RESUMO
BACKGROUND: The study of the tentorial notch can improve the understanding of brain injury mechanisms. Tentorial morphology has been analysed primarily in cadaveric studies. However, the postmortem effect can cause variability in the measurements. The objective was to evaluate the morphometry of the tentorial notch and the third cranial nerve on living subjects using magnetic resonance imaging (MRI). MATERIALS AND METHODS: A retrospective cross-sectional study was performed. Using consecutive cases, 60 MRI scans were analysed for tentorial notch morphology. Maximum notch width (MNW), notch length (NL), interpedunculoclival (IC) distance, apicotectal (AT) distance, third cranial nerve (CN-III) distance, and inter- CN-III angle, were obtained. For the classification of the tentorial notch quartile distribution technique for MNW, NL, AT distance, and IC distance were used. RESULTS: According to the quartile of the MNW, patients were stratified into narrow, midrange, and wide groups. Using the NL quartile groups, they were also classified as short, midrange, and long. With these, the tentorial notch could be classified into eight types. Statistical differences between genders in the MNW and inter-CN-III angle were found, as well as a strong positive correlation between NL and AT distance, and between right and left CN-III distances. CONCLUSIONS: There were differences between the cadaveric samples and living subjects in the CN-III distances. This difference could be explained by the dehydration of brain volume in the postmortem process which may cause nerve elongation. Morphometry of the tentorial notch and its neurovascular relations allows a better understanding of the mechanisms of brain herniation.
Assuntos
Imageamento por Ressonância Magnética , Humanos , Masculino , Feminino , Estudos Retrospectivos , Estudos Transversais , Imageamento por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética , CadáverRESUMO
The starch extracted from avocado (Persea americana L. cv. Hass) seeds was characterized and used in the preparation of an edible coating to reduce the oil uptake and acrylamide content in French fries. Starch characterization was carried out using Differential Scanning Calorimetry, Fourier transform infrared spectrophotometry, gelatinization, and scanning electron microscopy. Uncoated (UFF) and coated (CFF) French fries were compared and evaluated for moisture, water activity (Aw), fat, color, firmness, acrylamide content, and sensorial analysis. The extracted starch presented a high crystalline structure and good stability to mechanical work and heat treatments. The CFF French fries showed significantly higher Aw, color parameter a*, but lower luminosity and acrylamide content than UFF samples. Similarly, the CFF samples tended to decrease the fat content, although without statistical differences. Avocado seed starch can be an economical and technically feasible alternative to the food industry as an effective coating to reduce acrylamide content in French fries.
Assuntos
Anemia Ferropriva , Anticorpos Antinucleares/sangue , Ciclofosfamida/uso terapêutico , Ectasia Vascular Gástrica Antral , Hemorragia Gastrointestinal , Gastroscopia/métodos , Escleroderma Sistêmico , Fatores Etários , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/etiologia , Anemia Ferropriva/terapia , Antirreumáticos/uso terapêutico , Coagulação com Plasma de Argônio/métodos , Coagulação com Plasma de Argônio/estatística & dados numéricos , Brasil/epidemiologia , Feminino , Ectasia Vascular Gástrica Antral/epidemiologia , Ectasia Vascular Gástrica Antral/etiologia , Ectasia Vascular Gástrica Antral/imunologia , Ectasia Vascular Gástrica Antral/terapia , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Terapia a Laser/métodos , Terapia a Laser/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/fisiopatologia , Fatores SexuaisRESUMO
The association between cocaine abuse and systemic sclerosis (SSc) is rarely described. Two new cases of this association are presented: two young adults, after using inhaled cocaine for a few years, were diagnosed with SSc. While a 24 year-old white female patient presented with diffuse SSc with multiple digital ulcers and scleroderma renal crisis (SRC), a 27 year-old male patient presented limited SSc with skin ulcers and digital gangrene, rapidly evolving to death due to massive intestinal hemorrhage. The authors performed a literature search and found only eight previously published cases. The clinical picture of these patients shows a predominance of vascular involvement, including multiple ulcers and SRC. There is no association with specific SSc autoantibodies. The concomitance of alcohol and other drugs abuse, as well as the presence of drug adulterers, complicates a clear understanding of the role of cocaine in SSc patients.
Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Escleroderma Sistêmico/induzido quimicamente , Adulto , Autoimunidade , Feminino , Humanos , Masculino , Escleroderma Sistêmico/imunologiaRESUMO
BACKGROUND: Fractures of the lateral third of the clavicle represent 18% of all clavicle fractures. Even though non-displaced fractures can be managed conservatively, displaced fractures have a non-union percentage of 30%. Multiple approaches have been proposed to manage the displaced fractures. The objective of this study was to record the prevalence of fractures of the lateral third of the clavicle with involvement of the clavicular-acromial joint, as well as to briefly review the treatment performed in our center and compare it with the current literature. MATERIAL AND METHODS: Retrospective, cross-sectional, descriptive and observational study, which consisted in a review of the records of patients with a diagnosis of fracture of the lateral third of the clavicle with an injury to the clavicular-acromial joint. RESULTS: Lateral third fractures accounted for 24% of all clavicle fractures. Distribution by sex: 10: 2, men: women. Left shoulder predominance, 8:4. The predominant maneuvers were anatomical plate for the lateral third of the clavicle (50% of the cases), coracoclavicular cerclage technique plus resection of the lateral third of the clavicle (25%), plate hook (8.3%), Mumford combined with Waever/Dunn (8.3%), anchor plus Kirschner rods (8.3%). DISCUSSION: The choice of the appropriate treatment will depend on the type of fracture and specific characteristics of each patient. We suggest the use of the coracoclavicular cerclage technique in cases in which the lateral fragment is multifragmented, irreducible or smaller in size than its osteosynthesis would allow, performing plasty of clavicular and coracoclavicular ligaments.
ANTECEDENTES: Las fracturas del tercio lateral de la clavícula representan 18% de todas las fracturas de clavícula. A pesar de que las fracturas no desplazadas pueden manejarse conservadoramente, las desplazadas tienen un porcentaje de no unión de 30%. Múltiples manejos han sido propuestos para las fracturas desplazadas. El objetivo de este estudio fue registrar la prevalencia de fracturas del tercio lateral de la clavícula con afectación de la articulación acromioclavicular, así como hacer una revisión breve del tratamiento realizado en nuestro centro y compararlo con la literatura actual. MATERIAL Y MÉTODOS: Estudio retrospectivo, transversal, descriptivo y observacional, que consistió en una revisión de los expedientes de los pacientes con diagnóstico de fractura del tercio lateral de la clavícula con lesión de la articulación acromioclavicular. RESULTADOS: Las fracturas del tercio lateral representaron 24% de todas las fracturas de clavícula. Distribución por sexos: 10:2, hombres:mujeres. Predominio: hombro izquierdo, 8:4. Los manejos predominantes fueron placa anatómica para tercio lateral de la clavícula (50% de los casos), técnica de cerclaje coracoclavicular más resección del tercio lateral de la clavícula (25%), placa gancho (8.3%), Mumford combinado con Waever/Dunn (8.3%), ancla más varillas Kirschner (8.3%). DISCUSIÓN: La elección del tratamiento adecuado dependerá del tipo de fractura y las características específicas de cada paciente. Sugerimos el uso de la técnica de cerclaje coracoclavicular en los casos en que el fragmento lateral sea multifragmentado, irreductible o de tamaño menor al que permitiría su osteosíntesis, realizando plastía de ligamentos acromioclaviculares y coracoclaviculares.
Assuntos
Clavícula , Fraturas Ósseas , Placas Ósseas , Clavícula/lesões , Estudos Transversais , Feminino , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Resultado do TratamentoRESUMO
The authors describe the case of a 23-year-old woman who was referred to the rheumatologist due to symmetrical and progressive stiffness, induration, and swelling of arms and thighs at the 12th week of her first gestation. The characteristic clinical aspect of 'peau d'orange', associated to the histopathologic results of the deep biopsy of the skin confirmed the diagnosis of eosinophilic fasciitis. Treatment with oral prednisone, at an initial dose of 1 mg/kg/day, was effective and rapidly tapered to 10 mg/day till the birth of a healthy newborn. A literature review showed only one previous description of pregnancy and eosinophilic fasciitis.
