RESUMO

INTRODUCTION: Modern cardiovascular implantable electronic devices (CIEDs) have mechanisms that prevent damage from external electric shocks, and malfunction following accidental electrocution is rare. However, the effects of lightning injuries in patients with CIEDs are uncertain. CASE PRESENTATION: A 74-year-old man with a dual-chamber pacemaker due to complete heart block was struck by a lightning while farming. He had no serious injury at the time and sought medical evaluation 1 month later, when he presented with asymptomatic bradycardia. Device interrogation suggested major battery and lead damage, requiring extraction and subsequent placement of a new pacing system. DISCUSSION: While a previous report depicted pacing threshold elevation without extensive device impairment, our patient presented with major damage to the whole pacing system. The factors contributing to these divergent outcomes are unclear. Differences in injury mechanism, pacemaker model, and the pattern of electric current dispersion within the device may each play a part in this discrepancy.

RESUMO

To continue sleep research activities during the lockdown resulting from the COVID-19 pandemic, experiments that were previously conducted in laboratories were shifted to the homes of volunteers. Furthermore, for extensive data collection, it is necessary to use a large number of portable devices. Hence, to achieve these objectives, we developed a low-cost and open-source portable monitor (PM) device capable of acquiring electroencephalographic (EEG) signals using the popular ESP32 microcontroller. The device operates based on instrumentation amplifiers. It also has a connectivity microcontroller with Wi-Fi and Bluetooth that can be used to stream EEG signals. This portable single-channel 3-electrode EEG device allowed us to record short naps and score different sleep stages, such as wakefulness, non rapid eye movement sleep (NREM), stage 1 (S1), stage 2 (S2), stage 3 (S3) and stage 4 (S4). We validated the device by comparing the obtained signals to those generated by a research-grade counterpart. The results showed a high level of accurate similarity between both devices, demonstrating the feasibility of using this approach for extensive and low-cost data collection of EEG sleep recordings.

RESUMO

Low-level laser therapy (LLLT) has been targeted as a promising tool that can mitigate post-infarction cardiac remodeling. However, there is no gold standard energy delivered to the heart and few studies have evaluated the impact of LLLT on cardiac performance. This study evaluated effects of repeated LLLT applications with different energies delivered to the infarcted myocardium. Echocardiography and hemodynamic measurements were applied to evaluate left ventricular (LV) performance in rats with large infarcts. ELISA, Western blot and biochemical assays were used to assess LV inflammation and oxidative stress. An 830-nm Laser Photon III semiconductor aluminum gallium arsenide diode (DMC, São Carlos, SP, Brazil) was applied transthoracically three times a week for 4 weeks based on the energy (i.e., 10J, 20J, and 40J; respectively). LLLT on 10J and 20J had a similar action in attenuating pulmonary congestion and myocardial fibrosis. Moreover, 10J and 20J attenuated LV end-diastolic pressure and improved +dP/dt and -dP/dt. All LLLT groups had lower levels of inflammatory mediators, but only the 10J group had normalized oxidative stress. All LLLT doses improved superoxide dismutase levels; however, only the 20J group showed a high content of the catalase. There was a lower level of sarcoplasmic/endoplasmic reticulum Ca2+ ATPase 2a in the infarcted myocardium, which it was normalized in the 20J and 40J groups. A higher phospholamban content was found in the 10J group. This study supports the beneficial LLLT role post-infarction. Apparently, the 10J and 20J doses show to be chosen for clinical translation.

RESUMO

OBJECTIVES: The objective was to describe the ease and difficulty of removing intrauterine devices (IUDs). METHODS: We conducted a prospective study at the University of Campinas (UNICAMP), Faculty of Medical Sciences, UNICAMP. We included women who requested IUD removal. We excluded women with partial IUD expulsion in which the IUD was protruded at the external os. We identified difficult IUD removal when the removal was challenging, including the inability to visualize IUD strings extending from the cervical os. RESULTS: A total of 869 women participated. Women were aged 29.4 ± 8.0 years (mean ± SD; range 14-51) and the duration of IUD use at the time of removal was 4.3 ± 4.2 years. We found that 702 (80.8%) women had visible strings at the external os and the removals were performed at the first attempt without difficulty in 692 (79.6%) participants. The pain was more intense (>4) in cases of difficult removals. After multivariate logistic analysis, difficult removals were associated with users of IUD ≥3 years (3 times higher risk); for each previous cesarean delivery, the risk increased by 1.5 times. CONCLUSIONS: Our study showed that IUD removal is an easy and safe procedure, with only a small proportion of women reporting significant pain with IUD removal.

