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To compare bone marrow fat quantification using magnetic resonance spectroscopy (MRS) and six-point DIXON (6PD) techniques in patients with sickle cell disease (SCD) and healthy subjects.Prospective study, with 43 SCD patients (24 homozygous [SS], 19 double heterozygous [SC), and 41 healthy subjects paired by age, weight and sex with SCD patients. All participants underwent magnetic resonance imaging with 6PD and single voxel MRS in the L3 vertebral body. Pearson's correlation, ROC curve, and bland-altman analysis were performed, p-values ​​≤0.05 were considered statistically significant for all tests.Significant linear correlation was found between fat fraction (FF) by 6PD and Total Lipids (TL) (r = 0.932; p0.001) and Saturated Lipids (SL) (r = 0.934; p0.001), in all subjects. Strong correlations were also identified considering subjects of the SS/SC subgroups. Despite high correlations, no significant difference was observed only between FF and SL in the SS subgroup (Bland-Altman analysis), indicating excellent agreement between the fat estimations in this specific situation. Significant differences were observed in all variables (FF, TL, SL) comparing the SCD and healthy subjects. The ROC curve between SCD and healthy subjects showed the following areas under the curve: FF(0.924)TL(0.883)SL(0.892).The comparison between fat quantification by the 6PD with MRS demonstrated an excellent correlation in SCD patients, especially in the SS subgroup, which usually has a higher degree of hemolysis. The diagnostic performance of 6PD and MRS is similar, with advantages of shorter imaging processing time and larger studied area with the 6PD.

Background Palliative care is a set of procedures for patients and families facing terminal or advanced illnesses. Numerous studies have already evaluated the role of palliative care and indications in outpatient or emergency settings. Nonetheless, data referring to the role of palliative care during a pandemic, such as COVID-19, are lacking. This study aimed to analyze the profile of deaths by COVID-19 at a tertiary reference cardiology hospital, and to identify the factors associated with more frequent indication of palliative care during patient management. Methods From March 1 to July 31, 2020, all deaths due to confirmed COVID-19 were analyzed, and their clinical, epidemiological, laboratory and imaging data were obtained. Results Considering the deaths, 26.8% of patients had received palliative care during hospitalization. When the groups were compared (standard care versus palliative care), there was a statistically significant difference for age (67.1±12.1 versus 73.5±9.1 years), presence of chronic obstructive pulmonary disease (3.2% versus 14.7%), and hypoxemia as cause of death (17.2% versus 55.9%). Conclusion In this analysis of patients admitted to the emergency room of a tertiary cardiology hospital during the pandemic period, the determining factors for higher indication for palliative care were age and previous chronic obstructive pulmonary disease. The main cause of death was hypoxemia, which was more prevalent in the palliative group.

OBJECTIVE: The objective was to evaluate the level of evidence about the associated factors and the risk factors of osteonecrosis of femoral head (ONFH) in sickle cell individuals. METHODS: The review was based on the search and selection of studies available in the electronic databases PubMed, SCIELO, LILACS, BVS. As descriptors, the terms of Medical Subject Headings (MeSH) and Health Sciences Descriptors (DeCS) corresponding to “Osteonecrosis”, “Necrosis avascular” and “Aseptic necrosis” and “Femoral head” and “sickle cell disease” and “risk factor” and “predictor”. RESULTS: Among clinical and laboratorial factors the most promising risk factors were the severity of sickle cell disease and acute chest syndrome. As a result, from studies of a moderate level of quality, blood pressure, body weight, previous trauma, haemoglobin to haematocrit ratio (Hb/HCT), and number of hospitalizations can be highlighted. Others, such as genetic markers and male gender, have also been positively associated in lower quality studies. CONCLUSION: For a better clarification of what the risk factors are for the ONFH, it is necessary to study with populations of different origins, different ages, different profiles of Hb, which present greater methodological rigor and perform a multivariate analysis to control confounding factors. Further study is also needed to understand the genetic determinants of ONFH.

Background. The objective of this study was to determine whether individuals with hip osteoarthritis who undergo THA have higher HRQOL scores than those awaiting the procedure; An additional aim was to investigate associated factors exerting an impact on HRQOL. Materials and methods. A cross-sectional study was conducted. Participants were divided into two groups: pre-THA and post-THA. Functional capacity was assessed using the Harris Hip Score, and HRQOL was measured using a validated and adapted version of the WOMAC questionnaire. A multivariate analysis of the WOMAC results was used to identify the main variables associated with HRQOL in both groups. Results. The post-THA group had higher HRQOL scores (100.4 ± 88.5) than the pre-THA group (197.8 ± 54.1). The domains Pain (68.0 ± 19.0 versus 34.7 ± 30.8), Stiffness (61.2 ± 28.9 versus 29.9 ± 33.1), and Phy­sical Act­­vity (68.6 ± 16.1 versus 36.6 ± 30.2) also had higher scores in the post-THA group. Pain was the variable most frequently associated with the increase in post-THA HRQOL scores. Other variables such as occupation, time of diagnosis, joint function, and body weight also had an impact on the HRQOL of both groups. Conclusions. 1. Individuals who had undergone THA showed higher HRQOL scores in all domains when compared to those still awaiting the procedure, and pain reduction was the variable most strongly associated with the improvement in quality of life of those patients. 2. Occupation and mobility were associated with the Stiffness domain of QOL; Occupation also had a bearing on health-related quality of life as a whole. 3. Physical Activity of the WOMAC instrument was associated with time of diagnosis, patient’s body weight, and function as assessed by the HHS.

Efforts have been made to determine new predictors of morbidity and mortality in patients with severe burn injuries. This prospective cohort study aimed to determine the association of serum albumin concentration on admission and renal failure, pulmonary infection, sepsis, and death in patients with burn injuries. We included 141 patients, aged >18 years, who were admitted to our institution between April and August 2018. Among them, 59.1% were male and 83.8% had burns covering 2.2 g/dL (odds ratios [OR]: 18.7; 95% confidence interval [CI]: 4.9 to 70.8). Serum albumin ≤2.2 g/dL was also significantly associated with pulmonary infection (OR: 13.1, 95% CI: 3.8 to 45.7), renal failure (OR: 30.2, 95% CI: 7.4 to 122.3), and sepsis (OR: 16.9, 95% CI: 4.9 to 58.3). Serum albumin concentration cut-points and ABSIs were determined to be death predictors using areas under the receiver operating characteristic curves (AUCs). The AUCs with albumin or ABSI alone were 0.89 (95% CI: 0.79 to 0.98) and 0.92 (95% CI: 0.87 to 0.96), respectively. The AUC including both albumin and ABSI was 0.96 (95% CI: 0.90 to 0.98), indicating that the combination is a better death predictor than either measure alone. We confirmed that burn patients with a serum albumin concentration ≤2.2 g/dL on admission have substantially increased morbidity and mortality.

