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Objectives: This study compares Endovenous Laser Ablation (EVLA) alone versus combined with ultrasound-guided foam sclerotherapy (UGFS) for Great Saphenous Vein (GSV) insufficiency. Methods: Sixty patients were randomly allocated to EVLA or EVLA-UGFS groups which focused on GSV occlusion rates, complications, additional treatments, and quality of life (QoL) changes. Results: Among 55 participants, the EVLA group had higher 12-month occlusion rates (92.3% vs. 75.8%, p = 0.11). Nervous injury (NI) was rarer in EVLA-UGFS (3.4% vs. 23.1%, p = 0.04). No significant difference in other complication rates ( p > 0.05). QoL improved in both groups ( p < 0.001). EVLA-UGFS required more subsequent procedures (24.1% vs. 7.7%, p = 0.03). Conclusions: EVLA and EVLA-UGFS effectively treat GSV insufficiency, enhancing QoL. The combined method reduces NI risk but may require more follow-up procedures., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Latarjet surgery has emerged as a prevalent option for managing anterior glenohumeral instability. Despite its efficacy, concerns persist regarding the development of postoperative osteoarthritis (OA), a significant complication. Understanding arthritis pathogenesis in patients undergoing this procedure proves challenging, as OA can manifest even in cases without surgical repair. Additionally, studies suggest correlation between inadequate surgical technique and the occurrence of postoperative arthritis. Traditional radiographic imaging may also underestimate the identification of early OA. Therefore, the objective of this study aimed to analyze the risk factors associated with glenohumeral arthritis before and after the Latarjet procedure, with a minimum follow-up of five years, using computed tomography imaging (CT)., Methods: This retrospective study involved patients who underwent the Latarjet procedure between 2012 and 2017. Inclusion criteria were availability of preoperative and at least 5 years postoperative CT and physical examinations. The primary outcome studied was the presence of glenohumeral OA, classified preoperatively and postoperatively using CT scans. Risk factors for progression to pre and postoperative OA were assessed, including etiology, age at the initial injury, number of dislocation episodes before surgery, time interval from the initial injury to surgical stabilization, size of glenoid defect, position and presence of graft resorption, and screw position., Results: Fifty joints of 45 patients were included in the final analysis. The presence of preoperative OA was found in 21 of 50 cases (42%). The risk of osteoarthritis (OA) was significantly associated with both shoulder dislocation following a seizure disorder and a larger glenoid size defect (p < 0.05). Of the 29 shoulders without preoperative arthritis, 8 developed arthritis postoperatively (27.5%). Of those 21 cases with preoperative osteoarthritis, progression occurred in 11 cases (52.3%) (p=0.25). When considering all cases with OA progression, significant risk factors were the presence of intraarticular screws and when both screws had angulation above 15 o (p<0.06). When considering those patients with progression of OA above 2 grades, significant risk factors were lateral graft position, screw angulation and the presence of intraarticular screws., Conclusion: Our study reveals a higher incidence of osteoarthritis than reported in the literature, likely attributed to the imaging method employed. Preoperatively, risk factors for the presence of OA included cases resulting from seizure disorders and larger glenoid bone defects. Postoperatively, the only factors related to the progression of osteoarthritis were those associated with potential surgical technique issues., (Copyright © 2024. Published by Elsevier Inc.)

Background: The learning-curve cumulative sum method (LC-CUSUM) and its risk-adjusted form (RA-LC-CUSUM) have been proposed as performance-monitoring methods to assess competency during the learning phase of procedural skills. However, scarce data exist about the method's accuracy. This study aimed to compare the accuracy of LC-CUSUM forms using historical data consisting of sequences of successes and failures in brachial plexus blocks (BPBs) performed by anesthesia residents., Methods: Using historical data from 1713 BPB performed by 32 anesthesia residents, individual learning curves were constructed using the LC-CUSUM and RA-LC-CUSUM methods. A multilevel logistic regression model predicted the procedure-specific risk of failure incorporated in the RA-LC-CUSUM calculations. Competency was defined as a maximum 15% cumulative failure rate and was used as the reference for determining the accuracy of both methods., Results: According to the LC-CUSUM method, 22 residents (84.61%) attained competency after a median of 18.5 blocks (interquartile range [IQR], 14-23), while the RA-LC-CUSUM assigned competency to 20 residents (76.92%) after a median of 17.5 blocks (IQR, 14-25, P = .001). The median failure rate at reaching competency was 6.5% (4%-9.75%) under the LC-CUSUM and 6.5% (4%-9%) for the RA-LC-CUSUM method ( P = .37). The sensitivity of the LC-CUSUM (85%; 95% confidence interval [CI], 71%-98%) was similar to the RA-LC-CUSUM method (77%; 95% CI, 61%-93%; P = .15). Identical specificity values were found for both methods (67%; 95% CI, 29%-100%, P = 1)., Conclusions: The LC-CUSUM and RA-LC-CUSUM methods were associated with substantial false-positive and false-negative rates. Also, small lower limits for the 95% CIs around the accuracy measures were observed, indicating that the methods may be inaccurate for high-stakes decisions about resident competency at BPBs., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 International Anesthesia Research Society.)

