACKGROUND AND OBJECTIVES: Major neurocognitive disorder is characterized by progressive cognitive impairment, a decrease in the person's ability to perform activities of daily living and the appearance of psychological and behavioral symptoms that lead to a deterioration in the quality of life and progression towards institutionalization. The most common management of major neurocognitive disorder is pharmacological therapy that mitigates or slow progressive deterioration and symptom control. The objective of this study was to establish the effect of a nursing intervention based on Doll therapy, compared to conventional care on the quality of life of older adults with moderate to severe major neurocognitive disorder institutionalized in nursing homes in the city of Medellín, Colombia. METHODS: Pilot experimental study with two groups and pretest post-test measurement. The sample consisted of 26 institutionalized elderly adults with advanced-stage major neurocognitive disorder, randomly assigned to each group. The experimental group received Doll therapy, based nursing therapy, while the comparison group continued to receive conventional therapy according to the institution's protocol. The QUALID instrument was used, which was evaluated by professionals external to the care centers. RESULTS: The comparison of the groups, before and after the intervention, indicates that the experimental group showed a positive effect on quality of life, supported by the statistical significance of the data, with a moderate effect. CONCLUSIONS: The Doll therapy as a non-pharmacological therapy has a positive effect on the quality of life of patients with moderate to severe major neurocognitive disorder, which constitutes a contribution to strengthen the knowledge associated with the effects or this intervention.

Evolución de la pérdida sanguínea en la prótesis total de rodilla con recuperador de sangre vs drenaje convencional / Evolution of blood loss in total knee prosthesis with blood recovery system vs conventional drainage

Resumen: Introducción: la cirugía protésica total de rodilla (PTR) se puede asociar a pérdidas sanguíneas (PS) significativas. El objetivo es analizar la evolución de la PS tras PTR con recuperador sanguíneo vs drenaje convencional. Material y métodos: estudio prospectivo de dos grupos de 30 pacientes intervenidos de PTR, uno control (GC) y otro estudio con recuperador (GR). Se analizó la PS, hematocrito (Hcto), hemoglobina (Hb), tensión arterial sistólica (TAS) y diastólica (TAD) y frecuencia cardíaca (FC) a las tres, 24, 48, 72 y 96 horas postquirúrgicas, la necesidad de transfusión, el porcentaje de altas en 72 horas y las complicaciones. Resultados: la mayor PS y porcentaje de cambio de Hcto y Hb se produjo a las tres horas postquirúrgicas e inició su recuperación a las 72 horas en el GR (Hcto, p = 0.02) (Hb, p = 0.04) y a las 96 horas en el GC. La TAS, TAD y FC empezó su recuperación a las 72 horas en ambos grupos. El descenso de TAS fue mayor en el GC a las tres horas (p = 0.02), 24 horas (p = 0.02) y 48 horas (p = 0.01) postquirúrgicas. Veinte y 33% de los pacientes fueron transfundidos, además 20 y 74% fueron dados de alta a las 72 horas en el GC y GR, respectivamente. Conclusión: la mayor PS y porcentaje de cambio de Hcto y Hb se produce a las tres horas postquirúrgicas y empieza su recuperación a las 72-96 horas. El recuperador favorece la recuperación del Hcto, Hb y TAS, disminuye la necesidad de transfusión y favorece el alta precoz.

Abstract: Introduction: knee prosthetic surgery can be associated with significant blood loss that can account for up to 20% of blood volume. The objective of our study is to analyze blood loss (BL) after total knee replacement (TKR), with the use of a blood recovery system vs a normal drain. Material and methods: prospective, comparative, and observational study of two groups of 30 patients who underwent TKR, one control (CG) and another study group with a recovery system (RG). We analyzed PS, hemoglobin (Hb), hematocrit (Htc), systolic blood pressure (SBP) and diastolic blood pressure (DBP) and heart rate (HR) at 3-, 24-, 48-, 72- and 96-hours post-surgery, the need for transfusion, and the percentage of discharges in 72 hours and complications. Results: the highest percentage of change in Htc and Hb occurred in the first 3 hours post-surgery and recovery began at 72 hours in the RG (p = 0.02) and at 96 hours in the CG (p = 0.04). The decrease in Hb and Htc began his recovery at 72 hours in the RG and at 96 hours in the CG. The TAS, TAD and FC began their recovery at 72 hours in both groups. The decrease in SBP was greater in the CG at 3 hours (p = 0.02), 24 hours (p = 0.02) and 48 hours (p = 0.01) post-surgery. Six patients were transfused in RG and 10 in CG (p = 0.22). 20% and 74% of the patients were discharged at 72 hours in the CG and RG, respectively. Conclusion: the greatest BL occurs in the first 3 hours post-surgery and recovery begins at 72-96 hours. Recovery blood system decreases BL during the first 3 hours, enhance the recuperation of Hb and SBP, decreases the need for transfusion and favors early discharge.

Is just considering texture enough to define compaction on the basis of soil density? / Considerar apenas a textura é suficiente para definir a compactação a patir da densidade do solo?

The bulk density values indicative of compaction in clayey soils correspond to a wide range of values (1.30-1.47 Mg m-3), due to the diverse types of soil management. Our hypothesis is that if we consider bulk density values within similar management groups (those that fall to the ground and those that do not fall), the values will be more accurate within each management group. Our objective in this work was to analyze using the concepts of (Yates & Cochran, 1938; Whitehead, 2002) what is a suitable statistical way of grouping these results to reach a consensus regarding a tested hypothesis, the greatest number of density values surveyed between 1977 and 2021, considered for the study of compaction in clayey Oxisols under different managements, to verify whether our hypothesis will be confirmed. We selected 1,521 studies with bulk densities in the literature, corresponding to 44 years (1977 and 2021), which were analyzed by a statistical technique that integrates the results of two or more independent studies on the same subject and combines them into a summary measure (portion forestry). From the data collected in the literature, it was possible to separate two groups of bulk density and management in clayey soils indicative of compaction: the managements that perform little or no manipulation of the soil, such as pasture and no-tillage, densities between 1.41-1.45 Mg.m-3 (average 1.43 Mg m-3), and for the others, such as conventional plowing and minimum tillage, soil densities between 1.31-1.38 Mg.m-3 (average 1.35 Mg m-3). Finally, we conclude that compaction must be analyzed considering the texture and type of soil management.(AU)

