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Resumen El neumotorax espontaneo en el embarazo es una causa extremadamente rara de disnea con menos de 100 casos reportados en la literatura. Una nulipara de 28 anos con 39+4 semanas de gestacion, acudio al Servicio de Urgencias por disnea intensa y dolor toracico pleuritico. La radiografia de torax revelo un gran neumotorax izquierdo, con el pulmon colapsado. Se coloco un drenaje toracico y la reexpansion pulmonar fue incompleta. Por sospecha de macrosomia fetal, se realizo una cesarea bajo anestesia epidural. El posparto transcurrio sin incidentes. Aunque sea una condicion muy rara, el neumotorax espontaneo debe descartarse en todas las mujeres embarazadas que presenten una disnea subita y dolor toracico. Un elevado indice de sospecha es imprescindible para un abordaje oportuno de esta patologia, evitando asi complicaciones materno-fetales. Para un correcto diagnostico y tratamiento, se requieren recomendaciones mas solidas y un enfoque multidisciplinario.

Objective Alar batten grafts are used to treat in nasal valve dysfunction (NVD). They can be placed by open or closed rhinoplasty using rib, septal, or auricular concha cartilage. Our surgical team used a modified placement of the classic alar batten.We aim to describe these changes and to the technique and demonstrate that modified alar batten grafts can improve the effects of spreader grafts and classic alar batten grafts. Methods A retrospective study of 91 functional rhinoplasties was performed from March 2011 to November 2019 at a public university hospital in Murcia. The patients were divided into three groups. Group A included patients operated on using spreader grafts, group B included patients operated on using spreader grafts associated with alar batten grafts fixed to the caudal edge of the lateral crura of the lower lateral cartilage (LLC), and group C included patients operated on using modified alar batten grafts. Results A total of 91 functional rhinoplasties were performed, 31 patients were operated on in group A, 27 patients were operated on in group B, and 33 patients were operated on in group C. The success rate was 67.7% in group A, 70.4% in group B and 93.9% in group C. Conclusion Modified alar batten grafts achieved better results than spreader grafts and spreader grafts associated with classic alar batten grafts. The size, position and placement of the sutures of modified alar batten grafts were the key factors in improving our results.

Background: GHB (gamma-hydroxybutyric acid; sodium oxybate) is a general anaesthetic that is clinically used for the treatment of narcolepsy, cataplexy, alcohol withdrawal and alcohol relapse prevention. In addition, GHB is recreationally used. Most clinical and recreational users regard GHB as an innocent drug devoid of adverse effects, despite its high dependence potential and possible neurotoxic effects. At high doses, GHB may lead to a comatose state. This paper systematically reviews possible cognitive impairments due to clinical and recreational GHB use. Methods: PubMed and PsychINFO were searched for literature data about the acute and residual cognitive deficits following GHB use. This review is conducted using the PRISMA protocol. Results: A total of 43 reports covering human and animal data on GHB-induced cognitive impairments were eligible and reviewed. This systematic review found no indication for cognitive impairments after clinical GHB use. However, it supports the view that moderate GHB use may result in acute short-term cognitive impairments, whereas regular high-dose GHB use and/or multiple GHB-induced comas are probably neurotoxic resulting in long-term residual cognitive impairments. Conclusion: These results emphasize the need for awareness among clinicians and recreational users to minimize negative health consequences of recreational GHB use, particularly when high doses are used and GHB-induced comas occur.

Monobloc and facial bipartition combined with distraction osteogenesis (MFBDO) has gained popularity over the past several years as a treatment of syndromic craniosynostosis, in part because this surgical technique effectively removes many stigmatic clinical features associated with the syndromic face. The objective of this study is to detail the surgical planning used to achieve medialization of the orbits and describe the authors' experience using MFBDO to destigmatize the syndromic face. By using MFBDO, hypertelorism, vertical orbital dystopia, and downslanting of the palpebral fissure were surgically corrected in all patients, thereby destigmatizing the syndromic face.

Objective To investigate the epidural administration of combinations of ropivacaine, morphine and xylazine in bitches undergoing unilateral mastectomy. Study design Prospective, randomized, blinded, clinical study. Animals A total of 22 bitches scheduled to undergo unilateral mastectomy for mammary tumor excision. Methods Dogs were anesthetized with acepromazine (0.02 mg kg–1) and morphine (0.3 mg kg–1) intramuscularly, propofol intravenously (IV) and isoflurane. Prior to the beginning of surgery, dogs were randomly administered one of three epidural treatments: ropivacaine (0.75 mg kg–1) with morphine (0.1 mg kg–1) (group RM, n = 7); ropivacaine with xylazine (0.1 mg kg–1) (group RX, n = 8); or ropivacaine with morphine and xylazine (group RMX, n = 7). Cardiopulmonary variables and the expired concentration of isoflurane (F e ′Iso) were recorded intraoperatively. Meloxicam (0.1 mg kg–1) was administered IV during skin closure. Postoperative pain scores were evaluated with the Glasgow composite measure pain scale short form for 24 hours, and rescue analgesia with morphine (0.5 mg kg–1) was administered intramuscularly when pain scores were ≥ 6/24. Results F e′ Iso was significantly higher in group RM than in groups RX and RMX. Heart rate decreased significantly in groups RX and RMX, but blood pressure remained within acceptable values. The number of dogs administered rescue analgesia within 24 hours was significantly higher in group RX (seven out of eight dogs, 87.5%) than in groups RM (one out of seven dogs, 14.3%; p = 0.01) and RMX (two out of seven dogs, 28.6%; p = 0.04). Time to standing was significantly longer in group RX than in group RM. Conclusions and clinical relevance All epidural treatments provided adequate antinociception with minimal cardiovascular adverse effects during mastectomy. The inclusion of morphine (groups RM and RMX) provided the best postoperative analgesia. Owing to the undesirable effect of xylazine on ambulation, the combination ropivacaine–morphine appeared to provide greater benefits in bitches undergoing unilateral mastectomy.