Assuntos
Eosinofilia , Fasciite , Complicações na Gravidez , Biópsia , Eosinofilia/diagnóstico , Eosinofilia/tratamento farmacológico , Fasciite/diagnóstico , Fasciite/tratamento farmacológico , Feminino , Glucocorticoides/administração & dosagem , Humanos , Nascido Vivo , Prednisona/administração & dosagem , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/tratamento farmacológico , Resultado do Tratamento , Adulto JovemRESUMO
Climate change can influence the geographical range of the ecological niche of pathogens by altering biotic interactions with vectors and reservoirs. The distributions of 20 epidemiologically important triatomine species in North America were modelled, comparing the genetic algorithm for rule-set prediction (GARP) and maximum entropy (MaxEnt), with or without topographical variables. Potential shifts in transmission niche for Trypanosoma cruzi (Trypanosomatida: Trypanosomatidae) (Chagas, 1909) were analysed for 2050 and 2070 in Representative Concentration Pathway (RCP) 4.5 and RCP 8.5. There were no significant quantitative range differences between the GARP and MaxEnt models, but GARP models best represented known distributions for most species [partial-receiver operating characteristic (ROC) > 1]; elevation was an important variable contributing to the ecological niche model (ENM). There was little difference between niche breadth projections for RCP 4.5 and RCP 8.5; the majority of species shifted significantly in both periods. Those species with the greatest current distribution range are expected to have the greatest shifts. Positional changes in the centroid, although reduced for most species, were associated with latitude. A significant increase or decrease in mean niche elevation is expected principally for Neotropical 1 species. The impact of climate change will be specific to each species, its biogeographical region and its latitude. North American triatomines with the greatest current distribution ranges (Nearctic 2 and Nearctic/Neotropical) will have the greatest future distribution shifts. Significant shifts (increases or decreases) in mean elevation over time are projected principally for the Neotropical species with the broadest current distributions. Changes in the vector exposure threat to the human population were significant for both future periods, with a 1.48% increase for urban populations and a 1.76% increase for rural populations in 2050.
Assuntos
Distribuição Animal , Doença de Chagas/transmissão , Mudança Climática , Insetos Vetores/fisiologia , Reduviidae/fisiologia , Trypanosoma cruzi/fisiologia , Animais , Doença de Chagas/parasitologia , Insetos Vetores/parasitologia , México , Modelos Biológicos , Reduviidae/parasitologia , Estados UnidosRESUMO
The Peruvian Andes presents a climate suitable for many species of sandfly that are known vectors of leishmaniasis or bartonellosis, including Lutzomyia peruensis (Diptera: Psychodidae), among others. In the present study, occurrences data for Lu. peruensis were compiled from several items in the scientific literature from Peru published between 1927 and 2015. Based on these data, ecological niche models were constructed to predict spatial distributions using three algorithms [Support vector machine (SVM), the Genetic Algorithm for Rule-set Prediction (GARP) and Maximum Entropy (MaxEnt)]. In addition, the environmental requirements of Lu. peruensis and three niche characteristics were modelled in the context of future climate change scenarios: (a) potential changes in niche breadth; (b) shifts in the direction and magnitude of niche centroids, and (c) shifts in elevation range. The model identified areas that included environments suitable for Lu. peruensis in most regions of Peru (45.77%) and an average altitude of 3289 m a.s.l. Under climate change scenarios, a decrease in the distribution areas of Lu. peruensis was observed for all representative concentration pathways. However, the centroid of the species' ecological niche showed a northwest direction in all climate change scenarios. The information generated in this study may help health authorities responsible for the supervision of strategies to control leishmaniasis to coordinate, plan and implement appropriate strategies for each area of risk, taking into account the geographic distribution and potential dispersal of Lu. peruensis.