Os valores de densidade do solo indicativos de compactação em solos argilosos correspondem a uma ampla faixa de valores (1,30-1,47 Mg m-3), devido aos diversos tipos de manejo do solo. Nossa hipótese é que se considerarmos os valores de densidade do solo dentro de grupos de manejo semelhantes (os que caem no chão e os que não caem), os valores serão mais precisos dentro de cada grupo de manejo. Nosso objetivo neste trabalho foi analisar usando os conceitos de (Yates & Cochran, 1938; Whitehead, 2002) qual é uma forma estatística adequada de agrupar esses resultados para chegar a um consenso sobre uma hipótese testada, o maior número dos valores de densidade levantados entre 1977 e 2021, considerados para o estudo da compactação em Latossolos argilosos sob diferentes manejos, para verificar se nossa hipótese será confirmada. Selecionamos 1.521 estudos com densidades do solo na literatura, correspondentes a 44 anos (1977 e 2021), que foram analisados por uma técnica estatística que integra os resultados de dois ou mais estudos independentes sobre o mesmo assunto e os combina em uma medida resumida (forest plot). A partir dos dados levantados na literatura, foi possível separar dois grupos de densidade do solo e manejo em solos argilosos indicativos de compactação: os manejos que realizam pouca ou nenhuma manipulação do solo, como pastagem e plantio direto, densidades entre 1,41 -1,45 Mg.m-3 (média 1,43 Mg m-3), e para as demais, como aração convencional e preparo mínimo, densidades de solo entre 1,31-1,38 Mg.m-3 (média 1,35 Mg m-3). Por fim, concluímos que a compactação deve ser analisada considerando a textura e o tipo de manejo do solo.(AU)

Agronomic performance of Humuluslupulus L. varieties cultivated in organic and conventional systems in São Paulo center-west, Brazil / Desempenho agronômico de variedades de Humulus lupulus L. cultivadas em sistema orgânico e convencional no centro-oeste paulista, Brasil

Hop is a multifunctional specie; however, a large part of its production is destined for the beer market. In Brazil, all hop demand is imported, which has aroused interest in national production. Genetic material and cultivation systems can influence hops production. Thus, this study evaluated morphological and productive performance of hop varieties grown under organic and conventional management in the central-west region of São Paulo, Brazil. The hop yard was installed in the experimental area of the FCA/UNESP (São Paulo State University, School of Agriculture) - Botucatu, in November 2018, the data were collected in second year of production. A randomized block design was adopted, in 2 x 5 Split-Plot, being the main factor: cultivation systems (organic and conventional), and secondary factor: hop varieties (Columbus, Chinook, Nugget, Cascade, and HallertauMittelfrüeh), with four blocks and four plants per plot. Crop-specific morphological and productive parameters were evaluated. The results showed no significant influence of cultivation systems in morphological parameters. Regarding the varieties, Chinook, Cascade, and Nugget stand out for cone length. Columbus, Chinook and Cascade showed higher yields when grown in organic system, obtaining 1100.66, 1088.27 and 940.40 g of cones per plant, respectively. While, HallertauMittelfrüeh variety was the least productive in both systems, in organic system with 160.50 g per plant production, and 267.84 g per plant in conventional system, and, also showing lower cycle compared to the others.

O lúpulo é uma espécie multifuncional, entretanto, grande parte de sua produção é destinada ao mercado cervejeiro. No Brasil, toda a demanda de lúpulo é importada, o que tem despertado interesse pela produção nacional. Fatores como o material genético e sistemas de produção podem influenciar na produção do lúpulo, sendo assim, o trabalho teve como objetivo avaliar o desempenho morfológico e produtivo de variedades de lúpulo cultivadas sob manejo orgânico e convencional na região centro-oeste paulista, Brasil. O campo de lúpulo foi instalado na área experimental da FCA/UNESP - Botucatu, em novembro de 2018 e os dados coletados no segundo ano de produção. Foi adotado o delineamento de blocos casualizados, em esquema de parcelas subdivididas 2 x 5, sendo o fator principal os dois sistemas de cultivo (orgânico e convencional) e fator secundário as cinco variedades selecionadas (Columbus, Chinook, Nugget, Cascade e Hallertau Mittelfrüeh), com quatro blocos e quatro plantas por parcela. Foram avaliados os parâmetros morfológicos e produtivos específicos da cultura. Os resultados demonstraram que os sistemas de cultivo não promovem alterações significativas nos parâmetros morfológicos. Quanto às variedades, destaca-se Chinook, Cascade e Nugget para comprimento de cone. Columbus, Chinook e Cascade apresentaram maiores produções quando cultivadas em sistema orgânico, obtendo 1100,66; 1088,27 e 940,40 g de cones por planta, respectivamente. Enquanto que, a variedade Hallertau Mittelfrüeh foi a menos produtiva em ambos os sistemas, no sistema orgânico com produção de 160,50 g por planta, enquanto que no convencional 267,84 g por planta, apresentando também menor ciclo quando comparada com as demais.

Survival and distribution of weedy rice seedbank after twenty-two years of different rice cropping systems / Sobrevivência e distribuição do banco de sementes de arroz daninho após 22 anos de cultivo de arroz em diferentes sistemas

ABSTRACT: Weedy rice (Oryza sativa L.) is the most problematic weed in rice fields due to the few control management alternatives to control it, because of the genetic similarity with the crop. Different cropping systems (regarding soil preparation before sowing) have been used as options to control the persistence and emergence of the weed seedbank. Therefore, the objective of this study was to evaluate the longevity and vertical distribution of weedy rice seeds in the soil seedbank after 22 years of different rice cropping systems. Data was analyzed as a two-way factorial, with cropping systems carried out for 22 years [no-tillage (NT), conventional tillage (CT), wet direct-seeded (WDS)] as one factor and sampling depth (0-2, 2-5, 5-10 and 10-20 cm) as the other factor. The number of whole and deteriorated seeds per m-2 were assessed, as well as the viability (%). No effect between the systems were detected up to 5 cm, however at 5-10 cm CT and WDS showed higher amount of seeds, and WDS at 10-20 cm. As the sampling depth increased, NT showed fewer amount of seeds, while less reduction of the soil seedbank was observed in WDS. CT and WDS spread viable seeds in the soil profile from 0 to 20 cm depth. After 22 years there are viable weedy rice seeds up to 10 cm of depth in the three cropping systems and there is no difference among them up to 5 cm of depth, demonstrating the serious problem of the seedbank for this species.