The most commonly occurring syndromic craniosynostoses are Apert syndrome, Crouzon syndrome, Pfeiffer syndrome, and Saethre-Chotzen syndrome. There is insufficient data regarding postoperative syndrome–related outcomes following the posterior vault distraction osteogenesis (PVDO) procedure, as well as data addressing whether or not additional procedures will be subsequently necessary to comprehensively treat children who undergo PVDO. Thus, the objective of this study is to describe and compare syndrome-related potential complications and outcomes associated with the PVDO procedure. An observational retrospective study was performed on consecutive patients (n=24) with Apert syndrome, Crouzon syndrome, Pfeiffer syndrome, or Saethre-Chotzen syndrome, respectively, who underwent PVDO between 2012 and 2019. Demographic data (patient gender and age when the PVDO procedure was performed), diagnosis, surgery-related data, and outcome data (perioperative and midterm complications and need for additional surgery) were verified. Total relative blood transfusion volumes per kilogram for the patients were as follows: 22.75 ± 9.30 ml for Apert syndrome, 10.73 ± 2.28 ml for Crouzon syndrome (Apert versus Crouzon, p

Craniofrontonasal dysplasia (CFND) is a rare congenital craniofacial syndrome characterized by single suture synostosis, hypertelorism, other clinical facial features, and abnormalities in the upper extremities. There are only a few studies in the applicable literature that address hypertelorism management for CFND patients and outcomes and complication rates. A retrospective study was performed on consecutive late presenting CFND patients referred to our hospital with substantially completed craniofacial skeleton growth, who underwent hypertelorism correction between 2007 and 2019 following intracranial pressure screening, and who received at least 1 year of follow-up care. None of the patients in this study underwent prior craniofacial surgery. Only those patients with a confirmed mutation of the EFNB1 gene were included in this study. All patients in this study underwent hypertelorism correction by facial bipartition or box osteotomy. A total of ten late presenting CFND patients (all female) were treated at our hospital during the study period. None of the patients presented signs of elevated intracranial pressure. The average patient age at hypertelorism correction was 13.4 ± 7.68 years of age. Major complications, defined as complications requiring a return to the operating room, were limited to infection of the frontal bone, which required partial bone removal, and cerebrospinal fluid (CSF) leak, which was completely resolved by insertion of a lumbar shunt for a 7-day period. The absence of elevated intracranial pressure enables hypertelorism correction in late presenting CFND patients via facial bipartition or box osteotomy without the need for additional operations that provide for cranial expansion.

We present here the unique case of a patient with a Tessier 1-13 rare facial cleft accompanied by cleft lip and palate and Tessier grade 2 hypertelorism. The patient described in this article has a twin brother who shares a number of genetic traits and physical features but does not present facial cleft or hypertelorism. The 45-year follow-up in this case is believed to be the longest follow-up to date to have been reported in the literature, and sheds significant light on the importance of extended longitudinal follow-up to maximize patient outcomes.

Although the pathophysiology of pulmonary disease caused by coronavirus disease-2019 (COVID-19) is not yet fully understood, successful extracorporeal membrane oxygenation (ECMO) use has been reported for COVID-19-related severe acute respiratory distress syndrome (ARDS). We report a case series of 12 patients who received long venovenous ECMO (VV ECMO) runs for refractory hypoxia (median PF ratio of 71.8, interquartile range (IQR) 53.5–78.5) from COVID-19-related ARDS. A majority (75%) of the patients were males with a median age of 44 (IQR 37–53.5). Overall, six (50%) patients survived to hospital discharge with five of them (83.3%) noted to be cerebral performance category 1 or 2 at the time of discharge. Survivors consistently showed an improvement in sequential organ failure assessment scores within 72 hours of ECMO initiation. The median ECMO duration was 28 days (IQR 13.5–50). Despite using standard anticoagulation strategy, six (50%) of our patients had one or more major bleeding episodes, which proved to be directly fatal in four (25%) patients. Although the overall outcomes of our cohort were acceptable, our patients had much longer ECMO runs (mean 38 days in survivors) and with much higher, often fatal bleeding complications. We compare our data with other published COVID-19 VV ECMO series. How to cite this article Kakar V, North A, Bajwa G, Raposo N, Kumar PG. Long Runs and Higher Incidence of Bleeding Complications in COVID-19 Patients Requiring Venovenous Extracorporeal Membrane Oxygenation: A Case Series from the United Arab Emirates. Indian J Crit Care Med 2021;25(12):1452–1458.

High‐dose methylprednisolone plus rituximab (R‐HDMP) is a useful treatment in chronic lymphocytic leukaemia/small lymphocytic lymphoma (CLL/SLL) patients unfit for chemo‐immunotherapy and has proven its utility on the treatment of CLL/SLL complicated by auto‐immune cytopenias. We performed a retrospective, single‐centre study, of CLL/SLL patients treated with R‐HDMP for 9 years. Thirty‐nine patients were included, median age at time of treatment was 77 years. Most patients had stage Rai III/IV and Binet C disease. Twenty‐eight patients had relapsed/refractory disease at time of treatment with a median of 1 previous line of therapy; 53.8% had prior exposure to fludarabine and 25% to rituximab. Grade 3–4 neutropenia and thrombocytopenia were recorded in 10.2% and 17.9% patients, respectively. While on treatment, 51.3% had documented infectious complications, but no other non‐haematological toxicities grades 3–4 were identified. Overall response rate was 64%. Median overall survival and progression‐free survival were 24 and 13 months, respectively. Twenty four patients relapsed and 16 received another line of treatment after R‐HDMP, with median time to next treatment of 13.5 months. Thirteen out of the 24 patients improved performance status and were subsequently considered fit for chemo‐immunotherapy. R‐HDMP is a valuable option for elderly and frail patients, with low risk of severe myelotoxicity and other severe adverse events. It was shown to work as a bridge to other lines of treatment, including chemo‐immunotherapy., High dose methylprednisolone plus rituximab (R‐HDMP) is a useful treatment in chronic lymphocytic leukaemia/small lymphocytic lymphoma patients unfit for chemo‐immunotherapy. We present a cohort of patients with median age of 77 years, most with stage Rai III/IV and Binet C disease. Overall response rate was 64% and median overall survival and progression‐free survival were 24 and 13 months, respectively, with an acceptable toxicity profile, highlighting R‐HDMP utility for elderly and frail patients.

Introduction. Although uncommon from a population-based perspective, there is considerable morbidity and mortality associated with malignant tumors of the nose and paranasal sinuses.The objective of this study was to characterize the presentation, risk factors, management and survival of patients with these tumors treated at a single institution.Materials and methods. We retrospectively reviewed the clinical records of patients with malignancies of the nose and paranasal sinuses diagnosed between January 2010 and December 2014 at a tertiary cancer center. Univariate and multivariate analysis were performed.Results. Ninety patients were included in the study. Mean age at diagnosis was 62.8 years (range, 2–95 years) and mean follow-up was 44.5 months (range, 2–113 months). The maxillary sinus (33.3 %) and the nasal cavity (32.2 %) were the most frequent sites of origin. Squamous cell carcinoma (36.7 %), mucosal melanoma (15.6 %) and adenoid cystic carcinoma (10 %) were the most common histologic subtypes. Surgery was the primary treatment for 86.7 % of patients. Recurrence occurred in 45 patients (50 %). The overall 5‑year survival was 39.3 % and disease free-survival was 45.9 %. Survival was significantly decreased in non-smokers (p = 0.022), T3–4 tumors (p = 0.007), positive lymph nodes (p p = 0.036) and positive margins (p = 0.032). Survival was not affected by surgical approach between endoscopic, open and combined approaches (p = 0.088).Conclusion. Prognosis is poor, with high recurrences and low survival, but clearly histology, location and stage-dependent. Sound oncologic principles, with complete resections and negative margins, result in a better outcome.