Introduction: This study aimed to assess the learning curves of peribulbar anesthesia and estimate the number of blocks needed to attain proficiency., Methods: Anonymized records of sequential peribulbar blocks performed by first-year anesthesia residents were analyzed. The block sequential number and the outcomes were extracted from each record. Success was defined as a complete sensory and motor block of the eye, and failure was defined as an incomplete block requiring supplemental local anesthetic injections or general anesthesia. Learning curves using the LC-CUSUM method were constructed, aiming for acceptable and unacceptable failure rates of 10% and 20%, and 10% probability of type I and II errors. Simulations were used to determine the proficiency limit h 0 . Residents whose curves reached h 0 were considered proficient. The Sequential Probability Ratio Test Cumulative Sum Method (SPRT-CUSUM) was used for follow-up., Results: Thirty-nine residents performed 2076 blocks (median = 52 blocks per resident; Interquartile Range (IQR) [range] = 27-78 [4-132]). Thirty residents (77%) achieved proficiency after a median of 13 blocks (13-24 [13-24])., Conclusions: The LC-CUSUM is a robust method for detecting resident proficiency at peribulbar anesthesia, defined as success rates exceeding 90%. Accordingly, 13 to 24 supervised double-injection peribulbar blocks are needed to attain competence at peribulbar anesthesia., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2023 Sociedade Brasileira de Anestesiologia. Published by Elsevier España S.L.U. All rights reserved.)

Purpose: Conflicting evidence exists on the choice of surgical or non-surgical treatment of flail chest injuries. We aimed to perform a meta-analysis comparing outcomes in patients presenting flail chest undergoing surgical or non-surgical treatment., Methods: Embase, PubMed, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing surgery to no surgery in patients with acute unstable chest wall injuries. We computed weighted mean differences (WMDs) for continuous outcomes and risk ratios (RRs) for binary endpoints, with 95% confidence intervals (CIs). Random effects meta-analyses were performed. Heterogeneity was assessed using I 2 statistics., Results: Six RCTs (544 patients) were included, and surgical treatment was used in 269 (49.4%). Compared to no surgery, surgery reduced mechanical ventilation days (WMD - 4.34, 95% CI - 6.98, - 1.69; p < 0.01; I 2  = 87%; GRADE: very low; PI - 13.51, 4.84); length of intensive care unit stay (WMD - 4.62, 95% CI - 7.19, - 2.05; p < 0.01; I 2  = 78%; GRADE: low; PI - 12.86, 3.61) and the incidence of pneumonia (RR 0.50, 95% CI 0.31, 0.81; p = 0.005; I 2  = 54%; GRADE: moderate; PI 0.13, 1.91). No difference in mortality (RR 0.56, 95% CI 0.19, 1.65; p = 0.27; I 2  = 23%; GRADE: moderate; PI 0.04, 7.25), length of hospital stay (WMD - 5.39, 95% CI - 11.38, - 0.60; p = 0.08; I 2  = 89%; GRADE: very low; PI - 11.38, 0.60), or need for tracheostomy (RR 0.59, 95% CI 0.34, 1.03; p = 0.06; I 2  = 54%; GRADE: moderate; PI 0.11, 3.24) was found., Conclusions: Our results suggest that surgical treatment is advantageous compared to non-surgical treatment for patients with flail chest secondary to rib fractures., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Background: This study evaluated the efficacy of epidurally administered magnesium associated with local anesthetics on postoperative pain control., Methods: The study protocol was registered in PROSPERO as CRD42021231910. Literature searches were conducted on Medline, Cochrane, EMBASE, CENTRAL, and Web of Science for randomized controlled trials comparing epidural administration of magnesium added to local anesthetics for postoperative pain in elective surgical adult patients. Primary outcomes were the time to the first Postoperative (PO) Analgesic Request (TFAR), 24-hour postoperative opioid consumption, and Visual Analog Scale (VAS) scores at the first six and 24 postoperative hours. Secondary outcomes included Postoperative Nausea and Vomiting (PONV), pruritus, and shivering. Quality of evidence was assessed using GRADE criteria., Results: Seventeen studies comparing epidural were included. Effect estimates are described as weighted Mean Differences (MD) and 95% Confidence Intervals (95% CI) for the main outcomes: TFAR (MD = 72.4 min; 95% CI = 10.22-134.58 min; p < 0.001; I 2  = 99.8%; GRADE: very low); opioid consumption (MD = -7.2 mg (95% CI = -9.30 - -5.09; p < 0.001; I 2  = 98%; GRADE: very low). VAS pain scores within the first six PO hours (VAS) (MD = -1.01 cm; 95% CI = -1.40-0.64 cm; p < 0.001; I 2  = 88%; GRADE: very low), at 24 hours (MD = -0.56 cm; 95% CI = -1.14-0.01 cm; p = 0.05; I 2  = 97%; GRADE: very low)., Conclusions: Magnesium sulfate delayed TFAR and decreased 24-hour opioid consumption and early postoperative pain intensity. However, imprecision and inconsistency pervaded meta-analyses, causing very low certainty of effect estimates., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2022 Sociedade Brasileira de Anestesiologia. Published by Elsevier España, S.L.U. All rights reserved.)