Bilateral shoulder septic arthritis is a rare condition in immunocompetent patients without known risk factors, therefore, it can be easily misdiagnosed. Septic arthritis is an emergency due to its potential to cause rapid destruction of cartilage and bone as well as the risk for systemic spread. Aggressive early treatment is crucial for easing pain, preventing joint collapse, and permanent loss of shoulder function. We presented a case report of a 68 years-old man, suffering from multiple comorbidities and bilateral shoulder septic arthritis. The patient underwent arthroscopic surgery in the left shoulder. Antibiotic therapy was carried out after the surgical procedure using clindamycin. The patient had a satisfactory outcome, characterized by regression of the inflammatory symptoms in both shoulders. There was an improvement in pain and fevers settled. In this case report, we have also discussed treatment options as well as possible outcomes.

Introduction: The chronic degenerative condition related to Rare Diseases (DR) is permeated by complex social processes and access to health, whose understanding requires evaluation from the perspective of affected patients. Objective: To build up an instrument that allows those affected by these pathologies to evaluate their perception regarding access to healthcare and social support. Methods: Study on the development of an instrument based on the model proposed by Luiz Pasquali. Results: After a factorial analysis, the final result that showed preliminary evidence of validation was an instrument with four domains: Health Resources, Financial Resources, Social Aspects, and Individual Aspects, with 10 items. Final considerations: The final instrument developed gathered evidence of validity, revealing item quality in representing the concepts underlying each domain. Through its psychometric properties, the instrument showed that it has representativeness regarding the perception of the affected by DR regarding their access to health and social support.

ackground Chronic pain leads to functional and social disability, emotionally impacting individuals. Objective: To describe the main impairments of activities of daily living, anxious and depressive symptoms and quality of life in patients with chronic pain. Methods: Cross-sectional study with patients at the Chronic Pain Clinic attended between June / 2016 and March / 2019. Clinical and socio-demographic variables were collected, using the Hospital scale for Anxiety and Depression, Visual Numerical Scale for Pain, SF-36 scale for Quality of Life, and data analysis using the SPSS statistical program. Results: The mean age was 50.0±10 years, being (89.6%) female. There was a predominance of people with a partner, with religion, complete high school education and unemployed. Degenerative disease was the most frequent diagnosis (68.9%); pain intensity ranged from moderate to severe, score 6-8 (7). Most used drugs were analgesics (93.3%) followed by antidepressants (70.7%). Physical activity as an adjuvant treatment (41.5%), and anesthetic blocks (39.6%). When investigating daily activities, the work showed total limitation followed by movement; and, partially, leisure and home activity. The quality of life was well below the median, with the physical and emotional aspects being worse. Related to the subjects' activities, sleep is the most compromised; followed by partial difficulties with appetite and sexual activity. Most show self-esteem moderately satisfied with the treatment, even with anxious and depressive symptoms. Conclusion: Pain has a very significant impact on quality of life; compromises and limits daily activities and reveals more presence of anxious and depressive symptoms in people suffering from chronic pain.

Artigo original: Fernandes RB; Gomes EG; Gusmão MS; Amorim DC; Simões MTV; Gomes JF;Freire JB; Matos MA; Ajulay J; Pedreira AJS; Carvalho OEF. Clinical epidemiological study of spinal fractures. Coluna/Columna, vol.11 n°03. São Paulo July/Set 2012.

BACKGROUND AND OBJECTIVES: Chronic pain causes functional and social disability, resulting in emotional impact. This study’s objective was to describe the main impairments of activities of daily living, anxious and depressive symptoms, and quality of life in patients with chronic pain. METHODS: Cross-sectional study with chronic pain outpatients. Analysis of clinical and sociodemographic variables, as well as activities of daily living. Assessment of pain, anxious and depressive symptoms by the Hospital Anxiety and Depression Scale, quality of life by the Medical Outcomes Study 36 - Item Short Form Health Survey questionnaire and data analysis by the SPSS statistical software. RESULTS: The study observed limitations in work, movement, leisure and home activities, quality of life below the median and worse for the physical and emotional domains. Sleep was very impaired, followed by partial difficulty with appetite and sexual activity. Although they had anxious and depressive symptoms, most participants were moderately satisfied with their treatment. CONCLUSION: Chronic pain has a very significant impact on quality of life, impairing and limiting daily activities more intensely in individuals with anxious and depressive symptoms. RESUMO JUSTIFICATIVA E OBJETIVOS: Dor crônica acarreta incapacidade funcional e social, impactando emocionalmente os indivíduos. O objetivo deste estudo foi descrever os principais comprometimentos das atividades de vida diária, sintomas ansiosos e depressivos e qualidade de vida em pacientes com dor crônica. MÉTODOS: Estudo transversal com pacientes de ambulatório de dor crônica. Análise das variáveis clínicas e sociodemográficas, assim como das atividades de vida diária. Avaliação de dor, de sintomas ansiosos e depressivos pela Hospital Anxiety and Depression Scale, de qualidade de vida pelo questionário Medical Outcomes Study 36 - Item Short Form Health Survey e a análise dos dados no programa estatístico SPSS. RESULTADOS: Foi evidenciada limitação para o trabalho, movimento, lazer e atividade domiciliar, qualidade de vida abaixo da mediana e pior para os domínios aspectos físicos e emocionais. O sono foi muito comprometido, seguido de dificuldade parcial para apetite e atividade sexual. Embora apresentassem sintomas ansiosos e depressivos, a maioria dos participantes estavam moderadamente satisfeitos com o tratamento. CONCLUSÃO: A dor crônica impacta de forma muito significativa na qualidade de vida, comprometendo e limitando as atividades diárias de modo mais intenso nos portadores de sintomas ansiosos e depressivos.

Objetivo: Verificar o impacto da necrose avascular da cabeça do fêmur sobre a qualidade de vida de crianças e adolescentes com doença de Perthes e anemia falciforme. Material e Métodos: Estudo comparativo com 24 crianças entre oito e 18 anos com necrose avascular da cabeça do fêmur secundária à doença de Perthes e à anemia falciforme (grupo com necrose) e 24 crianças consideradas assintomáticas (grupo sem necrose). Foram coletados dados clínicos e sociodemográficos e aplicado o instrumento PedsQL 4.0 e o escore de Charnley para disfunção do quadril. Resultados: Não houve diferença no escore global e em nenhum domínio comparando os grupos Perthes (global=73,1) e anemia falciforme (global = 65,9). Quando comparados os grupos sem necrose e com necrose, nota-se que o grupo Perthes tem escore inferior apenas para o domínio Capacidade Física (87,5 versus 68,5); já o grupo anemia falciforme tem escore global inferior (64,9 versus 79,4) e também nos domínios Capacidade Física (68,5 versus 87,5) e Aspecto Escolar (62,9 versus 73,7). Conclusão: A necrose avascular da cabeça do fêmur produz escores de qualidade de vida inferiores tanto na avaliação global, como nos domínios Capacidade Física e Aspecto Escolar. Foram identificadas presença de necrose, lesão bilateral e função do quadril como fatores associados à perda de qualidade de vida. Nível de evidência III, Estudo seccional comparativo. Resumo do artigo: Matos MA, Silva LLDS, Alves GB, de Alcântara WS Júnior, Veiga D. Necrosis of the Femoral Head and Health-Related Quality of Life of Children and Adolescents. Acta Ortop Bras. 2018;26(4):227-230.

