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Propranolol (PRO) hydrochloride is one of the most commonly used β-blockers for cardiovascular diseases that is frequently detected in aquatic environment. Photocatalytic removal of propranolol using an efficient UV and visible light responsive neodymium (Nd)-modified photocatalyst has been investigated. Nd–TiO2 nanoparticles were synthesized by a simple ultrasonic method with Nd-modified in the range of 0–1.0 mol% to evaluate the effects of Nd3+ content in crystal structure and photocatalytic activity. The TiO2–Nd 0.10% sample was the most efficient photocatalyst to degrade PRO with 95% and 90% degradation after 60 min under UV and visible light radiation, respectively. The characterization analysis revealed that neodymium is dispersed on the surface semiconductor, where probably forming Ti–O–Nd bonds, which can induce oxygen vacancies and surface defects. The effective separation of the photogenerated electrons and holes was regarded as the main reason for the high photocatalytic activity. The effective separation of the photogenerated electrons and holes was regarded as the main reason for the high photocatalytic activity.

Foreign bodies in the external ear are very common. The same cannot be said about foreign bodies in the Eustachian tube (ET). We report the case of a 63-year-old woman with a history of painless left side otorrhea and hearing loss. She reported a left ear surgery when she was 30-year-old but she did not know the diagnosis that was made at that time neither the kind of surgery performed. Otoscopic examination revealed an inferior perforation of the eardrum. Audiologic evaluation demonstrated a unilateral, moderate-severe mixed hearing loss. Computed tomography scan showed, in left ear, a soft tissue density filling the middle ear cavity and a foreign body in ET. The patient underwent middle ear exploration which required endoscopic assistance to visualize and remove the foreign body. It appeared to be a stapes prothesis of Robinson type. The displacement of a stapes prosthesis to the ET has not been reported in the literature. Surgeries in this region are challenging. This case highlights the importance of the integration of endoscopy into otologic surgery.

Highlights • Diaphragmatic rupture is an uncommon trauma complication and it is most associated with blunt trauma. • Left diaphragmatic herniations are more common, once the liver is not susceptible to herniate through small perforation right-sided. • Chronic diaphragmatic herniation is associated with a higher morbimortality rate. • Chronic diaphragmatic herniation may take years to manifest any symptoms, which are not associated with herniated content., Introduction Diaphragmatic rupture is an uncommon trauma complication and it is associated with chronic diaphragmatic herniation, especially in the left side. Chronic diaphragmatic herniation is usually due to white weapon injury and as consequence of low suspicious and absence of proper investigation. Case report We report a chronic diaphragmatic herniation after three years of a stab in the left thoracoabdominal transition, managed through laparotomy. Discussion Traumatic diaphragmatic rupture is a rare trauma consequence, most common in the left side. The herniation occurs gradually because of negative pressure of the thoracic cavity that works as a suction of the abdominal organs. Conclusion Traumatic diaphragmatic ruptures diagnosis is difficult and might go unnoticed without high suspicious and proper investigation. Chronic herniation is associated with higher morbimortality.

INTRODUÇÃO: Bulimia nervosa (BN) é um transtorno alimentar caracterizado pelas recorrências de compulsões alimentares, seguido de métodos compensatórios inadequados para perder peso. O objetivo do presente trabalho foi realizar uma revisão narrativa literária sobre o uso de antidepressivos no tratamento da BN. METODOLOGIA: Trata-se de uma revisão literária narrativa, sendo que a pesquisa bibliográfica da literatura foi realizada nas bases de dados, UpToDate, PubMed e Scielo. RESULTADOS: A fluoxetina 60 mg/dia é o antidepressivo considerado como abordagem padrão para o tratamento da BN, apresentando efeito positivo no tratamento dessa condição na maioria dos estudos analisados. Outros medicamentos antidepressivos, como citalopram, sertralina e a fluvoxamina, também se mostraram eficazes e são considerados tratamento de segunda linha. Efeitos adversos relatados nos estudos incluem insônia, tremor, tonturas, náusea, ansiedade e diminuição da libido. DISCUSSÃO: Fluoxetina é a primeira linha de tratamento para BN, mas existem restrições. Nesses casos, troca-se a medicação pelas de segunda linha. Caso o paciente não obtenha resultados satisfatórios com a primeira e segunda linhas, existe a terceira linha, sendo composta por: antidepressivos tricíclicos, inibidores da monoaminoxidase (IMAO) e moduladores da serotonina. CONCLUSÃO: Conclui-se que a eficácia do uso de antidepressivos para o tratamento de BN é promissora, em especial, a fluoxetina.

Background This study analyzed and described factors related to necrotizing or non-necrotizing soft tissue infections (SSTIs) in a hospitalized patient population in Northeastern South America. Materials and methods This retrospective study included patients hospitalized with SSTIs between January 2011 and December 2016. The main factors related to necrotizing SSTIs (NSTIs) or non-necrotizing SSTIs were analyzed together or separately. Results Of 344 SSTI patients (161 [46.8%] non-necrotizing, 183 [53.2%] necrotizing), NSTI patients had a higher incidence of heart disease (P = 0.0081) and peripheral arterial disease (PAD; p, Highlights • Patients with necrotizing infections and poor glycemic control have higher risks for amputation. • Diabetes as a risk factor most associated with soft tissue infections. • Peripheral arterial disease is the main risk factor for amputation and death. • Soft tissue infections with necrosis evolve with more complications and risk of amputation and death.

Tonsillectomy is one of the most common surgical procedures in otorhinolaryngology. Hemorrhage in the postoperative period has an incidence of up to 20% and is a potentially fatal complication. We aim to assess the incidence of hemorrhage after tonsillectomy in our institution, and to evaluate and identify the possible associated risk factors. This retrospective study included 897 patients who underwent tonsillectomy between January 2015 and December 2018, 50.7% women and 49.3% men, aged between 2 and 83 years. No coagulopathies were identified. Comparison of age, gender, surgical indication, coagulation profile, concomitant adenoidectomy, surgical technique, surgeon’s experience and hemostasis method between groups with and without post-operative bleeding was made. Our incidence of post-tonsillectomy hemorrhage was 6%. Most patients (83.3%) had secondary bleeding (> 24 h after surgery). In 22.2% of the bleeding cases, it was necessary to revise the hemostasis in the operating room. Adulthood (age ≥ 18 years) (p

