S-ICD implantation under the serratus plane block and transversus thoracis muscle plane block. A clinical case.

INTRODUCTION: The development of a subcutaneous implantable cardioverter-defibrillator (S-ICD) combined with the typical patient comorbidities creates new challenges for anaesthesia. CLINICAL CASE: A young male, ASA II, was proposed for S-ICD placement, after recovery from a sudden CRP episode. We performed regional anaesthesia with a serratus plane block (SPB) and transversus thoracic muscle plane block (TTPB) with administration of Mepivacaine and Ropivacaine. S-ICD placement was achieved under regional anaesthesia. In the perioperative period, the patient remained hemodynamically stable, without any complications or pain. DISCUSSION: The implantation of the ICD occurs in fragile patients, with high anaesthetic risk. In this case, the association of SPB and TTPB was an effective anaesthetic/analgesic approach, has advantages when compared with other techniques and has potential use in other procedures.

Implantación subcutánea de DCI-S mediante bloqueos del plano del músculo serrato y del músculo torácico transverso. Caso clínico / S-ICD implantation under the serratus plane block and transversus thoracis muscle plane block. A clinical case

Introducción: El desarrollo de un desfibrilador-cardioversor implantable subcutáneo (DCI-S), combinado con las comorbilidades normales del paciente crea nuevos retos en anestesia. Caso clínico: Varón joven, ASA II, propuesto para implantación de DCI-S, tras recuperarse de un episodio de parada cardiaca súbita. Realizamos anestesia regional con bloqueo en el plano del músculo serrato y bloqueo del plano del músculo torácico transverso con administración de mepivacaína y ropivacaína. La implantación de DCI-S se logró bajo anestesia regional. En el periodo perioperatorio el paciente permaneció hemodinámicamente estable, sin complicaciones ni dolor. Discusión: La implantación de DCI se produce en pacientes frágiles, con alto riesgo anestésico. En este caso, la asociación de bloqueo en el plano del músculo serrato y bloqueo del plano del músculo torácico transverso fue una técnica anestésica/analgésica efectiva, con ventajas en comparación con otras técnicas, y uso potencial en otros procedimientos.(AU)

Introduction: The development of a subcutaneous implantable cardioverter-defibrillator (S-ICD) combined with the typical patient comorbidities creates new challenges for anesthesia. Clinical case: A young male, ASA II, was proposed for S-ICD placement, after recovery from a sudden CRP episode. We performed regional anesthesia with a serratus plane block and transversus thoracic muscle plane block with administration of mepivacaine and ropivacaine. S-ICD placement was achieved under regional anesthesia. In the perioperative period, the patient remained hemodynamically stable, without any complications or pain. Discussion: The implantation of the ICD occurs in fragile patients, with high anesthetic risk. In this case, the association of serratus plane block and transversus thoracic muscle plane block was an effective anesthetic/analgesic approach, has advantages when compared with other techniques and has potential use in other procedures.(AU)

S-ICD implantation under the serratus plane block and transversus thoracis muscle plane block. A clinical case. / Implantación subcutánea de DCI-S mediante bloqueos del plano del músculo serrato y del músculo torácico transverso. Caso clínico.

INTRODUCTION: The development of a subcutaneous implantable cardioverter-defibrillator (S-ICD) combined with the typical patient comorbidities creates new challenges for anesthesia. CLINICAL CASE: A young male, ASA II, was proposed for S-ICD placement, after recovery from a sudden CRP episode. We performed regional anesthesia with a serratus plane block and transversus thoracic muscle plane block with administration of mepivacaine and ropivacaine. S-ICD placement was achieved under regional anesthesia. In the perioperative period, the patient remained hemodynamically stable, without any complications or pain. DISCUSSION: The implantation of the ICD occurs in fragile patients, with high anesthetic risk. In this case, the association of serratus plane block and transversus thoracic muscle plane block was an effective anesthetic/analgesic approach, has advantages when compared with other techniques and has potential use in other procedures.

Molecular characterization and identification of digenean larval stages in Aylacostoma chloroticum (Prosobranchia: Thiaridae) from a neotropical floodplain.

Digeneans (Trematoda: Digenea) are endoparasites that present a complex life cycle, generally involving an intermediate invertebrate host and a vertebrate host. There is limited information about which species of molluscs may act as intermediate hosts in the upper Paraná River floodplain (UPRF), where Aylacostoma chloroticum can be considered a potential candidate. The study of digeneans in this region is important because some of these parasites are potentially zoonotic, and, therefore, are relevant to public health. However, the correct identification of these organisms during the larval stages is difficult because of the lack of morphologically diagnostic characteristics. The objective of this study was to identify and molecularly characterize the larval stages of digeneans found in A. chloroticum in the UPRF, using the mitochondrial marker of subunit I of cytochrome c oxidase and the 28S nuclear marker. The molluscs were examined in the laboratory and three morphotypes of cercariae were found. DNA was extracted from the specimens obtained and was then amplified and sequenced. The morphotypes exhibited high genetic similarities with Pseudosellacotyla, Paralecithodendrium and Philophthalmus, indicating that these organisms belong to these genera. This is the first record of larval stages of these genera in molluscs collected in the UPRF.

