Perfil de autodeterminação de adultos com e sem dificuldades intelectuais e desenvolvimentais: estudo comparativo / Self-determination profile of adults with and without intellectual and developmental difficulties: comparative study

RESUMO O reconhecimento da autodeterminação tem vindo a ser evidente também no campo da Dificuldade Intelectual e Desenvolvimental (DID), visto que a pessoa deve assumir-se como agente ativo e decisor na própria vida. A aprendizagem das competências autodeterminadas é fundamental dada a sua transversalidade contextual, não se devendo restringir apenas à adolescência. Em Portugal, as evidências são escassas e baseadas no anterior modelo. Assim sendo, o objetivo deste estudo foi identificar o perfil de autodeterminação, à luz da teoria do agente causal, de adultos com DID, no intuito de analisar as variáveis que o influenciam. A versão portuguesa do Inventário de Autodeterminação foi aplicada a 44 participantes entre os 21-73 anos (40.77±12.07), 20 do género feminino e 24 do masculino. Metade da amostra eram participantes com DID, todos institucionalizados. A consistência interna foi aceitável (α=.65). A análise comparativa pelo diagnóstico, género, idade, habilitações académicas, situação profissional e local de residência apontou a tendência para perfis semelhantes (p>.05). As diferenças encontradas estão associadas a perfis mais autodeterminados de adultos com DID, inferindo-se o maior peso das características envolvimentais do que individuais (diagnóstico). As pessoas com DID reconhecem a autodeterminação como relevante e apresentam as habilidades para a decisão. Recomendações para a investigação e para a prática serão avançadas.

ABSTRACT The recognition of self-determination has also become evident in the field of Intellectual and Developmental Disability (IDD), as the person must assume him/herself as an active agent and decision-maker in his/her own life. Learning self-determined skills is fundamental given their contextual transversality and should not be restricted to the period of adolescence. In Portugal, evidence is scarce and based on the previous model. Therefore, the aim of this study was to identify the self-determination profile, in the light of the causal agent theory, of adults with IDD, in order to analyze the variables that influence it. The Portuguese version of the Self-Determination Inventory was applied to 44 participants aged between 21-73 years old (40.77±12.07), 20 females and 24 males. Half of the sample were participants with IDD, all institutionalized. Internal consistency was acceptable (α=.65). The comparative analysis by diagnosis, gender, age, academic qualifications, professional status and place of residence showed a tendency towards similar profiles (p>.05). The differences found are associated with more self-determined profiles of adults with ID, inferring the greater weight of involvement characteristics than individual ones (diagnosis). People with IDD recognize self-determination as relevant and present decision-making skills. Recommendations for research and practice will be advanced.

Terapia a laser de baixa potência no manejo da cicatrização de feridas cutâneas / Low-level laser therapy in the management of skin wound healing

Introdução: O reparo tecidual e a cicatrização de feridas cutâneas são processos complexos que envolvem uma série de eventos dinâmicos, incluindo coagulação, inflamação, formação de tecido de granulação, contração da ferida e remodelação tecidual. A necessidade de cuidar de pacientes com dificuldades na cicatrização de feridas é um desafio crescente e requer estratégias inovadoras. Uma abordagem que se destaca no tratamento dessas lesões é a laserterapia de baixa potência. Este estudo tem como objetivo demonstrar a aplicabilidade e os resultados de um protocolo de laserterapia de baixa potência no manejo da cicatrização de feridas cutâneas. Métodos: Trata-se de estudo retrospectivo de revisão de casos relatando o uso de laser no tratamento de feridas cutâneas em um centro único. Resultados: Avaliamos os resultados do uso de laserterapia de baixa potência e relatamos cinco casos de pacientes com feridas cutânea que não apresentaram melhora com o tratamento convencional. As lesões eram localizadas em sítios diversos, com lesão no tronco, membro superior e membro inferior. Os cinco casos apresentaram uma boa resposta com a terapia a laser, evoluindo com a cicatrização das feridas em um curto período de tempo, com período médio de cicatrização de 48 dias. Conclusão: Conclui-se que a laserterapia de baixa potência quando aplicada sobre feridas cutâneas sugere uma ação benéfica, promissora e tem um potencial para aumentar as opções terapêuticas disponíveis para o cirurgião, porém, como relatamos um número de cinco casos, há necessidade de mais estudos para verificar a eficiência do laser em feridas.

Introduction: Tissue repair and skin wound healing are complex processes that involve a series of dynamic events, including coagulation, inflammation, granulation tissue formation, wound contraction and tissue remodeling. The need to care for patients with difficulties in wound healing is a growing challenge and requires innovative strategies. One approach that stands out in the treatment of these injuries is low-power laser therapy. This study aims to demonstrate the applicability and results of a low-power laser therapy protocol in the management of skin wound healing. Methods: This is a retrospective case review study reporting the use of laser in the treatment of skin wounds in a single center. Results: We evaluated the results of the implementation of this low-power laser therapy protocol and reported five cases of patients with skin wounds that did not improve with conventional treatment. The lesions were located in different places, with lesions on the trunk, upper limb and lower limb. The five cases showed a good response to laser therapy, evolving with wound healing in a short period of time, with an average healing time of 48 days. Conclusion: It is concluded that low power laser therapy when applied to skin wounds suggests a beneficial, promising action and has the potential to increase the therapeutic options available to the surgeon, however as we report a number of five cases, further studies are needed for check laser efficiency on wounds.