Introdução: O manejo no atendimento odontológico infantil torna-se fatigante quando não há cooperação por parte da criança e/ou dos responsáveis. A fim de minimizar esses quadros, quando não existe sucesso das técnicas de abordagem comportamental tradicionais, métodos terapêuticos alternativos têm sido amplamente estudados, em especial a sedação consciente com óxido nitroso associada ou não a fármacos sedativos. Objetivo: Dessa forma, objetivou-se realizar uma revisão crítica da literatura norteando o cirurgião-dentista sobre o uso do óxido nitroso e sua associação a fármacos, esclarecendo suas indicações, vantagens e desvantagens. Métodos: Foi realizada uma busca integrativa da literatura nacional e internacional, entre 2004 a 2019, nas bases Bireme e PubMed, utilizando os descritores: sedação consciente, ansiedade no tratamento odontológico e óxido nitroso. Resultados: No total, 43 artigos foram incluídos nesse estudo. O óxido nitroso tem sido bastante utilizado na odontologia, especialmente na odontopediatria. Este atua no sistema nervoso, promovendo uma leve depressão do córtex cerebral e não deprime o centro respiratório, sendo considerado seguro. A técnica pode ser combinada a outros fármacos, como Midazolam e Prometazina, sendo que cada abordagem medicamentosa apresenta suas indicações e vantagens específicas. Conclusão: A sedação consciente mostra-se como um método viável, e quando bem indicada é considerada segura. Seu papel na Odontologia vem sendo consolidado com o tempo, em decorrência dos inúmeros benefícios encontrados. No entanto, ainda existe certa resistência na utilização da mesma, tanto por parte dos responsáveis como também de alguns profissionais. Descritores: Sedação Consciente; Ansiedade ao Tratamento Odontológico; Óxido Nitroso. Referências Jain S. Sedation: A Primerfor Pediatricians. Pediatr Ann. 2018;47(6):254-58. Ashley PF, Chaudhary M, Lourenço-Matharu L. Sedation of children undergoing dental treatment. Cochrane Database Syst Rev.2018;12:1-152 Mozafar S, Bargrizan M, Golpayegani MV, Shayeghi S, Ahmadi R . Comparison of nitrous oxide/midazolam and nitrous oxide/promethazine for pediatric dental sedation: A randomized, cross-over, clinical trial. Use of nitrous oxide for pediatric patients. Dent Res J (Isfahan). 2018;15(6):411-19. Johnson C, Weber-Gasparoni K, Slayton RL, Qian F. Conscious sedation attitudes and perceptions: a survey of american academy of pediatric dentistry members. Pediatr Dent. 2012;34(2):132-37. Hand D, Averley P, Lyne J, Girdler N. Advanced paediatric conscious sedation: an alternative to dental general anaesthetic in the U.K. SAAD Dig. 201;27:24-9. Holroyd I. Conscious sedation in pediatric dentistry. A short review of the current UK guidelines and the technique of inhalational sedation with nitrous oxide. Paediatr Anaesth. 2008;18(1):13-7. Naudi AB, Campbell C, Holt J, Hosey MT. An inhalation sedation patient profile at a specialist paediatric dentistry unit: a retrospective survey. Eur Arch Paediatr Dent. 2006;7(2):106-9, Blumer S, Iraqui R, Bercovich R, Peretz B. Oxygen saturation and pulserate change in children during sedation with oral midazolam and nitrous oxide. J Clin Pediatr Dent. 2018;42(6):461-64. Choi SC, Yang Y, Yoo S, Kim J, Jeong T, Shin TJ. Decelopment of a web-based nationwide Korean pediatric dental sedation registry. J Clin Pediatr Dent. 2017;41(6):478-81. Wilson S, Houpt M . Project USAP 2010: use of sedative agents in pediatric dentistry- a 25- yar follow up survey. J Pediatr Dent.2016;38(2):127-33. Wilson S, Gosnell ES. Survey of American academy of pediatric dentistry on nitrous oxide and sedation: 20 years later. J Pediatr Dent. 2016;38(5):385-92. White J, Wells M, Arheart KL, Donaldson M, Woods MA. A questionnaire of parental perceptions of conscious sedation in pediatric dentistry. J Pediatr. Dent. 2016;38(2):116-21. Nelson TM, Xu Z. Pediatric dental sedation: challenges and opportunities. Clin Cosmet Investig Dent. 2015;7:97-106. Czlusniak GD, Rehbein M, Regattieri LR. Sedação consciente com oxido nitroso e oxigênio (NO2/O2): avaliação clínica pela oxime Publ. UEPG Ci Biol Saúde. 2007;13(4):23-8. Bham F, Perrie H, Scribante J, Lee CA. Paediatric dental chair sedation: An audit of current practice in Gauteng, South Africa. S Afr Med J. 2015;105(6):461-64. Diedericks BJ. Paediatric dental sedation: Will your child return home unharmed? S Afr Med J. 2015;105(6):453. Wilson S, Gosnell ES. Survey of American Academy of Pediatric Dentistry on Nitrous Oxide and Sedation: 20 Years Later. J Pediatr Dent. 2016;38(5):385-92. Levering NJ, Welie JVM. Current status of nitrous oxide as a behavior management practice routine in pediatric dentistry. J Dent Child (Chic). 2011;78(1):24-30. Ashley PF, Chaudhary M, Lourenço-Matharu L. Sedation of children undergoing dental treatment. Cochrane Database Syst Rev. 2018;12:3877. Hariharan S, Hosey MT, Bernabe E . Comparing the profile of child patients attending dental general anaesthesia and conscioussedation services. Br Dent J. 2017;222(9):683-87. Miranda-Remijo D, Orsini MR, Corrêa-Faria P, Costa LR. Mother-child interactions and young child behavior during procedural conscious sedation. BMC Pediatr. 2016;16(1):201. Morin A, Ocanto R, Drukteinis L, Hardigan PC . Survey of Current Clinical and Curriculum Practices of Postgraduate Pediatric Dentistry Programs in Nonintravenous Conscious Sedation in the United States. J Pediatr Dent. 2016;38(5):398-405. Woolley SM, Hingston EJ, Shah J, Chadwick BL. Paediatric conscious sedation: views and experience of specialists in paediatric dentistry. Br Dent J. 2009;207(6):280-81. Hosey MT, Makin A, Jones RM, Gilchrist F, Carruthers M. Propofol intravenous conscious sedation for anxius children in a specialist pediatric dentistry unit. Int J Pediatr Dent. 2004;14:2-8 Nathan JE .Effective and safe pediatric oral conscious sedation: philosophy and practical considerations. Alpha Omegan. 2006;99(2):78-82. Wilson S, Houpt M. Project USAP 2010: Use of Sedative Agents in Pediatric Dentistry-a 25-year Follow-up Survey. Amer Acad of Ped Dent. 2016;38(2):127-33. Paterson SA, Tahmassebi JF. Paediatric dentistry in the new millennium: 3. Use of inhalation sedation in paediatric dentistry. Dent Update. 2003;30(7):350-58. Wilson S. A survey of the American Academy of Pediatric Dentistry membership: nitrous oxide and sedation. Pediatr Dent. 1996;18(4):287-93. Zhong T, Hu D. Technology of nitrous oxide/oxygen inhalation sedation and its clinical application in pediatric dentistry. Hua Xi Kou Qiang Yi Xue Za Zhi. 2014;32(1):101-4. Levering NJ, Welie JVM. Ethical considerations in the use of nitrous oxide in pediatric dentistry. J Am Coll Dent;77(2):40-7 American academy of pediatric dentistry: recommendations- best practices. Reference manual. 2018;40(6):281-86. American academy of pediatric dentistry. Guideline on use of nitrous oxide for pediatric dental patients. 2011;33(6):181-84. Wilson KE. Overview of paediatric dental sedation: 2. Nitrous oxide/oxygen inhalation sedation. Dent Update. 2013;40(10):822-29. Foley J. A prospective study of the use of nitrous oxide inhalation sedation for dental treatment in anxious children. Eur J Paediatr Dent. 2005;6(3):121-28. Paterson SA, Tahmassebi JF. Paediatric dentistry in the new millennium: 3. Use of inhalation sedation in paediatric dentistry.Dent Update. 2003;30(7):350- Veerkamp JS, Gruythuysen RJ, Van Amerongen WE, Hoogstraten J. Dental treatment of fearful children using nitrous oxide. Part 2: The parent's point of view. ASDC J Dent Child.1992;59(2):115-19. Veerkamp JS, Van Amerongen WE, Hoogstraten J, Groen HJ. Dental treatment of fearful children, using nitrous oxide. Part I: Treatment times. ASDC J Dent Child.1991;58(6): 453-457. Muller TM, Alessandretti R, Bacchi A, Tretto PHW. Eficácia e segurança da sedação consciente com óxido nitroso no tratamento pediátrico odontológico: uma revisão de estudos clínicos. J Oral Invest. 2018;7(1):88-111. Woolley SM, Hingston EJ, Shah J, Chadwick BL. Paediatric conscious sedation: views and experience of specialists in paediatric dentistry. Br Dent J. 2009;207(6):280-81. Kotz S. Withdrawal symptoms in long-term conscious sedation exposure of pediatric intensive care patients. Kinderkrankenschwester. 2012;31(8):330-32. Fuhrer CT 3rd, Weddell JA, Sanders BJ, Jones JE, Dean JA, Tomlin A.Effect on behavior of dental treatment rendered under conscious sedation and general anesthesia in pediatric patients. J Pediatr Dent. 2009;31(7):492-97. Holroyd I. Conscious sedation in pediatric dentistry. A short review of the current UK guidelines and the technique of inhalational sedation with nitrous oxide. Paediatr Anaesth. 2008;18(1):13-7. Alexopoulos E, Hope A, Clark SL, McHugh S, Hosey MT.A report on dental anxiety levels in children undergoing nitrous oxide inhalation sedation and propofol target controlled infusion intravenous sedation. Eur Arch Paediatr Dent. 2007;8(2):82-6.