RESUMO: O arroz daninho (Oryza sativa L.) é a principal planta daninha do arroz cultivado e, devido à similaridade genética com a cultura, são poucas as alternativas de controle. Uma possibilidade são os sistemas de cultivo, em razão da influência na emergência e sobrevivência da espécie no banco de sementes do solo. Diante disso, o trabalho objetivou avaliar a longevidade e a distribuição das sementes de arroz daninho no perfil do solo, após 22 anos de cultivo, sob diferentes sistemas. Os tratamentos foram arranjados em esquema fatorial, em que o fator A foi composto por três sistemas de cultivo, realizados consecutivamente durante 22 anos, sendo esses: semeadura direta (SD), sistema convencional (SC) e pré-germinado (PG); e, o fator B composto por quatro profundidades de amostragem: 0-2, 2-5, 5-10 e 10-20 cm. As variáveis avaliadas foram: o número de sementes íntegras e deterioradas m-2; e, a porcentagem de viabilidade. Não foi verificado efeito dos sistemas até 5 cm, mas a 5-10 cm SC e PG mostraram maior quantidade de sementes, e PG a 10-20 cm. A SD proporcionou diminuição de sementes íntegras conforme aumentou a profundidade de amostragem, enquanto o sistema PG elimina menos sementes do banco de sementes do solo. Os sistemas SC e PG distribuem sementes viáveis no perfil do solo de 0 a 20 cm de profundidade. Após 22 anos, nos três sistemas de cultivo há sementes de arroz daninho viáveis até 10 cm de profundidade, sendo igual a quantidade de sementes viáveis até cinco centímetros de profundidade.

Plasma rico en plaquetas autólogo en la cicatrización de heridas por cirugía electiva, ¿mito o realidad? Estudio prospectivo experimental / Autologous platelet rich plasma in the healing of wounds by elective surgery, myth or reality? Experimental prospective study

El plasma rico en plaquetas es un producto biológico definido como parte de la fracción plasmática de sangre autóloga con concentración plaquetaria por encima de la línea de base, considerándose como tecnología terapéutica endógena con potencial para estimular y acelerar la cicatrización de los tejidos.Objetivo : Evaluar el uso del plasma rico en plaquetas autólogo en la cicatrización de heridas quirúrgicas de pacientes intervenidos por colecistectomía convencional electiva en el Hospital General Nacional "Dr. Ángel Larralde".Métodos : Estudio cohorte, observacional y analítico, con diseño experimental, prospectivo, de corte longitudinal. Muestra no probabilística, intencional, conformada por pacientes ajustados a criterios de inclusión. Ficha de Recolección de Datos diseñada con las escalas de Vancouver y de Evaluación Objetiva de Paciente y Observador. Los resultados obtenidos se tabularon en una matriz de datos realizada con Microsoft®Excel y, posteriormente, presentados por medio de tablas de distribución de frecuencias y gráficos. Para el análisis e interpretación de los resultados, se recurrió al programa SPSS 26®, de licencia libre. Se utilizó el estadístico Chi Cuadrado.Resultados : Total de 26 pacientes: grupo de estudio con 11 pacientes, grupo control con 15 pacientes. Se calculó valor de p para ambas escalas, resultando˂ 0.05 en todas las observaciones. Conclusión : Se observó una evolución satisfactoria evidente en los pacientes a los cuales se les aplicó el PRP respecto al grupo control, de manera que apoya la premisa de que el PRP contribuye a una cicatrización rápida, sin complicaciones y de fácil obtención(AU)

Platelet-rich plasma is a biological product defined as part of the plasmatic fraction of autologous blood with platelet concentration above the baseline, being considered as an endogenous therapeutic technology with the potential to stimulate and accelerate tissue healing.Objective : To evaluate the use of autologous platelet-rich plasma in the healing of surgical wounds in patients undergoing elective conventional cholecystectomy at the National General Hospital "Dr. Angel Larralde.Methods : Cohort, observational and analytical study, with an experimental, prospective design, longitudinal cut. Non-probabilistic, intentional sample, made up of patients adjusted to inclusion criteria. Data Collection Sheet designed with the Vancouver scales and the Objective Assessment of Patient and Observer. The results obtained were tabulated in a data matrix made with Microsoft®Excel and, later, presented by means of frequency distribution tables and graphs. For the analysis and interpretation of the results, the free license program SPSS 26® was used. The Chi Square statistic was used.Results : Total of 26 patients: study group with 11 patients, control group with 15 patients. The p value was calculated for both scales, resulting in˂ 0.05 in all observations. Conclusion : An evident satisfactory evolution was observed in the patients to whom the PRP was applied compared to the control group, so that it supports the premise that the PRP contributes to rapid healing, without complications and easy to obtain(AU)

Resultados de la cirugía bariátrica en pacientes obesos internados en el Hospital Nacional de Itauguá / Results of bariaric surgery in obese patients admitted to Itauguá National Hospital

Introducción: La obesidad es la segunda causa de muerte susceptible de prevención. El tratamiento quirúrgico es el único tratamiento eficaz y demostrado para pacientes con obesidad grave (índice de masa corporal > 40 kg/m²). Las operaciones bariátricas prolongan la supervivencia y corrigen las enfermedades asociadas con la obesidad grave. Objetivos: Caracterizar los resultados de la cirugía bariátrica en pacientes obesos internados en el Hospital Nacional de Itauguá de marzo a diciembre del año 2019. Materiales y métodos: Estudio observacional, descriptivo de corte transversal, retrospectivo con muestreo no probabilístico a conveniencia. Se incluyeron pacientes de ambos sexos, mayores a 16 años con obesidad sometidos a cirugía bariátrica en el Servicio de Cirugía General del Hospital Nacional de Itauguá. Resultados: Se incluyeron a 24 pacientes, cuyo promedio de peso fue de 117,5 kg y un promedio del IMC de 43,5. El 67% presentó obesidad grado III y el 70% un ASA III. La técnica quirúrgica empleada con mayor frecuencia fue gastrectomía vertical en manga laparoscópica. El promedio de pérdida de exceso de peso post quirúrgico a los 12 meses fue de 56,4 kg. La estancia hospitalaria post quirúrgico en promedio fue de 48 horas. En el 96% de los casos no se presentaron complicaciones. Conclusión: El resultado de nuestro estudio sugiere que la cirugía bariátrica ha demostrado ser una alternativa con excelentes resultados para el tratamiento de la obesidad, mejorando así no solo patologías clínicas crónicas sino también la calidad de vida del paciente.