Arc's Self-Determination Scale: Adaptação e Validação à População Adolescente e Adulta Portuguesa com DID / Arc's Self-Determination Scale: Adaptation and Validation to the Portuguese Adolescent and Adult Population with IDD

RESUMO: No atual contexto português, é ainda visível a generalizada dificuldade em obter instrumentos de avaliação adaptados à população com Dificuldades Intelectuais e Desenvolvimentais (DID) que avaliem o constructo da autodeterminação. Nesse sentido, este artigo tem por objetivo a adaptação e a validação da Arc's Self-Determination Scale à população adolescente e adulta portuguesa com DID. Para esse efeito, foram seguidas as recomendações internacionais inerentes a processos dessa natureza, culminando em uma avaliação de 11 peritos para a evidência quantitativa da validade de conteúdo. Todos os itens dessa escala foram considerados como relevantes ou muito relevantes (n=72), tendo-se obtido acordos moderados (k>.40) e excelentes (k>.75) entre os peritos no cálculo do Kappa de Cohen. A amostra foi constituída por 500 indivíduos adolescentes e adultos entre 16 e 70 anos de idade (24.03±9.15), sendo 256 do género feminino e 244 do género masculino com e sem DID. A escala apresentou uma excelente consistência interna (α=.89), com tendência para correlações fracas a moderadas (.01>r<.51). Os procedimentos inerentes à validade de constructo são, igualmente, apresentados e discutidos. Os principais resultados parecem apontar a ideia de que o instrumento em estudo apresenta as características de validade e de fiabilidade necessárias para que possa ser utilizado em nível nacional.

ABSTRACT: In the current Portuguese context, the generalized difficulty in obtaining assessment instruments adapted to the population with Intellectual and Developmental Difficulties (IDD) that evaluate the construct of self-determination is still visible. In this sense, this paper aims to adapt and validate the Arc's Self-Determination Scale to the Portuguese adolescent and adult population with IDD. To this end, it was considered the international guidelines in cross-cultural adaptation process, culminating with an evaluation of 11 experts for the quantitative evidence of the content validity. All items of this scale were considered as relevant or very relevant (n=72) and there was a moderated (k>.40) and an excellent agreement (k>.75) among the experts in the calculation of Cohen's Kappa. The sample comprised 500 adolescents/adults, aged between 16 and 70 years-old (24.03±9.15), 256 females and 244 males with and without IDD. The scale showed an excellent internal consistency (α=.89) and weak to moderate correlations between sections (.01>r<.51). The procedures inherent to the validity of construct are also presented and discussed. The main results seem to point out the idea that the instrument under study presents the characteristics of validity and reliability required so that it can be used at the national level.

Uso de anfotericina B por via intralesional associada ao itraconazol oral para tratamento de recidiva de esporotricose nasal em um gato - relato de caso / Intralesional use of amphotericin B associated with oral itraconazole for the treatment of recurrent nasal sporotrichosis in a cat - case report / Anfotericina B intralesional e itraconazole oral en el tratamiento de un cuadro recidivante de esporotricosis nasal en un gato - relato de caso

A esporotricose nasal é uma afecção de difícil resolução clínica, muitas vezes refratária ao tratamento e possivelmente recidivante em gatos. Neste caso, a anfotericina B foi utilizada por via intralesional em associação ao itraconazol (100 mg/gato/via oral a cada 24 horas) em felino com recidiva de esporotricose nasal. Durante o tratamento foram realizados exames laboratoriais para garantir a segurança do protocolo utilizado. O novo biomarcador para função renal SDMA IDEXXTM foi empregado antes e após o término do protocolo para monitorar a função renal. Os efeitos adversos encontrados foram edema e desconforto no local de aplicação. O tempo total de tratamento foi de três meses e não se observou efeito tóxico renal. Dessa maneira o protocolo utilizado mostrou-se eficaz e seguro no tratamento da esporotricose nasal.

Nasal sporotrichosis is a condition of difficult clinical resolution, which is commonly refractory to treatment and recurrent in cats. In this report, amphotericin B was used intralesionaliy in combination with oral itraconazole (100 mg/per catloral each 24 h) in order to treat a cat with relapse of nasal sporotrichosis. During the treatment, laboratory tests were performed to ensure the safety of the protocol used. The new biomarker for renal function SDMA IDEXX was used before and after the end of the protocol to monitor renal function. Adverse effects were edema and local discomfort. Total treatment duration was 3 months, and no renal toxic effect was observed. This protocol therefore proved to be effective and safe to treat nasal sporotrichosis.

La esporotricosis nasal es una afección de difícil manejo clínico que en muchas ocasiones resulta refractaria a los tratamientos y con importantes tasas de recidiva en gatos. En el presente caso, la anfotericina B se utilizó por vía intralesional en asociación con itraconazole (100 mg/gato/PO/24hs) en un gato con recidiva de esporotricosis nasal. Durante el tratamiento se realizaron exámenes de laboratorio a fin de garantizar la seguridad del protocolo utilizado. Se utilizó un nuevo biomarcador para función renal (SDMA IDEXXTM) antes y después del protocolo terapéutico. Los efectos adversos encontrados fueron edema y molestias en el lugar de aplicación. EI tiempo total de tratamiento fue de tres meses, sin que se hayan observado efectos tóxicos a nivel renal. Así, el protocolo usado se mostró eficiente y seguro para el tratamiento de la esporotricosis nasal.