With the emergence of the COVID-19 pandemic, people had to avoid crowded places and attend hospitals, clinics, and doctors' offices only in an emergency. The authors' institution developed a telehealth platform prototype in a joint effort between Health and Computer Science researchers and students to allow the participation of medical students under the supervision of medical professors to provide emergency health advice using online remote care supported by a video and form-filling tool to support in preliminary diagnosis. This paper presents a usability evaluation of the telehealth platform prototype involving 30 participants in a medium-sized town in the interior of Brazil. Participants simulated virtual consultations about COVID-19 with health professionals. The usability evaluations were fundamental to understanding users' mental models, how to provide a better experience and measuring the system's effectiveness and acceptance. The findings show implications to the design of telehealth systems and the impact of problems related to Information Architecture, user feedback, controlling video-based interfaces. The preliminary results encountered in the present study are essential to help improve the usability of telehealth solutions, which will have a significant growth following the trend from the COVID-19 pandemic.

Introduction Colovesical fistula is the pathological communication between the colon and urinary bladder. It is related with high morbimortality rate and it is and uncommon complication of diverticulosis in young adults. Case presentation We report a case of a 38-year-old Brazilian man with fecaluria and pneumaturia for eight months, whose colovesical fistula was undetectable in CT scan and with surgical management. Discussion Diverticulosis is the main inflammatory condition causing colovesical fistulas and the sigmoid colon is the most common part involved. It is more prevalent in patients over 60 years old and in western countries due to low fiber diet. Conclusion Colovesical fistula diagnosis is difficult, requiring high suspicious and proper investigation through good anamnesis, CT scan and also colonoscopy and cystoscopy when necessary., Highlights • Colovesical fistula is an uncommon disorder in young adults and it is more frequently in western countries. • Diverticulits is the main inflammatory condition causing enterovesical fistulas and the sigmoid colon the most common. • Colovesical fistula diagnosis is difficult, requiring proper investigation through CT scan or other exams. • Most cases of colovesical fistula are diagnosed during surgery approach and surgically managed.

Objective Pilocytic astrocytoma (PA) is rare in adults comprising 5.1% of the primary central nervous system tumors. The aim is to describe the first Brazilian series of adult patients with PA and compare its features with the available literature. Methods We retrospectively review all patients 18 years or older with PA from our institution's database from 1991 to 2018. We analyzed information regarding clinical presentation, location, imaging features, extent of resection, adjuvant treatments, and follow-up. Results Twenty-three patients with PA were analyzed: 60.9% male; median age 26 years. The most frequent symptoms were headache (34.8%) and seizure (26.1%). Temporal and parietal lobes were the most common locations, 21.7% each. All patients underwent a surgical procedure, gross total resection in 40.9%, subtotal resection in 22.7%, and biopsy in 27.3%. Adjuvant treatment with radiotherapy was performed in 2 patients. Only 4 patients had disease progression, 2 after gross total resection and 2 after subtotal resection. They were all alive and without evidence of new progression at the last follow-up (October 2018). Median overall survival was not reached after a median follow-up time of 88.9 months. Conclusions This is the first Brazilian series regarding adults with PA, and our patients had a favorable outcome as reported in recent literature reviews. The tumor's prevalence reduces within older patients and supratentorial lesions are more frequent, especially on the temporal lobe. There was no significant relationship between location and progression, although according to the literature the extent of resection remains the most important prognostic factor.

To compare ultrasound images of the kidney obtained, randomly or in a controlled manner (standardizing the physical aspects of the ultrasound system), by various professionals and with different devices.We evaluated a total of 919 images of kidneys, obtained by five professionals using two types of ultrasound systems, in 24 patients. The images were categorized into four types, by how they were acquired and processed. We compared the gray-scale median and different gray-scale ranges representative of virtual histological tissues.There were statistically significant differences among the five professionals, regardless of the type of ultrasound system employed, in terms of the gray-scale medians for the images obtained (Our findings indicate that a gray-scale analysis of ultrasound images of the kidney performs better when the image acquisition process is standardized and the images undergo a process of normalization.Comparar imagens renais ultrassonográficas obtidas de maneira aleatória e controlada (padronizando fatores físicos do aparelho de ultrassom) por diferentes profissionais e aparelhos.Foram obtidos quatro tipos de imagens, de acordo com sua aquisição e processamento por cinco profissionais e dois tipos de aparelhos de ultrassonografia, em 24 pacientes, totalizando 919 imagens. Comparamos a mediana de escala de cinza e diferentes intervalos de tons de cinza representantes de tecidos histológicos virtuais.As medianas de escala de cinza de imagens renais obtidas por dois tipos de aparelhos foram estatisticamente diferentes (Constatou-se que na análise de tons de cinza deve-se usar um mesmo tipo de máquina e uma imagem em que sejam padronizados aspectos físicos, passando por um processo de normatização/padronização.

Objectives: to describe the use of affinity chromatographies and laboratory serologies in the evaluation of immunodiagnoses during prenatal. Methods: quantitative study, characterized as a descriptive observational research. Data was collected from the records of 46 pregnant women who were in prenatal follow up in the Primary Health Care in a capital in the South of Brazil. The data found was codified and analyzed using descriptive statistics. Results: a mean of 43.1 days was found to take place between the request of laboratory serology and the evaluation by a professional. It was also found that 21.7% of pregnant women did not collect the serologies requested during the first prenatal consultation, and that the affinity chromatographies were only applied in 10.8% of the participants. Conclusions: in spite of the studies for the improvement of prenatal consultations, for the provision of new technologies and for the permanent education offered to the professionals, there are still questions that make the actual implementation of affinity chromatographies more difficult. RESUMEN Objetivos: describir la utilización de los inmunocromatográficos y de las serologías laboratoriales en la evaluación de inmunodiagnósticos durante el prenatal. Métodos: estudio de abordaje cuantitativo, caracterizado como una investigación observacional del tipo descriptiva. Recogidos datos de los prontuarios de 46 gestantes que realizan acompañamiento prenatal en la Atención Primaria de Salud del Sur de Brasil. Datos obtenidos tuvieron su contenido codificado y analizados mediante estadística descriptiva. Resultados: identificada una mediana de 43,1 días desde la solicitud de las serologías laboratoriales hasta la evaluación profesional. Así, también se verificó que 21,7% de las gestantes no recogieron las serologías solicitadas durante la primera consulta prenatal y que aplicaron inmunocromatográficos en solo 10,8% de los participantes. Conclusiones: sin embargo los estudios para perfeccionamiento de consulta prenatal, provisión de nuevas tecnologías y educación permanente ofertada a los profesionales, aún persisten cuestiones que dificultan la concreta implementación de inmunocromatográficos. RESUMO Objetivos: descrever a utilização dos testes imunocromatográficos e das sorologias laboratoriais na avaliação de imunodiagnósticos durante o pré-natal. Métodos: estudo de abordagem quantitativa, caracterizado como uma pesquisa observacional do tipo descritiva. Foram coletados dados dos prontuários de 46 gestantes que realizam acompanhamento pré-natal na Atenção Primária à Saúde de uma capital do Sul do Brasil. Os dados obtidos tiveram seu conteúdo codificado e analisados mediante estatística descritiva. Resultados: foi identificada uma média de 43,1 dias desde a solicitação das sorologias laboratoriais até a avalição profissional. Nesse sentido, também foi verificado que 21,7% das gestantes não coletaram as sorologias solicitadas durante a primeira consulta pré-natal e que foram aplicados testes imunocromatográficos em apenas 10,8% dos participantes. Conclusões: apesar dos estudos para o aprimoramento da consulta pré-natal, do fornecimento de novas tecnologias e da educação permanente ofertada aos profissionais, ainda persistem questões que dificultam a concreta implementação dos testes imunocromatográficos.