Ovarian tissue transplantation methods using cooled and cryopreserved samples have been attractive options for fertility preservation in animal models and humans. The aim of this study was to evaluate the impact of previous exposure to cooling, cryopreservation, and VEGF on the overall efficiency of equine ovarian tissue after heterotopic xenotransplantation in mice. The end points evaluated were follicular morphology and development, follicular and stromal cell densities, angiogenesis (i.e. the density of new and mature blood vessels), collagen types I and III fiber densities, and total fibrosis. Ovaries of adult mares were harvested after ovariectomy, and ovarian fragments were xenografted in the i.p. wall of BALB nude mice. Ten types of treatments involving different combinations of cooling, cryopreservation, xenografting procedures, and VEGF exposure were compared. The novel aspect of this study was the use of equine ovarian tissue xenotransplantation in mice, challenging the fragments with different combinations of treatments. The main findings were (i) cooling but not cryopreservation was effective in preserving the follicular morphology, (ii) a greater percentage of developing follicles but lower follicular and stromal cell densities were observed after ovarian tissue engraftment, (iii) exposure to VEGF increased new and mature vessels in cryopreserved-transplanted tissue, and (iv) an appropriate balance in the collagen types I and III fiber ratio in cooling-transplanted tissue was observed after exposure to VEGF. This study contributes to advancing knowledge in the preservation of ovarian tissue after cooling-cryopreservation and transplantation aiming to be applied to genetically superior/valuable horses, livestock, endangered animals, and, possibly, humans. Lay summary Due to ethical limitations involving humans, the female horse (mare) has recently emerged as an alternative model for reproductive comparisons with women to optimize fertility restoration using ovarian tissue transplantation techniques. This study determined if ovarian tissue from donor mares (n = 3), exposed or not to vascular endothelial growth factor (VEGF) before transplantation, better survives for 7 days after transplantation into mouse hosts (n = 12). Tissues submitted to different combinations of cooling, freezing, and transplanting treatments, along with control groups, were evaluated using the parameters morphology, development, the density of immature eggs (follicles), the density of supportive (stromal) cells, collagen protein proportions, and density of blood vessels. Frozen-thawed treatments had lower percentages of normal follicles. Exposure to VEGF increased blood vessel densities in frozen tissue and favored adequate collagen levels in cooled-transplanted treatments. In conclusion, VEGF exposure seems to be beneficial for mare ovarian tissue transplantation and warrants further investigation.

Human herpesvirus‐6 (HHV‐6) may cause serious diseases in immunocompromised individuals. SARS‐CoV‐2/HHV‐6 coinfection has been emphasized in previous works, mostly case reports, small series, or epidemiological studies, but few are known about its real clinical outcomes. Here we present a real‐world pilot study aiming to understand the frequency and the clinical impact of HHV‐6 coinfection in moderate to critically ill patients hospitalized due to COVID‐19. SARS‐CoV‐2 and HHV‐6 were evaluated in nasopharyngeal samples at the hospital admission of suspected COVID‐19 patients. From 173 consecutive cases, 60 were SARS‐CoV‐2 positive and 13/60 (21.7%) were HHV‐6 positive after identified as the HHV‐6B species by a Sanger sequencing. The SARS‐CoV‐2+/HHV‐6+ group was younger but not significant for cardiovascular diseases, diabetes, obesity, and cancer, but significant among therapeutic immunosuppressed patients (as systemic lupus erythematosus and kidney transplant patients). In the medical records, only sparse data on cutaneous or neurological manifestations were found. Biochemical and hematological data showed only a trend towards hyperferritinemic status and lymphopenia. In conclusion, despite the impressive high frequency of HHV‐6 coinfection in SARS‐CoV‐2 positive cases, it did not impact general mortality. We suggest larger future prospective studies to better elucidate the influence of HHV‐6 reactivation in cases of COVID‐19, designed to specific assessment of clinical outcomes and viral reactivation mechanisms.

This review paper summarises the yield of the different imaging modalities in the evaluation of patients for IV thrombolysis. Non-contrast CT and CTA or brain MRI combined with MRA are the recommended sequences for the evaluation of patients within the 4.5 hours time window. Multimodal MRI (DWI/PWI), and more recently, CT perfusion, offer reliable surrogate of salvageable penumbra, the target mismatch, which is now currently used as selection criteria for revascularisation treatment in an extended time window. Those sequences may also help the physician for the management of other limited cases when the diagnosis of acute ischemic stroke is difficult. Another approach the DWI/FLAIR mismatch has been proposed to identify among wake-up stroke patients those who have been experiencing an acute ischemic stroke evolving from less than 4.5hrs. Other biomarkers, such as the clot imaging on MRI and CT, help to predict the recanalisation rate after IVT, while the impact of the presence microbleeds on MRI remains to be determined.

Introduction and Objectives: Use of invasive physiological assessment in patients with coronary artery disease varies widely and is perceived to be low. We aimed to examine adoption rates as well as patterns and determinants of use in an unselected population undergoing invasive coronary angiography over a long time frame. Methods: We retrospectively determined the per-procedure prevalence of physiological assessment in 40 821 coronary cases performed between 2007 and 2018 in two large-volume centers. Adoption was examined according to procedure type and patient- and operator-related variables. Its association with relevant scientific landmarks, such as the release of clinical trial results and practice guidelines, was also assessed. Results: Overall adoption was low, ranging from 0.6% in patients undergoing invasive coronary angiography due to underlying valve disease, to 6% in the setting of stable coronary artery disease (CAD); it was 3.1% in patients sustaining an acute coronary syndrome. Of scientific landmarks, FAME 1, the long-term results of FAME 2 and the 2014 European myocardial revascularization guidelines were associated with changes in practice. Publication of instantaneous wave-free ratio (iFR) trials had no influence on adoption rates, except for a higher proportion of iFR use. In 42.9% of stable CAD patients undergoing percutaneous coronary intervention there was no objective non-invasive evidence of ischemia, nor was physiological assessment performed. Younger operator age (4.5% vs. 4.0% vs. 0.9% for ages 55 years, respectively; p 55 anos, respetivamente; p < 0,001) e a hora de realização do procedimento (2,9% entre as 6-8PM versus 4,4% durante o restante dia) relacionaram-se inversamente com a utilização de fisiologia durante os procedimentos. Conclusões: Esta análise confirma a baixa de utilização da avaliação funcional invasiva na prática clínica. A disponibilidade de evidência sobre o uso de índices não hiperémicos não aumentou a adoção. São necessárias estratégias dirigidas que potenciem a implantação das recomendações, de forma que o manejo dos doentes com doença coronária e os benefícios clínicos da estratificação invasiva possam ser aprimorados.