Uso de anfotericina B por via intralesional associada ao itraconazol oral para tratamento de recidiva de esporotricose nasal em um gato - relato de caso / Intralesional use of amphotericin B associated with oral itraconazole for the treatment of recurrent nasal sporotrichosis in a cat - case report / Anfotericina B intralesional e itraconazole oral en el tratamiento de un cuadro recidivante de esporotricosis nasal en un gato - relato de caso

A esporotricose nasal é uma afecção de difícil resolução clínica, muitas vezes refratária ao tratamento e possivelmente recidivante em gatos. Neste caso, a anfotericina B foi utilizada por via intralesional em associação ao itraconazol (100 mg/gato/via oral a cada 24 horas) em felino com recidiva de esporotricose nasal. Durante o tratamento foram realizados exames laboratoriais para garantir a segurança do protocolo utilizado. O novo biomarcador para função renal SDMA IDEXXTM foi empregado antes e após o término do protocolo para monitorar a função renal. Os efeitos adversos encontrados foram edema e desconforto no local de aplicação. O tempo total de tratamento foi de três meses e não se observou efeito tóxico renal. Dessa maneira o protocolo utilizado mostrou-se eficaz e seguro no tratamento da esporotricose nasal.(AU)

Nasal sporotrichosis is a condition of difficult clinical resolution, which is commonly refractory to treatment and recurrent in cats. In this report, amphotericin B was used intralesionaliy in combination with oral itraconazole (100 mg/per catloral each 24 h) in order to treat a cat with relapse of nasal sporotrichosis. During the treatment, laboratory tests were performed to ensure the safety of the protocol used. The new biomarker for renal function SDMA IDEXX was used before and after the end of the protocol to monitor renal function. Adverse effects were edema and local discomfort. Total treatment duration was 3 months, and no renal toxic effect was observed. This protocol therefore proved to be effective and safe to treat nasal sporotrichosis.(AU)

La esporotricosis nasal es una afección de difícil manejo clínico que en muchas ocasiones resulta refractaria a los tratamientos y con importantes tasas de recidiva en gatos. En el presente caso, la anfotericina B se utilizó por vía intralesional en asociación con itraconazole (100 mg/gato/PO/24hs) en un gato con recidiva de esporotricosis nasal. Durante el tratamiento se realizaron exámenes de laboratorio a fin de garantizar la seguridad del protocolo utilizado. Se utilizó un nuevo biomarcador para función renal (SDMA IDEXXTM) antes y después del protocolo terapéutico. Los efectos adversos encontrados fueron edema y molestias en el lugar de aplicación. EI tiempo total de tratamiento fue de tres meses, sin que se hayan observado efectos tóxicos a nivel renal. Así, el protocolo usado se mostró eficiente y seguro para el tratamiento de la esporotricosis nasal.(AU)

Effect of administration rate on propofol requirement in cats.

Objectives The objective of this study was to determine the effect of administration rate on propofol dose for induction of anesthesia and the effect of methadone on this dose. Methods This was a prospective, randomized, blinded clinical study. Forty male cats (mean ± SD age 1.5 ± 0.8 years) were admitted for orchiectomy. Cats were randomly allocated to receive acepromazine (0.05 mg/kg) with either methadone (MET; 0.3 mg/kg) or saline (SAL; 0.03 ml/kg). Each premedication group then received anesthetic induction with propofol at 5 (F) or 1.5 mg/kg/min (S), resulting in the following four groups: MET-F, SAL-F, MET-S and SAL-S. Sedation scores were assigned at 15 and 30 mins after premedication using a simple descriptive scale (SDS) and a visual analog scale (VAS). After assignment of sedation scores, respiratory frequency ( fR) was recorded, and anesthetic induction began and was continued until cats lost their palpebral reflexes and jaw tone, and the eye globe rotated ventromedially. The time for induction and the total amount of propofol needed was recorded, and intubation was then performed. After intubation, fR was also recorded. Results SDS and VAS sedation scores were low at 15 and 30 mins after premedication. There was no significant difference in sedation scores by time or between the groups at any time on any scale. The amount of propofol needed to achieve anesthetic induction was 5.3 ± 1.1 mg/kg in group MET-F, which was statistically lower when compared with the other three groups, which demonstrated no difference among them. Conclusions and relevance Premedication with acepromazine and methadone was not able to produce adequate sedation in healthy cats. The slow induction rate is not adequate for use in cats considering that all of the animals demonstrated excitement during anesthetic induction. The fast administration rate was able to produce adequate induction of anesthesia and reduce the amount of propofol needed to achieve intubation only when using methadone.