Resumo Objetivo Comparar os achados por imagem das alterações anatômicas da artrotomografia computadorizada multi-slice na avaliação das lesões do manguito rotador do ombro e correlacioná-los com os achados da artroscopia (exame diagnóstico padrão-ouro). Materiais e Métodos Estudo longitudinal, prospectivo, comparativo de acurácia diagnóstica, feito de junho de 2016 a junho de 2017, em pacientes de ambos os sexos, com idades entre 40 e 70 anos, com lesão dos tendões do manguito rotador do ombro, e que tinham necessidade terapêutica de fazer artroscopia do ombro. Foram incluídos pacientes com contraindicação à realização de ressonância magnética. Após a artrotomografia computadorizada multi-slice, todos os pacientes foram submetidos a artroscopia. Resultados Para a obtenção dos resultados, os seguintes parâmetros foram considerados: sensibilidade, especificidade, acurácia, valor preditivo positivo, valor preditivo negativo, coeficiente Kappa, e contraposição do método de imagem com a artroscopia. Conclusão Na impossibilidade da realização da ressonância magnética (exame de imagem padrão-ouro), a artrotomografia computadorizada multi-slice se mostra um exame de imagem capaz de avaliar/diagnosticar as lesões do manguito rotador.

This article has the goal of analyzing scientific studies about the Internet of Everything (IoE) and, under the security information concepts, understanding the relationship between then. With this objective, this article identifies researches, models, processing types, and tools about related issues of this theme. This research uses a qualitative methodology besides a systematic review of the literature to check all related keywords, such as OSI-ISO model, IoT, IoE, and Security, used to develop technological applications for smart buildings, houses, and cities. For this article, some databases were used: Scopus, Science Direct, IEEE, and ISO. This article provides detailed information on the present-day scientific articles focusing on security issues in IoT applications. This paper could serve as a basis for researchers seeking information for further investigation. The findings provide valuable contributions to scholars researching on the subject, and public managers considering implementing them in practice in their cities.

Cloud computing is a revolutionary paradigm in relation to its characteristics which can be highlighted the high connectivity, elasticity, assignment of measurable services and ease of management. These attributes favor the promotion of this technology, such as the increasing use of virtualization services in public and private institutions. Therefore, part of the efficiency of this service is based on the allocation of virtual resources that enable different configurations in different applications. In relation to this context, this paper aims to present the allocation module of the Architecture Management of Hybrid Resources in Private cloud Architecture (MoHRiPA), which was modeled with the purpose of providing high performance during the allocation of virtual machines. Its architecture and component specification will be presented, with emphasis on the resource allocation module that has hybrid properties, which makes it possible to support the use of different virtualization tools. The results obtained are described by means of a complete factorial planning with their respective more accurate analyzes about the functionalities and peculiarities of the allocation module.

Every day, numerous solutions focused on the Internet of Things (IoT) are developed to address domains such as environmental monitoring, mobility, and industry 4.0. The size of these ecosystems increases their complexity, and several of these domains have problems such as scalability, energy consumption, low-latency edge applications, multiobjective decision making, fog with cloud interaction, among other features and aspects that are not generally considered when designing a wireless network. The choices made during the design of the network influence its configuration, something that reinforces the importance of using a tool for simulating a wireless sensor network (WSN). Therefore, it is essential to model, analyze the degree of complexity of a network project before its implementation, and develop solutions. Based on this context, we presented a general review of some WSN simulators and the assignment of one of these simulators for the development of a network project for IoT sensors in public transport.

Background. Lower limb fractures are associated with severe disability, prolonged treatment and recovery time, and account for the greatest number of surgical procedures. Studies focusing on the health related quality of life (HRQOL) of patients who sustained lower limb fractures at a productive age are still scarce. The aim of the present study was to assess the HRQOL of individuals who sustained lower limb fractures at two time points: during the acute trauma period (hospitalization) and after six months. Materials and methods. A prospective observational longitudinal study was conducted including a total of 121 patients aged 18 years or older with fractures in the lower limbs evaluated based on clinical and sociodemographic variables and using the HRQOL questionnaire SF-36. The data were collected from referral trauma hospitals in two stages: during hospitalization (in-hospital period) and from the same individuals six months after the first interview. Results. At six months following the trauma, significant differences were found for the domains of functional capacity (from 2.77±7.82 to 51.11±28.43), pain (47.51±35.51 to 74.29±21.63), and emotional impairment (57.01±47.62 to 91.22±22.92) in the study period. However, no improvement was observed in the domains of physical limitations and social aspects. There was significant association for the domain “Pain” with age, level of education, and rehabilitation; the domain “Emotional impairment” was associated with treatment within 10 hours, level of education, and immediate osteosynthesis. At six months, only functional capacity exhibited significant associations with the level of education and rehabilitation. Conclusion. Lower limb fractures have a negative impact on the HRQOL that persists for at least six months after the traumatic event and is reflected in the psychosocial, physical and emotional burden imposed by the trauma.

O trabalho em unidade de terapia intensiva (UTI) pode ser considerado um dos mais estressantes para o médico e a relação entre este trabalho e o burnout ainda é pouco estudada. Realizou-se revisão sistemática com o objetivo de descrever a produção científica sobre a prevalência e os fatores associados ao burnout em médicos intensivistas, publicados nas bases de dados: IBECS, LILACS, MEDLINE, Psyc Info, PubMed e Scielo. Os critérios de inclusão foram estudos originais, com delineamento transversal, que utilizaram o Maslach Burnout Inventory (MBI) em médicos intensivistas. A busca identificou 118 artigos e destes, 09 artigos foram elegíveis. A segunda década dos anos 2000 teve a maior concentração de artigos e cinco publicações foram realizadas no Brasil, o que pode significar um incremento na produção científica nacional sobre o tema. Os resultados dos estudos que utilizaram como critério diagnóstico o nível alto em pelo menos uma dimensão da síndrome, apontaram elevada prevalência de burnout. Observou-se também uma diversidade de fatores associados a prevalência de burnout. Constatou-se uma heterogeneidade de critérios para identificação da síndrome e de formas de cálculo e de interpretação dos resultados do MBI. Sugere-se a padronização dos critérios para identificação da síndrome, dos cálculos e da interpretação dos resultados do MBI.

