Treatment of Wrist Dorsal Synovial Cyst with Percutaneous Sclerotherapy Using Hypertonic Saline Solution.

Objective To evaluate the efficacy of hypertonic saline infiltration as a sclerosing agent in the dorsal synovial cyst of the wrist. Method Patients of both genders, aged 18 years or older, with clinical and ultrasound diagnosis of synovial cyst, and without any previous treatment were selected. Case series in which 50 patients underwent aspiration of the contents of the cyst and infiltration of the hypertonic saline solution (2 ml sodium chloride solution 20% and 1 ml of lidocaine 2%). The patients were followed up for 24 weeks, when the parameters pain, strength, range of motion, function (quickDASH and Brief Michigan question), recurrence, and complications were evaluated. Results A total of 46 patients were evaluated for 24 weeks, 18 (39.1%) cysts evolved to resolution, and 28 (60.9%) presented recurrence. There was no statistically significant difference in the effect force or in the range of motion. There was no clinically significant difference in the scores of the questionnaires. The most frequent complications were pain and edema. Conclusion Infiltration with hypertonic saline solution for the treatment of dorsal synovial cyst of the wrist showed a recurrence rate of 60.9%.

Treatment of Wrist Dorsal Synovial Cyst with Percutaneous Sclerotherapy Using Hypertonic Saline Solution / Tratamento de cisto sinovial dorsal do punho com escleroterapia percutânea utilizando solução salina hipertônica

Abstract Objective To evaluate the efficacy of hypertonic saline infiltration as a sclerosing agent in the dorsal synovial cyst of the wrist. Method Patients of both genders, aged 18 years or older, with clinical and ultrasound diagnosis of synovial cyst, and without any previous treatment were selected. Case series in which 50 patients underwent aspiration of the contents of the cyst and infiltration of the hypertonic saline solution (2 ml sodium chloride solution 20% and 1 ml of lidocaine 2%). The patients were followed up for 24 weeks, when the parameters pain, strength, range of motion, function (quickDASH and Brief Michigan question), recurrence, and complications were evaluated. Results A total of 46 patients were evaluated for 24 weeks, 18 (39.1%) cysts evolved to resolution, and 28 (60.9%) presented recurrence. There was no statistically significant difference in the effect force or in the range of motion. There was no clinically significant difference in the scores of the questionnaires. The most frequent complications were pain and edema. Conclusion Infiltration with hypertonic saline solution for the treatment of dorsal synovial cyst of the wrist showed a recurrence rate of 60.9%.

Resumo Objetivo Avaliar a eficácia da infiltração da solução salina hipertônica como agente esclerosante no cisto sinovial dorsal do punho. Método Pacientes de ambos os sexos, com 18 anos ou mais, com diagnóstico clínico e ultrassonográfico de cisto sinovial, e sem nenhum tratamento prévio foram selectionados. Série de casos em que 50 pacientes foram submetidos a aspiração do conteúdo do cisto e infiltração da solução salina hipertônica (2 ml solução de cloreto de sódio 20% e 1 ml de lidocaína 2%). Seguimento realizado por 24 semanas, durante as quais foram avaliados os parâmetros dor, força, arco de movimento, função (questionários quick disabilities of the arm, hand, and shoulder [quickDASH] e brief Michigan), recorrência e complicações. ResultadoForam avaliados 46 pacientes por 24 semanas, 18 (39,1%) cistos evoluíram para cura e 28 (60,9%) cistos apresentaram recorrência. Não houve diferença estatisticamente significante nos quesitos força e arco de movimento. Não houve diferença clinicamente significante nos escores dos questionários. As complicações mais frequentes foram dor e edema. Conclusão A infiltração com solução salina hipertônica para tratamento do cisto sinovial dorsal do punho mostrou taxa de recorrência de 60,9%.

THE EFFECT OF THE USE OF ALCOHOL AND DRUGS ON MOTORCYCLICAL TRAUMAS WITH SURGICAL TREATMENT FRACTURES: EPIDEMIOLOGY.