RESUMO

INTRODUCTION: Surgical procedures in contemporary practice frequently employ energy-based devices, yet comprehensive education surrounding their safety and effectiveness remains deficient. We propose an innovative course for residents that aims to provide basic electrosurgery knowledge and promote the safe use of these devices. METHODS: We developed a simulated training course for first-year general surgery and orthopedic residents. First, a survey was conducted regarding their knowledge perception about energy devices. The course consisted of two online theoretical sessions, followed by three in-person practical sessions. First-year residents performed three video-recorded attempts using a cadaveric model and were assessed through a digital platform using the Objective Structured Assessment of Technical Skill (OSATS), a Specific Rating Scale (SRS), and a surgical energy-based devices scale (SEBS). Third-year residents were recruited as a control group. RESULTS: The study included 20 first-year residents and 5 third-year residents. First-year residents perceived a knowledge gap regarding energy devices. Regarding practical performance, both OSATS and checklist scores were statistically different between novices at their first attempt and the control group. When we analyzed the novice's performance, we found a significant increase in OSATS (13 vs 21), SRS (13 vs 17.5), and SEBS (5 vs 7) pre- and post-training scores. The amount of feedback referred to skin burns with the electro-scalpel reduced from 18 feedbacks in the first attempt to 2 in the third attempt (p-value = 0.0002). When comparing the final session of novices with the control group, no differences were found in the SRS (p = 0.22) or SEBS (p = 0.97), but differences remained in OSATS (p = 0.017). CONCLUSION: This study supports the implementation of structured education in electrosurgery among surgical trainees. By teaching first-year residents about electrosurgery, they can acquire a skill set equivalent to that of third-year residents. The integration of such courses can mitigate complications associated with energy device misuse, ultimately enhancing patient safety.

Assuntos

RESUMO

Using the example of the military regime in Argentina (1976-1983) and relevant archival materials, this article demonstrates the prerequisite of exalted language in constructing an enemy and how a discursive 'machine of the same' was put into operation. The author argues that what made this operation unique is its structure of repetition that stimulated "the tendency to merge" what is "foreigner-to-the-ego", and the "enemy outside" into a single concept in the Argentinian national psyche.As a theoretical lens, the author examines the military regime's language through Freud's understanding of groups and civilization and Laplanche's proposition that cultural narratives in the form of mytho-symbolic explanations help us translate the sexual drive and offer a "solution" to the helplessness of the infant-adult.The author further claims that at other times a cultural narration functions as an anti-translation device when set against the emergence of a new net of significations. The nation's founding narrative of an Occidental-Spanish-Catholic "being" that first effaced its indigenous origins and then its Arabic and Jewish inheritance was brought back by the military regime as a mytho-symbolic narration that formed a shield against the repressed remnants of the enigmatic message pressing for a new translation.

Assuntos

RESUMO

Microfluidic separators play a pivotal role in the biomedical and chemical industries by enabling precise fluid manipulations. Traditional fabrication of these devices typically requires costly cleanroom facilities, which limits their broader application. This study introduces a novel microfluidic device that leverages the passive Zweifach-Fung principle to overcome these financial barriers. Through Lagrangian computational simulations, we optimized an eleven-channel Zweifach-Fung configuration that achieved a perfect 100% recall rate for particles following a specified normal distribution. Experimental evaluations determined 2 mL/h as the optimal total flow rate (TFR), under which the device showcased exceptional performance enhancements in precision and recall for micrometer-sized particles, achieving an overall accuracy of 94% ± 3%. Fabricated using a cost-effective, non-cleanroom method, this approach represents a significant shift from conventional practices, dramatically reducing production costs while maintaining high operational efficacy. The cost of each chip is less than USD 0.90 cents and the manufacturing process takes only 15 min. The development of this device not only makes microfluidic technology more accessible but also sets a new standard for future advancements in the field.

RESUMO

BACKGROUND: This study aims primarily to assess the mandibular condyles and patient response to MAD therapy using cone-beam computed tomography (CBCT). Also, the study proposes to analyze whether variations in condylar position, OSA severity and mandibular protrusion influence patient response. METHODS: 23 patients diagnosed with mild/moderate OSA and treated with MAD comprised the sample. Clinical, CBCT, and PSG assessments were conducted at baseline and with MAD in therapeutic protrusion (4-6 months of MAD use). The condyle position was vertically and horizontally evaluated at baseline and at the therapeutic protrusion. RESULTS: The condyle position significantly changed with MAD, showing anterior (7.3 ± 2.8 mm; p < 0.001) and inferior (3.5 ± 1 mm; p < 0.001) displacement. Patients with mild OSA required more protrusion (p = 0.02) for improvement. Responders exhibited a significantly prominent (p = 0.04) anterior baseline condyle position. A negative modest correlation was found between treatment response and baseline condyle anterior position (p = 0.03; r=-0.4), as well as between OSA severity and the percentage of maximum protrusion needed for therapeutic protrusion (p = 0.02; r=-0.4). The patient protrusion amount did not predict condylar positional changes. Neither condyle position, OSA severity, nor therapeutic protrusion were predictors of MAD treatment response. CONCLUSION: MAD resulted in anterior and inferior condylar displacement, and the amount of protrusion did not predict condylar positional changes. Responders showed a more anterior baseline condyle position. OSA severity and mandibular protrusion did not predict treatment response.