To verify the impact of avascular necrosis of the femoral head on the quality of life of children and adolescents with Perthes disease and sickle cell disease.A comparative study including 24 children between eight and 18 years old with avascular necrosis of the femoral head secondary to Perthes disease and sickle cell disease (Group with Necrosis) and 24 children considered asymptomatic (Group without Necrosis). Clinical and sociodemographic data were collected and the PedsQL 4.0 and the Charnley score for hip dysfunction were applied.There was no difference in the overall score and in any domain when comparing the Perthes group (global = 73.1) and the sickle cell disease group (global = 65.9). When comparing the groups with necrosis and without necrosis, the Perthes group had a lower overall score only for the Physical Functioning domain (87.5 versus 68.5); sickle cell disease group had a lower overall score (64.9 versus 79.4) and in the Physical Functioning (68.5 versus 87.5) and School Functioning (62.9 versus 73.7) domains.Avascular necrosis of the femoral head produces lower quality of life scores both in the global evaluation and in the domains Physical Functioning and School Functioning. Necrosis, bilateral lesion, and hip function were found to be associated with the loss of quality of life.Verificar o impacto da necrose avascular da cabeça do fémur sobre a qualidade de vida de crianças e adolescentes com doença de Perthes e anemia falciforme.Estudo comparativo com 24 crianças entre oito e 18 anos com necrose avascular da cabeça do fémur secundária à doença de Perthes e à anemia falciforme (grupo com necrose) e 24 crianças consideradas assintomáticas (grupo sem necrose). Foram coletados dados clínicos e sociodemográficos e aplicado o instrumento PedsQL 4.0 e o escore de Charnley para disfunção do quadril.Não houve diferença no escore global e em nenhum domínio comparando os grupos Perthes (global = 73,1) e anemia falciforme (global = 65,9). Quando comparados os grupos sem necrose e com necrose, nota-se que o grupo Perthes tem escore inferior apenas para o domínio Capacidade Física (87,5 versus 68,5); já o grupo anemia falciforme tem escore global inferior (64,9 versus 79,4) e também nos domínios Capacidade Física (68,5 versus 87,5) e Aspecto Escolar (62,9 versus 73,7).A necrose avascular da cabeça do fémur produz escores de qualidade de vida inferiores tanto na avaliação global, como nos domínios Capacidade Física e Aspecto Escolar. Foram identificadas presença de necrose, lesão bilateral e função do quadril como fatores associados à perda de qualidade de vida.

Resumo Objetivo Analisar comparativamente a acuracia dos dois sistemas para classificacao de fraturas expostas mais usados na pratica medica atual, Gustilo e Tscherne, como preditores de infeccao nas fraturas expostas. Metodos Foi feito um estudo observacional retrospectivo com 121 individuos acometidos por fratura exposta do esqueleto apendicular atendidos em uma unidade de emergencia hospitalar. As fraturas expostas foram classificadas segundo os dois sistemas durante o atendimento inicial; as classificacoes eram posteriormente confirmadas ou retificadas durante o internamento. Foram calculados sensibilidade, especificidade, valores preditivos positivos e negativos e acuracia, segundo cada classificacao adotada. Resultados Os resultados demonstraram que ambas as classificacoes, de Gustilo e de Tscherne, apresentam associacao com o desfecho clinico infeccao em fraturas expostas. A classificacao de Gustilo obteve sensibilidade de 76,7%, especificidade de 53,8% e acuracia de 59,5%. A classificacao de Tscherne obteve sensibilidade de 56,7%, especificidade de 82,4% e acuracia de 76,1%. Conclusao O sistema de classificacao de Tscherne demonstrou maior acuracia, apresentou melhor especificidade como preditor de infeccao em fraturas expostas quando comparado com o sistema de Gustilo.

Diagnosis of synovitis/tenosynovitis by physical examination can be difficult. Ultrasound (US) can be an effective tool for the evaluation of joint involvement in systemic lupus erythematosus (SLE). This study will describe musculoskeletal findings by US in SLE patients and the evaluation of their correlation with physical examination. SLE patients underwent clinical/sonographic evaluation of hand/wrists. In total, 896 joints were evaluated: at least 1 change on physical examination was found in 136 joints and at least 1 US abnormality was found in 65 of 896 joints. Out of the 65 joints with US changes, only 13 had findings on physical examination. Conversely, 111 joints had tenderness on physical examination with no sonographic abnormalities. Tenosynovitis was statistically significant more frequently with joint edema (41%) (p = 0.0003). US can detect musculoskeletal changes in only a minority of symptomatic SLE patients. Clinical findings may be related to some reasons that cannot be explained using US.

Purpose To analyze the location of the femoral tunnel by three-dimensional computed tomography (3D CT) of the lateral condyle in patients who underwent arthroscopic single-bundle anterior cruciate ligament (ACL) reconstruction, performed using a modified transtibial technique, and to compare the results with data from the literature. Materials and methods Seventeen patients with ACL lesions underwent modified transtibial ACL reconstruction. Postoperatively, 3D CT examinations were performed and the images were analyzed by the quadrant system described by Bernard and Hertel to define the femoral tunnel coordinates. Results The mean value of femoral tunnel location coordinates was 37.1±5.9 in the horizontal plane and 23.9±7.5 in the vertical plane. Compared with other studies using the transtibial or transportal technique, femoral positioning was improved in the vertical plane. The outside-in technique provided the best results both in the vertical and horizontal planes. Conclusions The modified transtibial technique was not effective for systematically anatomic femoral tunnel positioning; however, it was relatively better than the conventional transtibial technique.

Transcranial Direct Current Stimulation (tDCS) uses a direct electrical current to modulate the activity of cortical neurons. Anodal tDCS (positive pole) increases the excitability of cortical neurons, while cathodic tDCS (negative pole) reduces it. However, when applied in the peripheral nervous system the effects are the opposite of cranial application. Furthermore, when central and peripheral stimuli are used concomitantly, their effects can be summed up. This has been demonstrated by combining tDCS with other forms of sensory peripheral stimulation. We propose a new electrode configuration to potentiate the excitatory and inhibitory effects of tDCS on neuronal excitability and increase upper limb motor function. Our hypothesis is that placement of the electrodes in the primary motor cortex (M1) and the contralateral brachial plexus (BP) would promote this potentiation by central and peripheral synaptic summation. We will test our hypothesis in two proof-of-concept studies. Study 1) Secondary trial, in which we will evaluate the effects of these configurations on the neuronal excitability of healthy individuals; Study 2) A double-blind, randomized and crossover clinical trial in which we will test the stimulation with the anode in M1 and the cathode in the contralateral BP on the motor function and electrophysiological markers of individuals with cerebral palsy. The effects of the new configurations will be compared with the conventional configuration (M1 / contralateral supraorbital region). We expect that our investigations will identify a more efficient way to apply tDCS and consequently a better clinical use of this technique.

Artigo original: Marcos Almeida Matos, Jandrice Carrasco, Luanne Lisle, Marilda Castelar. Avascular necrosis of the femoral head in sickle cell disease in pediatric patients suffering from hip dysfunction. Rev Salud Pública 2016; 18(6): 986-995.

Os profissionais de saude praticam suas atividades diariamente, com ciencia e dedicacao, em diversas situacoes de cuidados excessivamente complexos. Nobres, corajosos e cheios de compaixao, querem cada vez mais salvar pessoas, serem uteis, objetivam melhores resultados na assistencia, enfrentam bravamente longas jornadas de trabalho e horas sem dormir, e sao conhecidos como profissionais que se dedicam constantemente, tanto no trabalho quanto nos estudos. Alem disso, possuem uma forma de trabalhar que requer disposicao fisica e agilidade para avaliar, diagnosticar e [...]