Background: To evaluate the effect of duloxetine when added to a multimodal analgesia regimen on posthemorrhoidectomy pain, opioid consumption, and side effects., Methods: Prospective, randomized, double-blind placebo-controlled trial. This study included 62 patients who underwent hemorrhoidectomy. The patients were randomly assigned to receive oral duloxetine 60 mg or placebo 2 h before and 24 h after surgery. The primary outcomes were pain intensity - measured on an 11-point visual analog pain scale - and cumulative morphine consumption at 12, 24, and 48 postoperative hours., Results: Fifty-two patients completed the study (25 in the duloxetine group and 27 in the placebo group). Pain scores did not differ between duloxetine and placebo: 4.5; 3.0 - 7.0 vs. 5.0; 3.5 - 7.0, p = 0.68 at 12 h, 3.0; 2.0 - 5.0 vs. 3.0; 2.0 - 5.0, p = 0.56 at 24 h, and 2.5; 1.75 - 3.75 vs. 1.5; 0.5 - 3, p = 0.08 at 48 h. Further, cumulative morphine consumption did not differ between the duloxetine and placebo groups: 4; 1.25 - 10.75 mg vs. 7; 1.0 - 12.0 mg, p = 0.68 at 12 h, 9.5; 2.0 - 17.5 mg vs. 8.0; 4.0 - 18.0 mg; p = 0.80 at 24 h, and 11.0; 2.0 - 27.0 mg vs. 10; 4.0 - 24.0 mg, p = 0.78 at 48 h. Side effects did not differ between the groups., Conclusions: Compared with placebo, duloxetine did not decrease pain intensity or morphine consumption during the first 48 h postoperatively., Trial Registration: The study was retrospectively registered on the Brazilian Clinical Trials Registry (identifier: RBR-9pdgms, registration date: 08/10/2020)., (© 2022. The Author(s).)

Study Objective: To test the hypothesis that duloxetine reduces postoperative morphine consumption and pain intensity in patients undergoing major colonic surgeries., Design: Single-center, prospective, double-blinded, randomized, controlled trial., Setting: Tertiary university hospital, from December 2019 to September 2021., Patients: Sixty 18-85 years old, ASA I - III patients undergoing elective open major colonic surgeries were randomly allocated into duloxetine (duloxetine) or placebo (placebo) groups (n = 30 per group)., Interventions: Duloxetine 60 mg or placebo was administered orally 2 h before and 24 h after surgery., Measurements: PCA morphine consumption, surgical pain at rest, and movement measured on 10-cm visual analog scales (VAS), Ramsay sedation scores, and the incidence of adverse effects potentially associated with duloxetine were assessed at patients' admission to the post-anesthesia care unit (PACU), 6, 24, and 48 h postoperatively (PO)., Main Results: After adjusting for age, BMI, ASA physical status, education level, and incision type, no differences were found between groups in PCA morphine consumption 24 PO h (duloxetine = 5.44 ± 2.06 mg; placebo = 10.33 ± 2.06 mg, p = 0.62) or 48 h PO (duloxetine = 9.18 ± 2.06 mg, placebo = 12.93 ± 2.06, p = 1). Pain at rest also did not differ between groups at 24 h PO (duloxetine = 1.76 ± 0.67 cm; placebo = 1 ± 0.67 cm, p = 1) or at 48 h PO (duloxetine = 0.84 ± 0.67 cm; placebo = 0.49 ± 0.67 cm, p = 1). Similarly, groups did not differ regarding pain on movement at 24 h PO (duloxetine = 2.09 ± 0.68 cm; placebo = 1.80 ± 0.68, p = 1) or at 48 h PO (duloxetine = 1.16 ± 0.68 cm; placebo = 0.88 ± 0.68 cm, p = 1). Sedation scores and adverse effects also did not differ between groups., Conclusion: Under this study's conditions, short-term duloxetine did not reduce total opioid consumption or pain intensity during the initial 48 h following major colon surgery., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Cognitive aids have been shown to facilitate adherence to evidence-based guidelines and improve technical performance of teams when managing simulated critical events. Few studies have explored the effect of cognitive aids on non-technical skills, such as teamwork and communication. The current study sought to explore the effects of different decision support tools (DST), a type of cognitive aid, on the technical and non-technical performance of teams. The current study represents a randomized, blinded, control trial of the effects of three versions of an electronic DST on team performance during multiple simulations of perioperative emergencies. The DSTs included a version with only technical information, a version with only non-technical information and a version with both technical and non-technical information. The technical performance of teams was improved when they used the technical DST and the combined technical and non-technical DST when compared to memory alone. The technical performance of teams was significantly worse when using the non-technical DST. All three versions of the DST had a negligible effect on the non-technical performance of teams. The technical performance of teams in the current study was affected by different versions of a DST, yet there was no effect on the teams' non-technical performance. The use of a DST, including those that focused on non-technical information, did not impact the non-technical performance of the teams., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Traumatic rib fractures result in significant patient morbidity and mortality, which increases with patient age and number of rib fractures. A dedicated acute pain service (APS) providing expertize in multimodal pain management