Identifying a victim of alligator attack and scavenger fish in the Brazilian Amazon rainforest using smile photographs: a case report.

Reports of deaths caused by alligators or crocodiles are rare in the literature. These deaths may be related to sharp force trauma caused by the teeth of these animals, with or without mutilation, or even drowning after seizure and submersion of the victim. It is difficult to forensically identify bodies in cases of mutilation of the upper limbs during the attack or when the corpse is in an advanced stage of skeletonization. Smile photographs are an important source of ante-mortem references for comparison. We report a human identification based on a photograph of a victim, with the absence of limbs caused by an alligator attack and the advanced skeletonization stage due to scavenger fish action in the Amazon within only 36 hours after his disappearance. The description of alligator attacks and the marks observed on the victim's body are essential to help medical and forensic professionals diagnose the injuries found and, consequently, define the cause of death.

Aprender a cuidar de estoma e as contribuições de um vídeo educativo / Learning to take care of stoma and the contributions of an educational video

Objetivo: conhecer a percepção de pacientes colostomizados por causas não oncológicas e seus familiares acerca da forma como aprenderam a cuidar do estoma e da possibilidade de utilização de um vídeo educativo como estratégia de educação em saúde. Métodos: pesquisa qualitativa, realizada por meio de grupo focal com oito pessoas, sendo quatro pacientes e quatro familiares. Os dados foram submetidos à análise de conteúdo temática. Resultados: organizou-se três categorias: Aprendendo a cuidar do estoma; o apoio familiar como potencializador do cuidado e da adaptação; as possibilidades e limitações no uso do vídeo educativo. Considerações finais: o processo de aprender a cuidar do estoma foi marcado pela escassez de orientações de enfermagem e concretizado no aprender fazendo, sendo a colaboração da família importante para o cuidado. O vídeo educativo mostra-se como tecnologia útil para educação em saúde, ao apresentar orientações básicas para o cuidado da colostomia, podendo complementar as orientações de enfermagem.

Objective: to know the perception of colostomized patients due to non-oncological cause and their relatives in front of the use of an educational video as a health education strategy. Methods:qualitative research, performed through a focus group with eight people, four patients and fourrelatives. The data were submitted to the thematic content analysis. Results: three categories were organized: Learning how to take care of and manage the stoma; Acceptance and adaptation: family support as a potentiator of this process; Educational video: possibilities and limitations. Final considerations: the process of learning to take care of the stoma was marked by the scarcity of nursing guidelines and made feasible in learning-doing, with family collaboration being important to care. The educational video is a useful technology in the health education process, presenting basicguidelines for colostomy care, and can to complement nursing orientations.

Extended Granger causality: a new tool to identify the structure of physiological networks.

Granger causality (GC) is a very popular tool for assessing the presence of directional interactions between two time series of a multivariate data set. In its original formulation, GC does not account for zero-lag correlations possibly existing between the observed time series. In the present study we compare the GC with a novel measure, termed extended GC (eGC), able to capture instantaneous causal relationships. We present a two-step procedure for the practical estimation of eGC based on first detecting the existence of zero-lag correlations, and then assigning them to one of the two possible causal directions using pairwise measures of non-Gaussianity. The proposed method was validated in a simulation study, showing that the estimation procedure based on the extended representation overcomes the limits of the classic computation of GC, correctly detecting the presence and direction of zero-lag interactions and providing a meaningful causal interpretation based on the eGC. Then, GC and eGC were computed on the physiological variability series of heart period (HP), mean arterial pressure (AP) and cerebral blood flow velocity (FV) in ten subjects with postural related syncope (PRS), during different epochs of an head-up tilt test protocol. We found that both measures reflect the baroreflex impairment and the loss of cerebral autoregulation during pre-syncope. Furthermore, eGC analysis suggests that fast, within-beat effects between AP and FV variability contribute substantially to the mutual regulation of these physiological variables, and may play an important role in the impairment of cerebrovascular regulation associated with PRS.

Cerebral distribution of white matter lesions in migraine with aura patients.

OBJECTIVE: The objective of the study was to compare the cerebral distribution of white matter lesions (WMLs) between migraine patients with different aura symptoms. METHODS: Migraine with aura (MA) patients were consecutively enrolled as part of the Shunt-Associated Migraine (SAM) study. According to clinical symptoms, aura was classified as motor, aphasic, sensory, visual or vertebrobasilar. Standard and FLAIR (fluid attenuated inversion recovery) T(2)-weighted MRI sequences were inspected for WMLs by three independent raters blinded to clinical data. WMLs were assessed in the periventricular areas (PV-WMLs) with the Fazekas scale and in the deep white matter (D-WMLs) with the Schelten's scale. Interobserver agreement was good to excellent (k = 0.64 to 0.96, p < .0001). RESULTS: One hundred and eighty-five patients (77% women) were included. Aura symptoms were classified as visual in 172 (99%) patients, sensory in 76 (42%), aphasic in 54 (30%), motor in 39 (21%) and vertebrobasilar in 17 (9%) patients. One hundred and four patients (57%) exhibited more than one type of aura. D-WMLs were mainly detected in the frontal lobes (86%). There was no association between type of aura and the presence of WMLs in any cerebral location. CONCLUSION: Aura symptoms do not influence the cerebral distribution of WMLs associated with migraine disease.

Right-to-left shunt does not increase white matter lesion load in migraine with aura patients.

BACKGROUND: White matter lesions (WMLs) are commonly found on brain MRI of migraine patients. Migraine with aura (MA+) is associated with an increased frequency of right-to-left shunt (RLS) mostly due to patent foramen ovale. The relationship between WML load and RLS in MA+ is currently unknown. METHODS: MA+ patients were consecutively enrolled as part of the Shunt Associated Migraine (SAM) study. Patients underwent a standardized headache and vascular risk factors questionnaire, contrast-enhanced transcranial Doppler, blood coagulation tests, and brain MRI. RLS was categorized into four grades: no shunt, <10 microbubbles (mb), >10 mb single spikes pattern, and >10 mb shower/curtain pattern. Standard and fluid-attenuated inversion recovery T2-weighted MRI sequences were inspected for WMLs by three independent raters blinded to RLS grade. WML load was scored in the periventricular areas (PV-WMLs) with the Fazekas scale and in the deep white matter (D-WMLs) with the Scheltens scale. Interobserver agreement was good to excellent (kappa = 0.64 to 0.96, p < 0.0001). WML load was then correlated between patients with and without RLS. RESULTS: One hundred eighty-five patients (77% women) were included. PV-WML load was similar between patients with and without RLS. D-WML load decreased in patients with RLS (p = 0.045). On logistic regression analysis, only age was associated with WMLs (p < 0.001). CONCLUSIONS: The presence of right-to-left shunt does not increase white matter lesion load in patients who have migraine with aura.