Mucopolysaccharidoses (MPS) are inborn errors of metabolism caused by deficient lysosomal enzymes, leading to organomegaly, hip osteonecrosis, coarse facial features, bone deformities, joint stiffness, cardiac and pulmonary symptoms (MPS VI) or hypermobility (MPS IVA). Some patients may present with non-classical forms of the disease in which osteoarticular abnormalities are the initial symptoms of non-classical forms. As orthopedists and surgeons are the specialists most frequently consulted before the diagnosis, it is critical that MPS may be considered as a differential diagnosis for patients with bone dysplasia. Experts in Latin America reviewed medical records focusing on disease onset, first symptoms and the follow-up clinical and surgical outcomes of non-classical MPS VI and IVA patients. All patients displayed orthopedic issues, which worsened over time, followed by cardiac and ophthalmological abnormalities. Our findings enlighten the necessity of including non-classical MPS as possible diagnosis for patients who report osteoarticular abnormalities in absence of inflammation.

To measure the functional independence to perform activities of daily living of pediatric patients diagnosed with mucopolysaccharidoses.A descriptive cross-sectional study was carried out with the population of pediatric patients with a confirmed enzymatic diagnosis of mucopolysaccharidoses, enrolled in the Orthopedics outpatient clinic of a hospital in the State of Bahia. The data were collected between October 2016 and March 2017, based on the documentary analysis of the assessment forms used in the department. The variables of this study comprised sex, age, type of MPS and level of functional independence, measured by the Functional Independence Measure scale.Twenty-six patients participated in the study. These were predominantly male (61.5%), with a mean age of 10 ± 4.5 years, affected by MPS VI (73.1%). In the motor domain, the mean score was 65 (± 19.9 points); the cognitive domain obtained a mean score equal to 28 (± 8.2 points); and the total FIM score was 93 (± 26.5).Impaired functional independence was observed among children and adolescents with mucopolysaccharidoses. Tasks related to dressing, toileting, bathing, problem solving and social interaction were those that required the most assistance and/or supervision.Medir a independência funcional para realização de Atividades de Vida Diária de pacientes pediátricos diagnosticados com mucopolissacaridoses (MPS).Estudo transversal, descritivo, realizado com a população de pacientes pediátricos com diagnóstico enzimático confirmado de mucopolissacaridoses, cadastrados no ambulatório de ortopedia de um hospital no Estado da Bahia. Os dados foram coletados entre outubro de 2016 e março de 2017, a partir da análise documental das fichas de avaliação utilizadas no serviço. As variáveis deste estudo compreenderam sexo, idade, tipo de MPS e nível de independência funcional, mensurado pela escala de Medida de Independência Funcional.Participaram do estudo 26 pacientes, que eram predominantemente do sexo masculino (61,5%), com média de idade de 10 ± 4,5 anos, acometidos por mucopolissacaridoses VI (73,1%). No domínio motor, a pontuação média foi 65 (± 19,9 pontos); o domínio cognitivo obteve escore médio igual a 28 (± 8,2 pontos); e o escore total da MIF foi 93 (±26,5).Foi observado comprometimento da independência funcional de crianças e adolescentes com mucopolissacaridoses. Tarefas relacionadas ao vestuário, utilização do vaso sanitário, banho, resolução de problemas e interação social foram as que demandaram maior assistência e/ou supervisão.

Objective To evaluate the association between bone changes due to vaso-occlusive events in sickle cell disease (SCD) revealed by conventional MRI sequences and the fat fraction obtained using a 6-point DIXON technique (FFdix), in an attempt to use quantitative data as a biomarker for bone complications. Methods Cross-sectional study, with 48 SCD patients, 26–homozygous (HbSS), and 22–compound heterozygous (HbSC). Forty-eight healthy individuals paired by age, weight, and sex with SCD patients. All participants underwent lumbar spine and pelvis MRI. Conventional sequences: bone complications related to vaso-occlusive events—femoral head avascular necrosis, bone infarctions, “H”-shaped vertebrae, bone marrow necrosis. Six-point DIXON technique: quantitative evaluation of the bone marrow at pre-established sites (lumbar vertebrae, sacrum, iliacs, femoral heads, greater femoral trochanters, femoral necks). Pearson's correlation, ROC curve, and binary logistic regression analysis were performed. Results The most frequent findings in the SCD group included femoral head avascular necrosis (75%), bone infarctions (58.3%), “H”-shaped vertebrae (58.3%), and typical imaging findings of bone marrow necrosis (8.3%). Cortical bone thickness in the proximal femoral diaphysis in patients with SCD was moderately negatively correlated with FFdix in lumbar vertebrae, iliacs, femoral necks, and first sacral vertebrae. The ROC curves and odds ratios demonstrated excellent performance of FFdix in all the evaluated anatomical sites and identified patients having bone complications. Conclusions FFdix could serve as a potential biomarker in SCD because of its association with bone complications secondary to vaso-occlusive events in patients with SCD, especially in femoral heads, femoral necks, and iliacs.

Background The aim of the present study was to evaluate health-related quality of life in pediatric patients with avascular necrosis of the femoral head. Material and methods A comparative study was conducted involving 32 children and adolescents in "ONFH Group" (subjects with a diagnosis of ONFH) and 44 in "Comparison Group" (asymptomatic children), both aged between 8 and 18. Clinical and sociodemographic data were obtained along with PedsQL 4.0 questionnaires to evaluate the quality of life in the age-ranges studied. Results The two groups were similar as regards sociodemographic characteristics. Comparison of the quality of life total scores demonstrated significant differences between the ONFH group and the comparison group (58.86±16.54 versus 82.08±9.51), and this also occurred in all the domains analyzed. The predictors that showed correlation with the quality of life were: presence of necrosis, age, time of diagnosis, radiographic classification, Charnley score, educational level, previous surgeries, and previous infections. Conclusion Our data confirm the hypothesis that pediatric patients with ONFH demonstrate a lower quality of life than healthy children in all the domains evaluated, especially with regard to the physical aspect.

Purpose To verify the association between functional independence (FI) and quality of life (QOL) in patients with knee osteoarthritis. Materials and Methods A cross-sectional study composed of 93 patients with knee osteoarthritis was performed. Osteoarthritis was stratified according the classification of Ahlbach. For evaluation of the patient's overall FI, the Barthel index was used. The patient's QOL was measured by means of the Medical Outcomes Study 36–Item Short Form Health Survey (SF-36) questionnaire. Results The mean age of the patients was 60 years (range, 54.0 to 69.5 years) and only 32 patients (34.3%) were found to be independent. Dependent or independent individuals presented difference in all domains of the QOL including physical function (p=0.001), role-physical (p=0.005), bodily pain (p=0.001), general health (p=0.004), vitality (p=0.009), social function (p=0.010), role-emotional (p=0.002) and mental health (p=0.001). Correlation between FI and QOL was different for all domains of the SF-36. Correlation with FI was strongest for physical function (r=0.609, p

Introdução: A pandemia do COVID-19, ocasionada pelo SARS-CoV-2, provoca desde infecções assintomáticas até a síndrome respiratória aguda grave, que por vezes, pode ser fatal, necessitando de enfrentamento. Objetivo: Analisar a epidemiologia da COVID-19 nas seis mesorregiões do estado do Pará, correlacionando-a com Índice de Desenvolvimento Humano Médio (IDHm) e o Percentual de Tratamento de esgoto do Estado. Métodos: Trata-se de um estudo descritivo transversal com abordagem quantitativa, realizado através do levantamento de dados secundários dos casos de COVID-19, coletados no período de 07 de março a 30 de maio de 2020, e dados sócio-demográficos das seis mesorregiões do estado do Pará. Resultados: Foram notificados 267.700 casos confirmados da COVID-19 em todo o estado do Pará. As mesorregiões do Sudeste paraense e da Região Metropolitana de Belém, apresentaram os maiores valores, com 81.556 e 71.117, respectivamente. Não houve diferença de número de casos entre os gêneros, porém as duas faixas etárias mais acometidas pela infecção estão entre 30 a 39 anos (64.138 casos) e 40 a 49 anos (51.535 casos). Dentre as comorbidades mais prevalentes estão as Cardiopatias e o Diabetes. Conclusão: As maiores taxas de incidência da COVID-19 estão concentradas nas mesorregiões com grande fluxo de pessoas, havendo uma tendência dos aspectos sociodemográficos se relacionarem com a epidemiologia da COVID-19 nas mesorregiões do estado do Pará.