may reduce these risks and improve outcomes. We aimed to test the hypothesis that protocolized APS consultation decreases mortality and morbidity in traumatic rib fracture patients., Methods: This is a retrospective observational, propensity-matched cohort study of adult patients with trauma with rib fractures from 2012 to 2015, at a single, large level 1 trauma center corresponding to introduction and incorporation of APS consultation into the institutional rib fracture pathway. Using electronic medical records and trauma registry data, we identified adult patients presenting with traumatic rib fractures. Patients with hospital length of stay (LOS) ≥2 days were split into two cohorts based on presence of APS consult using 1:1 propensity matching of age, gender, comorbidities and injury severity. The primary outcome was difference in hospital mortality. Secondary outcomes included LOS and pulmonary morbidity., Results: 2486 patients were identified, with a final matched cohort of 621 patients receiving APS consult and 621 control patients. The mortality rate was 1.8% among consult patients and 6.6% among control patients (adjusted OR 0.25, 95% CI 0.13 to 0.50; p=0.001). The average treatment effect of consult on mortality was 4.8% (95% CI 1.2% to 8.5%;. p<0.001). APS consultation was associated with increased intensive care unit (ICU) LOS (1.19 day; 95% CI 0.48 to 1.90; p=0.001) and hospital LOS (1.61 days; 95% CI 0.81 to 2.41 days; p<0.001). No difference in pulmonary complications was observed., Discussion: An APS consult in rib fracture patients is associated with decreased mortality and no difference in pulmonary complications yet increased ICU and hospital LOS., Competing Interests: Competing interests: None declared., (© American Society of Regional Anesthesia & Pain Medicine 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective  To evaluate whether the parallelism of screws with glenoid in Latarjet surgery interferes in the positioning of the graft and to verify the reproducibility of a method of measuring screws positioning. Methods  Retrospective, multicenter study, of patients with anterior shoulder instability submitted to modified Latarjet surgery and at least one year of postoperative follow-up. Two radiologists analyzed the postoperative tomographic images, acquired in a database, to evaluate the positioning of screws and radiographic complications. Results  We evaluated 34 patients, aged between 21 and 60 years, one of them with bilateral shoulder involvement, totaling 35 shoulders evaluated. The tomographic evaluation of the inclination angles of the screws showed no difference between the observers. There was intra- and interobserver agreement to evaluate the following surgical parameters: graft position, presence or not of radiographic complications. Conclusion  The technique described for measuring the parallelism of screws in Latarjet surgery presented a very good and excellent intra-observer agreement, respectively. Screw parallelism with glenoid is recommended; however, it is not a mandatory and unique condition to avoid radiographic complications., Competing Interests: Conflito de Interesses Os autores não têm conflito de interesses a declarar., (Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Background: Locked posterior dislocation of the shoulder (LPDS) is a challenging condition for the orthopedic surgeon. The problem with cases of chronic LPDS is that they may result in worse clinical outcomes because the size of the reverse Hill-Sachs lesion and cartilage damage can increase over time. Multiple treatment strategies have been reported in the literature for the treatment of chronic cases. The purpose of this study was to report our experience with the modified McLaughlin technique for the treatment of chronic LPDS and evaluate the mid- and long-term functional outcomes., Methods: This was a retrospective single-center study including a consecutive series of 10 patients who underwent the modified McLaughlin procedure for the treatment of chronic LPDS. The time between dislocation and treatment ranged from 6 weeks to 14 months (mean, 20.9 weeks). Postoperative imaging and functional evaluation were performed with a minimum of 2 years' follow-up (range, 24-110 months). Functional outcomes were assessed by means of a visual analog scale score for pain and patient satisfaction regarding the operation, the Constant-Murley score, and the University of California, Los Angeles shoulder rating scale., Results: The mean follow-up period was 59.4 months (range, 24-110 months). Range of motion improved significantly after surgery: Mean forward flexion improved from 71° ± 5° to 126°± 37° (P < .001), mean external rotation improved from 7°± 7° to 52° ± 18° (P = .012), and mean internal rotation improved from gluteal region ± 1 vertebral level to L1 ± 4 vertebral levels (P = .001). Functional outcome measures demonstrated significant improvements: The mean Constant-Murley score improved from 22 ± 2.4 (range, 20-26) to 65 ± 21.5 (P < .001); the mean University of California, Los Angeles score improved from 9.8 ± 1.3 (range, 8-12) to 27 ± 9.7 (P < .001); and the mean visual analog scale score improved from 4.6 ± 0.8 (range, 3-6) to 2.4 ± 2.3 (P < .001). Of the patients, 8 (80%) were satisfied with the procedure. The 2 remaining