Search

Resumo Em todo paciente submetido a reparo endovascular do aneurisma de aorta abdominal (REVA) que se apresente subitamente com quadro de dor abdominal ou sinais de choque, a hipótese de endoleak ou vazamento, com expansão do aneurisma e ruptura deve ser aventada. Apresentamos o caso de um paciente em pós-operatório de REVA que apresentou uma neoplasia de duodeno mimetizando um endoleak. Abstract Whenever a patient who has undergone endovascular repair of an abdominal aortic aneurysm (EVAR) presents with sudden onset abdominal pains or signs of shock, the hypothesis of endoleak with aneurysm expansion and rupture should be considered. We present the case of an EVAR patient in whom a tumor of the duodenum mimicked an endoleak during the postoperative period.

Resumo Em todo paciente submetido a reparo endovascular do aneurisma de aorta abdominal (REVA) que se apresente subitamente com quadro de dor abdominal ou sinais de choque, a hipótese de endoleak ou vazamento, com expansão do aneurisma e ruptura deve ser aventada. Apresentamos o caso de um paciente em pós-operatório de REVA que apresentou uma neoplasia de duodeno mimetizando um endoleak.

IntroductionThe National Committee for Health Technology Incorporation (CONITEC) evaluates health technologies to recommend their inclusion or exclusion within the Brazilian Public Health System (SUS), and uses the budget impact assessment to estimate costs to the system. The Ministry of Health (MS) guideline recommends treatment of phenylketonuria (PKU) with restricted phenylalanine diet and phenylalanine-free amino acid formula (PFAAf) supplementation. CONITEC evaluated the inclusion of sapropterin dihydrochloride for PKU in the SUS.MethodsThe population eligible for treatment was evaluated by the number of patients receiving PFAAf between 2014 and 2017 registered in the SUS. Patients were stratified by age/weight and a simple linear regression was performed to estimate the future population. The costs of treatment and testing the responsiveness of sapropterin dihydrochloride were estimated according to the recommended dosage guideline of the MS, leaflet and public purchasing prices. A univariate deterministic sensitivity analysis was performed to evaluate different prices, responsiveness test methods and variations in the reduction of formula use.ResultsThe incorporation of sapropterin dihydrochloride would generate an incremental budget impact in the SUS of around BRL 79 million (USD 21.7 million) in 2019 and BRL 300 million (USD 82.1 million) in five years (2019-2023). The univariate sensitivity analysis estimated that the incremental budget impact could be between BRL 66 and BRL 103 million (USD 18 and USD 28 million) in the first year and between BRL 251 and BRL 388 million (USD 69 and USD 106 million) in five years. Sensitivity analysis showed that the price of sapropterin dihydrochloride was the most sensitive variable in the model.ConclusionsThe incorporation of sapropterin dihydrochloride in the SUS represents a significant budgetary impact and covers a small number of patients. Sapropterin dihydrochloride was recommended by CONITEC for the treatment of women with PKU, with a positive drug responsiveness test, and who are in the preconception period or in the gestational period.

IntroductionThe National Committee for Health Technology Incorporation (CONITEC) evaluates health technologies to recommend their inclusion or exclusion within the Brazilian Public Health System (SUS), and uses the budget impact assessment to estimate costs to the system. This study estimated the budget impact of the supply of methionine-free amino acid formula (MFAAf) for patients with classical homocystinuria (HCU) in the SUS.MethodsThe incidence of one case per 250,000 live births in Brazil and the registration of a Brazilian association of patients with HCU was assumed to calculate the population. Mortality and responsiveness to pyridoxine rates were applied. The costs of treatment were estimated according to the recommended dosage in literature and public purchasing prices. For calculating the dose of MFAAf patients, a median age of 19 years and weight of 60 kg were assumed, according to Brazilian study data.ResultsThe annual cost of treatment was estimated at BRL 77,000 (USD 21,084) per patient. The incorporation of MFAAf for HCU would generate a budget impact in SUS of around BRL 37 million (USD 10.1 million) in 2019 and BRL 188 million (USD 51.5 million) after five years which considers the epidemiological data, and a budget impact of around BRL 6.4 million (USD 1.75 million) in 2019 and BRL 33 million (USD 9 million) after five years which considers the information of a Brazilian association of patients with HCU. The wide range of values in the incremental budgetary impact is due to the lack of information on the epidemiology of the disease in Brazil.ConclusionsThe incorporation of the MFAAf in the SUS represents an important budgetary impact and covers a small number of patients. CONITEC recommended the incorporation of the MFAAf in the SUS, according to clinical protocol.