Tratamento cirúrgico bem sucedido de quilotórax idiopático em gato / Successful surgical treatment of idiopathic chylothorax in a cat

Background: Chylothorax in cats represents a challenge due to the possibility of involvement of multiple etiologies and the harmful consequences resulting of the presence of the chylous effusion in the thorax. The causes include neoplasms in the thoracic cavity, heart disease and thoracic injuries. It is imperative that clinical nutritional and therapeutic and / or surgical management be immediate and directed to the treatment of the cause. The objective of this work was to report a case of idiopathic chylothorax in a domestic cat solved through surgical intervention and dietary maintenance applied.Case: A 4-year-old male cat, fed with diet for the age range of adult cats, was attended at the Veterinary Hospital of the Federal Rural University of Rio de Janeiro (HV - UFRRJ), with clinical complaint of difficulty breathing, inappetence, prostration and weight loss. In the clinical examination was verified intense tachypnea, presence of heart murmur, normocorated mucosae, dehydration 7%. The animal was sedated to be submitted to radiographic examination of the thorax with pethidine and midazolam. Thoracic radiographs on the lateral, ventral-dorsal and orthostatic positions were realized and severe pleural effusion was observed in both hemitorax with drainage of 180 mL of lactescent fluid from the right hemithorax and 120 mL of left hemithorax liquid. Through analysis of cavity liquids the effusion was classified as chylous effusion. The hemogram showed a neutrophilic leukocytosis. Serum cholesterol and triglyceride concentrations (28 mg/ dL and 43 mg/dL, respectively) were lower than the concentrations of the cavity liquid (67 mg/dL and 722 mg/dL, respectively). Ultrasound examination revealed no mass in the thoracic cavity and no changes in the pulmonary parenchyma. The echocardiographic examination was also performed and did not reveal any cardiac alterations.[...]

Hemangiosarcoma associated with polypropylene suture in a cat

Background: Sutures plays an important role in wound repair by providing hemostasis and support for healing suture. Synthetic non-absorbable like polypropylene suture materials induce minimal tissue reaction. Polypropylene has not been associated to neoplasms in domestic animals. The aim this study is to describe the first case of polypropylene suture induced hemangiosarcoma in an abdominal wall of a feline.Case: A 13-year-old female domestic shorthair cat was presented with a ventral abdominal subcutaneous mass. Clinical examination revealed a firm, rough, and irregular, approximately 6 x 4 cm subcutaneous mass involving the caudal ventral abdomen. A complete blood (cell) count (CBC) was within normal limits. Leukemia and FIV tests were negative; and the results of a chemistry panel revealed elevated creatinine (valor: 2.0 reference range: 0.5-1.9). Abdominal ultrasound revealed a large mass of mixed echogenicity in the mid-ventral abdomen cranial to the bladder, measuring approximately 6 x 4 cm in the middle line with suture deeply embedded within mass suggesting foreign body reaction or neoplasm. There was evidence of sutures (hyperechoic lines) along the caudal abdominal wall extending into the mass. Records indicated that ovariohysterectomy procedure was performed 12 years previously at the same clinic and the closure of the abdominal wall was made with polypropylene sutures. No other abdominal surgery was performed in this cat. A fine-needle aspirate of the mass and contrast-enhanced computed tomography was not performed due to owner’s finance restrains. The cat was referred to surgery and the mass was excised. No evidence of metastasis was noted during surgery. Histologically, the neoplastic cells were oval to round with granular cytoplasm and vesicular nucleus and exhibited moderate cellular and nuclear pleomorphism. A diagnosis of abdominal wall hemangiosarcoma was made with suture deeply embedded within mass. Surgical margins were clear. [...]

Hemangiosarcoma associated with polypropylene suture in a cat

Background: Sutures plays an important role in wound repair by providing hemostasis and support for healing suture. Synthetic non-absorbable like polypropylene suture materials induce minimal tissue reaction. Polypropylene has not been associated to neoplasms in domestic animals. The aim this study is to describe the first case of polypropylene suture induced hemangiosarcoma in an abdominal wall of a feline.Case: A 13-year-old female domestic shorthair cat was presented with a ventral abdominal subcutaneous mass. Clinical examination revealed a firm, rough, and irregular, approximately 6 x 4 cm subcutaneous mass involving the caudal ventral abdomen. A complete blood (cell) count (CBC) was within normal limits. Leukemia and FIV tests were negative; and the results of a chemistry panel revealed elevated creatinine (valor: 2.0 reference range: 0.5-1.9). Abdominal ultrasound revealed a large mass of mixed echogenicity in the mid-ventral abdomen cranial to the bladder, measuring approximately 6 x 4 cm in the middle line with suture deeply embedded within mass suggesting foreign body reaction or neoplasm. There was evidence of sutures (hyperechoic lines) along the caudal abdominal wall extending into the mass. Records indicated that ovariohysterectomy procedure was performed 12 years previously at the same clinic and the closure of the abdominal wall was made with polypropylene sutures. No other abdominal surgery was performed in this cat. A fine-needle aspirate of the mass and contrast-enhanced computed tomography was not performed due to owners finance restrains. The cat was referred to surgery and the mass was excised. No evidence of metastasis was noted during surgery. Histologically, the neoplastic cells were oval to round with granular cytoplasm and vesicular nucleus and exhibited moderate cellular and nuclear pleomorphism. A diagnosis of abdominal wall hemangiosarcoma was made with suture deeply embedded within mass. Surgical margins were clear. [...](AU)

Complicações em mamoplastia de aumento via abdominal no HSPM / Complications in HSPM abdominal augmentation mammoplasty