Introduction: Obesity is the second cause of death susceptible to prevention. Surgical treatment is the only effective and proven treatment for severely obese patients (body mass index > 40 kg/m²). Bariatric operations prolong survival and correct diseases associated with severe obesity. Objectives: To determine the short-term and long-term results of bariatric surgery in obese patients admitted to the National Hospital of Itauguá from March to December 2019. Materials and methods: Observational, descriptive cross-sectional, retrospective study with non-probabilistic sampling at convenience. We included patients of both sexes, over 16 years of age with obesity who underwent bariatric surgery and were admitted to the General Surgery Service of the Hospital Nacional de Itauguá in 2019. Results: Twenty-four patients were followed up in the study, with an average weight of 117.5 kg and a mean BMI of 43.5. 67% presented with grade III obesity and 70% with ASA III. The most frequently used surgical technique was vertical gastrectomy in the laparoscopic sleeve. The average postoperative weight loss at 12 months was 56.4 kg. The average postoperative hospital stay was 48 hours. There were no complications in 96% of cases. Conclusion: The result of our study suggests that bariatric surgery has proven to be an alternative with excellent results for the treatment of morbid obesity, , thus improving not only chronic clinical pathologies but also the quality of life of the patient with increased life expectancy.

Ácidos grasos omega-3 y función endotelial en pacientes con síndrome coronario agudo / Omega-3 fatty acids and endothelial function in patients with acute coronary syndrome

Las enfermedades cardiovasculares son la principal causa de muerte a nivel mundial, manifestándose principalmente como enfermedad isquémica coronaria. El pronóstico y desenlace del Síndrome Coronario Agudo (SCA) depende en gran proporción de la disfunción endotelial asociado a este cuadro. Objetivo:Evaluar el efecto de los ácidos grasos omega­3, sobre la función endotelial en el Síndrome Coronario Agudo (SCA). Métodos: Se realizó estudio con 16 pacientes con síndrome coronario agudo (SCA) tratados con Omega-3 a dosis de 3 gramos/día+Terapia Convencional (O3+Tc) durante 30 días. Se les realizó a las 12 horas del ingreso y los a 30 días, perfil lipídico, proteína C reactiva ultrasensible (PCRus), Endotelina 1 (ET-1), y Péptido Natriurético cerebral (NTproBNP). Resultados: Durante 4 semanas de seguimiento, el uso de 3 gramos/día de ácidos grasos omega-3, añadido a la terapia convencional en el Síndrome Coronario Agudo, mostró una reducción significativa de la concentración plasmática de NTproBNP (p = 0,000), PCRus (p =0,000) y triglicéridos (p = 0,004). Conclusión: Tres gramos al día de ácidos grasos omega-3 contribuye a la reducción de la concentración plasmática de Triglicéridos y NTproBNP en pacientes con síndrome coronario agudo(AU)

Mainly as coronary ischemic disease. the prognosis and outcome of Acute Coronary Syndrome (ACS) depend largely on the endothelial dysfunction associated with this condition. Objective: To evaluate the effect of omega-3 fatty acids on endothelial function in Acute Coronary Syndrome (ACS). Method: A study was conducted with 16 patients with acute coronary syndrome (ACS) treated with Omega-3 at a dose of 3 grams/day+Conventional erapy (O3+Tc) for 30 days. Lipid profile, ultrasensitive C-reactive protein (usCRP), Endothelin 1 (ET-1), and Brain Natriuretic Peptide (NTproBNP) were performed 12 hours aer admission and 30 days later. Results: During 4 weeks of follow-up, the use of 3 grams/day of omega-3 fatty acids, added to conventional therapy in Acute Coronary Syndrome, showed a significant reduction in the plasma concentration of NTproBNP (p = 0.000), hsCRP (p =0.000) and Triglycerides (p = 0.004). Conclusion: three grams a day of omega-3 fatty acids contributes to the reduction of the plasmatic concentration of Triglycerides and NTproBNP in patients with acute coronary syndrome(AU)

Aortic valve replacement using minimally invasive surgery, a safe technique in our setting: experience of one center.

AIM: The aim of this study was to analyze the results of minimum access surgery in comparison with conventional surgery, especially in relation to post-operative (PO) mortality. MATERIALS AND METHODS: This study was retrospective observational study, employing regressions, and bivariate correlations in the statistical analysis. A total of 114 patients over 65 years of age referred to cardiac surgery: 57 subjects in the minimum access group and 57 subjects in the sternotomy group. The main variables of interest were: demographic variables, PO course, mainly mortality, as well as duration of admission to critical care and total admission time. RESULTS: The mean age was 73.11 years, with 52.6% of women and 47.4% of men, and no significant differences between the pre-operative characteristics of either group. Regarding mortality, this was lower in the minimum access group, statistically significant in the analysis using bivariate correlations. CONCLUSIONS: Aortic valve replacement using a minimally invasive approach is a safe technique in our environment, despite its necessary learning curve.

OBJETIVOS: Analizar los resultados de la cirugía de mínimo acceso en comparación con la cirugía convencional, especialmente en cuanto a la mortalidad postoperatoria. MATERIAL Y MÉTODOS: Estudio observacional retrospectivo, empleando regresiones y correlaciones bivariadas en el studio estadístico. Un total de 114 pacientes de más de 65 años derivados a cirugía cardíaca: 57 sujetos en el grupo de mínimo acceso y 57 sujetos en el grupo esternotomía. Las principales variables de interés: demográficas, evolución postoperatoria, sobre todo mortalidad, así como la duración del ingreso en cuidados críticos e ingreso total hospitalario. RESULTADOS: La edad media fue de 73,11 años, con un 52,6% de mujeres y 47,4% de hombres, y sin diferencias estadísticamente significativas entre las características preoperatorias de cada grupo. En cuanto a la mortalidad, ésta result más baja en el grupo de mínimo acceso, siendo estadísticamente significativo en el análisis por correlaciones bivariadas. CONCLUSIONES: La sustitución valvular aórtica mediante cirugía mínimamente invasive es una técnica segura en nuestro medio, a pesar de su curva de aprendizaje.