Background: Crude glycerol is the main byproduct of the biodiesel industry. Although it can have different applications, its purification is costly. Therefore, in this study a biotechnological route has been proposed for further utilization of crude glycerol in the fermentative production of lactic acid. This acid is largely utilized in food, pharmaceutical, textile, and chemical industries, making it the hydroxycarboxylic acid with the highest market potential worldwide. Currently, industrial production of lactic acid is done mainly using sugar as the substrate. Thus here, for the first time, Pichia pastoris has been engineered for heterologous l-lactic acid production using glycerol as a single carbon source. For that, the Bos taurus lactate dehydrogenase gene was introduced into P. pastoris. Moreover, a heterologous and a novel homologous lactate transporter have been evaluated for l-lactic acid production. Results: Batch fermentation of the P. pastoris X-33 strain producing LDHb allowed for lactic acid production in this yeast. Although P. pastoris is known for its respiratory metabolism, batch fermentations were performed with different oxygenation levels, indicating that lower oxygen availability increased lactic acid production by 20 %, pushing the yeast towards a fermentative metabolism. Furthermore, a newly putative lactate transporter from P. pastoris named PAS has been identified by search similarity with the lactate transporter from Saccharomyces cerevisiae Jen1p. Both heterologous and homologous transporters, Jen1p and PAS, were evaluated in one strain already containing LDH activity. Fed-batch experiments of P. pastoris strains carrying the lactate transporter were performed with the batch phase at aerobic conditions followed by an aerobic oxygen-limited phase where production of lactic acid was favored. The results showed that the strain containing PAS presented the highest lactic acid titer, reaching a yield of approximately 0.7 g/g. Conclusions: We showed that P. pastoris has a great potential as a fermentative organism for producing l-lactic acid using glycerol as the carbon source at limited oxygenation conditions (below 0.05 % DO in the bioreactor). The best strain had both the LDHb and the homologous lactate transporter encoding genes expressed, and reached a titer 1.5 times higher than the strain with the S. cerevisiae transporter. Finally, it was also shown that increased lactic acid production was concomitant to reduction of acetic acid formation by half.

Introduction Iontophoresis is a noninvasive technique used to increase transdermal penetration of substances through the skin layer (epidermis, dermis and hypodermis) in a controlled manner. Technological advance in recent decades have provided reduced cost of equipment needed for implementation, which allowed for the expansion of this technique. Objective The aim of this paper is to present the state of the art on iontophoresis, ranging from the atomic characteristics of the ion formation to the current applications of the technique. Methods Were researched papers from databases: IOP publishing, ScienceDirect, Pubmed, Springer, IEEE Xplore, Google Scholar and books with keywords iontophoresis, ions, topical applications between 1967 and 2010. Results Were selected (number of papers and database) 1 IOP Publishing, 1 from ScienceDirect, Central, 1 from Springer, 2 from PubMed, 11 from IEEE Xplore, 35 from Google Scholar, and 15 books, totaling 66 references and websites with nationally marketed electrotherapy products. Conclusion Iontophoresis is suitable for applications such as acetic acid (calcific tendinitis and myositis ossificans), calcium chloride and magnesium sulfate (control of musculoskeletal spasms), dexamethasone (inflammation), lidocaine (inflammation of soft tissues), zinc oxide (rheumatoid arthritis). It is also used in cosmetic applications with devices attached to the skin and for eye treatment aimed at specific tissues of the eye, providing a treatment option for various eye diseases, reducing the complications secondary to traditional methods of treatment. The advantages are the significant increase in the release and control of therapeutic agents, including drugs with high molecular weight. The disadvantages of iontophoresis are the complexity of the drug release system and prolonged exposure of the skin to an electrical current. Introdução A iontoforese é uma técnica não invasiva utilizada para aumentar, de forma controlada, a penetração transdermal de substâncias através das camadas da pele (epiderme, derme e hipoderme). O avanço tecnológico nas últimas décadas proporcionou uma redução no custo dos equipamentos necessários à sua aplicação, o que possibilitou a expansão dessa técnica. Objetivo Apresentar o estado da arte sobre iontoforese, abrangendo desde as características atômicas da formação do íon até as atuais aplicações da técnica. Métodos Foram pesquisados artigos das bases de pesquisa: IOP publishing, ScienceDirect, Pubmed, Springer, IEEE Xplore, Google Scholar e livros com os unitermos: iontophoresis, ions, topical applications entre os anos de 1967 e 2010. Resultados Foram selecionados (número de artigos e base de pesquisa) 1 da IOP Publishing, 1 da ScienceDirect, 1 da Springer, 2 da PubMed, 11 da IEEE Xplore, 35 do Google Scholar e 15 livros, totalizando 66 referências, além de websites com produtos comerciais nacionais de eletroterapia. Conclusão A iontoforese é indicada para aplicações como de ácido acético (tendinite calcificante e miosite ossificante), cloreto de cálcio e sulfato de magnésio (controle de espasmos musculoesqueléticos), dexametasona (inflamação), lidocaína (inflamação de tecidos moles), óxido de zinco (artrite reumatóide). Também é utilizada em aplicações cosméticas com dispositivos aderidos à pele e em tratamento ocular visando tecidos específicos do olho, oferecendo uma forma de tratamento para diversas doenças oculares, diminuindo as complicações apresentadas em métodos clássicos de tratamento. As vantagens são o significativo aumento na liberação e controle de agentes terapêuticos, incluindo fármacos com alto peso molecular. As desvantagens encontradas na iontoforese são a complexidade do sistema de liberação do fármaco e exposição prolongada da pele a uma corrente elétrica.