Bloqueo lumbar del plano del músculo erector de la columna: control exitoso del dolor agudo tras cirugía de la columna lumbar. Un caso clínico / Lumbar erector spinae plane block: Successful control of acute pain after lumbar spine surgery - A clinical report

Divulgamos el caso clínico de una paciente programada para cirugía de la columna lumbar, en la cual realizamos el bloqueo del plano del músculo erector de la columna lumbar como parte de una estrategia analgésica multimodal para el control del dolor agudo. La realización del bloqueo preoperatoriamente descartó la necesidad de opioides intraoperatorios adicionales a los de la intubación y permitió el uso de paracetamol solo para la analgesia. Además, no hubo necesidad de técnicas hipotensivas, ya que el bloqueo proporcionó bloqueo simpático satisfactorio y vasodilatación regional con un campo quirúrgico claro. En el postoperatorio, la paciente tenía un consumo menor de opiáceos y podía moverse libremente sin ningún deterioro motor, ni dolor desde el principio en la Unidad de Cuidados Postanestésicos. El uso del bloqueo del plano del músculo erector de la columna lumbar a nivel lumbar para la analgesia en la cirugía de la columna lumbar enfatiza su amplia aplicación y eficacia analgésica

We report the successful clinical case of a patient scheduled for lumbar spine surgery in which we performed a bilateral single-shot erector spinae plane block as part of a multimodal analgesic strategy for pain control. Performing the block preoperatively dismissed the need for extra intraoperative opioids other than those for intubation, and enabled the use of paracetamol for analgesia only. Further, there was no need for hypotensive techniques, as the block provided satisfactory sympathetic blockade and regional vasodilation with a clear surgical field. Postoperatively, the patient had minor opioid consumption and was able to freely move without any motor impairment or pain from early on in the Post Anaesthesia Care Unit. The use of single-shot erector spinae plane block at the lumbar level for lumbar spine surgery analgesia emphasises its wide application and analgesic efficacy

Lumbar erector spinae plane block: Successful control of acute pain after lumbar spine surgery - A clinical report. / Bloqueo lumbar del plano del músculo erector de la columna: control exitoso del dolor agudo tras cirugía de la columna lumbar. Un caso clínico.

We report the successful clinical case of a patient scheduled for lumbar spine surgery in which we performed a bilateral single-shot erector spinae plane block as part of a multimodal analgesic strategy for pain control. Performing the block preoperatively dismissed the need for extra intraoperative opioids other than those for intubation, and enabled the use of paracetamol for analgesia only. Further, there was no need for hypotensive techniques, as the block provided satisfactory sympathetic blockade and regional vasodilation with a clear surgical field. Postoperatively, the patient had minor opioid consumption and was able to freely move without any motor impairment or pain from early on in the Post Anaesthesia Care Unit. The use of single-shot erector spinae plane block at the lumbar level for lumbar spine surgery analgesia emphasises its wide application and analgesic efficacy.

Sleep habits in infants: the role of maternal education.

OBJECTIVE: Sleep disturbances are frequent in infants. Early development of sleep routines has a positive effect on sleep quality. The objective of this study was to assess the impact of maternal education on the development of infants' sleep habits (SHs). METHODS: This was an experimental, longitudinal study. Postnatal mothers were allocated into two groups: to receive (intervention group, IG), or not receive (control group, CG) information on sleep hygiene. Individual 15-min sessions were provided and a leaflet was handed to the IG. A questionnaire on infants' SHs was applied by telephone/e-mail at 1, 2, 4, and 6 months of age. RESULTS: At least three questionnaires were answered by 314 mothers. Results were adjusted for maternal age, education, and race. In the IG, infants acquired more independent sleep habits, an effect still present at six months; slept more frequently in their own beds; adjusted odds ratio (ORadj) 3.8, 95% confidence interval (CI) (1.1-13.5); fell asleep more frequently alone (ORadj, 4.29; 95% CI, 2.4-7.6); fell asleep more frequently in their own beds (ORadj, 6.1; 95% CI, 3.5-10.6) and needed less breast/bottle feeding to fall asleep (ORadj, 2.68; 95% CI, 1.5-4.6). The autonomy was greater in IG infants after night awakenings; also until six months they went back to sleep more frequently alone (ORadj, 3.88; 95% CI, 2-7.5) and needed less breast/bottle feeding (ORadj, 2.35; 95% CI, 1.3-4.3). No differences were found regarding the need for light, television or other routines to fall asleep or after night awakenings. CONCLUSION: Maternal education is positively associated with the adoption of autonomous SHs in infants. Early maternal education is an adequate prevention strategy to be considered in neonatal care.