Chemical composition, vitamins, and minerals of family farming biribiri (Averrhoa bilimbi L) in the middle Doce River region, Minas Gerais, Brazil / Composição química, vitaminas e minerais do biribiri (Averrhoa bilimbi L) da agricultura familiar da região do médio Rio Doce, Minas Gerais, Brasil

This study evaluated physical characteristics, chemical composition, content of vitamin C, vitamin E, carotenoids, and minerals in biribiri fruits (Averrhoa bilimbi) from the Middle Doce River region (Minas Gerais, Brazil). Titratable acidity was determined by volumetric neutralization, pH by direct potentiometry, soluble solids by refractometry, humidity by gravimetry, ash by calcination in muffle, proteins by the micro-Kjeldahl method, dietary fiber by non-enzymatic gravimetric method and lipids using a Soxhlet extractor. Carotenoids and vitamin C were analyzed by high-performance liquid chromatography (HPLC) and vitamin E by HPLC with fluorescence detector. Fourteen minerals were analyzed by inductively coupled plasma atomic emission spectrometry. Biribiri showed high yield of edible portion (100%), low lipid, protein and carbohydrate content, and; consequently, low total energy value (25.36 kcal 100 g-¹). The fruit also showed low dietary fiber content (0.62 g 100 g-¹), total vitamin E (17.62 µg 100 g-¹), total carotenoids (0.32 g 100 g-¹), and high vitamin C, zinc, copper, iron content, manganese, molybdenum and chrome content. Regarding the heavy metals, the fruit showed no cadmium, and traces of aluminum and nickel. In conclusion, biribiri presented low energy value and expressive contents of dietary fibers, vitamin C, iron, manganese, molybdenum, chromium, zinc, and copper.

Este estudo teve como objetivo avaliar as características físicas, a composição química, teor de vitamina C, vitamina E, carotenoides e minerais em frutos de biribiri (Averrhoa bilimbi) do território do Médio Rio Doce (Minas Gerais, Brasil). A acidez titulável foi determinada por neutralização volumétrica, o pH por potenciometria direta, os sólidos solúveis por refratometria, a umidade por gravimetria, as cinzas por calcinação em mufla, as proteínas pelo método micro-Kjeldahl, as fibras alimentares pelo método gravimétrico não enzimático e os lipídios usando um extrator Soxhlet. Os carotenoides e a vitamina C foram analisados por cromatografia líquida de alta eficiência (CLAE). A vitamina E foi analisada por CLAE com detector de fluorescência e quatorze minerais foram analisados por espectrometria de emissão atômica com plasma indutivamente acoplado. O biribiri apresentou alto rendimento de porção comestível (100%), baixos teores de lipídios, proteínas e carboidratos e, consequentemente, baixo valor total de energia (25,36 kcal 100 g-¹). Os frutos também apresentaram baixos teores de fibra alimentar (0,62 g 100 g-¹), vitamina E total (17,62 µg 100 g-¹), carotenoides totais (0,32 g 100 g-¹) e altos teores de vitamina C, zinco, cobre, ferro, manganês, molibdênio e conteúdo cromado. Em relação aos metais pesados, os frutos não apresentaram cádmio e tiveram vestígios de alumínio e níquel. Em conclusão, o biribiri apresentou baixo valor energético e conteúdos expressivos de fibras alimentares, vitamina C, ferro, manganês, molibdênio, cromo, zinco e cobre.

Simulador de fosa ilíaca derecha para la adquisición de habilidades básicas en apendicectomía convencional / RIGHT ILIAC FOSSA SIMULATOR FOR THE ACQUISITION OF BASIC SKILLS IN CONVENTIONAL APPENDICECTOMY

Introducción: La simulación quirúrgica es un método de enseñanza que cada día va abarcando más terreno, dejando de lado al modelo tradicional de aprendizaje en los servicios de cirugía. El proceso inflamatorio del apéndice cecal es todavía una de las patologías más prevalentes en el área del cirujano general, quien debe tener varias estrategias para poder resolver la misma. Aquí presentamos un simulador de fosa iliaca derecha para la adquisición de habilidades básicas en apendicetomía convencional. Material y Métodos: se desarrolló un simulador de fosa iliaca derecha de la siguiente manera: se recorta el centro la tapa de una caja de aglomerado, y tanto los foamy como el papel crepé en rectángulos del tamaño de la tapa de la caja; se crea un preparado cadavérico utilizando el intestino vacuno; se coloca el preparado y por encima una compresa teñida en la bolsa de polietileno, dentro de la caja; se cierra la caja y se colocan las láminas de foamy y el papel crepé encima de la tapa, fijadas con los tornillos y tuercas, representando la pared abdominal. Resultado: Simulador reproducible, económico y de fácil elaboración. Tiempo total de armado: 1 hora. Conclusiones: Se puede utilizar para simular la técnica quirúrgica de apendicectomía convencional y sus variantes

Introduction: Surgical simulation is a teaching method that covers more ground every day, leaving aside the traditional apprenticeship model in surgery services. The inflammatory process of the cecal appendix is still one of the most prevalent pathologies in the area of the general surgeon, who must have several strategies to solve it. Here we present a right iliac fossa simulator for the acquisition of basic skills in conventional appendectomy. Material and Methods: We cut the center of the lid of the chipboard box, then cut the foamy and the crepe paper into rectangles the size of the lid of the box. We create a cadaveric preparation using the bovine intestine. Then put the preparation with a dyed compress above it in the polyethylene bag, inside the box. We close the box and place on the lid the foamy and crepe paper, fixed with bolts and nuts. Result: Cheap and easy-made simulator. We can armed de simulator in one hour. Conclusions: It can be used to simulate the conventional appendectomy surgical technique and its different variants.

Hiperparatiroidismo primario: experiencia en cirugía por mini abordaje unilateral / Primary hyperparathyroidism: experience in surgery by unilateral mini-approach

INTRODUCCIÓN: En el hiperparatiroidismo primario el origen del trastorno, como su nombre lo indica, está en la propia glándula paratiroides, la cual genera una secreción autónoma y excesiva. La cirugía de las glándulas paratiroides evolucionó en forma considerable en los últimos 30 a 40 años, pasamos de exploraciones cervicales exhaustivas, hasta una época en que gracias al desarrollo tecnológico y sobre todo medicina nuclear, podemos localizar en forma preoperatoria el tejido patológico; siendo esta a su vez la base fundamental en la realización de procedimientos más selectivos. OBJETIVO: mostrar la casuística de cirugía por mini abordaje de la glándula paratiroides en el hiperparatiroidismo primario en un centro mutual de Montevideo. MATERIAL Y MÉTODOS: Realizamos un estudio observacional descriptivo y retrospectivo. Se estudió una muestra de 18 pacientes con diagnóstico de hiperparatiroidismo primario y con sospecha de lesión única los cuales fueron intervenidos en un centro mutual de la ciudad de Montevideo entro julio de 2017 y enero de 2020. CONCLUSIÓN: La cirugía por mini abordaje de la glándula paratiroides puede ser aplicada en el hiperparatiroidismo primario en pacientes seleccionados con las ventajas de; tener un menor tiempo quirúrgico, ser ambulatoria (reintegro al hogar en pocas horas), indemnidad de la logia tiroidea contralateral, mejor resultado estético con similar tasa de éxito que la cirugía convencional.