A oclusão aguda de stent fêmoro-poplíteo pode ser causa de isquemia crítica dos membros inferiores. A terapia fibrinolítica pode não ser a forma de tratamento mais indicada para o grupo de pacientes com esse quadro clínico. Neste artigo, apresentamos um caso em que a retirada de um fragmento de stent por endarterectomia tornou possível a revascularização do membro. Femoropopliteal stent obstruction may be responsible for acute lower limb ischemia. Fibrinolytic treatment may not be the best therapeutic approach in this group of patients. We report a clinical case in which stent fragmentation and endarterectomy enabled femoropopliteal below knee bypass and limb revascularization.

PURPOSE: To compare the healing of abdominal wall aponeurosis of rats after incision with either cold scalpel or electrocautery. METHODS: Twelve male adults Wistar inbreed rats weightin 258-362g entered the experiment. They were randomly divided in two groups, control group (N= 6) and experimental group (N= 6). All animals underwent anesthesia followed abdominal wall incision with either cold scalpel (controls) or electrocautery (experimental group). The animals were killed on the 10th day and necropsied. Tissue samples containig the abdominal wall aponeurosis were sent for both histological study and hydroxyproline content assay. RESULTS: The histological study showed no significant difference between the two groups. Hydroxiproline content in experimenral group (128,56 [78,98-198,92] µg /100m) was not significantly different from control group (140,27 [116,20-166,59] mg /100ml; p = 0.53). CONCLUSION: Healing of abdominal wall after dieresis with either cold scalpel or electrocautery are equivalent and do not differ. OBJETIVO: Comparar a cicatrização da aponeurose abdominal de ratos submetidos à dierese com o uso de eletrocautério e de bisturi de lâmina. MÉTODOS: Utilizou-se 12 ratos Wistar, machos, adultos, com peso entre 258-362g. Os animais foram divididos aleatoriamente em dois grupos: controle (N= 6) e experimental (N= 6). Sob anestesia parenteral, realizou-se no grupo controle a abertura da aponeurose abdominal utilizando-se o bisturi de lâmina e no experimental abertura com o uso do eletrocautério. Os animais foram sacrificados no 10° PO, a aponeurose foi ressecada e enviada para estudo histológico e dosagem de hidroxiprolina. RESULTADOS: Não houve diferença na avaliação histológica entre os grupos. O conteúdo de hidroxiprolina no grupo experimental (128,56 [78,98-198,92] mg /100m) não foi diferente do grupo controle (140,27 [116,20-166,59] µg /100ml; p = 0.53). CONCLUSÃO: A cicatrização da aponeurose da parede abdominal de ratos submetidos à diérese com bisturi de lâmina e eletrocautério se equivalem e não diferem entre si.