Objective: To verify the prevalence of patients who were victims of motorcycle trauma who were under the influence of alcohol and drugs. Methods: The study was observational and prospective, with patients hospitalized to the Orthopedics and Traumatology Ward of Hospital São Paulo (UNIFESP), from March 2015 to March 2016. The study included patients of all genders, over 18 years old, hospitalized due to motorcycle trauma and who needed orthopedic surgical treatment. Results: During the research, 282 patients were hospitalized, of which 23.8% were victims of motorcycle trauma. Of these, 49.3% motorcyclists reported the use of alcohol and drugs before the accident, while 50.7% denied their consumption. In the analysis of alcohol and drug consumption in patients with motorcycle injuries, the results showed that: 65% used only alcohol; 16% used both alcohol and drugs; and 19% used only illicit drugs. Conclusion: The incidence of patients who suffered motorcycle accidents under the influence of alcohol and drugs was 49.3%. Level of Evidence IV, Prospective Case Series.

Objetivo: Verificar a prevalência de pacientes vítimas de trauma motociclístico que estavam sob efeito de álcool e drogas. Métodos: Estudo observacional e prospectivo, com pacientes internados na Enfermaria de Ortopedia e Traumatologia do Hospital São Paulo (Unifesp), de março de 2015 a março de 2016. Foram incluídos pacientes de ambos os sexos, idade superior a 18 anos, internados por trauma motociclístico e que necessitavam de tratamento cirúrgico ortopédico. Resultados: Durante a pesquisa, foram internados 282 pacientes, dos quais 23,8% eram vítimas de trauma motociclístico. Desses, 49,3% motociclistas referiram o uso de álcool e drogas previamente ao sinistro, enquanto 50,7% negaram o consumo. Na análise do consumo de álcool e drogas nos pacientes de traumas motociclísticos, foi observado que 65% estavam sob efeito apenas de álcool, 16% estavam sob efeito de álcool e drogas, e 19% sob efeito de drogas ilícitas. Conclusão: A incidência de pacientes que sofreram acidentes motociclísticos sob efeito de álcool e drogas foi de 49,3%. Nível de Evidência IV, Série de Casos Prospectivos.

The effect of the use of alcohol and drugs on motorcyclical traumas with surgical treatment fractures: epidemiology / O efeito do uso de álcool e drogas em traumas motociclísticos com fraturas de tratamento cirúrgico: epidemiologia

ABSTRACT Objective: To verify the prevalence of patients who were victims of motorcycle trauma who were under the influence of alcohol and drugs. Methods: The study was observational and prospective, with patients hospitalized to the Orthopedics and Traumatology Ward of Hospital São Paulo (UNIFESP), from March 2015 to March 2016. The study included patients of all genders, over 18 years old, hospitalized due to motorcycle trauma and who needed orthopedic surgical treatment. Results: During the research, 282 patients were hospitalized, of which 23.8% were victims of motorcycle trauma. Of these, 49.3% motorcyclists reported the use of alcohol and drugs before the accident, while 50.7% denied their consumption. In the analysis of alcohol and drug consumption in patients with motorcycle injuries, the results showed that: 65% used only alcohol; 16% used both alcohol and drugs; and 19% used only illicit drugs. Conclusion: The incidence of patients who suffered motorcycle accidents under the influence of alcohol and drugs was 49.3%. Level of Evidence IV, Prospective Case Series.

RESUMO Objetivo: Verificar a prevalência de pacientes vítimas de trauma motociclístico que estavam sob efeito de álcool e drogas. Métodos: Estudo observacional e prospectivo, com pacientes internados na Enfermaria de Ortopedia e Traumatologia do Hospital São Paulo (Unifesp), de março de 2015 a março de 2016. Foram incluídos pacientes de ambos os sexos, idade superior a 18 anos, internados por trauma motociclístico e que necessitavam de tratamento cirúrgico ortopédico. Resultados: Durante a pesquisa, foram internados 282 pacientes, dos quais 23,8% eram vítimas de trauma motociclístico. Desses, 49,3% motociclistas referiram o uso de álcool e drogas previamente ao sinistro, enquanto 50,7% negaram o consumo. Na análise do consumo de álcool e drogas nos pacientes de traumas motociclísticos, foi observado que 65% estavam sob efeito apenas de álcool, 16% estavam sob efeito de álcool e drogas, e 19% sob efeito de drogas ilícitas. Conclusão: A incidência de pacientes que sofreram acidentes motociclísticos sob efeito de álcool e drogas foi de 49,3%. Nível de Evidência IV, Série de Casos Prospectivos.