BACKGROUND: In primary hyperparathyroidism, the origin of the disorder, as its name indicates, is in the parathyroid gland itself, which generates excessive and autonomous secretion. Parathyroid gland surgery has evolved dramatically in the last 30 to 40 years, from exhaustive cervical examinations, to nowadays when, thanks to technological development and especially nuclear medicine, we can locate pathological tissue preoperatively; this, in fact, is the fundamental basis for the performance of more selective procedures. OBJECTIVE: to show the casuistry of mini-approach surgery of the parathyroid gland in primary hyperparathyroidism in a mutual center in Montevideo. METHODS: We carried out a descriptive and retrospective observational study. We studied a sample of 18 patients diagnosed with primary hyperparathyroidism and a single suspicious lesion, who underwent surgery in a private center in the city of Montevideo from July 2017 to January 2020. CONCLUSION: Mini-approach surgery of the parathyroid gland can be applied in primary hyperparathyroidism in selected patients, with the advantages of a shorter surgical time, ambulatory (return home in a few hours), keeping the indemnity of the contralateral thyroid loggia, a better cosmetic result with a similar success rate than conventional surgery.

Processing tomato waste as a potential bioactive compounds source: phenolic compounds, antioxidant capacity and bioacessibility studies / Resíduo do processamento do tomate como potencial fonte de compostos bioativos: compostos fenólicos, capacidade antioxidante e bioacessibilidade

A comparative study was perfomed with conventional and ultrasound assisted extraction on tomato processing waste. Ultrasound extraction exhibited slightly higher phenolic and flavonoids content, as well as higher ABTS + radical scavenging capacity (4.63 mg GAE.g-1, 0.96 mg RUE.g-1 and 27.90 µmol TE.g -1 respectively). On both extracts, a high percentage of flavonoids was lost during simulated digestion, resulting on a bioacessibility of approximately 13 %. Extracts presented good stability during storage conditions, which indicates a possible technological application.

Foi realizado um estudo comparativo com a extração convencional e assistida por ultrassom em resíduos do processamento de tomate. A extração ultrassônica exibiu teor de fenólicos e flavonóides ligeiramente maiores, bem como maior capacidade antioxidante ABTS + (4,63 mg AG.g-1, 0,96 mg RUE.g-1 e 27,90 µmol TE.g -1, respectivamente). Em ambos os extratos, uma alta porcentagem de flavonóides foi perdida durante a digestão simulada, resultando em uma bioacessibilidade de aproximadamente 13%. Os extratos apresentaram boa estabilidade durante as condições de armazenamento, o que indica uma possível aplicação tecnológica.

Exploración de las vías biliares como tratamiento de la litiasis coledociana: manejo laparoscópico vs. convencional. Estudio prospectivo y comparativo / Common bile duct exploration as treatment of choledocal lithiasis: laparoscopic vs conventional approach. Prospective and comparative study

La litiasis coledociana es una complicación poco frecuente asociada a la litiasis vesicular. Puede ser resuelta mediante colangiopancreatografía retrógrada endoscópica (CPRE) o en su defecto, una exploración de las vías biliares por abordaje convencional (cirugía abierta) o laparoscópico. Objetivos: Determinar la efectividad del abordaje laparoscópico versus el convencional en la exploración de las vías biliares como tratamiento de la litiasis coledociana. Métodos : Se realizó un estudio prospectivo y comparativo con una muestra de 31 pacientes con litiasis coledociana seleccionados de manera no aleatoria. Resultados : Ambos grupos fueron comparables en edad, sexo, frecuencia de litiasis vesicular y CPRE preoperatoria. El tiempo quirúrgico promedio fue 4,52 versus 3,49 horas para los abordajes laparoscópico y convencional respectivamente. En el grupo laparoscópico se usó tubo de Kehr en 21% de los pacientes y en 79 % sutura primaria. En el grupo convencional se usó tubo de Kehr en 29% de los pacientes y en 71 % sutura primaria. La fuga biliar fue la complicación más frecuente. La estancia hospitalaria fue 3,14 días en el grupo laparoscópico versus 5,23 días en el grupo convencional, sin diferencia estadísticamente significativa. Conclusión : No se logró demostrar una superioridad evidente de alguno de los grupos estudiados, sin embargo nuestros pacientes podrían beneficiarse de las ventajas del abordaje laparoscópico en términos de tener menor dolor postoperatorio y una reincorporación más rápida a sus actividades habituales. Estudios similares con mayor número de casos son necesarios para llegar a datos más concluyentes(AU)

Common bile duct (CBD) lithiasis are an unusual complication associated to gallbladder stones. It can be resolved by endoscopic retrograde cholangiopancreatography (ERCP) or, alternatively, a CBD exploration by conventional (open surgery) or laparoscopic approach.Objectives : To determine the effectiveness of laparoscopic approach versus conventional approach in CBD exploration as a treatment for choledochal lithiasis.Methods : A prospective and comparative study was carried out with a non-random intentionally selected sample consisting of 31 patients with CBD stones.Results : Both groups had no statistical differences regarding age, sex, frequency of gallbladder stones, and preoperatory ERCP. The average surgical time was 4.52 versus 3.49 hours for the laparoscopic and conventional approaches, respectively. In laparoscopic group, Kehr tube was used in 21% of patients and primary closure in 79%. In conventional group, Kehr tube was used in 29% of patients versus 71% of patients with primary closure. Biliary leak was the most frequent complication. Hospital stay was 3.14 days in the laparoscopic group versus 5.23 days in the conventional group, with no statistically significant difference.Conclusion : It was not possible to demonstrate an evident superiority of any of the groups studied, however our patients could benefit from the advantages of the laparoscopic approach in terms of less postoperative pain and faster return to their usual activities. Similar and larger studies are necessary to achieve stronger and conclusive data(AU)