Assuntos
Mudança Climática , Ecossistema , Insetos Vetores/fisiologia , Leishmaniose/transmissão , Psychodidae/fisiologia , Distribuição Animal , Animais , Leishmania/fisiologia , Leishmaniose/parasitologia , Modelos Biológicos , PeruRESUMO
Laparoscopic Nissen fundoplication is currently considered the surgical treatment of choice for gastroesophageal reflux disease (GERD) and its long-term effectiveness is above 90%. Adequate patient selection and the experience of the surgeon are among the predictive factors of good clinical response. However, there can be new, persistent, and recurrent symptoms after the antireflux procedure in up to 30% of the cases. There are numerous causes, but in general, they are due to one or more anatomic abnormalities and esophageal and gastric function alterations. When there are persistent symptoms after the surgical procedure, the surgery should be described as "failed". In the case of a patient that initially manifests symptom control, but the symptoms then reappear, the term "dysfunction" could be used. When symptoms worsen, or when symptoms or clinical situations appear that did not exist before the surgery, this should be considered a "complication". Postoperative dysphagia and dyspeptic symptoms are very frequent and require an integrated approach to determine the best possible treatment. This review details the pathophysiologic aspects, diagnostic approach, and treatment of the symptoms and complications after fundoplication for the management of GERD.
Assuntos
Fundoplicatura , Refluxo Gastroesofágico/cirurgia , Complicações Pós-Operatórias , Fundoplicatura/métodos , Humanos , Laparoscopia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Recidiva , Resultado do TratamentoRESUMO
Until recently, it was believed that only two lymnaeid species (i.e. Galba viatrix and Pseudosuccinea columella) occurred in Uruguay. However, based on a molecular approach, an additional species Galba cubensis, was recently discovered. The aim of this study was to molecularly characterize different lymnaeid populations from the northern region of Uruguay. The lymnaeids collections were carried out in two farms of the departments of Paysandú and Tacuarembó. The collected lymnaeids were divided in two fractions, one fraction was used for conchological analyses and detection of trematode larval stages, while the other fraction was used for molecular studies. Three PCRs targeting the 16S, ITS-2 and COI DNA regions were performed and the amplicons obtained were direct sequenced. The sequences were used for homology search and construction of phylogenetic trees by the maximum-likelihood method. The sequencing results revealed that both isolates corresponded to Galba neotropica. The phylogenetic analyses placed our isolates among the G. neotropica monophyletic group, closely related to other isolates of this species found in several South American countries. To our knowledge, this is the first record of G. neotropica in Uruguay and the confirmation as competent intermediate host of Fasciola hepatica. Further studies are needed to define the distribution and the role of each lymnaeid species in the transmission of F. hepatica in Uruguay.
Tradicionalmente se indicaba que existían dos especies de limneidos en Uruguay: Galba viatrix y Pseudosuccinea columella. Sin embargo, en los últimos años se identificó por medio de técnicas moleculares una tercera especie, Galba cubensis. El objetivo de los autores fue muestrear e identificar por medios moleculares poblaciones de limneidos del norte del país. Las colectas fueron realizadas en establecimientos rurales de los departamentos de Tacuarembó y Paysandú. Los caracoles colectados fueron divididos en dos fracciones, una de ellas fue destinada para el estudio morfológico de las conchillas y búsqueda de larvas de trematodos. La otra fracción se usó para la caracterización molecular. Tres genes fueron amplificados (ITS2, COI y 16S) utilizando protocolos de PCRs previamente descriptos. Las secuencias obtenidas se utilizaron para estudios de homología y construcción de árboles filogenéticos por medio del método de máxima verosimilitud. Por medio de la secuenciación se pudo confirmar que los dos aislamientos corresponden a Galba neotropica. Los estudios filogenéticos colocan ambos aislamientos dentro del grupo monofilético de G. neotropica junto a otros encontrados en distintas regiones de Sudamérica. Hasta lo que sabemos, el presente, es el primer registro de G. neotropica en Uruguay, además de comprobarse su capacidad para actuar como hospedero intermediario de Fasciola hepatica en condiciones de campo. Se sugieren futuros estudios para determinar la distribución y el rol de cada especie de limneido en la transmisión de F. hepatica.