Molecular characterization of Urocleidoides cuiabai and U. malabaricusi (Monogenea: Dactylogyridae) from the trahira fish Hoplias aff. malabaricus in the Paraná River, Brazil.

Urocleidoides ectoparasites are mainly found on fish of the neotropical regions. Although molecular research on monogeneans is available, no genetic data exist characterizing species in the Urocleidoides genus. Some DNA sequences have been efficacious in systematic studies and in the reconstruction of phylogenies of fish parasites. Relevant roles have been given to the sequence of the mitochondrial gene of cytochrome c oxidase I (COI). This study characterized COI sequences of the parasites Urocleidoides malabaricusi and U. cuiabai in trahira fish Hoplias aff. malabaricus of the flood plain of the Upper River Paraná, Brazil. The two species under analysis were distinguished by sequencing and analysing a 420-bp fragment of the COI gene, which suggested the existence of the cryptic species U. malabaricusi.

Bioactivity of isoflavones: assessment through a theoretical model as a way to obtain a "Theoretical Efficacy Related to Estradiol (TERE)".

The increase of human life span will have profound implications in Public Health in decades to come. By 2030, there will be an estimated 1.2 billion women in post-menopause. Hormone Replacement Therapy with synthetic hormones is still full of risks and according to the latest developments, should be used for the shortest time possible. Searching for alternative drugs is inevitable in this scenario and science must provide physicians with other substances that can be used to treat the same symptoms with less side effects. Systematic research carried out on this field of study is focusing now on isoflavones but the randomised controlled trials and reviews of meta-analysis concerning post-menopause therapy, that could have an important impact on human health, are very controversial. The aim of the present work was to establish a theoretical calculation suitable for use as a way to estimate the "Theoretical Efficacy (TE)" of a mixture with different bioactive compounds as a way to obtain a "Theoretical Efficacy Related to Estradiol (TERE)". The theoretical calculation that we propose in this paper integrates different knowledge about this subject and sets methodological boundaries that can be used to analyse already published data. The outcome should set some consensus for new clinical trials using isoflavones (isolated or included in mixtures) that will be evaluated to assess their therapeutically activity. This theoretical method for evaluation of a possible efficacy could probably also be applied to other herbal drug extracts when a synergistic or contradictory bio-effect is not verified. In this way, it we may contribute to enlighten and to the development of new therapeutic approaches.

Use of alkaline phosphatase staining to differentiate canine osteosarcoma from other vimentin-positive tumors.

Aspiration of lytic bone lesions is an excellent diagnostic test in the initial evaluation of primary bone neoplasia. However, cytologically, it can be difficult to differentiate osteosarcoma (OSA) from other bone neoplasms, including fibrosarcoma, chondrosarcoma, synovial cell sarcoma, and plasma cell myeloma. The purpose of this study is to determine the sensitivity and specificity of alkaline phosphatase (ALP) staining to differentiate OSA from other tumors that express vimentin by immunocytochemistry or immunohistochemistry. ALP is a hydrolytic enzyme present in multiple tissues including liver, kidney, intestine, placenta, and bone. Hypothetically, neoplasms actively producing bone should be specifically positive for ALP staining. Unstained, cytologic specimens were incubated for 8-10 minutes with nitroblue tetrazolium chloride/5-bromo-4-chloro-3-indolyl phosphate toluidine salt-phosphatase substrate. A positive reaction stains the membrane of the cells gray to black. Samples were counterstained with a Romanowsky's stain to determine whether the sample was of representative cellularity. A total of 61 vimentin-positive neoplasms have been evaluated and confirmed histopathologically. Tumors that expressed vimentin and were positive for ALP included 33 OSAs, one multi-lobular tumor of bone, one amelanotic melanoma, and one chondrosarcoma. Tumors that expressed vimentin and were negative for ALP included chondrosarcomas (three of four), multiple fibrosarcomas, and multiple synovial cell sarcomas. The sensitivity is 100%, and the specificity is 89%. In conclusion, ALP appears to be a highly sensitive and fairly specific marker in the diagnosis of OSA.

Disease knowledge and attitudes toward predictive testing and prenatal diagnosis in families with Machado-Joseph disease from the Azores Islands (Portugal).