Accuracy of Intraoral Scanners and Conventional pressions in Full-Arches: A Systematic Review

ABSTRACT: The aim of this study was to evaluate intraoral scanners accuracy in full-arches, comparing them with conventional impressions. A scientific research performed in MEDLINE, EBSCOhost, and SciELO databases was conducted to analyze articles published between 2015 and 2020. Clinical and in vitro studies that evaluated accuracy (precision and trueness) from intraoral scanners and conventional impressions in full-arches were included. Two tests were applied to evaluate the methodological bias from the studies. Out of the 191 articles found, seven of them were selected for a qualitative analysis. In clinical studies,intraoral scanners CEREC Omnicam and 3Shape TRIOS Colorhad the highest precision compared to conventional irreversible hydrocolloid impressions. In in vitro studies, conventional polyvinyl siloxane impressions showed the highest accuracy, followed by intraoral scanners Cadent iTero and CEREC Omnicam, while irreversible hydrocolloid impressions showed the lowest accuracy. Digital intraoral impression systems do not show superior accuracycompared to highly accurate conventional impression techniques. However, they provide excellent clinical results and both methods are clinically accepted.

RESUMEN: El objetivo de este estudio fue evaluar la exactitud de escáneres intraorales en impresiones digitales de arco completo en comparación con las impresiones convencionales. Se realizó una revisión sistemática en las bases de datos MEDLINE, EBSCOhost y SciELO para analizar artículos publicados entre los años 2015 y 2020. Se incluyeron estudios clínicos e in vitro que evaluaran exactitud (precisión y/o veracidad) de escáneres intraorales impresiones convencionales en arcos completos. Dos pautas se aplicaron para evaluar el riesgo de sesgo de los estudios. De 191 artículos encontrados, 7 fueron seleccionados para un análisis cualitativo. En los estudios clínicos, los escáneres intraorales CEREC Omnicam y 3Shape TRIOS Color presentaron la mayor precisiónen comparación con las impresiones convencionales de hidrocoloide irreversible. En los estudios in vitro, las impresiones de polivinil siloxano presentaron la mayor exactitud seguido por los escáneres intraorales CadentiTero y CEREC Omnicam, mientras quelas impresiones de hidrocoloide irreversible presentaron la menor exactitud. Los sistemas de impresión digital intraoral no mostraron tener una exactitud superior comparados con las técnicas de impresión convencional de gran exactitud. Sin embargo, proveen excelentes resultados clínicos y ambos métodos son clínicamente aceptables.

Análisis de la evolución de los operados mediante cirugía de mínimo acceso en nuestro hospital. ¿Presenta mejores resultados que la convencional? / Analysis of the evolution of those operated on with minimal access surgery in our hospital. Does it present better results than the conventional one?

Resumen La estenosis aórtica severa sintomática es la patología quirúrgica más prevalente en cirugía cardiaca y su sustitución aislada se ha realizado históricamente mediante esternotomía media completa. Sin embargo, se ha producido recientemente una gran revolución, especialmente tras la llegada de las prótesis aórticas sin suturas que, unido a un nuevo impulso por la cirugía cardiaca hacia un rumbo menos invasivo, ha provocado que el reemplazo de dicha válvula se lleve a cabo cada vez más frecuentemente por dichas prótesis y por incisiones de mínimo acceso. Por ello, realizamos una revisión de los casos intervenidos en nuestro servicio desde el inicio del programa de cirugía de mínimo acceso comparándolos con los resultados de los casos intervenidos en la misma época mediante cirugía convencional.

Abstract Symptomatic severe aortic stenosis is the most prevalent surgical pathology in cardiac surgery, and its isolated replacement has historically been performed by means of complete middle sternotomy. However, a great revolution has recently taken place, especially after the arrival of sutureless aortic prostheses that, together with a new impulse by cardiac surgery towards a less invasive course, has caused the replacement of said valve to be carried out more and more frequently due to these prostheses and minor access incisions. For this reason, we carried out a review of the cases operated on in our service from the beginning of the minimum access surgery program, comparing them with the results of the cases operated at the same time using conventional surgery.

Avaliação de ressecção de mucosa endoscópica sob imersão d'água de pólipos colorretais em um centro ambulatorial no Brasil / Evaluation of underwater endoscopic mucosal resection for colorectal polyps in an outpatient clinic in brazil

ABSTRACT BACKGROUND: Since 2012, a new technique for resection of large polyps has been described, the underwater endoscopic mucosal resection (UEMR). Some advantages that emerge from it is the needless of injection in submucosal layer and a greater chance of complete capture of the polyp. OBJECTIVE: There are few studies of UEMR in Brazil. The aim of this study is to evaluate the safety and efficacy of this technique in one Brazilian center. METHODS: This case series was conducted from February to December of 2020. Colorectal polyps greater than 9 mm without features of deep submucosal invasion were resected using UEMR. RESULTS: Twenty-four large polyps were resected with the UEMR approach from 24 patients. The mean size of the polys was 19 mm, ranging from 12 to 35 mm. All lesions were successful resected and 66% (16/24) were resected en bloc. In histologic analyses, most of them were adenomas (70.8%) and only one had deep submucosal invasion. There were no cases of acute complications, such perforation or acute bleeding. CONCLUSION: The UEMR is a safe and feasible procedure. With the emerging data on the procedure, it seems to be a wonderful tool in preventing colorectal cancer and its applicability and scope should be encourage to surpass reference centers.

RESUMO CONTEXTO: Desde 2012, uma nova técnica para ressecção de pólipos grandes tem sido descrita, a ressecção da mucosa endoscópica sob imersão d'água (REMS). Algumas vantagens que surgem desta técnica são evitar a injeção na camada submucosa e a maior chance de captura completa do pólipo. Objetivo - Há poucos estudos com REMS no Brasil. Nosso objetivo é avaliar a segurança e a eficácia da técnica em um centro brasileiro. MÉTODOS: Esta série de casos foi conduzida de fevereiro a dezembro de 2020. Pólipos colorretais maiores que 9 mm sem sinais endoscópicos de invasão de submucosa foram ressecados utilizando RMES. RESULTADOS: Vinte e quatro pólipos foram ressecados com RMES em 24 pacientes diferentes. O tamanho médio dos pólipos era de 19 mm, variando de 12 a 35 mm. Todas as lesões foram ressecadas e 66% (16/24) foram ressecadas em monobloco. Na análise histológica, a maioria era adenoma (70.8%) e apenas uma havia invasão profunda da submucosa. CONCLUSÃO: O uso de REMS é um procedimento seguro e factível. Com o aumento de dados relativos ao procedimento, esta parece ser uma excelente ferramenta na prevenção do câncer colorretal e sua aplicabilidade deve ser encorajada para fora dos centros de referência.