OBJECTIVE To investigate the association between migraine and signs and symptoms of eating disorders among teenagers. And as secondary objectives: to investigate the prevalence of eating disorders signs and symptoms and to identify the prevalence of migraine among teenagers. METHODS Cross-sectional study was carried out in public schools which included adolescents aged 11-18 years, of both sexes. For eating disorders evaluation two self-reported questionnaires were used: Eating Attitudes Test-26 (EAT-26) and The Bulimic Investigatory Test of Edinburg (BITE). The presence and characterization of headache were verified following the International Classification of Headache Disorders (ICHD-II). RESULTS 607 adolescents (388 females) with mean age of 13.9 years (95% CI: 13.7; 14) were included. The eating disorders symptoms based on EAT-26 (p = 0.041) and the bulimia nervosa symptoms (p = 0.014) evaluation were more prevalent among teenagers with migraine compared with non-migraine. Also, in multivariate analysis, the adjusted odds ratio (OR) to present bulimia nervosa symptoms is 1.85 times higher among females than males. And, the adjusted OR to present bulimia nervosa symptoms among teenagers with migraine is 1.51 times (OR) higher than among non-migraine. CONCLUSIONS The presence of migraine symptoms were associated with a higher likelihood to present eating disorders symptoms among teenagers, especially in females, that was associated with a 1.85-fold increase in the risk to present bulimia nervosa symptoms. LEVEL OF EVIDENCE III, Evidence obtained from cross-sectional study.

espanolEl catalogo del patrimonio arquitectonico no solo lo componen los edificios construidos, sino todas aquellas arquitecturas no construidas, de las que se conserva documentacion grafica. Segun la UNESCO el patrimonio es el legado cultural del pasado que se transmite a las generaciones futuras. Englobados en el patrimonio arquitectonico, los dibujos de arquitectura son una produccion particular de nuestra herencia cultural, y deben ser tratados desde enfoques que reunan diferentes perspectivas conceptuales, metodologicas y profesionales. En un siglo tan convulso como el siglo xx en el que afloraron tantas expresiones radicalizadas que se apropiaron de manera excluyente del espacio publico, los arquitectos tuvieron que aprender a luchar contra esta distorsion de la memoria pasada y futura con la mejor arma de la que disponian: el dibujo. Este articulo, hace un recorrido por alguna de las arquitecturas dibujadas mas controvertidas de ese siglo, bien por encarnar una actitud disidente frente a la vision univoca imperante o bien por su propio contenido simbolico o argumental. Su legado no solo comprende una documentacion de altisimo valor artistico, tambien un sinfin de ideas controvertidas, polemicas y a veces comicas, sin las cuales, seria imposible entender la arquitectura actual. EnglishThe catalog of architectural heritage is made up not only by built buildings, but by all those unbuilt architectures with remaining graphic documentation. According to UNESCO, heritage is the cultural legacy of the past that is transmitted to future generations. Architectural drawings are a particular production of our culture, included in the architectural heritage and must be approached considering different conceptual, methodological and professional perspective. In such a turbulent century as the 20th century, many radicalized expressions emerged, exclusively based on the appropriation of public space. Architects had to learn to fight against this distortion of past and future memory with the best weapon at their disposal: drawing. This article surveys some of the most controversial drawn architectures of that century, either because they embody a dissident attitude in the face of the prevailing univocal vision or because of their own symbolic or argumentative content. Their legacy includes not only documentation of the highest artistic value, but also a myriad of controversial, radical and sometimes comic ideas, without whom it would not be possible to understand current architecture.

Aim To determine in the adult population the crude and the sex- and age-adjusted prevalence rates of hypertriglyceridaemia (HTG) and to assess its association with cardiovascular risk factors, chronic kidney disease, cardiovascular and cardiometabolic diseases. Methods Cross-sectional observational study conducted in Primary Care, with 6,588 adult study subjects, randomly selected on base-population. Patients had HTG if the triglyceride level was ≥150 mg/dL (≥1.7 mmol/L), or were on lipid-lowering therapy to lower triglyceride. Associations were assessed by univariate and multivariate analysis, and crude and sex- and age-adjusted prevalence rates were determined. Results The arithmetic and geometric means of triglyceride levels were respectively 120.5 and 104.2 mg/dL in global population, 135.7 and 116.0 mg/dL in men, and 108.6 and 95.7 mg/dL in women. The crude HTG prevalence rates were 29.6% in global population, 36.9% in men and 23.8% in women. The sex- and age-adjusted HTG prevalence rates were 27.0% in global population, 34.6% in men and 21.4% in women. The independent variables that were most associated with HTG were hypercholesterolemia (OR: 4.6), low HDL-C (OR: 4.1), hepatic steatosis (OR: 2.8), diabetes (OR: 2.0), and obesity. (OR: 1.9). Conclusions The means of triglyceride levels and HTG prevalence rates are intermediate between those of other national and international studies. A fifth of the female adult population and more than a third of the male population had HTG. The independent factors associated with HTG were hypercholesterolemia and low HDL-C, and the cardiometabolic variables diabetes, hepatic steatosis and obesity.

Monobloc advancement is a complex procedure used to treat patients with syndromic craniosynostosis. Studies directly addressing the long-term stability of monobloc advancement with distraction osteogenesis are underreported in the literature. The objectives of this study were to assess 5-year midface bone stability following monobloc advancement performed on patients with syndromic craniosynostosis, identify risk factors for relapse, and present strategies for prevention and management of complications.An observational retrospective study was performed on consecutive patients with Apert, Crouzon, or Pfeiffer syndrome (n = 23) who underwent monobloc advancement using distraction osteogenesis between 1994 and 2013. A total of 130 lateral cephalograms were used to assess both long-term stability after monobloc advancement with distraction osteogenesis and risk factors for relapse. All serious complications were identified and recorded. The analysis of variance test was used to assess horizontal relapse of the midface and mandibular plane.Cephalometric analysis revealed long-term stability of frontofacial advancement using distraction osteogenesis, regardless of the presence of tested variables. Serious complications arising from monobloc advancement using distraction osteogenesis included cerebrospinal fluid leakage in six patients (26 percent), accompanying meningitis in two patients (8.7 percent), seizures in seven patients (30.4 percent), and impaired visual acuity in one eye of one patient (4.3 percent).Frontofacial monobloc advancement with distraction osteogenesis provides long-term midface bone stability.Therapeutic, IV.