Houve aumento na demanda por cirurgias plásticas combinadas no Brasil e no mundo. A mamoplastia de aumento e a abdominoplastia estão entre os procedimentos estéticos mais realizados e as técnicas utilizadas para este fim são diversas. A fim de atender a essa demanda e otimizar os resultados estéticos, foi descrito em 1975, por Hinderer, a mamoplastia de aumento por via abdominal. Esta técnica permite a inclusão de implantes mamários e correção da flacidez da pele abdominal no mesmo tempo cirúrgico e através de uma única incisão. Apesar disso não é uma técnica amplamente difundida, o posicionamento da prótese por esta via pode ser um desafio para o cirurgião plástico por exigir um instrumental específico para a dissecção das lojas e não esta isento de complicações. MÉTODOS : Estudo retrospectivo e observacional de todos os casos de Mamoplastia de aumento via abdominal operados entre março de 2011 a novembro de 2017, no Serviço de Cirurgia Plástica do Hospital do Servidor Público Municipal de São Paulo. Vinte pacientes com idade entre 24 e 47 anos foram submetidas a técnica uma vez que atendessem aos critérios selecionados. RESULTADOS : Durante sete anos de observação, pacientes selecionados, mulheres, não fumantes, com história de gestações anteriores, índice de massa corporal abaixo de 27, sem ptose mamária, foram submetidas a abdominoplastia e colocação de implantes de silicone em plano subglandular através da incisão abdominal. Todos os procedimentos foram realizados sob anestesia geral. O tempo operatório variou de 150 a 275 min, o tamanho do implante variou de 265 a 400cc e o peso do tecido dermogorduroso ressecado variou de 320 a 2160g. Os pacientes receberam alta um dia após a cirurgia. Uma das 20 pacientes operadas evoluiu com assimetria do sulco, exigindo o reposicionamento de implantes por incisão infra-mamária. As complicações na região abdominal foram: dois casos de deiscência da ferida operatória e um caso de estenose umbilical. Até agora nenhum caso de trombose venosa profunda (TVP), tromboembolismo pulmonar (TEP), contratura capsular ou infecção foi observado. CONCLUSÃO : A inclusão dos implantes através da incisão da abdominoplastia mostrou resultados satisfatórios ao proporcionar a obtenção de forma, volume e simetria das mamas, sem criar cicatrizes na região mamária ou axilar. Não observamos aumento significativo no número de complicações ou tempo operatório e as pacientes demonstraram grande satisfação com resultados.

Tratamento cirúrgico bem sucedido de quilotórax idiopático em gato / Successful surgical treatment of idiopathic chylothorax in a cat

Background: Chylothorax in cats represents a challenge due to the possibility of involvement of multiple etiologies and the harmful consequences resulting of the presence of the chylous effusion in the thorax. The causes include neoplasms in the thoracic cavity, heart disease and thoracic injuries. It is imperative that clinical nutritional and therapeutic and / or surgical management be immediate and directed to the treatment of the cause. The objective of this work was to report a case of idiopathic chylothorax in a domestic cat solved through surgical intervention and dietary maintenance applied.Case: A 4-year-old male cat, fed with diet for the age range of adult cats, was attended at the Veterinary Hospital of the Federal Rural University of Rio de Janeiro (HV - UFRRJ), with clinical complaint of difficulty breathing, inappetence, prostration and weight loss. In the clinical examination was verified intense tachypnea, presence of heart murmur, normocorated mucosae, dehydration 7%. The animal was sedated to be submitted to radiographic examination of the thorax with pethidine and midazolam. Thoracic radiographs on the lateral, ventral-dorsal and orthostatic positions were realized and severe pleural effusion was observed in both hemitorax with drainage of 180 mL of lactescent fluid from the right hemithorax and 120 mL of left hemithorax liquid. Through analysis of cavity liquids the effusion was classified as chylous effusion. The hemogram showed a neutrophilic leukocytosis. Serum cholesterol and triglyceride concentrations (28 mg/ dL and 43 mg/dL, respectively) were lower than the concentrations of the cavity liquid (67 mg/dL and 722 mg/dL, respectively). Ultrasound examination revealed no mass in the thoracic cavity and no changes in the pulmonary parenchyma. The echocardiographic examination was also performed and did not reveal any cardiac alterations.[...](AU)

Complicações em mamoplastia de aumento via abdominal no Hospital do Servidor Público Municipal de São Paulo / Complications in abdominal augmentation mammoplasty at Hospital do Servidor Público Municipal de São Paulo