Wearable smart bands connected to mobile apps in smartphones provide essential resources for health and activity monitoring. Evaluating this kind of application has many challenges, considering the mobile and wearable nature. This paper presents a comparative study employing heuristic evaluations and user tests of three health monitoring apps used with their wearable smart bands, to analyse the types of problems identified by each method. The study examined the Mi Band 2 with the MiFit app, the MTR-01 with the DayDay Band app, and Goral Y5 with the Lefun app. The apps and wearable smart bands were evaluated by three inspectors and employing user tests in a laboratory with a panel of 11 users simulating a short walk. After mapping similar problems encountered, the study found 18 problems by both methods, 27 problems encountered only by users, and 105 problems encountered only by the heuristic evaluations. The results in this study are relevant to inform designers about the types of problems in wearable health apps and devices using different methods, and research gaps to improve usability methods and resources to strengthen evaluations in this domain.

Introduction. This report aims at demonstrating the treatment of complex mandibular fracture functional reimplantation of the maxillary alveolar fragment (FRAF), denoting the possibility and feasibility of this reduction with an excellent prognosis. Case Report. Patient E.M.S, 25 years old, male, leucoderma, referred to the Emergency Room of our institute. He reported being a victim of physical aggression, occlusal alteration, limitation of mouth opening, sensibility loss in the mentalis region, right infraorbital, and denied visual alteration. On physical examination, during the inspection and palpation, the crackling was observed in the right mandibular region and apical displacement of the maxillary alveolar process, corresponding to elements 13, 14, and 15. Conclusion. The rigid fixation of the complex jaw fracture and alveolar maxilla process, through functional reduction, indicated satisfactory applicability, and favorable prognosis.

A suspensão de atividades presenciais de ensino decorrentes da pandemia de COVID-19 trouxe modificações na vida de milhares de acadêmicos e docentes. Este estudo teve por objetivo descrever um relato de experiência sobre a adaptação pedagógica para o ensino remoto de tópicos em Epidemiologia em uma instituição de ensino superior pública. Trata-se de um estudo descritivo que incluiu três disciplinas ofertadas regularmente pelos cursos presenciais de Enfermagem e Farmácia que tiveram planejamento didático adequado para ensino via Regime de Exercícios Domiciliares Especiais. Os planos de ensino e metodologias foram adaptados para utilização de tecnologias digitais e ambiente virtual de aprendizagem. O cenário epidemiológico foi utilizado como base para questões norteadoras e análises de situação na abordagem adaptada dos conteúdos. Quanto à estrutura geral das disciplinas e potencialidades do ensino durante a pandemia, verificou-se que adoção de metodologias ativas com a problematização e subsídio no contexto atual da COVID-19 e a valorização do conhecimento prévio dos acadêmicos sobre o tema figuram como potenciais e determinantes para o aprendizado ativo e desenvolvimento de competências importantes para os futuros profissionais de saúde. A adaptação permitiu desenvolvimento de todos os tópicos de ensino de Epidemiologia e a conexão mantida entre docentes e discentes mostrou-se importante aliada no enfrentamento da pandemia. Reitera-se que as limitações do ensino remoto, como falta de acesso à internet e utilização de tecnologias digitais, precisam seguir amplamente discutidas pelas instituições.

As recent research indicates that virtual games are beneficial to the player's brain health, games have been used to aid aging-related disease treatment. There are also studies that imply that sensory effects improve user's Quality of Experience. Combining both concepts, this paper proposes the Stroop Game, a cognitive game inspired by the Stroop test, which uses light sensory effects. The Stroop Game was developed for the Brazilian Digital TV System using the Ginga-NCL middleware, which implements the ITU H.761 standard. Evaluating the Stroop Game implementation with elderly users, it indicates that the game proposed in this paper was well received by the users and also that the light sensory effect makes it more attractive to them.

This essay discusses the models and transformations of fairies’ iconography from High Middle Ages to the 20th century. Exposing at first the most prevalent notions on these beings in medieval culture, and then discussing their subsequenttransformations, this study aims to determine, approximately, when and how their most characteristic iconographic elements have been attributed to them, emphasis being given on the discussion of the role of classical iconography and Romantic medievalism therein., Este artigo discute os modelos e as transformações da iconografia dos seres feéricos entre a Baixa Idade Média e o século XX. Partindo-se de uma breve exposição das principais concepções sobre esses seres na cultura medieval, e discutindo-se então suas transformações subseqüentes, busca-se determinar, aproximativamente, quando e de que modo lhes foram atribuídas seus elementos iconográficos mais característicos, discutindo-se o papel que tiveram nesse processo a iconografia clássica e o medievalismo romântico.

As novas diretrizes propostas pela American Heart Association (AHA) em 2017 trouxeram mudanças expressivas na forma como abordamos a hipertensão arterial sistêmica (HAS), considerando valores menores de pressão arterial para o diagnóstico e também a estimativa do risco cardiovascular para a decisão terapêutica. O presente artigo traz considerações sobre o diagnóstico e o tratamento farmacológico da HAS — tema de importância inquestionável em qualquer área da medicina — sob a perspectiva da nova diretriz americana e também de conceitos prévios a ela, mas ainda vigentes. Unitermos: Hipertensão arterial sistêmica. Diagnóstico. Tratamento medicamentoso. Risco cardiovascular. Hipertensão resistente.

Background: Traumatic brain injury (TBI) represents one of the leading public health problems and a significant cause of neurological damage. Unintentional causes of TBI are the most frequent. However, fruit falling over the head causing TBI is extremely rare. In the Amazon region, accidents with ouriços, a coconut-like shell fruit, seem relatively common. However, to the best our knowledge, it has never been described in a scientific journal before. Therefore, we aim to evaluate a series of TBI caused by this tropical fruit. Methods: This study is a retrospective review of 7 TBI cases due to the fall of ouriços admitted to two tertiary hospitals in the Amazon region from January 2017 to December 2018. The collected data included: age, Glasgow Coma Scale, skull fracture, venous sinus injury, hematoma, surgical treatment, and outcome. Results: All patients were men, with an average age of 38, ranging from 8 to 77-years-old. Four out of seven had skull fractures. Five patients developed an epidural hematoma, and two of them had an associated subdural hematoma. Dura mater injury was observed in two patients, whereas four patients were operated. There was one related death. Conclusion: This case series is the first to describe an unconventional but potentially fatal cause of TBI in the Amazon: the falling of the Brazil-nut fruit. Most patients were diagnosed with mild TBI. Nevertheless, patients may have cranial fractures and epidural hematomas, leading to death when there’s a delay in medical assistance.