SCLEROTHERAPY WITH 75% HYPERTONIC GLUCOSE TO TREAT DORSAL SYNOVIAL CYSTS OF THE WRIST.

OBJECTIVE: To evaluate the cure rate for dorsal synovial cysts of the wrist with aspiration and percutaneous sclerotherapy using 75% hypertonic glucose. METHODS: We enrolled 45 patients older than 18 years with untreated dorsal synovial cysts of the wrist. They underwent percutaneous aspiration and sclerotherapy with 75% hypertonic glucose 75%. A maximum of two procedures were conducted for each cyst at a 4-week interval. We analyzed age, sex, affected side, history of previous trauma, wrist goniometry, grip strength, wrist pain by the visual analogue scale, complications, and hand function questionnaire scores. RESULTS: We evaluated 45 patients (30 female, 15 male, mean age 38.2 years with 47 cysts). Four weeks after the first procedure, 72.3% cysts were palpable and visible. At 24 weeks after the first procedure, 57.4% cysts evolved to cure and 42.6% persisted. CONCLUSION: Treatment of dorsal synovial cyst of the wrist with aspiration and percutaneous sclerotherapy using 75% hypertonic glucose achieved a 57.4% cure rate after 24 weeks. Level of Evidence IV, Case series.

OBJETIVO: Avaliar o índice de cura do cisto sinovial dorsal do punho, com aspiração e escleroterapia percutânea utilizando glicose hipertônica 75%. MÉTODOS: Foram selecionados pacientes maiores de 18 anos, portadores de cisto sinovial dorsal do punho, sem tratamento prévio. Foram submetidos a aspiração e escleroterapia percutânea com glicose hipertônica 75%. Foi realizado no máximo dois procedimentos em cada cisto, em um intervalo de 4 semanas. Foram analisados idade, gênero, lado acometido, história de trauma prévio, goniometria, força de preensão, dor no punho pela escala visual analógica, complicações e os escores dos questionários funcionais. RESULTADOS: Foram avaliados 45 pacientes com 47 cistos, houve perda de seguimento de 3 pacientes (3 cistos). A média de idade foi de 38,2 anos. Na quarta semana após o primeiro procedimento, tivemos cura em 23,4% cistos, 4,3% cistos apresentavam-se palpáveis porém não visíveis e 72,3% cistos se apresentavam palpáveis e visíveis. Os cistos visíveis e palpáveis foram submetidos ao segundo procedimento. Após 24 semanas do primeiro procedimento, 57,4% cistos foram curados e 42,6% cistos apresentaram persistência. CONCLUSÃO: O tratamento do cisto sinovial dorsal do punho com escleroterapia percutânea utilizando Glicose Hipertônica 75%, proporcionou cura de 57,4% após 24 semanas. Nível de Evidência IV, Série de casos.

The ecology of herd immunity

The COVID-19 pandemic that began in early 2020 is currently the subject of thousands of articles on the various aspects of its epidemiology. One recurrent theme is the phenomenon of herd immunity or herd effect. In this article, I present a short history of the concept, the arguments around its nomenclature, and the ecologist's view of the herd effect, using the case history of the sleeping sickness control in Africa.

Pets in hospitals: benefits and risks

This paper argues the risks of the humanization programs in hospitals which allow visits by pets. The issue of hospital-acquired infections and the risks posed by the introduction of parasites, including viruses, bacteria and helminths, is here discussed. We highlight the difficulties inherent to the implementation of guidelines to prevent infections in the nosocomial environment.

Este artigo discute os riscos dos programas de humanização em hospitais que permitem visitas de animais de estimação. A questão das infecções adquiridas em hospitais e os riscos decorrentes da introdução de parasitas, incluindo vírus, bactérias e helmintos, são aqui discutidos. Destacamos as dificuldades inerentes à implementação de diretrizes de prevenção de infecções em ambiente hospitalar.