Made available in DSpace on 2022-05-01T08:15:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-11-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Mirabegron is a selective β₃-adrenergic receptors agonist, which has been recently shown to improve metabolic health in rodents and humans. In this study, we investigated the effects of 2-week mirabegron treatment on the metabolic parameters of mice with a diet-induced obesity (DIO). C57BL/6JUnib mice were divided into control (CTR) and obese (OB) groups treated with vehicle, and an OB group treated with mirabegron (OB + MIRA). The obese groups were fed a high-fat diet for 12 weeks. Mirabegron (10 mg/kg/day) was administrated orally by gavage from weeks 10–12. After 2 weeks of mirabegron treatment, the energy expenditure was assessed with indirect calorimetry. Blood glucose, insulin, glycerol, free fatty acids (FFA), thiobarbituric acid reactive substance (TBAR), and tumour necrosis factor (TNF)-α levels were also assessed, and the HOMA index was determined. Liver tissue, brown adipose tissue (BAT), and inguinal white adipose tissue (iWAT) samples were collected for histological examination. The protein expressions of uncoupling protein 1 (UCP1) and mitochondrial transcription factor A (TFAM) were assessed using western blotting of the BAT and iWAT samples. In this study, mirabegron increased the energy expenditure and decreased adiposity in OB + MIRA. Increased UCP1 expression in BAT without changes in iWAT was also found. Mirabegron decreased circulating levels of FFA, glycerol, insulin, TNF-α, TBARS and HOMA index. DIO significantly increased the lipid deposits in the liver and BAT, but mirabegron partially reversed this change. Our findings indicate that treatment with mirabegron decreased inflammation and improved metabolism in obese mice. This effect was associated with increased BAT-mediated energy expenditure, but not iWAT beiging, which suggests that mirabegron might be useful for the treatment of obesity and diabetes. Dorothy M. Davis Heart and Lung Research Institute The Ohio State University Wexner Medical Center Department of Physiology and Cell Biology The Ohio State University Wexner Medical Center Department of Physical Education Institute of Biosciences São Paulo State University (UNESP) Department of Pharmacology Faculty of Medical Sciences University of Campinas (UNICAMP) Department of Structural and Functional Biology Institute of Biology University of Campinas (UNICAMP) Medical School Graduate Program in Environmental Health Metropolitan University of Santos Department of Physical Education Institute of Biosciences São Paulo State University (UNESP)

The need for permanent pacemaker implantation (PPMI) is a burdensome complication of transcatheter aortic valve implantation (TAVI). The aim of our study was to evaluate different anatomical, clinical, electrocardiographic, and procedural variables associated with the development of conduction abnormalities after TAVI across the entire device spectrum. Single-center prospective cohort of consecutive patients who underwent TAVI since March 2017. Final cohort was studied to detect areas of calcium within aortic valve characterized by leaflet sector and region. Membranous septum (MS) length was assessed throughout a modified coronal view. Device selection and positioning were performed according to the operator criteria. Device selection and positioning were performed according to the operator criteria. From the 273 patients included, 57 underwent PPMI (20.8%). Univariate analysis determined right bundle branch block (RBBB), QRS duration, MS length and calcium within LVOT of non-coronary cuspid as independent predictors. After multivariable logistic regression, both RBBB (OR 6.138; 95% CI 1.23–30.73, P = 0.027) and MS length (OR 0.259; 95% CI 0.164–0.399, P

O objetivo deste artigo é relatar um caso clínico no qual foi instalado dois implantes com a necessidade da utilização de enxerto ósseo, sendo associado com membrana de fibrina rica em plaquetas, visando à reabilitação do paciente. Paciente gênero feminino, 55 anos, compareceu ao consultório odontológico tendo como queixa principal à ausência das coroas dos elementos dentais 36 e 37. Desta forma, foi realizada a exodontia e em seguida foi instalado na região dois implantes, do tipo Titamax Cone Morse 4,1 X 11,5 da empresa *Neodent. A mesma tinha um defeito alveolar que resultou em um volume ósseo insuficiente, por conta disso foi inserido o enxerto ósseo com osso liofilizado bovino Bio-oss granulado (Geistlich*). O tratamento obteve um excelente resultado, tendo como consequência o sucesso cirúrgico com um pós-operatório sem complicações. De acordo com o caso relatado foi observado, que a fibrina rica em plaquetas associada ao enxerto Bio-Oss® auxiliou e favoreceu no processo de reparo tecidual, contribuindo para aceleração e neoformação tecidual e óssea, fazendo assim uma reparação mais rápida do tecido, permitindo reabilitar o paciente em curto período de tempo e com biomaterial do próprio paciente.

The normal development of puberty depends on the specific pulsatility of gonadorelin, which is finely regulated by genetic and environmental factors. In the published literature, eating disorders figure as a cause of pubertal delay/arrest in females but are rarely considered in males with disordered puberty. A 16.7-year-old male was referred to the Department of Pediatrics with arrested puberty due to severe malnutrition in the context of food restriction. Past medical history was relevant for asthma. Generalized cachexia, facial lanugo hair, cutaneous xerosis, and Russell’s sign were noted; he had a height of 155.5 cm (−2.5 SD; target height: 168 cm, −1.1 SD) and a BMI of 12.4 kg/m2 (−6.8 SD); left and right testicular volumes were 8 mL and 10 mL, respectively. He had a twin brother who had normal auxological/pubertal development (height: 167 cm, −1.05 SD; testicular volumes: 20 mL). Anorexia nervosa was diagnosed, and he was enrolled in a personalized treatment and surveillance program. “Nonthyroid illness” resembling secondary hypothyroidism was noted, as was low bone mineral density. Clinical and biochemical follow-up showed significant improvements in BMI (16.2 kg/m2, −2.55 SD), completion of puberty (testicular volumes: 25 mL), and reversion of main neuroendocrine abnormalities. Herein, we present an adolescent male with arrested puberty in the context of anorexia nervosa. The recognition of this rare condition in males allows a personalized approach to disordered puberty, with resumption of normal function of the hypothalamic-pituitary-gonadal axis and achievement of pubertal milestones.

Introdução: As Doenças Respiratórias Crônicas (DRCs) são caracterizadas como um grupo de doenças que comprometem os pulmões e outras estruturas afetando também a mecânica respiratória. As DRCs levam ao comprometimento da capacidade funcional nos indivíduos portadores podendo levar então a um comprometimento da Qualidade de Vida (QV). Objetivos: mostrar por meio da análise e discussão dos dados apresentados em cada estudo os aspectos funcionais, os aspectos físicos, qualidade do sono, aspectos emocionais e sociais e a importância de terapêuticas e suas correlações com a qualidade de vida. Metodologia: Trata-se de uma revisão sistemática com dados coletados nas bases de dados da Biblioteca Virtual em Saúde (BVS): BIREME, MEDLINE/PUBMED, SCIELO, PEDro, utilizando os DeCs Fisioterapia, DPOC, Pacientes internados, Qualidade de vida, Qualidade de sono. Resultados: dez artigos se encaixaram nos critérios de inclusão se tornando elegíveis para o presente estudo. Conclusão: Esta revisão evidenciou, com base nos estudos analisados e discutidos que a QV precisa ser discutida e acompanhada em pacientes com DPOC.

Over the course of the COVID-19 pandemic, technology has been widely deployed to deter the spread of the virus. One such technology is wearable devices that can collect health data and inform healt...