International audience; Computational fluid dynamics (CFD) techniques have become an important tool for investigating and predicting flow behavior in many industrial and engineering processes. In the last two decades, CFD has been used for the study, design, and improvement of irrigation equipment. Numerical simulations can be used to predict fluid flow, heat transfer, and chemical reactions within complex systems. The objective of this review is to provide an overview of the uses of CFD in irrigation engineering applications. The paper is organized into two main sections: fundamentals of CFD and irrigation engineering applications. The first section presents the main methods used in numerical simulations, basic equations to predict fluid flow parameters, meshing concerns, and convergence criteria. In the second section, we present applications related to friction and local head losses in pipes, liquid and solid-liquid flow simulation in drippers, chemical scaling, filters, sprinklers, direct-acting pressure-regulating valves, and Venturi injectors. The briefly described applications indicated that CFD modeling can be an accurate, quick, and feasible method for the investigation of flow parameters in irrigation pipes, fittings, emitters, and accessories. The CFD simulations can be useful for designing new products as well as for improving and optimizing existing products. Computational fluid dynamics uses in irrigation engineering must be encouraged, particularly for innovation purposes resulting from the cooperation between academia and irrigation companies.; Técnicas de fluido dinâmica computacional (CFD) se tornaram uma importante ferramenta para estudos e estimativas relacionadas ao escoamento de fluidos em diversos processos industriais e de engenharia. Nas últimas duas décadas, CFD tem sido utilizado para o estudo, projeto e aprimoramento de equipamentos de irrigação. Simulações numéricas podem ser utilizadas para estimativas de escoamento de fluidos, transferência de calor e reações químicas em sistemas complexos. O objetivo desta revisão é fornecer uma visão geral sobre uso de CFD em aplicações de engenharia de irrigação. O artigo está organizado em duas seções principais: fundamentos sobre CFD e aplicações em engenharia de irrigação. A primeira seção apresenta os principais métodos utilizados para simulação numérica, equações básicas para estimativa de parâmetros de escoamento, recomendações relacionadas a malha utilizada nas simulações, e critérios de convergência de resultados. Na segunda seção, são apresentadas aplicações relacionadas a perda distribuída e localizada de carga em tubulações, simulações de escoamento em labirinto de gotejadores com líquidos e sólidos-líquidos, precipitação de químicos, filtros, aspersores, válvulas reguladoras de pressão e injetores Venturi. As aplicações, embora descritas de modo breve, evidenciam que a modelagem utilizando CFD caracteriza um método que pode ser exato, rápido e viável para o estudo de parâmetros de escoamento em tubulações, conexões, emissores e acessórios de irrigação. As simulações empregando CFD podem ser úteis para o projeto de novos produtos, assim como para o aprimoramento e otimização de produtos existentes. Usos de CFD em engenharia de irrigação devem ser estimulados, especialmente com o propósito de inovação envolvendo parcerias entre a universidade e empresas de irrigação.

Made available in DSpace on 2020-12-12T01:58:38Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-01-01 Introduction: The success of anterior rehabilitation requires more skills than knowledge. It is necessary that the professional has updates on a new approach to obtain the best result considering the high degree of the exigency of these cases. The relationship between red and white esthetic is known and consolidated in the literature. Then, to achieve success in an esthetic smile is indispensable to apply periodontal surgery associated with restorative technique. Methods: In this report, a 28-year-old female patient sought care in a private clinic with a major cosmetic complaint due to disproportion of the clinical crown and gingival smile. Result: After planning, a clinical crown increase was performed, followed by the labial repositioning technique after the healing time of the initial surgery. Conclusion: It can be concluded that some of the surgical techniques, demonstrated in the literature, for gingival correction are feasible when correctly indicated. The best esthetic results will be achieved when the professional can understand the necessity to correct the disharmony of white and red esthetic. Department of Dentistry Marília University-UNIMAR, Av. Higino Muzi Filho, nº 1001 Department of Dental Materials and Prosthodontics Araçatuba Dental School UNESP, Rua José Bonifácio, 1193 Araçatuba Dental School UNESP, Rua José Bonifácio, 1193 Department Bucomaxillofacial Surgery State University of North Paraná-UENP, Av. Getúlio Vargas, n° 850 Department of Endodontics Marília University-UNIMAR, Av. Higino Muzi Filho, nº 1001 Department of Periodontics Marília University-UNIMAR, Av. Higino Muzi Filho, nº 1001 Department of Dental Materials and Prosthodontics Araçatuba Dental School UNESP, Rua José Bonifácio, 1193 Araçatuba Dental School UNESP, Rua José Bonifácio, 1193

Background: Different treatments have been proposed for Fibromyalgia, but only few studies have compared their effects on multiples outcomes over time. Objective: The objective of this study was to...

Because of the anterior disposition on the face and the fragility of the anatomy, the mandible is commonly affected in facial fractures, and the angle region represents 32% of the mandibular fractures; therefore, the objective of the paper was to present a proposal for late correction of the mandibular fracture already consolidated and with occlusal alteration. Patient J.C.P.R., 32, during anamnesis reported loss of sensibility in the mentalis region as well as unilateral posterior open bite for having been a victim of an automobile accident about 1 year and 3 months ago. Physical examination showed elevation in the right mandibular angle region due to the poor positioning of fractured stumps. It has been found that the patient suffered a simple fracture at the mandibular angle, but that had not been treated previously, and it was necessary to treat the fracture sequel. Refraction was performed with a new reduction and fixation through titanium plates and screws, showing that, even being late, the procedure to reduce the fracture sequela was effective, even with the correct functional occlusal adjustment.

Forest land-use planning and restoration requires effective tools for mapping and attributing linear disturbances such as roads, trails, and asset corridors over large areas. Most existing linear-feature databases are generated by heads-up digitizing. While suitable for cartographic purposes, these datasets often lack the fine spatial details and multiple attributes required for more demanding analytical applications. To address this need, we developed the Forest Line Mapper (FLM), a semi-automated software tool for mapping and attributing linear features using LiDAR-derived canopy height models. Accuracy assessments conducted in the boreal forest of Alberta, Canada showed that the FLM reliably predicts both the center line (polyline) and footprint (extent polygons) of a variety of linear-feature types including roads, pipelines, seismic lines, and power lines. Our analysis showed that FLM outputs were consistently more accurate than publicly available datasets produced by human photo-interpreters, and that the tool can be reliably deployed across large application areas. In addition to accurately delineating linear features, the FLM generates a variety of spatial attributes associated with line geometry and vegetation characteristics from input canopy height data. Our statistical evaluation indicates that spatial attributes generated by the FLM may be useful for studying and classifying linear features based on disturbance type and ground conditions. The FLM is open-source and freely available and is aimed to assist researchers and land managers working in forested environments everywhere.

Spontaneous rupture of the urinary bladder (SRUB) is a rare urological emergency and even more uncommon in the puerperium. Post-partum bladder rupture might be associated with fetal pressure on the not emptied bladder wall during labor. We report a case of SRUB three days after normal vaginal delivery with high values of creatinine and absence of hematuria, surgically managed in an emergency hospital in the Amazon.

Objective: To provide a tool to assist health professionals in the medical clinic regarding treatments still under study to combat COVID-19 and serve as a basis for future studies. Methods: For the development of this systematic review, research was carried out on the Embase, Pubmed databases and on the website clinicaltrials.gov, with the following inclusion criteria: selection of clinical trials carried out in adults, randomized or not, who addressed the discussion on the treatment or development of vaccines for COVID-19. Of the articles found, 22 studies were selected and those with a different methodological design were excluded. Results: The studies cover clinical trials that are divided into double or triple blind and present a low risk of bias. Among the tested interventions, Hydroxychloroquine and antivirals are the drugs that show the most promise in controlling the disease. The final results, however, are not yet available, as studies are ongoing. Final considerations: There is still no scientific evidence to recommend the use of any of the tested drugs, making it necessary to continue and maintain ongoing studies.

Objetivo: Discutir sobre o aumento da obesidade infantil e adolescente, correlacionando aos riscos cardiovasculares que essa doença pode causar no adulto. Revisão Bibliográfica: A obesidade infantil cresce, no mundo, de forma alarmante. No Brasil é considerado um dos principais problemas de saúde pública, pelo fato dessa patologia trazer sérios riscos na vida infanto-juvenil e principalmente na vida adulta, dentre eles: diabetes, hipertensão, doença arterial coronariana (DAC), acidente vascular cerebral (AVC), entre outros. Além disso, deve-se ressaltar que mais da metade das crianças obesas se tornam adultos também obesos, e com isso aumenta a quantidade de cardiopatas. Considerações Finais: Visto que cardiopatias são a principal causa de morte mundial e que a obesidade infantil se relaciona diretamente com essas patologias no adulto, faz-se necessário a realização de estudos longitudinais para acompanhar a saúde dessas crianças de forma contínua durante a vida. A partir disso, será possível implementar melhores medidas preventivas com objetivo de diminuir a incidência de doenças cardíacas na vida adulta.