En este trabajo se argumentan los riesgos de los programas de humanización en hospitales que permiten la visita de mascotas. Aquí se analiza la cuestión de las infecciones adquiridas en el hospital y los riesgos que plantea la introducción de parásitos, incluidos virus, bacterias y helmintos. Destacamos las dificultades inherentes a la implementación de guías para la prevención de infecciones en el ambiente nosocomial.

Spontaneous Aortoesophageal Fistula And Ruptured Aortic Aneurysm - A Case Report On Combined Aortic And Esophageal Prosrhesis Palliative Treatment.

Aortoesophageal fistulas are uncommon, dreadful vascular events, most frequently found in the setting of thoracic aorta aneurysms. Patients usually present with thoracic pain, dysphagia and sentinel hematemesis - the Chiari triad - followed by life threatening hematemesis. Emergent open surgery with debridement of necrotic tissue and in situ aortic graft repair is currently the best strategy. However, in patients which cannot withstand surgery, endovascular repair is currently gaining acceptance as a palliative treatment or as a bridge to surgery. We present a case of a 55-year-old female with a past of heavy alcohol abuse and a previously unknown massive aortic aneurysm, who presented to the emergency department complai- ning of acute dysphagia and epigastric pain. An abdominal ultrasound revealed left pleural effusion and suspected clots in the pleural space. A thoracic CTA was promptly done, where a spontaneous ruptured aortic aneurysm with aortoesophageal fistula was discovered. The team, fearing open surgery due to poor cardiac function, opted for a thoracic endovascular aortic repair. The aortoesophageal fistula dissected the esophageal wall in all of its thickness without rupture into the lumen. This was complicated with esophageal ischemia, aneurysmal sac infection and mediastinitis. Because the patient was in shock, in order to help control the infection, an esophageal prosthesis was placed, followed by proximal esophagostomy, distal esophageal closure and gastrostomy. Six months after initial presentation, the patient died at the emergency room, shortly after reentering with massive hematemesis and hypovolemic shock of undetermined origin.

Rare mesenchymal antral gastric tumors: Case reports of glomus tumor and plexiform fibromyxoma.

Gastrointestinal stromal tumors account for the majority of the mesenchymal neoplasms of the gastric antrum, but other entities should also be considered. We present the case of a 70-year-old man with an ulcerated well-circumscribed polypoid submucosal mass in the gastric antrum which was proven to be a glomus tumor. CT showed progressive contrast enhancement. Magnetic resonance imaging showed a high T2 signal intensity and heterogeneous arterial contrast enhancement which became more homogeneous in later phases. We also present the case of a 50-year-old woman with a large polypoid mass occupying half the circumference of the distal gastric antrum that was proven to be a plexiform fibromyxoma. Contrast-enhanced CT and magnetic resonance imaging revealed a pattern of progressive and heterogeneous enhancement. Although gastrointestinal stromal tumors are the most frequent gastric mesenchymal neoplasms, other rare mesenchymal tumors such as glomus tumor and plexiform fibromyxoma may arise in the gastric antrum.

The 'spread" of jungle yellow fever

The saga of yellow fever has been recounted by several science historians. It is a chronicle of errors, fight for recognition, historical mis-interpretations, and human experiments that would be unacceptable today. But it is also a record of forecasts that would be later confirmed by sound field work and through laboratory and clinical research. It is also an example of the contribution of local native lore to sound scientific discoveries. In this paper we try to demonstrate how we are advancing towards the natural foci of the jungle cycles of a zoonosis, not the reverse.

The true nature of zoonoses: the identity of transmissible diseases in man and in other vertebrates

This paper argues the nature and identity of diseases as they affect man and other vertebrates, and its importance when selecting animal models for experimental laboratory research (Russell et al., 2017). Here I stress the notion that in the case of the zoonoses, what is transmitted are parasites/microorganisms and not diseases, as the same microorganism may cause distinct clinical symptoms and signs in different hosts.

Gender-specific histopathological response in guppies Poecilia reticulata exposed to glyphosate or its metabolite aminomethylphosphonic acid.