Objectives: We compared the characteristics and clinical outcomes of hospitalized individuals with COVID-19 with [people with HIV (PWH)] and without (non-PWH) HIV co-infection in Spain during the first wave of the pandemic. Methods: This was a retrospective matched cohort study. People with HIV were identified by reviewing clinical records and laboratory registries of 10 922 patients in active-follow-up within the Spanish HIV Research Network (CoRIS) up to 30 June 2020. Each hospitalized PWH was matched with five non-PWH of the same age and sex randomly selected from COVID-19@Spain, a multicentre cohort of 4035 patients hospitalized with confirmed COVID-19. The main outcome was all-cause in-hospital mortality. Results: Forty-five PWH with PCR-confirmed COVID-19 were identified in CoRIS, 21 of whom were hospitalized. A total of 105 age/sex-matched controls were selected from the COVID-19@Spain cohort. The median age in both groups was 53 (Q1-Q3, 46-56) years, and 90.5% were men. In PWH, 19.1% were injecting drug users, 95.2% were on antiretroviral therapy, 94.4% had HIV-RNA

Aim To evaluate the real need for coronary access after transcatheter aortic valve implantation (TAVI). Methods and results Prospective observational single-center registry, including 563 consecutive patients who underwent TAVI between April 2008 and November 2018, with both self- and balloon-expandable valves in a tertiary European center. Mean age was 82.4 ± 6.9 years, 53.3% were female, 16% had previous history of coronary artery bypass grafting, 33% of previous percutaneous coronary intervention (PCI), and 16.6% of myocardial infarction (MI). Twenty-four percent of the patients were revascularized within one year before TAVI in preparation for the procedure. Median Society of Thoracic Surgeons score was 4.82 (IQ 2.84). In a median follow-up of 24 months (IQ 21.5), 18 patients (3.2%) were identified as potentially in need for invasive coronary angiography: 9 (1.6%) in the setting of stable coronary artery disease and 9 (1.6%) for an acute coronary syndrome. A total of 11 PCIs were performed in 9 patients, with a complete success rate of 63.6%. Procedures that were unsuccessful or partially unsuccessful were due to the inability to cross the stent or the drug-eluting balloon through the valve struts or misplacement within the coronary artery due to lack of catheter support. Conclusion In this population, a strategy of previous guideline-directed revascularization before TAVI was associated with a low rate of MI and repeated need of coronary access, with a scattered distribution over time. Assuring future access to coronary arteries in patients at increased risk may depend on the revascularization strategy rather than device selection.

Adolescents’ relationship with technology is controversial both because of the possibilities it offers and because of the risks it entails, even being perceived by them as a real need. In order to improve the knowledge about it, a non-experimental research of transversal style has been carried out using a methodology based on data mining. 1,048 students of Secondary Education participated and answered a questionnaire about their use of the Internet and social networks. Six factors were indentified, which could be recognized as patterns of behavior in the network. They are grouped around: (1) the communicative and informative dimension of the resources; (2) the one related to the security in the network; (3) the risk and vulnerability; (4) the specialized information both general and specific, (5) the transfer and acquisition of goods; and (6) the leisure and parental surveillance. The main findings show that their habits are mostly oriented towards the transfer and transaction along with the maintenance of security, avoinding situations that could involve risk and vulnerability in navigation. The identification of these subgroups is timely in order to develop training and digital literacy actions.

Objectives To analyze the inter-observer reliability of risk for venous thromboembolism (VTE) in a population of adult acutely-ill medical patients. Methods In this prospective cohort study, we collected risk factors and risk classification for VTE using RAM IMPROVE7. Kappa statistics was used to evaluate inter-observer reliability between lead clinicians and trained researchers. We evaluated occurrence of VTE in patients with mismatched classification. Results We included 2,380 patients, median age 70 years (interquartile range [IQR], 58-79), 56.2% female. Adjusted Kappa for VTE risk factors ranged from substantial (0.64, 95% confidence interval [CI], 0.61-0.67) for “immobilization”, to almost perfect (0.98; 95% CI 0.97-0.99) for “thrombophilia”; risk classification was 0.64 (95% CI 0.60-0.67). Divergent risk classification occurred in 434 patients (18.2%) of whom seven (1.6%) developed VTE. Conclusion Despite substantial to almost perfect reliability between observers for risk factors and risk classification, lead clinicians tended to underestimate the risk for VTE.

In the asynchronous time-based image sensor (ATIS) pixel, capture is performed only when a significant luminance change is detected, thus avoiding redundant transmission of data. Furthermore, luminance capture is performed by generating events when the photodiode voltage crosses two thresholds, at the pixel level, which contributes to a high dynamic range in image capture. The ATIS disadvantages are large pixel area and low fill factor. In order to reduce the pixel area, we propose the design of an ATIS in which the dynamic vision sensor (DVS) module is shared by a block of capture modules. A pixel with a 2 $$\times$$ 2 sharing block has roughly 29% fewer components than a pixel with one DVS module per capture module. A Verilog-A model of the proposed circuit is presented and compared to the electrical (device-level) model. Due to the mixed-signal nature of the circuit, the Verilog-A is an important tool for increasing simulation speed. We show that the Verilog-A model simulation of a 4 $$\times$$ 4 matrix is 70% faster than the electrical device-level simulation, while yielding similar reconstruction results.

There is controversy about whether there is an association between headache and internet addiction. Therefore, the objective was to assess whether there is an association between the headache, insomnia, and internet addiction. This was a cross-sectional study with 420 university students. We used a semi-structured questionnaire, Headache Impact Test, Hospital Anxiety Depression Scale, Insomnia Severity Index, and Internet Addiction Test. 51.4% were men, the median age was 21 (19, 23), 399 (95.0%) suffered from headaches in the last year, 265 (63.1%) had migraine, 182 (43.3%) had migraine with aura, 119 (28.3%) had episodic tension-type headache, 84 (20%) had internet addiction, and 95 (22.6%) had insomnia. Internet addiction was associated with anxiety (OR = 2.3; 95% CI: 1.3, 4.0; p = 0.003), insomnia (OR = 3.0; 95% CI: 2.0, 4.6; p

Ectrodactyly, commonly referred to as cleft hand, is a rare pathology characterized by a deficiency and/or complete absence of the central ray in each hand. In order to customize treatment and improve the patient's quality of life, a more detailed functional evaluation is required. Although several studies evaluate functionality in different types of cleft hands, there are only a few studies that show self-reported evaluations. The objective of this study is to assess the hand function of cleft hand patients.An observational retrospective study was performed on 12 cleft hand patients who were treated between 2008 and 2018. There were 8 male patients and 4 female patients. Patients were divided into 2 groups according to their ages: (Group 1) 6 patients between 1 and 7 years of age, and (Group 2) 6 patients between 8 and 18 years of age, respectively. Each group was sub-stratified into 5 subgroups according to the classification system created by Manske and Halikis.Regardless of age, intragroup hand type comparisons within Groups 1 and 2 did not demonstrate statistically significant differences (P 0.05) between hand outcomes according to Manske and Halikis classification. Comparison between cleft hand patients and their age matched controls demonstrated statistically significant differences (P 0.05), as the patients in the control group had higher outcome scores.Regardless of cleft hand type and patient age, patients with cleft hands experience impaired hand function and present lower outcome scores in comparison to their age matched controls.