Objetivo: Abordar as estratégias terapêuticas no manejo da Síndrome dos Ovários Policísticos (SOP), sendoo foco dessa obra a análise do impacto das alternativas terapêuticas farmacológicas e de mudanças de estilode vida no tratamento dessa síndrome, elucidando quais são as terapêuticas mais adotadas, seus efeitos eeficácias. Métodos: Trata-se de uma revisão integrativa de artigos do ano 2015 a 2020, cuja finalidade édiscorrer sobre o arsenal terapêutico frente à SOP. Resultados: A primeira opção a ser indicada a todas aspacientes é a mudança de hábitos de vida, entretanto, embora seja primordial, existem empecilhos para aeficácia dessa modalidade devido à variedade psicossocial das portadoras dessa síndrome e da dificuldadede adesão. Frente a isso, conta-se também com a terapia medicamentosa que deve ser avaliada em conjuntocom a realidade clínica e social da paciente. Conclusão: A mudança de estilo de vida é estabelecida comoprimeira linha de intervenção para tratamento e manejo da SOP, devendo ser prescrita e incentivada a todasas pacientes. Contudo, existem limitações no que diz respeito às intervenções não-farmacológicas. Dito isso,as alternativas medicamentosas devem ser associadas de forma responsável.

Objetivo: Avaliar a eficácia da eletroconvulsoterapia (ECT) no tratamento da depressão, considerando seusbenefícios e comparando sua eficácia entre depressão unipolar e bipolar. Além de também observar o riscode surgimento de episódios de mania após o uso da ECT. Revisão Bibliográfica: Atualmente, embora sejauma terapêutica muito promissora, o uso da ECT tem sido reservado para casos refratários ao tratamentomedicamentoso, em função de ainda ser uma ferramenta pouco disponível para uso na prática clínica. Deacordo com as evidências atuais quanto menor o tempo de duração da doença, maiores são as taxas deresposta e remissão dos sintomas com o uso da terapia eletroconvulsiva, sendo que alguns estudosafirmam que a taxa de resposta da depressão bipolar é maior que da depressão unipolar. Alguns efeitosadversos foram percebidos, entre eles o desenvolvimento de episódios maníacos em pacientes previamentedeprimidos. Considerações finais: Os estudos demonstraram melhora clínica dos pacientes comtranstorno depressivo bipolar e unipolar utilizando a ECT como tratamento, em especial na depressãobipolar. Foi observado a ocorrência de episódios de mania após o uso dessa terapêutica, como um efeitoadverso. No entanto, faz-se necessário mais pesquisas no intuito de diminuir o estigma e obter mais dados.

Objetivo: Realizar uma revisão narrativa sobre a fisiopatologia da Pneumonia por Pneumocistose (PCP) em pacientes com o Vírus da Imunodeficiência Humana (HIV), seus aspectos clínicos, diagnósticos, profiláticos e tratamento, com foco particular em sua fisiopatologia. Revisão bibliográfica: A PCP é uma doença oportunista causada pelo fungo atípico Pneumocystis jirovecii, que atinge principalmente pacientes com HIV. Ela foi responsável por grande parte das mortes em pacientes HIV positivos, mas com a popularização das terapias antirretrovirais sua prevalência nesse grupo reduziu. No entanto, ainda permanece como uma causa importante de morbimortalidade nesses pacientes. Normalmente, a PCP se desenvolve em pacientes que ainda não têm conhecimento de sua soropositividade ou que não aderem à terapia antiretroviral. Ademais, pacientes com contagem de LT CD4

Adenomatoid Odontogenic Tumor (AOT) was considered a variant of the ameloblastoma, being called “adenoameloblastoma”; however, its clinical characteristics and biological behavior indicate that it is a separate entity. It has probable origin of the remnants of the dental blade. Patient EWRO, male, 16 years old, leucoderma, in routine care by the orthodontist, presented a radiolucent, sclerotic borders image, inverted drop shape, between the canine and the lateral incisor and superiorly the margim the floor of the nasal cavity, in addition to superficially, expanding the vestibular wall compromising its integrity suggesting injury. The patient was referred to the Bucomaxillofacial Surgery and Traumatology Service of the Hospital Beneficencia Portuguesa de Bauru. After completing a clinical and complementary examination, the patient had a diagnostic hiphotesys of AOT, and the Partsch II Technique with Immediate Suture was recommended for removal. Although presenting confused diagnosis to the clinical dentist surgeon, the AOT has peculiar features and invasive surgical treatment, since its removal is brief and the correct surgical care is an injury of unlikely recurrence and possible rehabilitation.

Made available in DSpace on 2022-04-29T08:45:26Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-12-01 Introduction The present article presents a rare case of variation of the left vertebral artery, which originated from the aortic arch, between the common carotid artery and the subclavian artery, although classic descriptions of the vertebral artery indicate its origin at the subclavian artery, where it penetrates the foramen transverse and ascends cervically to the foramen magnum. Case presentation The anatomical peculiarity of the vertebral artery is evidenced. The origin of the vertebral artery was identified directly from the aortic arch in a dissected human specimen. Conclusion In view of the numerous surgical procedures performed in this area, the clear understanding of its topographic layout is indispensable, and might change surgical procedures performed in the region. Department of Biological Sciences-Anatomy Faculdade de Odontologia de Bauru Universidade de Sâo Paulo Faculdade de Odontologia de Marilia Universidade de Marilia, Avenida Waldemar Kireff 185, apt, 22, 17525-020 Department of Physical Education Faculdade de Ciências Universidade Estadual Paulista Department of Oral Maxillofacial Surgery Faculdade de Odontologia de Marília Universidade de Marília Department of Physical Education Faculdade de Ciências Universidade Estadual Paulista

As doenças cardiovasculares secundárias à aterosclerose são a principal causa de morte no Brasil, sendo a dislipidemia um dos principais fatores de risco para seu desenvolvimento. Nas últimas duas décadas, houve avanço considerável no tratamento das dislipidemias. Hipolipemiantes com potenciais crescentes para redução da hipercolesterolemia foram descobertos, permitindo a obtenção de metas terapêuticas e a redução de risco cardiovascular. A utilização das estatinas e ezetimibe configura-se como terapêutica com evidência de redução na morbimortalidade por doenças cardiovasculares; outras classes de medicamentos têm sido estudadas e validadas mundialmente, entre elas, os inibidores da pró-proteína convertase subtilisin/kexin tipo 9 (PCSK9), já aprovadas nos EUA e validadas em diversos estudos. Perspectivas futuras para terapêutica das dislipidemias envolvem terapia de silenciamento gênico, medicações que estão em fase 3 de estudo clínico até o momento. Unitermos: Dislipidemia. Estatina. Ezetimiba. Fibratos. Inibidores da PCSK9.

Organizations need to improve their processes for developing products and services that meet the needs of their customers or users. In many cases, the use of an application can facilitate the work to be done in the organizations. Based on this premise, the following research question has been proposed: how the use of a software can help an organization to identify, implement process improvements and raise their level of maturity. In order to seek an answer to this problem, the “Octogono” application was created, incorporating a model to assess process maturity developed by BPTG - Business Process Transformation Group, called 8 Omega ORCA. The application and respective validation of the software were performed through interviews with managers of the International Council of the Federal Rural University of Rio de Janeiro (UFRRJ). The method of content analysis was applied to data collected in the interviews, converging to a common result and outlining a pattern of Octogono validation. The study results showed that the software is applicable in the assessment of process maturity, providing consistent results for the managers decision making with the indication of improvement in several areas evaluated by the methodology 8 Omega ORCA. Considering this application's functionality, it is believed that its utility can go beyond the university processes and can be applied to companies, government agencies and other institutions.