Background. Osteoarthritis of the knee is a degenerative disease which affects the functional status and qua­lity of life of patients. The treatment of choice in advanced stages is total knee arthroplasty (TKA). Although the procedure consistently yields good results, functional limitations may persist after surgery. The aim of the study was to evaluate the impact of TKA on the practice of sport and how this relates to factors such as demographic and clinical data. Material and methods. This is a cross-sectional cohort study of operated vs. unoperated patients. A standar­diz­ed instrument for data collection was employed. Information collected comprised personal, socio-demographic and clinical data. Patients were asked about their current practice of physical exercise. We also recorded group-specific data; for the operated group, we recorded data about the surgery and, for the unoperated group, we recorded data about the disease. Results. Patients who had undergone TKA practiced sport twice as much as those who had not been opera­ted on yet (33.8% versus 15.5%). The prevalence of the practice of sports was significantly higher in older patients with lower levels of pain, p < 0.001 and p < 0.001, respectively. Conclusions. 1.The findings of our study support the conclusion that patients are significantly more active after total knee arthroplasty. 2. Low and medium intensity sports modalities were more prevalent in operated patients. 3.We also identified that active patents tend to be older, with lower level of pain, have better functional class, and a higher level of education.

Mucopolysaccharidosis (MPS) is a rare and neglected disorder. Only a few studies to date have focused on humanistic impacts of the disease, particularly health-related quality of life (HRQOL). The objective of our research is to (1) evaluate HRQOL in Brazilian patients with MPS and (2) assess the validity of the PedsQL 4.0 Generic Core Scales (PedsQL) in this specific disease. We performed an analytical cross-sectional study using the Brazilian Portuguese version of the PedsQL in 22 patients with MPS between the ages of 8 and 21. With regard to assessing the validity of the PedsQL for MPS, we evaluated internal consistency using Cronbach’s α coefficient and reliability using the Spearman–Brown estimate of agreement. The mean HRQOL score in our sample was 63.6 points. The worst score was obtained in the Psychosocial domain (61.9) on account of interference with school (56.1), while the Physical Health domain had the highest score (67.6). The total PedsQL internal consistency was .764 points. The Physical Health domain obtained the highest internal consistency (.914), whereas the Psychosocial Health domain obtained the lowest one (.754). MPS was demonstrated to decrease HRQOL, and PedsQL seems to be a valid instrument to perform this kind of analysis.

Objective: To estimate the prevalence of burnout in intensivist doctors working in adult, pediatric and neonatal intensive care units in five Brazilian capitals. Methods: Descriptive epidemiological study with a random sample stratified by conglomerate with 180 intensivist doctors from five capitals representing the Brazilian geographic regions: Porto Alegre (RS), Sao Paulo (SP), Salvador (BA), Goiania (GO) and Belem (PA). A self-administered questionnaire examining sociodemographic data and the level of burnout was evaluated through the Maslach Burnout Inventory. Results: A total of 180 doctors were evaluated, of which 54.4% were female. The average age was 39 ± 8.1 years, 63.4% had specialization as the highest degree, 55.7% had up to 10 years of work experience in an intensive care unit, and 46.1% had the title intensive care specialist. Most (50.3%) had weekly workloads between 49 and 72 hours, and the most frequent employee type was salaried. High levels of emotional exhaustion, depersonalization and inefficacy were found (50.6%, 26.1% and 15.0%, respectively). The prevalence of burnout was 61.7% when considering a high level in at least one dimension and 5% with a high level in three dimensions simultaneously. Conclusion: A high prevalence of burnout syndrome among intensivist doctors was observed. Strategies for the promotion and protection of health in these workers must be discussed and implemented in hospitals.

Varus supracondylar osteotomy of the femur is the established procedure for treating painful knees that present lateral arthrosis and valgus deformity. In descriptions of the conventional surgical techniques, there are divergences regarding the location, access route, correction level, fixation type and area for synthesis insertion. This is most evident in cases of severe valgus with angles greater than 30° and distal femoral deformation, in association with hypoplasia of the lateral condyle. The authors describe a new surgical technique for distal femoral osteotomy, based on anatomical and geometrical criteria, which was developed in their clinic for treating severe valgus cases, and they present one of the cases treated. In the new technique, the wedge to be surgically resected has an oblique direction and the format of an isosceles triangle. This new proposal thus seeks to resolve problems that have been presented in such cases, through enabling valgus correction without causing any new deformity of the distal femur. Good cortical bone contact is promoted, and application of a stable synthesis system is made easier. However, the age limits for such patients and the degree of knee arthrosis that might contraindicate this procedure remain unknown. Hence, a larger sample and longer follow-up for operated cases are required.

Objective. To evaluate the influence of hip dysfunction on quality of life of pediatric patients with sickle cell disease (SCD). Methods. Clinical demographic, Charnley hip score, Barthel scale and Pediatric Quality of Life Inventory (PedsQL 4.0) questionnaires were used. Results. Seventeen patients were placed into the group “with hip dysfunction,” and 54 into the group “without hip dysfunction.” The group “with hip dysfunction” had a higher average age ( P = .026), weight ( P = .029), and height ( P = .019) than the group “without hip dysfunction.” There was also a higher prevalence of hip trauma ( P = .05) and pain ( P = .00). The study demonstrated that hip dysfunction negatively influenced quality of life in the physical activity ( P = .11) and psychosocial ( P = .003) domains. Conclusion. Hip dysfunction and previous hip trauma negatively influenced quality of life, especially in the physical activity and psychosocial domains.