Objective: This article aims to analyze the Brazilian scientific production related to communication and the Rede Cegonha, see king to raise questions about the communication process in these which is one of the health care networks present in the daily activities of the family health strategy. Methods: Bibliometric literature review research, searched in the Biblioteca Virtual de Saúde - BVS and The Scientific Electronic Library Online - SciELO.org databases, in the months of August and September 2019, using the key words: Rede Cegonha, Assistência Materno-Infantil(as a synonym of the first) and comunicação through the following peer associations: rede cegonha / communication and assistência materno-infantil/comunicação, through the Boolean operator AND the proximity operator quotation marks (“”), using the second consideringth e use of compound descriptors. Results: After excluding all articles that were not relevant to the topic and with all descriptors, 35 articles were found in the virtual library BVS and SciELO.org, however 18 were duplicated, leaving 17 articles. Regarding these arches performed with the descriptors associations, there was also duplicity, and all articles found were also inserted in the search with the descriptor Rede Stork. There was a tendency for publications to increase between 2015 and 2018, mainly in the VHL. Conclusion: The publication about stork net is still incipient, but with in increase in production in the last four years. KEYWORDS: Pregnant Women, Health Care Networks, Stork Network and Maternal Child Care. RESUMO: Objetivo: Esse artigo tem como objetivo analisar a produção científica brasileira relacionada à comunicação na Rede Cegonha, buscando levantar questionamentos sobre o processo de comunicação nessas que é uma das redes de atenção à saúde presente no cotidiano da atuação da estratégia de saúde da família. Métodos: Pesquisa de revisão de literatura tipo bibliométrica, pesquisada nos bancos de dados Biblioteca Virtual em Saúde – BVS e The Scientific Electronic Library Online – SciELO.org, nos meses de agosto e setembro de 2019, utilizando os descritores: Rede cegonha, Assistência Materno-Infantil (enquanto sinônimo do primeiro) e comunicação através das seguintes associações de pares: rede cegonha/comunicação e assistência materno-infantil/comunicação, por meio do operador booleano AND e o operador de proximidade aspas (“”), utilizando-se o segundo tendo em vista o uso de descritores compostos. Resultados: Após a exclusão de todos os artigos que não estavam pertinentes ao tema e com todos descritores, foram encontrados 35 artigos no total, nas bases de dados BVS e SciELO.org, contudo 18 estavam duplicados, restando 17 artigos. Com relação a busca realizada com as associações dos descritores, houve também duplicidade, sendo que todos os artigos encontrados estavam também inseridos na busca com o descritor Rede Cegonha. Houve uma tendência de aumento das publicações entre os anos de 2015 a 2018, principalmente na BVS. Conclusão: A publicação sobre rede cegonha ainda é incipiente, mas com um aumento na produção nos últimos quatro anos. PALAVRAS-CHAVE: Gestantes, Rede Cegonha, Assistência Materno Infantil.

The main goal of this paper is to investigate the effect of different types of self-representations through floating members (hands vs. hands + feet), virtual full body (hands + feet vs. full-body avatar), walking fidelity (static feet, simulated walking, real walking), and number of tracking points used (head + hands, head + hands + feet, head + hands + feet + hip) on the sense of presence and embodiment through questionnaires. The sample consisted of 98 participants divided into a total of six conditions in a between-subjects design. The HTC Vive headset, controllers, and trackers were used to perform the experiment. Users were tasked to find a series of hidden objects in a virtual environment and place them in a travel bag. We concluded that (1) the addition of feet to floating hands can impair the experienced realism ( $$p=0.039$$ ), (2) both floating members and full-body avatars can be used without affecting presence and embodiment ( $$p>0.05$$ ) as long as there is the same level of control over the self-representation, (3) simulated walking scores of presence and embodiment were similar when compared to static feet and real walking tracking data ( $$p>0.05$$ ), and (4) adding hip tracking overhead, hand and feet tracking (when using a full-body avatar) allows for a more realistic response to stimuli ( $$p=0.002$$ ) and a higher overall feeling of embodiment ( $$p=0.023$$ ).

In March 2020, the Portuguese Government issued a remarkable regulation by which irregular migrants who had previously started the regularization procedure were temporarily regularized and thus allowed full access to all social benefits, including healthcare. The Portuguese constitutional and legal framework is particularly generous regarding the right to healthcare to irregular migrants. Nevertheless, until now, several practical barriers prevented full access to healthcare services provided by the national health service, even in situations in which it was legally granted. This decision is not only remarkable in light of the fulfilling of migrants’ rights to health, as imposed by international commitments assumed by, but also in view of the fight against COVID-19. The decision is grounded both on human rights and in public health reasons. The paper is divided in two main parts. In the first one, it analyzes national State obligations with regard to healthcare provision to migrants in irregular situation. In the second part, it analyzes the Portuguese solution, using this case study to discuss the possible mechanisms to comply with such obligations.

Intercostal nerve cryoablation (INCA) coupled with surgical stabilization of rib fractures (SSRF) has been shown to reduce post-operative pain scores but at what monetary cost. We hypothesize that in-hospital outcomes improve with the addition of INCA to SSRF and potential increased hospital charges are justified by patient benefits.Multi-institutional, retrospective review of patients undergoing SSRF with and without INCA over an 8-year period. Institutions involved were Level II or higher trauma centers. Basic demographics were obtained. Patients were included if SSRF was performed during the index hospitalization. Primary outcomes included total hospital length of stay (HLOS) and HLOS after SSRF, total hospital charges (HC), HC the day of surgery and HC after surgery. Secondary outcome included total narcotic consumption in morphine milliequivalents (MME) after SSRF. Mann-Whitney U test was used for analysis. Statistical significance p 0.05.136 patients analyzed; 92 underwent SSRF only and 44 underwent SSRF with INCA. Demographics were similar between groups. Number of ribs stabilized was comparable; 4.78 ± 1.64 SSRF only and 4.73 ± 1.66 SSRF with INCA (p = 0.463). Median ISS [16 (IQR 11.5-16) SSRF only and 14 (IQR 9-18.75) SSRF with INCA (p = 0.463)] was not statistically different. The INCA group showed a decrease in the median total HLOS, 9 versus 10 days (U = 1517.5, p = 0.026) and HLOS after SSRF, 4 versus 6 days (U = 1217.5, p 0.001). HC the day of surgery were higher for the INCA group, $93,932 versus $71,143 (U = 1106, p 0.001). However, total HC were similar between groups and total HC after SSRF was significantly less for the INCA group, $10,556 versus $20,269 (U = 1327, p = 0.001). Total median narcotic use after SSRF was significantly less for the INCA group, 88.6 vs 113.7 MME (U = 1544.5, p = 0.026).SSRF with INCA is safe and does not increase overall HC with the added benefit of decreased HLOS post-operatively and decreased narcotic consumption.