cases had a delay from injury to diagnosis > 6 months and evolved with poor functional outcomes and severe glenohumeral degenerative joint disease. There were no cases of recurrent dislocation, infection, or neurologic injury during the follow-up., Conclusion: Our study findings demonstrated that the modified McLaughlin procedure showed good results over a 2-year minimum follow-up period. The clinical outcomes of this procedure are worse when there is a delay from injury to diagnosis > 6 months., (Copyright © 2021 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Objective  In the present study, we investigated the intra and interobserver agreement of the new Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification for fractures of the proximal extremity of the femur. Methods  One hundred hip radiographs were selected from patients who suffered fractures of the trochanteric region or femoral neck. Four orthopedists, fellowship trained hip surgeons, and four orthopedic residents evaluated and classified fractures according to the new AO/OTA system on two separate occasions. The kappa (k) coefficient was used to evaluate intra and interobserver agreement in the different steps of the classification, namely: type , group , subgroup , and qualifier. Results  Hip surgery experts obtained almost perfect intraobserver agreement of type , substantial for group and, only moderate, for subgroup and qualifiers. The residents had lower performance, with substantial agreement for type, moderate for group , and reasonable for subgroup and qualifier. In the specialists' interobserver evaluation, there was also a gradual decrease in the agreement between type (almost perfect) and group (moderate), which was even lower for subgroup and qualifiers. Residents had a substantial interobserver agreement for type , moderate for group , and reasonable in the other branches. Conclusion  The new AO/OTA classification for fractures of the trochanteric region and femoral neck showed intra and interobserver agreements considered appropriate for type and group , with a drop in the subsequent branches, that is, for subgroup and qualifier. Still, in relation to the old AO/OTA classification, there was an improvement in the agreements for subgroup., Competing Interests: Conflito de Interessses Os autores declaram não haver conflito de interesses., (Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Objective  The present study aimed to determine the average hip anthropometry of a regional Brazilian population using measurements based on computerized axial tomography (CAT). Methods  Retrospective, descriptive analysis of hip measurements from 200 abdominal CATs from patients visiting a medical center. The tests were selected at random to determine 30 previously defined anthropometric measurements. The data were statistically analyzed and compared according to gender and age. Results  The prevalence of hip dysplasia was 6%. Signs suggesting femoroacetabular impingement were seen in 26% of cases. Patients over 50 years old presented significantly greater measures of horizontal acetabulum sectors, center-edge angle, and acetabular arch, as well as lower extrusion index, cervical-diaphyseal angle and vertical offset. Some measurements were significantly different according to gender: the lateral center-edge angle (µ = 35.5°) and the acetabular arch (µ = 68.7°) were higher in females. Males presented increased extrusion index (µ = 16%), lateral offset (µ = 38.3 mm), depth (µ = 19.5 mm), and neck diameter (µ = 26.4 mm). Conclusion  The present study characterized the hip anthropometry of a regional Brazilian population. It also demonstrated significant morphological differences per age group and gender., Competing Interests: Conflito de Interesses Os autores declaram não haver conflito de interesses., (Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Introduction: Many neuropsychiatric and neurodegenerative disorders produce Theory of Mind impairment. We aimed to implement a Brazilian Portuguese version of the Faux Pas Recognition Test (FPRT) and evaluate its psychometric properties. Methods: We first completed an English-Brazilian Portuguese translation and adaptation to obtain an FPRT Brazilian Portuguese version. We performed a multicentric study with 153 healthy participants (68.6% women), mean age of 38.8 years (SD = 14.6) and 12.9 years of schooling (SD = 4.5). Linear regression analysis was performed to evaluate the association of social class, age, schooling, and FPRT scores. The psychometric analyses comprised item analysis, exploratory factor analysis, reliability, and validity analysis. Results: Normative data in a Brazilian population is presented. A positive correlation of scores with years of schooling, social class, and an inverse relation with age was found. The exploratory factorial analysis found a two-component structure, one component, consisting of questions 1 through 6 ( Eigenvalue 5.325) and another component, consisting of questions 7 and 8 ( Eigenvalue 1.09). Cronbach's alpha of the 20 stories was .72. All control stories had a poor discriminative index. Conclusion: The FPRT Brazilian Portuguese version demonstrated good internal consistency and, psychometric properties and is adequate for use even in lower educational contexts in Brazil.