Instrumental piezoeléctrico comparado con sierra convencional en cirugía ortognática / Piezoelectric bone surgery compared to conventional saw in orthognathic surgery

RESUMEN: Introducción: La utilización de instrumental piezoeléctrico en cirugía ortognática ha ido en aumento con el fin de minimizar el riesgo de daño a tejidos blandos en comparación al uso de sierra convencional. Sin embargo, aún existe incertidumbre respecto a las complicaciones asociadas a cada instrumental. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un meta análisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos cuatro revisiones sistemáticas que en conjunto incluyeron 10 estudios primarios, de los cuales, cuatro corresponden a ensayos aleatorizados. Concluimos que el uso de instrumental piezoeléctrico en comparación con la sierra convencional podría disminuir el riesgo de daño nervioso grave y disminuir el sangrado grave (>500 mL), pero la certeza de la evidencia es baja. Por otra parte, el uso de instrumental piezoeléctrico podría presentar poca o nula diferencia en el dolor postoperatorio, pero la certeza de la evidencia es baja. Finalmente no es posible establecer con claridad si el uso de instrumental piezoeléctrico disminuye la pérdida de sangre intraoperatoria (variable continua), la inflamación postoperatoria o el tiempo operatorio, ya que la certeza de la evidencia existente ha sido evaluada como muy baja.

ABSTRACT: Introduction: The use of piezoelectric bone surgery in orthognathic surgery has been increasing to minimize the risk of soft tissue damage compared to conventional saws. However, there is still uncertainty regarding the complications associated with each instrument. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed primary studies' data, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified four systematic reviews that included 10 primary studies, four of which corresponded to randomized trials. We conclude that the use of piezoelectric instrumentation compared to the conventional saw may reduce the risk of severe nerve damage and decrease severe bleeding (>500 mL), but the certainty of the evidence is low. On the other hand, the use of piezoelectric bone surgery may make little or no difference in postoperative pain, but the certainty of the evidence is low. Finally, we are uncertain whether piezoelectric bone surgery reduces intraoperative blood loss (continuous variable), postoperative inflammation, and operative time, as the certainty of the evidence has been assessed as very low.

Comparison of automated breast ultrasound and hand-held breast ultrasound in the screening of dense breasts / Comparação entre a ultrassonografia automatizada e a ultrassonografia convencional no rastreio de mamas densas

Abstract Objective To compare hand-held breast ultrasound (HHBUS) and automated breast ultrasound (ABUS) as screening tool for cancer. Methods A cross-sectional study in patients with mammographically dense breasts was conducted, and both HHBUS and ABUS were performed. Hand-held breast ultrasound was acquired by radiologists and ABUS by mammography technicians and analyzed by breast radiologists. We evaluated the Breast Imaging Reporting and Data System (BI-RADS) classification of the exam and of the lesion, as well as the amount of time required to perform and read each exam. The statistical analysis employed was measures of central tendency and dispersion, frequencies, Student t test, and a univariate logistic regression, through the odds ratio and its respective 95% confidence interval, and with p<0.05 considered of statistical significance. Results Atotal of 440 patientswere evaluated. Regarding lesions,HHBUS detected 15 (7.7%) BI-RADS 2, 175 (89.3%) BI-RADS 3, and 6 (3%) BI-RADS 4, with 3 being confirmed by biopsy as invasive ductal carcinomas (IDCs), and 3 false-positives. Automated breast ultrasound identified 12 (12.9%) BI-RADS 2, 75 (80.7%) BI-RADS 3, and 6 (6.4%) BI-RADS 4, including 3 lesions detected by HHBUS and confirmed as IDCs, in addition to 1 invasive lobular carcinoma and 2 high-risk lesions not detected by HHBUS. The amount of time required for the radiologist to read the ABUS was statistically inferior compared with the time required to read the HHBUS (p<0.001). The overall concordance was 80.9%. A total of 219 lesions were detected, from those 70 lesions by both methods, 126 only by HHBUS (84.9% not suspicious by ABUS) and 23 only by ABUS. Conclusion Compared with HHBUS, ABUS allowed adequate sonographic study in supplemental screening for breast cancer in heterogeneously dense and extremely dense breasts.

Resumo Objetivo Comparar a ultrassonografia convencional das mamas (US) com a ultrassonografia automatizada das mamas (ABUS) no rastreio do câncer. Métodos Realizamos um estudo transversal com pacientes com mamas mamograficamente densas, sendo avaliadas pela US e pela ABUS. A US foi realizada por radiologistas e a ABUS por técnicos de mamografia e analisada por radiologistas especializados em mama. A classificação Breast Imaging Reporting and Data System (BIRADS) do exame e das lesões o tempo de leitura e de aquisição foram avaliados. A análise estatística foi realizada através de medidas de tendência central, dispersão e frequências, teste t de Student e regressão logística univariada, através do odds ratio, com intervalo de confiança de 95%, e com p<0,05 sendo considerado estatisticamente significante. Resultados Foram avaliadas 440 pacientes. Em relação às lesões, a US detectou 15 (7,7%) BI-RADS 2, 175 (89,3%) BI-RADS 3 e 6 (3%) BI-RADS 4, das quais 3 foram confirmadas, por biópsia, como carcinomas ductais invasivos e 3 falso-positivos. A ABUS identificou 12 (12,9%) BI-RADS 2, 75 (80,7%) BI-RADS 3 e 6 (6,4%) BI-RADS 4, incluindo 3 lesões detectadas pela US e confirmadas como carcinomas ductais invasivos, além de 1 carcinoma lobular invasivo e 2 lesões de alto risco não detectadas pela US. O tempo de leitura dos exames da ABUS foi estatisticamente inferior ao tempo do radiologista para realizar a US (p<0,001). A concordância foi de 80,9%. Um total de 219 lesões foram detectadas, das quais 70 por ambos os métodos, 126 observadas apenas pela US (84,9% não eram lesões suspeitas no ABUS) e 23 apenas pela ABUS. Conclusão Comparado à US, a ABUS permitiu adequado estudo complementar no rastreio do câncer de mamas heterogeneamente densas e extremamente densas.