BACKGROUND: Psoriatic arthritis is the most frequent and impactful comorbidity among psoriatic patients and appears in most cases after skin disease. Dermatologists play a key role in its early diagnosis and treatment. OBJECTIVE: To determine the prevalence of psoriatic arthritis and associated variables among patients with plaque psoriasis seen at a reference center for treating psoriasis. DESIGN AND SETTING: Retrospective cross-sectional study conducted among 300 patients at an outpatient clinic in a university center in Juiz de Fora, MG, Brazil. METHODS: Standardized records of 300 patients with plaque psoriasis were examined. Demographic data and medical variables relating to psoriasis (Psoriasis Area and Severity Index (PASI), family history, age at onset and disease progression) and psoriasis arthritis (CASPAR criteria) were evaluated. Laboratory and radiographic tests in the medical records were reviewed. RESULTS: Seventy-three (24.3%) of these 300 patients with plaque psoriasis had psoriatic arthritis. Asymmetric oligoarthritis (58.9%) was the most common clinical form, followed by polyarthritis (20.5%), distal interphalangeal arthritis (15.2%) and spondyloarthritis (5.4%). Dactylitis was present in 21.9% and enthesitis in 35.6% of patients. Compared with patients without arthritis, patients with arthritis had higher average age, higher frequency of positive family history of psoriasis, longer duration of evolution and higher PASI rates. CONCLUSION: Psoriatic arthritis is often underdiagnosed. Since dermatologists perform the initial approach, these professionals need to be trained to diagnose this comorbidity and treat it, together with rheumatologists.

Objective To analyze the medium‐term impact of the COVID‐19 pandemic on epilepsy patients, focusing on psychological effects and seizure control. Methods Prospective follow‐up study to evaluate the medium‐term effects of the COVID‐19 pandemic on a cohort of epilepsy patients from a tertiary hospital previously surveyed during the first peak of the pandemic. Between July 1, 2020, and August 30, 2020, the patients answered an online 19‐item questionnaire, HADS, and PSIQ scales. Short‐ and medium‐term effects of the pandemic confinement and the perception of telemedicine were compared. Results 153 patients completed the questionnaire, mean ± SD age, 47.6 ± 19.3 years; 49.7% women. Depression was reported by 43 patients, significantly more prevalent than in the short‐term analysis (29.2% vs. 19.7%; p = .038). Anxiety (38.1% vs. 36.1%; p = 0.749) and insomnia (28.9% vs. 30.9%, p = .761) remained highly prevalent. Seventeen patients reported an increase in seizure frequency (11.1% vs. 9.1%, p = .515). The three factors independently associated with an increase in seizure frequency in the medium term were drug‐resistant epilepsy (odds ratio [OR] = 8.2, 95% CI 2.06–32.52), depression (OR = 6.46, 95% CI 1.80–23.11), and a reduction in income (OR = 5.47, 95% CI 1.51–19.88). A higher proportion of patients found telemedicine unsatisfactory (11.2% vs. 2.4%), and a lower percentage (44.8% vs. 56.8%) found it very satisfactory (p = .005). Conclusions Depression rates increased significantly after the first wave. Depression, drug‐resistant epilepsy, and a reduction in family income were independent risk factors for an increased seizure frequency. Perception of telemedicine worsened, indicating need for re‐adaptation.

Background The social isolation enforced as a result of the new coronavirus (COVID‐19) pandemic may impact families’ lifestyle and eating habits. The present study aimed to assess the behaviour and dietary patterns of Brazilian children and adolescents during the social isolation imposed by the COVID‐19 pandemic. Methods The present study was conducted using an online, anonymous cross‐sectional survey with 589 children and 720 adolescents from Brazil during a nationwide social isolation policy. The Mann–Whitney U‐test or the Kruskal–Wallis with the Dunn post‐hoc method and a radar chart were used to compare the weekly consumption of each food by age group and isolation status. p, The social isolation enforced as a result of the new coronavirus (COVID‐19) pandemic may impact families’ lifestyle and eating habits. Non‐isolated families tend to present a lower consumption of healthy food, especially among the lower class.

Hydrocarbon exploration in Angola commenced in 1910 with its first oil recovered in 1955. The proven reserves in Angola are estimated to reach up to 13 billion barrels (2.1 billion m3). Most of the Angolan oil fields are mature or maturing and some are or may be abandoned due to unprofitable recovery limit beyond the conventional type of oil production. The oil recovery is mainly by primary and secondary recovery methods. Apart from the issue of maturity, there is increasing energy demand due to population growth and difficulties in discovering and developing new fields as alternatives to the current oil fields. For incremental and sustained production rate of these fields and in addition to instability of oil prices and concerns about future oil supply, Angola has started to work towards developing affordable and efficient technologies capable of recovering residual oil in reservoirs as well as extend the life of many current fields which can be achieved through the implementation of enhanced oil recovery (EOR). Therefore, this paper discusses the EOR planning strategy from project selection, project implementation and optimization, and field abandonment. It further highlights the mutual benefits that may be derived from a cross-collaboration between the government and other stakeholders in Angola.

In the present work are shown results obtained from a computational model for the dynamic analysis of planed curved beams with constant cross-section and curve radius, based on the exact solution of the differential equilibrium equations of a beam element. This model allows the estimation of the forced harmonic motion, both in-plane and out-of-plane of curvature on a free-free support condition. The input data of the model is the geometry section of the beam, material properties, type of motion, consideration of the shear stiffness, and rotatory inertia effects. The output result is possible either in a frequency response of a fixed parameter curved beam or a plot representation of the natural frequencies curves for an opening angle range, from an approximated straight beam to a closed opened ring. Each of those curves is defined as family of modes and performed on present work. The objective of this work is to clarify the general behaviour of curved beams with the mentioned conditions by using an accurate model showing results as a reference for the scientific community. The model was validated by testing and comparing results with three beam specimens previously studied in other publications. The biggest aim is also to present new results and hypothesis, contesting other authors regarding the natural frequencies of curved beams.

The goal for a virtual reality (VR) training system is to enable trainees to acquire all the knowledge they need to perform effectively in a real environment. Such a system should provide an experience so authentic that no further real-world training is necessary, meaning that it is sufficient to train in VR. We evaluate the impact of a haptic thermal stimulus, which is of paramount importance to decision making, on trainees performance and knowledge acquisition. A thermal device was created to deliver the stimulus. As a proof of concept, a procedure from firefighter training is selected, in which sensing the temperature of a door with one's hand is essential. The sample consisted of 48 subjects divided among three experimental scenarios: one in which a virtual thermometer is used (visual stimulus), another in which the temperature is felt with the hand (thermal stimulus) and a third in which both methods are used (visual + thermal stimuli). For the performance evaluation, we measured the total time taken, the numbers of correctly executed procedures and identified neutral planes, the deviation from the target height, and the responses to a knowledge transfer questionnaire. Presence, cybersickness, and usability are measured to evaluate the impact of the haptic thermal stimulus. Considering the thermal stimulus condition as the baseline, we conclude that the significantly different results in the performance among the conditions indicate that the better performance in the visual-only condition is not representative of the real-life performance. Consequently, VR training applications need to deliver the correct stimuli for decision making.