Introduction: The pediatric perioperative setting is a dynamic clinical environment where multidisciplinary interprofessional teams interact to deliver complex care to patients. This environment requires clinical teams to possess high levels of complex technical and nontechnical skills. For perioperative teams to identify and maintain clinical competency, well-developed and easy-to-use measures of competency are needed., Methods: Tools for measuring the technical and nontechnical performance of perioperative teams were developed and/or identified, and a group of raters were trained to use the instruments. The trained raters used the tools to assess pediatric teams managing simulated emergencies. A psychometric analysis of the trained raters' scores using the different instruments was performed and the agreement between the trained raters' scores and a reference score was determined., Results: Five raters were trained and scored 96 recordings of perioperative teams managing simulated emergencies. Scores from both technical skills assessment tools demonstrated significant reliability within and between ratings with the scenario-specific performance checklist tool demonstrating greater interrater agreement than scores from the global rating scale. Scores from both technical skills assessment tools correlated well with the other and with the reference standard scores. Scores from the Team Emergency Assessment Measure nontechnical assessment tool were more reliable within and between raters and correlated better with the reference standard than scores from the BARS tool., Conclusions: The clinicians trained in this study were able to use the technical performance assessment tools with reliable results that correlated well with reference scores. There was more variability between the raters' scores and less correlation with the reference standard when the raters used the nontechnical assessment tools. The global rating scale used in this study was able to measure the performance of teams across a variety of scenarios and may be generalizable for assessing teams in other clinical scenarios. The Team Emergency Assessment Measure tool demonstrated reliable measures when used to assess interprofessional perioperative teams in this study., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Society for Simulation in Healthcare.)

Background: Duloxetine administered during the acute perioperative period has been associated with lesser postoperative pain and analgesic consumption., Study Objectives: The study aimed to quantify the pooled effects of duloxetine on postoperative pain, analgesic consumption, and side-effects in the first 48 postoperative (PO) hours., Design: Systematic review with meta-analysis., Setting: Postoperative pain management., Patients: Adult patients undergoing elective surgery. Search strategy and study selection. Medline, Cochrane, EMBASE, CENTRAL, and Web of Science were searched without language restrictions for prospective, parallel randomized controlled trials comparing duloxetine to placebo for the management of postoperative pain in adult patients., Measurements: Pain scores (11-point scales), opioid consumption (i.v. morphine equivalents), and frequency of side-effects were compared between duloxetine and placebo. Effect sizes were summarized as mean differences (MD), standardized mean differences (SMD) or risk ratios (RR) with the respective 95% confidence intervals (95% CI). Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria were used to classify the quality of evidence., Results: Thirteen studies were included. Duloxetine decreased pain at 24 h (MD = -0.66 points; 95% CI = -1.14 to -0.19 points; SMD = -0.59; 95% CI = -1.06 to -0.12; p = 0.01; I2 = 88%), and at 48 PO hours (MD = -0.90 points; 95% CI = -1.54 to -0.26 points; SMD = -0.66; 95% CI = -0.94 to -0.38; p = 0.01; I2 = 93%); and opioid consumption at 24 PO hours (MD = -8.21 mg; 95% CI = -13.32 mg to -3.10 mg; SMD = -2.17; 95% CI = -3.10 to -1.24; p < 0.001; I2 = 95%), and at 48 PO hours (MD = 7.71 mg; 95% CI = -13.86 mg to -1.56 mg; SMD = -2.13; 95% CI = -3.51 to -0.75; p = 0.02; I2 = 97%). Duloxetine did not affect the prevalence of postoperative nausea and/or vomiting (PONV) pruritus, headache or dizziness. High inter-study heterogeneity and within-study bias resulted in very-low quality of evidence for the primary outcomes., Conclusions: Although statistically significant effects of duloxetine were found on postoperative pain and opioid consumption during the first 48 postoperative hours, the effect sizes were below the expected minimal clinically relevant differences. Also, high risk-of-bias and inter-study heterogeneity caused the very-low quality of evidence (GRADE). We conclude that the currently available evidence does not support the clinical use of duloxetine for the management of acute postoperative pain., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020. Published by Elsevier Inc.)