The aim of this study was to evaluate the behavior of glycogen reserves over an acute exercise condition (50 minutes of swimming at low intesity), after treatment with metformin in rats. Forty Wistar rats (180- 200g) adults were divided into four groups (treated or not for a fortnight) and represented as follows: Control; Acute exercise by swimming (perform a session of swimming, 50 min on light intensity); Treated with metformin (received the drug metformin at a dose 1.4 mg/ml during the experimental period; Treated with metformin and exercised by swimming (received the drug metformin at a dose 1.4 mg/ml and held a swimming, 50 min on light intensity). The acute exercise decreased the glycogen reserves, while animals treated with metformin showed an increase in their muscle and liver glycogen reserves (p>0,05). Additionally, the drug showed no increase glucose and corticosterone concentration compared to the control and treated with metformin groups (p>0,05). Treatment with metformin improved energy conditions and lowers the stress response, suggesting that an important pharmacological tool for the potentiation of performance. O objetivo deste estudo foi avaliar o comportamento das reservas glicogênicas de ratos, submetidos a uma condição de exercício agudo (50 minutos de natação na intensidade leve), após o tratamento com metformina. Quarenta ratos Wistar (180-200g) adultos foram divididos em quatro grupos (tratados ou não por quinze dias) e assim representados: Controle; Exercício agudo por natação (realizaram uma sessão de natação, sendo 50 minutos na intensidade leve); Tratado com metformina (receberam o fármaco metformina na dosagem de 1,4 mg/ml, durante o período experimental; Tratados com metformina e submetidos a condição exercício agudo por natação (receberam o fármaco metformina na dosagem de 1,4 mg/ml e realizaram uma sessão de natação, sendo 50 minutos na intensidade leve). O exercício agudo diminuiu as reservas glicogênicas, já os animais tratados com metformina, apresentaram um aumento em suas reservas glicogênicas musculares e hepáticas em relação ao grupo que realizou o exercício sem suplementação (p0,05). O tratamento com metformina promoveu melhora nas condições energéticas e menor resposta ao estresse, sugerindo ser uma importante ferramenta farmacológica para a potencialização da performance.

OBJECTIVE: To assess socio-demographic characteristics of individuals that suffered open fractures caused by motorcycle traffic accident and evaluate infection rate in search of associated risk factors. METHODS: A retrospective study comprising 81 patients with open fractures caused by motorcycle accidents was carried out. Clinic and socio-demographic features were collected from patients' records. Comparison between infected and non-infected patients was performed to find out which variables were possibly associated to this complication. RESULTS: Patients were mostly young adults (mean 32.9 years old), of the masculine gender (83.9%), single (60.5%), from the country side (40.7%), mostly presenting tibial open fractures (48.2%). Fractures type IIIA and type IIIB were the most prevalent lesions (68,8%), and soft tissue damage graded as I and II were the most frequent (64.62%). Infection was present in 23.7% of the patients and it was associated to age higher than 40 years old (p=0.011), to time delay from trauma to first surgical procedure longer than 24 hours (p=0,012), and also to soft tissue damage extent (p=0.001). CONCLUSIONS: Patients with open fractures caused by motorcycle traffic accident were mostly young single men, coming from the state capital and presented severe tibial open fractures, which 23.7% of the cases progressed to infection. Level of Evidence III, Retrospective Comparative Study.

BACKGROUND. The objective of this study is to evaluate the response of the musculoskeletal system to enzyme replacement therapy in a group of patients with Mucopolysaccharidosis (MPS). MATERIAL AND METHODS. A retrospective study was done based on records from 22 patients with different types of MPS (I, II and VI) who were treated with enzyme replacement therapy (ERT). Patient data were evaluated after an average of 21.4 months. Data collected were: Global Motor Function Classification System (GMFCS); measured range of motion (ROM) of the knee, elbow, and shoulder joints; and an evaluation of hand function as proposed by Haddad. A comparison was done between data from the "pre-treatment" and "posttreatment" groups to evaluate the significant clinical differences between the pre and post-treatment periods. RESULTS. In the total group, 13 (59.1%) maintained or improved their motor score and 8 (36.3%) ended up with a worse score. Only ROM of the shoulders saw a statistically significant improvement. The right shoulder increased from 59.7º to 78.4º (p = 0.017), and the left one from 65.2º to 80.2º (p=0,036). CONCLUSIONS. Based on the data, it is possible to conclude that ERT was able to stabilize or improve motor function in the majority of patients and also significantly increase the range of motion of shoulder joints in patients with MPS.

The Cloud computing market encompasses an ever-growing number of providers offering a multitude of infrastructure-as-a-service (IaaS) and platform-as-a-service (PaaS) solutions. In order to exploit the peculiarities of each Cloud solution as well as to optimize performances, availability, and cost, an emergent need is to run and manage multi-Cloud applications [1] (i.e., applications that can execute on multiple Cloud infrastructures and platforms).

SOFTEAM is a French middle-sized company that provides the Modelio modelling tool. Modelio is an enterprise-level open source modelling solution delivering functionality for business, software and infrastructure architects.

Over recent years, there has been a significant increase of integrated computing devices and systems within the healthcare sector, including computerized machines which can see deep within the human body to detect illnesses previously missed, help engage the patient, provide enhanced education, and access medical data not readily accessible before. However, as new technologies, medications, treatments, and procedures are being developed rapidly, clinicians are expected to incorporate this new information into their daily practices, apply this knowledge to their patients, track each patient’s individual health status and background, while communicating quickly with patients, hospitals, and other providers. Additionally, clinicians are expected to keep up with the latest published medical data in the hopes of increasing the accuracy of diagnoses and treatments to improve patient health outcomes. However, there is a “small” problem with this expectation, there is not enough hours in a day to accomplish all of these tasks. According to a report by the Memorial Sloan-Kettering Cancer Center, it would take at least 160 hours (or four 40-hour work weeks) of reading every single week just to keep up with new medical knowledge as it’s published, let alone applying the effort to consider its relevance or to implement it practically. This places false expectations on clinicians. While they may be an experienced doctor, they still require a process which delivers functional, meaningful, efficient, and user-friendly technology to their daily work environment. Therefore, it is important to develop a methodology to support and compliment the recent strategy of health care delivery and payments.

Objective The aim of this study is to verify the prevalence of avascular necrosis (AVN) in pediatric patients with sickle cell anemia and hip dysfunction, and to evaluate the presence of associated risk factors. Method A cross-sectional study was conducted in a group of 92 patients with sickle cell disease and hip dysfunction. Clinical and sociodemographic characteristics were collected, and laboratory variables were evaluated. All the subjects underwent radiographic and clinical evaluation of the hip. The participants were divided into two groups: the "AVN Group" consisting of patients with AVN, and the "Comparison Group" without AVN. Both groups were evaluated in search of factors associated with osteonecrosis of the femoral head. Results 43 (46.7 %) out of 92 individuals presented hip dysfunction, and 13 were diagnosed with AVN (30.2 %). Comparison between groups showed significant differences in time of diagnosis, previous trauma, presence of pain, and mean values of functional scores. Higher percentage rates of fetal hemoglobin, higher platelet counts and lower rates of total hemoglobin were perceived in the Comparison Group. Conclusions Pediatric patients with sickle cell anemia with hip dysfunction present a prevalence of 39.4 % of osteonecrosis of the femoral head. This was associated with a longer time of diagnosis (97 months), previous trauma in 92 % of patients, and a mean Charnley score of 15 points. Also, an association with lower rate of fetal hemoglobin (7.2 versus 11.8) was found, which supports the hypothesis that fetal hemoglobin may function as a protective factor against avascular necrosis.