RESUMO INTRODUÇÃO : Houve aumento na demanda por cirurgias plásticas combinadas no Brasil e no mundo. A mamoplastia de aumento e a abdominoplastia estão entre os procedimentos estéticos mais realizados e as técnicas utilizadas para este fim são diversas. A fim de atender a essa demanda e otimizar os resultados estéticos, foi descrito em 1975, por Hinderer, a mamoplastia de aumento por via abdominal. Esta técnica permite a inclusão de implantes mamários e correção da flacidez da pele abdominal no mesmo tempo cirúrgico e através de uma única incisão. Apesar disso não é uma técnica amplamente difundida, o posicionamento da prótese por esta via pode ser um desafio para o cirurgião plástico por exigir um instrumental específico para a dissecção das lojas e não esta isento de complicações. MÉTODOS : Estudo retrospectivo e observacional de todos os casos de Mamoplastia de aumento via abdominal operados entre março de 2011 a novembro de 2017, no Serviço de Cirurgia Plástica do Hospital do Servidor Público Municipal de São Paulo. Vinte pacientes com idade entre 24 e 47 anos foram submetidas a técnica uma vez que atendessem aos critérios selecionados. RESULTADOS : Durante sete anos de observação, pacientes selecionados, mulheres, não fumantes, com história de gestações anteriores, índice de massa corporal abaixo de 27, sem ptose mamária, foram submetidas a abdominoplastia e colocação de implantes de silicone em plano subglandular através da incisão abdominal. Todos os procedimentos foram realizados sob anestesia geral. O tempo operatório variou de 150 a 275 min, o tamanho do implante variou de 265 a 400cc e o peso do tecido dermogorduroso ressecado variou de 320 a 2160g. Os pacientes receberam alta um dia após a cirurgia. Uma das 20 pacientes operadas evoluiu com assimetria do sulco, exigindo o reposicionamento de implantes por incisão infra-mamária. As complicações na região abdominal foram: dois casos de deiscência da ferida operatória e um caso de estenose umbilical. Até agora nenhum caso de trombose venosa profunda (TVP), tromboembolismo pulmonar (TEP), contratura capsular ou infecção foi observado. CONCLUSÃO : A inclusão dos implantes através da incisão da abdominoplastia mostrou resultados satisfatórios ao proporcionar a obtenção de forma, volume e simetria das mamas, sem criar cicatrizes na região mamária ou axilar. Não observamos aumento significativo no número de complicações ou tempo operatório e as pacientes demonstraram grande satisfação com resultados. Palavras-chave: Cirurgia plástica. Mamoplastia. Implante mamário. Abdominoplastia.

Stroke subtypes and comorbidity among ischemic stroke patients in Brasilia and Cuenca: a Brazilian-Spanish cross-cultural study.

BACKGROUND: With the increase in life expectancy worldwide, changes in stroke subtypes and burden of stroke population are expected in both developing and developed countries. Prevalence of stroke subtypes and comorbidity in ischemic stroke patients was assessed in Brasilia, Brazil, and Cuenca, Spain. METHODS: This was an international (Brazilian-Spanish) cross-sectional study. Stroke subtypes were assessed by means of Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. Modified Rankin scale was used to measure functional recovery and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) was used to assess comorbidity. RESULTS: A total of 500 patients (mean age 66.2 ± 16.4 years; 48% female; 48.2% Spanish) were included in the study. Spanish patients were significantly older than Brazilian ones (76.4 ± 11.2 versus 56.7 ± 14.6 years; P < .0001). Prevalence of ischemic cardiopathy (20.3% versus 6.2%) and atrial fibrillation (25.7% versus 6.6%) was significantly higher in Spanish stroke patients, whereas they less frequently used tobacco (28.3% versus 52.9%); P less than .0001. Prevalence of stroke subtypes in Spanish and Brazilian stroke patients was: stroke of undetermined etiology (58.1% versus 32.4%), cardioembolism (24.5% versus 11.6%), lacunar infarct (11.6% versus 25.5%), atherothrombotic (3.7% versus 19.7%), and other causes (2.1% versus 10.8%); P less than .0001. The Spanish sample had a significantly higher frequency of comorbidities. The CIRS-G total score and CIRS-G mean number of affected organs significantly increased with age, and correlated with the level of functional dependence as measured by Rankin scale (rS = 0.50; P = .0005). CONCLUSION: Spanish stroke people had a higher frequency of comorbid conditions, atrial fibrillation, and cardioembolism and these facts were associated with age. Atherothrombotic and lacunar strokes were more common in the younger Brazilian stroke population.

Determination of total organic halogen (TOX) in humic acids after microwave-induced combustion.

Chemically chlorinated organic matter as well as natural background humic acids contain significant amounts of organically bound halogens that must be determined for assessment of environmental pollution. In this work the use of ion chromatography (IC) and inductively coupled plasma mass spectrometry (ICP-MS) is proposed for the determination of total organic Cl, Br and I concentration in humic acids extracted from various forest soil horizons after a single digestion by microwave-induced combustion (MIC). Samples were pressed as pellets and combusted using 20 bar of oxygen and ammonium nitrate solution as igniter. Analytes were absorbed in diluted alkaline solution (50mM (NH(4))(2)CO(3)) and a reflux step was applied after combustion to improve analyte recoveries (5 min, microwave power of 1400W). The accuracy was evaluated using certified reference materials (CRM) and spiked samples. Using MIC the agreement with CRM values and spike recoveries was higher than 97% for all analytes. As an advantage over conventional procedures, using MIC it was possible to digest up to eight samples in only 25 min, obtaining a single solution suitable for all halogens determination in humic acids samples by different techniques (IC and ICP-MS). The limit of detection (3σ) for Cl, Br and I obtained by IC was 1.2, 2.5 and 4.3µgg(-1) and by ICP-MS it was 1.4, 0.03 and 0.002µgg(-1), respectively.