Introduction and Objectives. Vertigo is a described complication of stapedial surgery. Many studies have been conducted to assess the improvement of hearing loss, but there are few studies that assess vestibular function after stapedial surgery. The aim of this study was to evaluate the presence and characterize the vertigo after stapedial surgery.Methods. We conducted a prospective observational study. Patients undergoing stapedial surgery in our hospital between October 2013 and December 2014 were invited to participate. The vertigo was assessed before and 4 months after surgery, using the Dizziness Handicap Inventory.Results. We included 140 patients in the study. 12 patients (8.6%) reported vertigo before surgery, and all of them denied vertigo after surgery. 36 patients (25.7%) reported vertigo four months after surgery, and none of them had vertigo before surgery. Postoperative total scores in patients with vertigo ranged between 2 and 18 points.Conclusion. The study shows that vestibular disorders may remain after the immediate postoperative period and reinforces the need for clarification of the patient in the informed consent act.

Medial meatal fibrosis is a rare condition in which the medial portion of the external auditory canal is obliterated with fibrous tissue. We selected 4 cases of patients with medial meatal fibrosis with a history of recurrent otorrhea who underwent surgery during the years of 2012 and 2013, presenting the surgical results here. Physical examination showed an obliterated external auditory canal and conductive hypoacusis. All cases were solved using a split thickness skin graft from the thigh. The surgical principles that appear to correlate with a favorable outcome are the removal of all fibrous tissue and unhealthy skin, a wide canaloplasty and the use of a split thickness skin graft.

CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior A tecnologia Long Term Evolution (LTE) foi idealizada pelo 3rd Generation Partnership Project (3GPP) com o intuito de proporcionar aos seus usuários maiores taxas de transferência de dados e uma qualidade de experiência mais satisfatória. A garantia de qualidade de serviço (QoS) aos usuários se tornou parte importante no desenvolvimento da tecnologia LTE, já que é essencial para a disponibilidade de aplicações, tais como voz e vídeo, cuja demanda é cada vez maior. Em redes LTE, a QoS é garantida a partir do Gerenciamento de Recursos de Rádio (RRM), através de algoritmos que regem a maneira pela qual os recursos finitos da rede são compartilhados entre todos os usuários. Dentre os algoritmos RRM, o controle de admissão de chamadas (CAC) é um dos mais relevantes, pois ele toma a decisão de admitir ou rejeitar uma conexão, levando em consideração a natureza da conexão, seus requisitos de QoS e a taxa de ocupação da rede. Uma vez que é impraticável a admissão de toda a demanda das conexões, seu objetivo é garantir que os recursos de rádio sejam utilizados de maneira otimizada, de forma a suprir os requisitos de QoS das conexões admitidas, esperando assim que o usuário tenha uma qualidade de experiência (QoE) satisfatória. Pelo fato do padrão LTE não especificar mecanismos para admissão de conexões, propõe-se neste trabalho um algoritmo de CAC, capaz de atender as principais classes de serviços definidas pelo padrão. A estratégia do algoritmo de CAC apresentada neste trabalho prioriza conexões GBR (Guaranteed Bit Rate) e conexões em handoff (chamadas que já estão em andamento) através da adaptação dinâmica de seções reservadas da largura de banda e preempção de conexões non-GBR, que são mais tolerantes à redução de taxa de dados. A avaliação da eficiência do algoritmo de CAC proposto foi feita através de modelagem e simulação em um cenário tipicamente urbano. Seus resultados foram comparados com os resultados de outros algoritmos de CAC encontrados na literatura e bastante populares, que também foram modelados no mesmo cenário. Os resultados das simulações mostram que as funções implementadas no algoritmo foram capazes de apresentar uma redução considerável da taxa de perdas de conexões e aumento no número de conexões admitidas. Long Term Evolution (LTE) technology was devised by the 3rd Generation Partnership Project (3GPP) to provide its users with higher data transfer rates and a more satisfying quality of experience. The guarantee of quality of service (QoS) to users has become an important part of the development of LTE technology, as it is essential for the availability of applications such as voice and video, which are increasingly in demand. In LTE networks, QoS is guaranteed from Radio Resource Management (RRM), through algorithms that lead how finite network resources are shared among all users. Among the RRM algorithms, CAC - Call Admission Control is one of the most relevant: it takes the decision to admit or reject a connection, based on the type of the connection, your requirements of QoS and the network occupancy rate. Since it is impractical to admit all connection requests, it aims to assure that radio resources are used optimally to meet the QoS requirements of the admitted connections, thus expecting the user to have a satisfactory quality of experience. Because the LTE standard does not specify mechanisms for connection admissions, it is proposed in this work a call admission control algorithm (CAC), capable of attending the main classes of services defined by the standard. The strategy of the CAC algorithm presented in this work prioritizes GBR (Guaranteed Bit Rate) connections and handoff connections (calls that are already in progress) through the dynamic adaptation of reserved sections of the bandwidth and preemption of non-GBR connections, which are more tolerant to the reduction of data rate. The evaluation of the efficiency of the proposed CAC algorithm was done through modeling and simulation in a typically urban scenario. Their results were compared with the results of other CAC algorithms found in the literature and quite popular, which were also modeled in the same scenario. Simulation results show that the functions implemented in the algorithm were able to present a considerable reduction in the rate of connection drops and increase in the number of admitted connections. Dissertação (Mestrado)

Several issues have limited the widespread adoption of transanal endoscopic microsurgery (TEM). The need for specialized equipment and the steep learning curve represent one of them. To operate on within a 4-cm diameter, rectoscope represents a major technical challenge. However, minilaparoscopic surgery has been introduced to reduce invasiveness and abdominal wall trauma. In TEM, instrument miniaturization may lead to technique optimization. We hypothesized that visualization and maneuverability during TEM performed with 3-mm minilaparoscopic instruments would be superior to TEM performed with conventional 5-mm instruments.Eighteen general and colorectal surgeons with experience with TEM under ten cases were recruited. Two tasks should be accomplished using the TEO(®)-Neoderma simulator. First, using conventional 5-mm TEO(®) curved-tip instruments, a "polypoid lesion" should be excised. Next, closure of the "rectal" defect should be undertaken. In the second part, the same participants repeated the same excision/closure tasks using 3-mm minilaparoscopic instruments. After tasks conclusion, participants fulfilled an evaluation questionnaire with seven questions regarding visualization and maneuverability when using 3-mm compared to 5-mm instruments.For each one of the seven questions in the questionnaire, the score results were significantly higher for the 3-mm instruments indicating that performance with the 3-mm minilaparoscopic instruments in the TEO simulator was in all cases between "better than expected" and "much better than expected." Appropriateness of the diameter of the minilaparoscopic instruments was the best evaluated parameter. The question addressing the ease of performing the tasks in the simulator presented the lowest mean score.The perceptions of participating surgeons indicated that there is better visualization and maneuverability during basic transanal endoscopic microsurgery tasks conducted in a simulator using 3-mm minilaparoscopic instruments when compared to conventional 5-mm instruments.

This article presents a clinical case of unilateral maxillo-zygomatic complex fracture in a patient with cleft palate submitted to surgical treatment at the Oral and Maxillofacial Surgery and Traumatology Service of the Bauru Hospital Complex (Brazil). Factors related to the aetiopathogenesis of the entity in question are discussed, highlighting the importance of early diagnosis and correct management with the aim of minimising complications andsequelae.

Introduction: Chordoma is a rare malignant tumor that arises from remnants cells of the primitive notochord, which are located at caudal and cephalic ends of the vertebral column. It represents 2 to 5 % of all primary bone tumors. Description: We report the case of a patient with a clival chordoma, asymptomatic, diagnosed as an accidental finding in a paranasal sinus. imaging study. Discussion: The imaging findings were suggestive of a potentially malignant lesion given the underlying bone lysis. Once the diagnosis is histological, biopsy of clival suspicious lesions should be promptly carried out. In this case report, the surgical approach and the postoperative follow-up are presented. Introducción: El cordoma es un tumor maligno raro que surge de las células remanentes de la notocorda primitiva, que se localizan en los extremos caudal y cefálico de la columna vertebral. Representa del 2 al 5% de todos los tumores óseos primarios. Descripción: Presentamos el caso de un paciente con un cordoma del clivus, asintomático, diagnosticado como hallazgo accidental en estudio de imagen de los senos paranasales. Discusión: los hallazgos de imagen fueron sugestivos de una lesión potencialmente maligna dada la lisis ósea subyacente. Dado que el diagnóstico es histológico, la biopsia de una lesión clival sospechosa debe llevarse a cabo con prontitud. En este caso clínico, se presentan el abordaje quirúrgico y el seguimiento postoperatorio.