Ecotoxicity of glyphosate (GLY) and its metabolite aminomethylphosphonic acid (AMPA) was investigated in guppies, Poecilia reticulata. We tested the effects of these chemicals on the gills and liver of both male and female guppies using qualitative and quantitative histopathological analyses associated with histopathological condition indexes. Both genders showed similar median lethal concentration (LC50 ) at 96 h for GLY (68.78 and 70.87 mg l-1 ) and AMPA (180 and 164.32 mg l-1 ). However, the histopathological assessment of both fish organs exposed to sublethal concentrations of GLY (35 mg l-1 ) and AMPA (82 mg l-1 ) for 96 h showed a tissue- and gender-specific histopathological response. In both exposure assays, fish presented mainly progressive changes, such as proliferation of the interlamellar epithelium, partial and total fusion of secondary lamellae. The liver showed mainly regressive changes, such as steatosis, pyknotic nuclei and high distribution of collagen fibers. Unusually large hepatocytes as degenerated cells were also detected. Histopathological changes in gills were similar for the males and females, but the liver response was different between the genders. The hepatic inflammatory changes were more common in males. The increase in the area of hepatocyte vacuoles is gender dependent with higher values in the male compared to the female guppies exposed to GLY and AMPA. Multiparametric analysis indicated that the male guppies are more sensitive than females, particularly in the presence of AMPA. Our study shows that the histopathological assessment associated with gender-specific response can be successfully used in ecotoxicological assessment of GLY and the metabolite AMPA. Copyright © 2017 John Wiley & Sons, Ltd.

[Thymic lesions: A 4 years-review]. / Patologia do Timo: Revisão de 4 Anos.

INTRODUCTION: The difficulty in differentiating invasive from non-invasive thymic tumours solely by histological features, leads to the decision of resecting suspected lesions except in the presence of: (a) diffuse metastasis; or (b) typical imaging findings of thymic hyperplasia or after recovering from some recent stress. Therefore, the role of radiology is of the utmost importance in the initial evaluation and staging of thymic mediastinal masses. METHODS: The objective of this study was to elaborate a retrospective analysis of the cases of thymic lesions that underwent surgery at the Cardiothoracic Department of Centro Hospitalar Vila Nova de Gaia/Espinho (CHVNG/E), from January 2013 to December 2016, illustrating their main radiologic findings with computed tomography (CT) images. RESULTS: During the studied time period, 35 patients were diagnosed with thymic lesions including: 14 thymomas (40%), 9 thymic cysts (26%), 4 thymic hyperplasias (11%), 3 thymic carcinomas (9%), 2 thymolipomas (6%), 2 lymphomas (6%) and 1 neuroendocrine tumour (3%). The mean age of the sample was 60 years, ranging from 23 to 88 years, with a predomi- nance of the female sex (69%). In this article, 11 CT images and 1 thoracic x-ray are presented to illustrate the common imaging features of each thymic disease. Thymoma was the most frequent thymic lesion found in our 4-year case sample, similarly to what is described in literature for the adult age. CONCLUSION: Knowledge of the main radiologic findings of each pathological entity of the thymus is vital for the correct therapeutic management and disease staging, frequently allowing the differentiation of non-surgical from surgical lesions.

Introdução: A dificuldade na diferenciação de neoplasias tímicas invasivas de não invasivas apenas pelas suas caracte- rísticas histológicas, leva a que se preconize a resseção cirúrgica destas lesões, exceto na presença de: (a) metastização difusa; e (b) manifestações imagiológicas típicas de hiperplasia tímica ou após um stress corporal conhecido. Dessa forma, o papel da radiologia torna-se de suma importância na avaliação da suspeita inicial e no seu estadiamento. Métodos: O objetivo do presente trabalho foi estudar retrospetivamente os casos de patologia tímica submetidos a cirurgia pelo Serviço de Cirurgia Cardiotorácica do Centro Hospitalar Vila Nova de Gaia/Espinho (CHVNG/E) entre janeiro 2013 e dezembro 2016, ilustrando, com as respetivas imagens de tomografia computorizada (TC), as principais manifestações ima- giológicas deste espectro de lesões. Resultados: Neste período foram operados 35 doentes com patologia tímica com os seguintes diagnósticos: 14 timomas (40%), 9 quistos (26%), 4 hiperplasias tímicas (11%), 3 carcinomas tímicos (9%), 2 timolipomas (6%), 2 linfomas (6%), e 1 tumor neuroendócrino (3%). A média de idades foi de 60 anos, com idade mínima de 23 anos e máxima de 88 anos, e predomínio do sexo feminino (69%). São apresentadas 11 imagens de cortes de TC e 1 radiograma torácico, representativas das manifestações imagiológicas de cada patologia obtida. Na amostra estudada, a patologia tímica mais frequente foi o timoma, de forma semelhante ao descrito na literatura para a idade adulta. Conclusão: O conhecimento das principais características imagiológicas das diferentes entidades patológicas do timo é fulcral na orientação terapêutica, permitindo por vezes diferenciar a hiperplasia de "verdadeiras" neoplasias, e possibilitar o estadiamento das lesões.