Experimental Infection by Tripanossoma evansi in Rabbits: Levels of Sodium, Potassium, Calcium and Phosphorus in Serum

Background: Trypanosoma evansi is the most widely distributed of the pathogenic African animal trypanosomes, affecting domestic livestock and wildlife in country. The animals presented clinical sings as anemia, emaciation, apathy, recurrent fever , enlarged lymph nodes, edema and abortion The minerals have different functions in the organism, and an imbalance, either by excess or deficiency, or a pathological condition, causes alterations in the respective serum levels, as well as in trypanosomosis. Therefore, the aim of this study was to evaluate the concentrations of sodium, potassium, calcium and phosphorus in blood serum of rabbits experimentally infected with Trypanosoma evansi. Materials, Methods & Results: Twelve adult female Oryctolagus cuniculus, weighing average 3.9 kg, were used. Rabbits were divided into two groups, a control group with six animals (rabbits 1-6) and an infected group with six animals (rabbits 7-12). Animals from trypanosome-infected groups were inoculated intraperitoneally with 0.5 mL of rat blood containing 10 8 trypanosomes (Day 1). Control group received physiological solution by the same route. Parasitemia was estimated daily for 118 days post- inoculation (PI) by microscopic examination of smears. Blood samples for hematology and evaluation of serum minerals were collected at days 1, 5, 20, 35, 50, 80 and 118 PI. Hematocrit was evaluated for monitoring of the disease. Inductively coupled plasma optical emission spectrometry (ICP OES) was used to measure the levels of sodium, potassium, calcium and phosphorus. Hyporexia, edema and fever were clinical signs associated with change in the levels of the minerals. A decrease in the number of red blood cells was only observed at day 5 post-inoculation. Significant differences were observed among groups (P < 0.05) in minerals levels. Sodium and calcium were reduced at days 35, 50, 80 and 118 PI. [...]

Experimental Infection by Tripanossoma evansi in Rabbits: Levels of Sodium, Potassium, Calcium and Phosphorus in Serum

Background: Trypanosoma evansi is the most widely distributed of the pathogenic African animal trypanosomes, affecting domestic livestock and wildlife in country. The animals presented clinical sings as anemia, emaciation, apathy, recurrent fever , enlarged lymph nodes, edema and abortion The minerals have different functions in the organism, and an imbalance, either by excess or deficiency, or a pathological condition, causes alterations in the respective serum levels, as well as in trypanosomosis. Therefore, the aim of this study was to evaluate the concentrations of sodium, potassium, calcium and phosphorus in blood serum of rabbits experimentally infected with Trypanosoma evansi. Materials, Methods & Results: Twelve adult female Oryctolagus cuniculus, weighing average 3.9 kg, were used. Rabbits were divided into two groups, a control group with six animals (rabbits 1-6) and an infected group with six animals (rabbits 7-12). Animals from trypanosome-infected groups were inoculated intraperitoneally with 0.5 mL of rat blood containing 10 8 trypanosomes (Day 1). Control group received physiological solution by the same route. Parasitemia was estimated daily for 118 days post- inoculation (PI) by microscopic examination of smears. Blood samples for hematology and evaluation of serum minerals were collected at days 1, 5, 20, 35, 50, 80 and 118 PI. Hematocrit was evaluated for monitoring of the disease. Inductively coupled plasma optical emission spectrometry (ICP OES) was used to measure the levels of sodium, potassium, calcium and phosphorus. Hyporexia, edema and fever were clinical signs associated with change in the levels of the minerals. A decrease in the number of red blood cells was only observed at day 5 post-inoculation. Significant differences were observed among groups (P < 0.05) in minerals levels. Sodium and calcium were reduced at days 35, 50, 80 and 118 PI. [...](AU)

Burden and perceived health status among caregivers of stroke patients.

OBJECTIVE: To identify the main determinants of burden and perceived health status in caregivers of Brazilian stroke survivors. METHODS: Cross-sectional study. Caregivers answered the Hospital Anxiety and Depression Scale (HADS), Zarit caregiver burden interview (ZCBI) and EuroQol. Patients were assessed with the National Institute of Health Stroke Scale, Barthel index (BI), modified-Rankin scale (m-RS), Mini Mental State Examination and HADS. RESULTS: 200 caregiver-patient dyads were assessed. Caregivers were significantly younger (42 vs. 57.7 years) and had more years of formal education (10 vs. 7.8 years); p < 0.0001. Seventy-seven percent of caregivers were females, and 41% were spouses. The prevalence of anxiety disorders was significantly higher in female caregivers than in males (26.1 vs. 10.9%; p = 0.04). ZCBI mean score was 27.2, and female caregivers had significantly worse scores (28.7 vs. 22.3, p = 0.003). ZCBI mean score significantly increased (worsened) as the severity of the disease, based on m-RS, increased. ZCBI mean scores were significantly higher in wives than in other relatives (31.4 vs. 22.6; ANOVA, p < 0.0001). The EuroQol-5D and EuroQol-Visual Analog Scale mean scores were 0.7 (range: 0.04-0.85) and 75.2 (range: 1-100), respectively. Adequate convergent validity (r = -0.38 to -0.40) between EuroQol and ZBCI mean scores was observed. Patient s disability (as measured by the BI) and caregiver's factors (female sex, depression as measured by HADS-depression) were independent predictors of caregiver's burden (r2 adjusted = 0.48; p < 0.0001) in the multivariate regression analysis. CONCLUSIONS: Caregiver's mood was the most consistent factor influencing caregiver burden and perceived health in stroke caregivers.