OBJECTIVE: Machado-Joseph disease (MJD) reaches its highest prevalence world-wide in the Azores, thus constituting a public health problem in these islands. The aim of the study was thus to (1) determine the level of knowledge about the disease; (2) estimate the expected level of request for predictive testing, and (3) analyse the intentions of at-risk individuals concerning their reproductive decisions. METHODS: A questionnaire on these points was distributed to 42 affected and 36 at-risk individuals. RESULTS: As expected, the educational level of the respondents was significantly associated with the level of knowledge about the disease. The survey indicated that 83.3% of the at-risk individuals would make use of predictive test and that 77.8% would make use of prenatal diagnosis. Of the latter, 36.1% would terminate pregnancy if confronted with a positive result for the fetus. CONCLUSIONS: The level of knowledge about MJD in the Azorean families is considered to be fair. Although the actual behavior can prove to be different from the intentions put forward by at-risk individuals based solely on the results of this study we can estimate that the request for a predictive test would be quite high. The intentions expressed by at-risk individuals seem to indicate that the prenatal diagnosis will have an effect on their reproductive decisions. Results obtained certify the importance of implementing genetic testing for MJD in the Azores.

Trabalho e assistência à saúde - Um estudo sobre a assistência em saúde mental prestada pelo serviço médico de uma empresa bancária no município do Rio de Janeiro / Work and assistance to the health - A study about the assistance in mental health from a state bank in Rio de Janeiro

O artigo apresenta os resultados do estudo sobre o serviço médico de uma empresa bancária estatal no município do Rio de Janeiro. O objetivo geral da pesquisa foi conhecer a posiçäo ocupada pelos afastamentos do trabalho por distúrbios mentais no total de licenças médicas, assim comoavaliar o papel do Serviço Médico da empresa na concessäo desses afastamentos. Foram recolhidos dados de licenças-saúde no período de março a maio de 1990 e 1992. Também realizou-se entrevistas semiestruturadas com funcionários do serviço médico. Os transtornos mentais ocuparam o 4§ lugar entre as licenças-saúde iniciais em 1990 (com 8,2 por cento) e o 3§ lugar em 1992 (com 25,6 por cento). Quanto às licenças-saúde prorrogadas o grupodos transtornos mentais ocupou o 2§ lugar em 1990 (com 27,5 por cento) e o 1§ lugar em 1992 (com 25,6 por cento). Comparando os dois períodos constatou-se que de 1990 para 1992 quando os psiquiatras do serviço passaram a avaliar e a conceder as licenças nos casos mais graves, houve uma diminuiçäo da duraçäo dos afastamentos por transtornos mentais

Trabalho e assistencia a saude: um estudo sobre a assistencia em saude mental prestada pelo servico medico de uma empresa bancaria no municipio do Rio de Janeiro

O artigo apresenta os resultados do estudo sobre o servico medico de uma empresa bancaria estatal no municipio do Rio de Janeiro. O objetivo geral da pesquisa foi conhecer a posicao ocupada pelos afastamento do trabalho por disturbios mentais no total de licencas medicas, assim como avaliar o papel do Servico Medico da empresa na concessao desses afastamentos. Foram recolhidos dados de licenca-saude no periodo de marco a maio de 1990 e 1992. Tambem realizou-se entrevistas semiestruturadas com funcionarios do servico medico. Os transtornos mentais ocuparam o quarto lugar entre as licencas-saude iniciais em 1990 (com 8,2 por cento) e o terceiro lugar em 1992 (com 25,6 por cento). Quanto as licencas-saude prorrogadas o grupo dos transtornos mentais ocupou o segundo lugar em 1990 (com 27 5 por cento) e o primeiro lugar em 1992 (com 25,6 por cento). Comparando os dois periodos constatou-se que de 1990 para 1992 quando os psiquiatras do servico passaram a avaliar e a conceder as licencas nos casos mais graves, houve uma diminuicao da duracao dos afastamentos por transtornos mentais.

Anterior interosseous nerve palsy complicating a forearm fracture in a child.

An anterior interosseous nerve palsy occurring as a complication of a closed both bone forearm fracture in a child is presented. Surgical exploration showed that a bone spike from the proximal fragment was perforating the median nerve. The fractured radius was reduced and inspection of the nerve under the microscope showed no fasicular disruption. Complete motor recovery occurred in 4 months and sensibility had fully returned at 10 months after the operation.

O emprego do fio de acido poliglicolico em ortopedia e traumatologia. / The use of polyglycolic acid suture in orthopedics and traumatology

Os autores realizaram 30 cirurgias ortopedicas usando o fio do acido poliglicolico (P.G.A.). A idade dos pacientes variou entre 7 e 76 anos, com a media de 40,2 anos.De acordo com a opiniao dos autores, o fio P.G.A. foi considerado bom ou excelente em 93,4% dos casos. Os fios mostraram-se de facil manuseio, nao desfiando nem soltando os nos. Nao foram observados nenhuma reacao alergica, efeitos antigenicos, metabolicos ou pirogenicos. Mesmo em presenca de infeccoes nao foi evidenciada perda da tensao ou deiscencia de sutura