Contribuição à história da transmissão vetorial da leishmaniose tegumentar americana / Contribution to the history of vector transmission of American cutaneous leishmaniasis

Uma menção pioneira a possíveis vetores de leishmaniose tem passado despercebida pelos autores que se dedicaram a escrever sobre a história da leishmaniose no continente americano. Esta contribuição é aqui resgatada.

An early mention of the possibility of transmission of leishmaniasis by mosquito vectors in theAmerican continent has been overlooked by historians of this disease. This contribution drawsattention to this early mention.

A distant echo of eco-epidemiology: a review

Epidemiologia é definida aqui como o estudo da distribuição, frequência e causas das doenças humanas e com o estudo dos riscos para a saúde e práticas de saúde pública para a prevenção de todos os riscos para a saúde. Dirigida inicialmente aos fenômenos que afetam populações, osresultados de investigações epidemiológicas têm sido aplicadas a indivíduos, em especial no queconcerne a riscos, o que ficou sendo conhecido como a grande falácia. Uma outra distorção ficou conhecida como epidemiologia de caixa-preta, ou seja, a adoção de ações sanitárias e de saúdepública sem conhecimento dos fatores biológicos subjacentes, em favor da investigação dos fatores de risco. Isso levou à teoria de que doenças poderiam ser prevenidas pela alteração do ambiente, independente do conhecimento detalhado dos mecanismos patogênicos. Finalmente, Susser e Susser defenderam um paradigma para uma era emergente da eco-epidemiologia, denominado caixas chinesas, uma alusão aos conjuntos de caixas que se encaixam umas nas outras. Este trabalho discute em maior detalhe as discussões sobre esses conceitos e as armadilhas que cercam a aplicação das teorias epidemiológicas para a saúde pública.

Worms, slugs and humans: the medical and popular construction of an emerging infectious disease.

The identification of the worm Angiostrongylus costaricensis parasitizing land snails and humans in Southern Brazil suggests under-diagnosis and under-notification of patients with abdominal angiostrongyliasis. This article analyzes how the concept of abdominal angiostrongyliasis was constructed in different ways in Costa Rica and Brazil and how these changes affected the understanding of its clinical and epidemiological diagnosis. The research shows that abdominal angiostrongyliasis is, de facto, a sociocultural construct, although the parasites and vectors are real. The analisys also shows the importance of an interdisciplinary approach for understanding disease.

[Socioeconomic impacts of an emerging disease]. / Impactos socioeconômicos de uma doença emergente.

In 1955 a population explosion of the slug Sarasinula linguaeformis (Semper, 1885) damaged crop plantations in the municipalities of Nova Itaberaba and Planalto Alegre, western of Santa Catarina State, Brazil. In this article we analyze the socioeconomic impacts caused by the emergence of this plague, which raised the suspicion, eventually confirmed, of the occurrence of human cases of abdominal angyostrongiliasis. The data were collected through the observation of a serological study during the period of August 2000 to August 2001 by a research team from the Catholic University of Rio Grande do Sul (PUCRS) together with field technicians from the Empresa de Pesquisa Agropecuária e Extensão Rural de Santa Catarina S.A. (Epagri-SC), and with the members of 50 local families. In order to analyze these impacts, we elaborated several analytical categories as economic losses; preventive measures, habit change and social prejudice, that emerged from the narratives of the residents interviewed. It became evident the need for sociological analyses of epidemiological problems, in addition to strictly medico-sanitary considerations.