Prostate cancer represents the most frequent non-cutaneous neoplasia in males. This type of neoplasia can develop peculiar patterns of evolution, presenting, in many cases, precocious relapses and metastasis. Bone metastasis in the mouth is extremely rare, and represents 1% of all malignant mouth neoplasias. The aim of the present study is to report a clinical case of bone metastasis in the mandibular region associated with a tumoral prostate adenocarcinoma, as well as to discuss connected aspects about diagnosis, prognosis and integrated treatment of this condition.

Este estudio propone el uso de un tubo de polietileno poroso (PPE) como elemento conductor en la regeneracion del nervio ciatico seccionado y evaluar el uso de relleno con grasa autologa. Al azar se formaron cinco grupos, 3 y 2 de control experimental (PPE protesis tubular con / sin grasa autologa). Cada grupo fue seleccionado para estudiar la forma funcional, histologica y evaluacion morfometrica del nervio ciatico. Un analisis funcional del nervio ciatico se produjo a traves de los valores de "huella", cerca de -100 se refiere al nervio ciatico seccionado; cerca de 0 (cero) se refiere al grupo control. En el analisis histologico de los grupos experimentales se observo una gran cantidad de tejido conjuntivo denso que sustituye el tejido nervioso. En el analisis morfometrico, el grupo experimental de injerto de polietileno lleno de grasa (EGPGf) obtuvo un mayor rendimiento en todas las variables. El uso de PPE ha mostrado ser prometedor en la regeneracion del nervio, con resultados favorables cuando se asocia con la grasa como un factor trofico en la regeneracion.

A 20-year-old woman presented with a two-month history of temporal headache and right trigeminal nerve palsy. An MRI showed enlargement and contrast enhancement of the right trigeminal nerve, suggestive of a schwannoma (). Cerebrospinal fluid analysis disclosed: 10 cells/mm3, protein 76mg/dl, glucose 50mg/dl and positive Venereal Disease Research Laboratory test (VDRL). Serum VDRL was 1/256 and the Treponema pallidum haemagglutination was positive. She was treated with IV crystalline penicillin G 2.400.000 U/day for 14 days with clinical and radiological improvement [...]

A 52-year-old woman with a past history of a tumefactive demyelinating lesion five years ago with left hemiparesis presented with a 30-day history of uninterrupted clonic movements involving her left face and upper limb, compatible with epilepsia partialis continua. An MRI showed right hemispheric cortical swelling (). She received phenytoin, valproate and phenobarbital with control of the epilepsia partialis continua and resolution of the MRI abnormalities (). […] Epilepsia partialis continua induces transient brain edema

CONTEXTO: Hemocultura positiva associada a cateter venoso central tem sido estudada em unidades de terapia intensiva (UTI), mas ainda é controverso se o acesso jugular tem maior incidência de complicações infecciosas que o acesso na veia subclávia. OBJETIVO: Comparar índice de infecção entre os acessos na jugular interna e os na veia subclávia em pacientes internados nas enfermarias de cirurgia. MÉTODOS: Estudo prospectivo, descritivo e comparativo com 114 cateteres em 96 pacientes admitidos nas enfermarias de cirurgia de um Hospital Quaternário, tendo como variáveis o local de inserção, número de lumens, tempo de uso, comparando-os com o índice de complicações infecciosas. RESULTADOS: O índice de infecção foi de 9,64% (11 cateteres), sem significância estatística quando comparados o número de lumens (mono versus duplo) e infecção (p=0,274); também sem significância estatística a comparação entre o tempo de uso (>14 dias) e infecção (p=0,156). Comparando os acessos jugular e subclávia, encontramos significância estatística tendo infecção em 17,2% na subclávia e 1,8% na jugular, com p=0,005. Índice de Hemocultura positivo associado a cateter venoso central foi maior no acesso subclávia quando comparado com jugular interna, com OR 11,2, IC95% (1,4-90,9; p=0,023). CONCLUSÕES: O acesso venoso central na jugular interna tem menor risco de infecção se comparado com subclávia em enfermarias. BACKGROUND: Positive hemoculture associated with central venous catheters has been studied in intensive care units (ICU), but is still controversial if the internal jugular vein access has a higher incidence of infection than subclavian or femoral vein access. OBJECTIVE: To compare catheter-related bloodstream infection (CABSI) rates between internal jugular and subclavian vein access in patients admitted to surgical wards. METHODS: This is a prospective, descriptive and comparative study of 114 central venous catheters placed in 96 patients admitted to the surgical wards of a tertiary-care hospital. The following parameters were studied: local of insertion of the catheter (internal jugular versus subclavian), number of lumens (single versus double) and duration of use (longer or shorter than 14 days), in order to determine their influence in CABSI rates. RESULTS: The CABSI rate was 9,64% (11 catheters), with no significant statistical differences regarding the number of lumens (p=0.274), and duration of use (p=0.156). The CABSI rate was higher in the subclavian vein than in the internal jugular vein access (OR 11.2, 95%CI 1.4-90.8; p=0.023). CONCLUSIONS: The internal jugular vein access has a lesser incidence of CABSI than subclavian vein access in patients admitted to surgical wards.

Resumo Blastomicose Sul Americana, tambem conhecida como Paracoccidioidomicose, Blastomicose brasileira ou molestia de Lutz, foi observada pela primeira vez no Brasil em 1908, por Adolpho Lutz. O pulmao e o orgao mais frequentemente acometido e da origem a manifestacoes clinicas de maneira muito insidiosa. As lesoes da mucosa oral, faringe e laringe sao muito comuns e com frequencia sao a causa de consulta ao Medico Dentista ou ao clinico geral, em estado inicial as lesoes, principalmente na lingua podem simular carcinoma. Para tal, considera-se o manejo terapeutico da Blastomicose Sul Americana deve,obrigatoriamente, compreender alem da utilizacao de drogas antifungicas, o emprego de medidas que melhorem as condicoes gerais do paciente, e acompanhamento pos-terapeutico. Os principais medicamentos utilizados sao a associacao trimetropim/sulfametoxazol (co trimoxazol), itraconazol e cetoconazol. O diagnostico definitivo desta patologia e obtido com a demonstracao do agente etiologico em fluidos biologicos ou tecidos, principalmente por exame micologico direto e/ou histopatologico. Esse artigo traz um levantamento bibliografico, bem como um caso clinico tratado com associacao de inidazois sistemico e topico.

In those cases where a PEG tube cannot be placed safely, a laparoscopic-assisted technique may be a viable option to complete the procedure., Background: Percutaneous endoscopic gastrostomy (PEG) is the most common way of placing a feeding tube. Sometimes PEG cannot be used to safely place a feeding tube, most commonly secondary to an inability to transilluminate the abdominal wall. Whereas open gastrostomy was previously necessary in such cases, laparoscopic-assisted percutaneous endoscopic gastrostomy (LAPEG) is a viable option and is reviewed here. Methods: All patients referred for surgical feeding tube placement after unsuccessful PEG were considered for LAPEG. A diagnostic laparoscopy was performed to identify the reason for the failed PEG attempt. Additional ports were placed as needed for the retraction of organs and lysis of adhesions. The stomach was visualized, and the PEG was placed. Results: Eight patients who underwent an unsuccessful PEG were taken to the operating room for LAPEG. All patients had successful LAPEG placement. No postoperative complications occurred. The most common reason identified for failed PEG attempt was adhesions followed by overlying organs. Average OR time was 32 minutes. Conclusion: When conventional PEG placement is not possible, LAPEG placement should be considered as a time efficient, minimally invasive alternative to open gastrostomy.