RESUMO

Envisaging to improve the evaluation of ophthalmic drug products while minimizing the need for animal testing, our group developed the OphthalMimic device, a 3D-printed device that incorporates an artificial lacrimal flow, a cul-de-sac area, a moving eyelid, and a surface that interacts effectively with ophthalmic formulations, thereby providing a close representation of human ocular conditions. An important application of such a device would be its use as a platform for dissolution/release tests that closely mimic in vivo conditions. However, the surface that artificially simulates the cornea should have a higher resistance (10 min) than the previously described polymeric films (5 min). For this key assay upgrade, we describe the process of obtaining and thoroughly characterizing a hydrogel-based hybrid membrane to be used as a platform base to simulate the cornea artificially. Also, the OphthalMimic device suffered design improvements to fit the new membrane and incorporate the moving eyelid. The results confirmed the successful synthesis of the hydrogel components. The membrane's water content (86.25 ± 0.35 %) closely mirrored the human cornea (72 to 85 %). Furthermore, morphological analysis supported the membrane's comparability to the natural cornea. Finally, the performance of different formulations was analysed, demonstrating that the device could differentiate their drainage profile through the viscosity of PLX 14 (79 ± 5 %), PLX 16 (72 ± 4 %), and PLX 20 (57 ± 14 %), and mucoadhesion of PLXCS0.5 (69 ± 1 %), PLX16CS1.0 (65 ± 3 %), PLX16CS1.25 (67 ± 3 %), and the solution (97 ± 8 %). In conclusion, using the hydrogel-based hybrid membrane in the OphthalMimic device represents a significant advancement in the field of ophthalmic drug evaluation, providing a valuable platform for dissolution/release tests. Such a platform aligns with the ethical mandate to reduce animal testing and promises to accelerate the development of safer and more effective ophthalmic drugs.

Assuntos

RESUMO

O uso da proteção auditiva pode representar uma série de preocupações de segurança quando considerados o treinamento e orientação, os prejuízos à comunicação e o ambiente ocupacional. O objetivo deste estudo foi verificar os benefícios da dupla proteção auditiva em risco de ruído ocupacional. Os artigos científicos de embasamento foram selecionados pelas bases de dados MEDLINE (Pubmed), Lilacs, Scielo, SCOPUS e Web of Science, sem restrição de idioma, período e localização. Foram localizados 197 artigos em que três atenderam aos critérios de admissão desta pesquisa. Os Equipamentos de Proteção Individual (EPIs) exigem controle rigoroso quanto ao seu uso adequado, que por vezes é negligenciado na rotina diária de trabalho. Conclui-se que a modernização e o uso de tecnologias mais seguras tem o intuito de diminuir o impacto da exposição ao ruído, entretanto, as barreiras entre a economia e a adesão pelos trabalhadores ainda precisam ser minimizadas.

Use of hearing protection can raise a series of safety concerns when considering training and guidance, communication impairments, and occupational environment. Hence, this study assessed the benefits of dual hearing protection in occupational noise risk. Scientific articles were selected from the MEDLINE (PubMed), LILACS, SCIELO, SCOPUS, and Web of Science databases, with no language, period, or location restrictions. A total of 197 articles were located, of which three met the inclusion criteria. Proper PPE (Personal Protective Equipment) usage requires strict monitoring, which is sometimes overlooked in the daily work routine. Modernization and use of safer technologies aim to reduce the impact of noise exposure; however, the barriers between the economy and worker adherence still need to be mitigated.

El uso de protección auditiva puede implicar una serie de preocupaciones de seguridad al considerar el entrenamiento y orientación, el daño a la comunicación y el ambiente laboral. El objetivo de este estudio fue determinar los beneficios de la doble protección auditiva en riesgo de ruido laboral. Se seleccionaron los artículos científicos de las bases de datos MEDLINE (PubMed), LILACS, SciELO, Scopus y Web of Science, sin restricciones de idioma, período y ubicación. Se encontraron 197 artículos, de los cuales tres cumplieron con los criterios de inclusión para este estudio. Los equipos de protección individual (EPI) requieren un riguroso control sobre su adecuado uso y, muchas veces, no son utilizados por los trabajadores durante su rutina laboral. Se concluye que la modernización y el uso de tecnologías más seguras pueden reducir el impacto de la exposición al ruido, sin embargo, las barreras entre la economía y el uso de estos equipos por los trabajadores aún necesitan mitigarse.