Case: We report the case of a patient who suffered traumatic avulsion of the gluteus medius and minimus tendons associated with posterior fracture-dislocation of the femoral head. The patient was treated with open reduction and internal fixation, followed by gluteus tenodesis with intraosseous anchors., Conclusion: Although in isolation, gluteus medius or gluteus minimus tendons tear, hip dislocation, and head fractures are relatively common injuries; the concurrence of these lesions is noteworthy for its rarity. This patient had an uneventful postoperative evolution, with a complete functional recovery, healing of the femoral head fracture and the tendons, and absence of signs of avascular necrosis.

Expeditions to unexplored or little explored places are important for discovering new species and also for collecting new samples (including specimens and tissues for DNA sequencing ) that may help resolve a plethora of taxonomic problems. In the 19th century, several naturalists explored a number of localities in Amazonia, describing species for which type material was deposited, mostly, in European museums of natural history. Some of these types were lost or destroyed in World War II and recent expeditions have focused on sampling new material from the type localities. material from Boana cinerascens, which allowed us to infer phylogenetic relationships of the Boana punctata group (i.e., green Boana), based on DNA sequence data, and to revaluate the status of B. cinerascens and its synonyms. We designate, redescribe and illustrate a neotype for B. cinerascens, which was described by Spix in 1824, from the Municipality of Tefé, State of Amazonas, Brazil. We revalidate, redescribe, and illustrate Hyla granosa gracilis Melin, 1941(= Boana gracilis). Corroborating previous studies, the green Boana were not recovered as a monophyletic group. Boana cinerascens is sister of B. gracilis plus a clade containing B. atlantica + B. punctata (both species not recovered as monophyletic).

Objective  To determine if the dimensions of selected national and imported implants used in total hip arthroplasty surgeries are adequate regarding the anthropometric profile of the Brazilian population. Methods  A retrospective study of patients submitted to primary total hip arthroplasty. Patients with femoral or acetabular morphological deformities that could influence the choice of implant size, including dysplasia and previous fractures, were excluded from the study. Two national implants and six imported implants were included in the study. Every patient was treated by the same group, with one of the four senior authors or under their strict supervision, following the same surgical technique. The data were analyzed regarding gender, age, fixation type and implant model. Results  The analysis of 682 hips submitted to total hip arthroplasty demonstrated that 2 models of cemented femoral stems and 1 of non-cemented stem did not seem to be perfectly adequate for the femoral morphology of the studied population, since these 3 implants were mostly used in the smallest size available, resulting in a non-Gaussian curve. The mean diameter of the native acetabulum was 54 mm in men and 52 mm in women. Conclusion  Out of the eight models studied, five were deemed adequate for the studied population. The other three models available in our market (two national models and one imported model) apparently require more appropriate sizing. We emphasize that anthropometric studies of the Brazilian hip are necessary to give scientific subsidies to the ideal implant design for our market.

Background: Prostate cancer and benign prostatic hyperplasia have an increased incidence with aging. The most effective treatments are radical prostatectomy and transurethral resection of the prostate. To reduce perioperative bleeding in these surgeries, an approach is the use of tranexamic acid (TXA). Studies show that TXA is effective in reducing the blood loss and the need for transfusion in cardiac, orthopedic, and gynecological surgeries. In prostate surgeries, its efficacy and safety have not been established yet., Study Objective: To determine whether there are differences between TXA versus placebo in terms of intraoperative blood loss, transfusion requirements, hemoglobin levels and the incidence of thromboembolic events., Design: Systematic review with meta-analyses., Setting: Anesthesia for prostate surgery., Patients: We searched the Medline, Cochrane, EBSCO, and Web of Science databases up to 2017 for randomized controlled trials that compared TXA administration with a control group in patients who submitted to prostate surgery., Measurements: The primary outcomes were the intraoperative blood loss and transfusion rate. Data on hemoglobin levels and the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) were also collected., Results: Nine comparative studies were included in the meta-analyses. The estimated blood loss and transfusion rate were lower in patients receiving TXA, with a standardized mean difference of -1.93 (95% CI = -2.81 to -1.05, I 2  = 96%), and a risk ratio of 0.61 (95% CI = 0.47 to 0.80, I 2  = 0%), respectively. The hemoglobin levels and the incidence of DVT and PE did not differ between the groups., Conclusions: TXA reduced intraoperative blood loss and the need for transfusion, without increasing the risk of DVT and PE in prostate surgeries. Due to the limited