Self- and proxy-report agreement on the Stroke Impact Scale.

BACKGROUND AND PURPOSE: The purpose of this study was to examine proxy-patient agreement on the domains of the Stroke Impact Scale (SIS), as per the proxy-proxy perspective. METHODS: Stroke patients were prospectively assessed by means of the NIH Stroke Scale, Barthel index, and modified Rankin scale. Proxies and patients answered the Hospital Anxiety and Depression Scale and the SIS 3.0. Comparisons of patient-proxy mean scores (paired t test), effect size, and intraclass correlation coefficients (ICC) were calculated for each of the SIS domains, and weighted kappa for individual items. RESULTS: 180 proxy-patient pairs were assessed. Proxies were younger (mean age: 43.1 versus 57.9 years) and had a higher education level (P<0.0001). The bias between patient-proxy mean differences was low (from 5.3, Strength, to 0.1, Communication). Proxies significantly scored patients as more severely affected in Strength (41.7 versus 36.6; P<0.0001) and ADL (46.2 versus 43.1; P=0.01) domains, and Composite Physical Domain (CPD; 39.7 versus 34.9; P<0.0001). The magnitude of difference was small (size effect: 0.21). ICC values for the SIS domains ranged from 0.17 (Emotion) to 0.79 (Hand function). The ICC value for the CPD was 0.83. Memory, Communication, Emotion, and Social Participation domains had ICC lower values. The weighted kappa values for the SIS items ranged from 0.09 (item 4e) to 0.80 (item 7d). Highest values (moderate/high agreement) were observed for the SIS-16 and CPD (kappa values: 0.31 to 0.80). CONCLUSIONS: Agreement between stroke patients and proxies was acceptable for most SIS domains and SIS-16. Proxy's assessment of SIS subjective domains should be taken with caution.

Poststroke depression: prevalence and determinants in Brazilian stroke patients.

BACKGROUND: Poststroke depression (PSD) is one of the most important long-term adverse psychosocial consequences in stroke survivors. Our objective was to assess the prevalence of PSD in Brazilian stroke patients and identify significant associated factors. METHODS: A cross-sectional study of stroke patients consecutively admitted for rehabilitation was conducted. The patients were evaluated by means of the NIH Stroke Scale, Mini-Mental State Examination, Barthel Index, Lawton Scale, modified Rankin Scale, Hospital Anxiety and Depression Scale (HADS), Geriatric Depression Scale (GDS) and MOS-Short Form 36. Patients with a HADS-depression subscale score > or = 11 and/or GDS score > or = 8 were classified as depressed. RESULTS: Three hundred stroke survivors were assessed (mean age: 56.3 years; 51.7% males). Half (46.7%) of the stroke patients had an m-RS score < or = 2. The proportion of stroke patients who scored > or = 11 points on the HADS-depression and HADS-anxiety subscales were 19.2 and 23.7%, respectively. One third (29.7%) had a GDS mean score > or = 8. The GDS scores significantly correlated (p < 0.0001) with the HADS-depression (r = 0.51) and HADS-anxiety subscales (r = 0.54). The prevalence of mood disorders was significantly higher in females than in males (24.8 vs. 14.2%; x(2), p = 0.03). PSD was significantly associated (p < 0.0001) with work status (housewife), education level, lower social and cognitive functioning, dependence in the instrumental activities of daily living and presence of diabetes in the multivariable regression analysis (R adjusted = 0.32). CONCLUSIONS: PSD was highly prevalent in the chronic phase of stroke. Early detection and recognition of associated risk factors is important to treat and prevent PSD in a rehabilitation setting.

Determinants of quality of life in Brazilian stroke survivors.

OBJECTIVE: To identify the main determinants of health-related quality of life (HRQoL) in Brazilian stroke survivors. METHODS: Patients were assessed with the NIH Stroke Scale, Barthel index (BI), Lawton scale, modified-Rankin scale, Cumulative Illness Rating Scale for Geriatrics, Mini-Mental State Examination, Hospital Anxiety and Depression Scale, and Stroke Impact Scale (SIS) 3.0. RESULTS: 260 stroke survivors were assessed (mean age: 55.9 years; 55.2% males). Eighty-eight per cent of patients had an ischemic infarction. Approximately one third (31.5%) had a BI score < or = 60 (severe disability), and 34.5% were independent in the activities of daily living. Prevalence of post-stroke depression was significantly higher in females than in males (25% vs 15.4%; p=0.05). Post-stroke depression was associated with female sex, disability, and lower cognitive functioning (p<0.001). SIS Physical Composite Domain mean score was 46.6. Hand Function (26.5), Strength (47.6), Mobility (50.1), Social participation (50.6), and Emotion (52.2) were the most affected domains. HRQoL of stroke survivors decreased in a significant way as motor impairment severity, disability, functional status and mood worsened (ANOVA, p<0.0001). Motor impairment, disability, and mood disturbances were independent predictors of HRQoL in the multivariate regression analysis. CONCLUSIONS: Post-stroke depression and disability are consistent determinants of HRQoL in Brazilian stroke patients.