OBJECTIVE : To assess the quality of life of knee osteoarthritis patients using the SF-36 questionnaire METHODS : Cross-sec-tional study with 93 knee osteoarthritis patients. The sample was categorized according to Ahlbӓck score. All individuals were interviewed with the SF-36 questionnaire RESULTS : The main finding of the study is related to the association of edu-cation level with the functional capacity, functional limitation and pain. Patients with higher education level had better functional capacity when they were compared to patients with basic level of education CONCLUSION : Individuals with osteoarthritis have a low perception of their quality of life in functional capacity, functional limitation and pain. There is a strong association between low level of education and low perception of quality of life. Level of Evidence IV, Clinical Case Series.

Objective To determine the prevalence of depressive symptoms among elderly and correlate the agreement between the screening methods used. Methods A cross-section study of 137 elderly attending the Programa Vivendo a Terceira Idade [Living for the Elderly Program]. Depressive symptoms were screened by the Patient Health Questionnaire-9 and the 15-item Geriatric Depression Scale, by Yesavage. Cohen´s kappa analyzed the degree of agreement of these scales. Results The prevalence of depressive symptoms screened by the Patient Health Questionnaire-9 was 62.8% and, by the Geriatric Depression Scale, 52.6%. The Spearman correlation between the results of scales obtained rho=0.387, p

Spinal anesthesia for knee arthroscopy is a well-documented and safe procedure. However, some complications and higher costs have been reported. Also, many orthopaedic surgeons are reluctant to use local anesthesia for fear of having to convert to general anesthesia due to inadequate pain control. The purpose of this study is to compare local with spinal anesthesia in two groups of patients submitted to knee arthroscopy. Sixty-five patients were divided in two groups; based on the anesthesia method used, and submitted to the same surgical routine and postoperative analgesia protocol. They were evaluated for analgesia, level of postoperative pain, and level of satisfaction with the type of anesthetic. The two groups did not present any significant differences in relation to perioperative analgesia and pain on the first postoperative day, neither was there any difference in relation to emotional state. However, there was a significant difference in terms of acceptance of the procedure; 100% said they would accept the procedure again in the local anesthesia group, compared with 60.5% in the spinal anesthesia group; also, 100% in the local anesthesia group said they felt encouraged by the type of anesthesia, compared with 67.7% in the spinal anesthesia group. We can conclude that local anesthesia is similar to spinal anesthesia in almost all the aspects investigated, except in terms of acceptance and patients’ level of satisfaction with the procedure. Local anesthesia can be a good alternative to spinal anesthesia, especially in outpatient departments, or when patients have restrictions to traditional models of anesthesia.

Background Bisphosphonates have become the treatment of choice for a variety of bone diseases in which excessive osteoclastic activity is an important pathologic feature. However, inhibition of osteoclastic activity could lead to inhibition of remodeling during bone healing or repair. The objective of this study is to investigate the effect of zoledronate (the most potent bisphosphonate) in the biological process of bone healing. Methods Thirty immature male rabbits were divided into two groups (control and experimental) of 15 animals each. Both groups were submitted to fibular osteotomy. Only in the experimental group a single dose of zoledronate was administered. After 1, 2, and 4 weeks, animals of both groups were euthanized and the osteotomy site was histomorphometrically evaluated. The associated parameters analyzed were tissue volume (TV), fractional trabecular bone volume (BV/TV), fractional woven bone volume (WoV/TV), fractional periosteal fibrous volume (FbV/TV), and medullary fibrous volume (MaV/TV). Results The first week of healing was characterized by small callus area (experimental group) and less periosteal fibrosis. The second week was characterized by a large quantity of woven bone and marked decrease in periosteal fibrosis in the two groups. In the control group there was also a significant increase in trabecular bone. The fourth week was characterized by increased amount of woven bone and trabecular bone in the experimental group; there was increased medullary fibrosis in the two groups, while there continued to be significantly less periosteal fibrosis in the experimental group. Conclusions Zoledronate does not prevent bone healing. However, the effect of zoledronate was characterized by accentuated stimulation of primary bone production and probably inhibition of remodeling, leading to retention of trabecular bone.

Obstructive Sleep Apnea Syndrome (OSAS) is defined as recurrent episodes of complete or partial obstruction of the upper airway during sleep. The airflow can be reduced or completely stopped despite of inspiratory effort, resulting in intermittent episodes of hypoxemia and hypercapnia. OSAS may be a factor in the worsening of nocturnal hypoxemia, of the underlying disease, leading to acute chest syndrome. The aim of this work was to review data on the pathophysiology of OSAS in children and adolescents with sickle cell anemia. We revisited articles published over the last ten years linked to the Medline and Lilacs databases, as well as cross-referencing using these articles. The following keywords were used: sleep apnea, obstructive sleep apnea, sickle cell anemia, sickle cell disease. Studies suggest that OSAS may increase clinical complications, such as painful crises, delayed growth, cognitive and intelligence disorders, nocturnal arterial desaturation and strokes in children with sickle cell anemia. Studies suggest that OSAS may increase the clinical complications of children with sickle cell anemia. Rev. Bras. Hematol. Hemoter.

OBJETIVOS: Determinar a prevalencia da hipertrofia adenotonsilar obstrutiva em criancas e adolescentes portadores de anemia falciforme; investigar possivel associacao entre presenca de mais de cinco episodios de tonsilite nos ultimos 12 meses e episodios de crise algica no mesmo periodo; e comparar a hemoglobina anual media entre os que apresentam e os que nao apresentam hipertrofia adenotonsilar obstrutiva. METODOS: Trata-se de estudo prospectivo, observacional do tipo corte transversal, com 85 criancas e adolescentes com anemia falciforme. Todos responderam questionario e avaliacao otorrinolaringologica, incluindo endoscopia nasossinusal. Para o diagnostico da hipertrofia adenotonsilar obstrutiva foram adotados os criterios de Brodsky. RESULTADOS: A prevalencia da hipertrofia adenotonsilar obstrutiva foi de 55,3%. A hipertrofia adenotonsilar obstrutiva associou-se a historia de dificuldade para alimentar-se (76,7 versus 23,5%; p = 0,003), presenca de mais de cinco episodios de tonsilites nos ultimos 12 meses (70,6 versus 29,4%; p = 0,021), roncar alto (73,0 versus 27,0%; p = 0,004) e apneia do sono assistida (71,8 versus 28,2%; p = 0,005). Portadores de hipertrofia adenotonsilar obstrutiva apresentaram maior numero de infeccoes das vias aereas superiores (62,5 versus 37,5; p = 0,010). Tambem foi observada associacao entre presenca de mais de cinco episodios de tonsilite nos ultimos 12 meses e episodios de crise algica no mesmo periodo (mediana = 12 versus 2; p = 0,017). Nao houve diferenca significante da hemoglobina anual media entre portadores de hipertrofia adenotonsilar obstrutiva versus hipertrofia adenotonsilar nao-obstrutiva (7,6 versus 8,2 g/dL; p = 0,199). CONCLUSAO: A prevalencia da hipertrofia adenotonsilar obstrutiva foi de 55,3% em criancas e adolescentes com anemia falciforme. A presenca de mais de cinco episodios de tonsilite nos ultimos 12 meses associaram-se com episodios de crise algica no mesmo periodo; e nao houve diferenca quanto ao valor da hemoglobina anual media entre os que apresentaram e os que nao apresentaram hipertrofia adenotonsilar obstrutiva.