number of studies and the high heterogeneity of the results, more clinical trials with a large number of patients are necessary to confirm these findings., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Proficiency in needle-to-ultrasound beam alignment and accurate approach to structures are pivotal for ultrasound-guided regional anesthesia. This study evaluated the effects of high-frequency, structured expert feedback on simulation training of such abilities., Methods: Forty-two subjects randomly allocated as controls or intervention participated in two 25-trial experiments. Experiment 1 consisted of inserting a needle into a bovine muscular phantom parallel to the ultrasound beam while maintaining full imaging of the needle. In experiment 2, the needle aimed to contact a target inside the phantom. Intervention subjects received structured feedback between trials. Controls received a global critique after completing the trials. The slopes of the learning curves derived from the sequences of successes and failures were compared. Change-point analyses identified the start and the end of learning in trial sequences. The number of trials associated with learning, the number of technical errors, and the duration of training sessions were compared between intervention and controls., Results: In experiment 1, learning curves departed from 73% (controls) and 76% (intervention) success rates; slopes (standard error) were 0.79% (0.02%) and 0.71% (0.04), respectively, with mean absolute difference of 0.18% (95% confidence interval [CI], 0.17%-0.19%; P = 0). Intervention subjects' learning curves were shorter and steeper than those of controls. In experiment 2, the learning curves departed from 43% (controls) and 80% (intervention) success rates; slopes (standard error) were 1.06% (0.02%) and 0.42% (0.03%), respectively, with a mean difference of 0.65% (95% CI, 0.64%-0.66%; P = 0). Feedback was associated with a greater number of trials associated with learning in both experiment 1 (mean difference, 1.55 trials; 95% CI, 0.15-3 trials; P = 0) and experiment 2 (mean difference, 4.25 trials; 95% CI, 1.47-7.03 trials; P = 0) and a lower number of technical errors per trial in experiments 1 (mean difference, 0.19; 95% CI, 0.07-0.30; P = .02) and 2 (mean difference, 0.58; 95% CI, 0.45-0.70; P = 0), but longer training sessions in both experiments 1 (mean difference, 9.2 minutes; 95% CI, 4.15-14.24 minutes; P = .01) and 2 (mean difference, 7.4 minutes; 95% CI, 1.17-13.59 minutes; P = .02)., Conclusions: High-frequency, structured expert feedback compared favorably to self-directed learning, being associated with shorter learning curves, smaller number of technical errors, and longer duration of in-training improvement, but increased duration of the training sessions.

Background: Assessment of clinical competence is essential for residency programs and should be guided by valid, reliable measurements. We implemented Baker's Z-score system, which produces measures of traditional core competency assessments and clinical performance summative scores. Our goal was to validate use of summative scores and estimate the number of evaluations needed for reliable measures., Methods: We performed generalizability studies to estimate the variance components of raw and Z-transformed absolute and peer-relative scores and decision studies to estimate the evaluations needed to produce at least 90% reliable measures for classification and for high-stakes decisions. A subset of evaluations was selected representing residents who were evaluated frequently by faculty who provided the majority of evaluations. Variance components were estimated using ANOVA., Results: Principal component extraction from 8,754 complete evaluations demonstrated that a single factor explained 91 and 85% of variance for absolute and peer-relative scores, respectively. In total, 1,200 evaluations were selected for generalizability and decision studies. The major variance component for all scores was resident interaction with measurement occasions. Variance due to the resident component was strongest with raw scores, where 30 evaluation occasions produced 90% reliable measurements with absolute scores and 58 for peer-relative scores. For Z-transformed scores, 57 evaluation occasions produced 90% reliable measurements with absolute scores and 55 for peer-relative scores. The results were similar for high-stakes decisions., Conclusions: The Baker system produced moderately reliable measures at our institution, suggesting that it may be generalizable to other training programs. Raw absolute scores required few assessment occasions to achieve 90% reliable measurements.

Background: Pneumoperitoneum during laparoscopic cholecystectomy (LC) can cause hypercapnia, hypoxemia, hemodynamic changes and shoulder pain. General anesthesia (GA) enables the control of intraoperative pain and ventilation. The need for GA has been questioned by studies suggesting that neuraxial anesthesia (NA) is adequate for LC., Study Objective: To quantify the prevalence of intraoperative pain and to verify whether evidence on the maintenance of ventilation, circulation and surgical anesthesia during NA compared with GA is consistent., Design: Systematic review with meta-analyses., Setting: Anesthesia for laparoscopic cholecystectomy., Patients: We searched Medline, Cochrane and EBSCO databases up to 2016 for randomized controlled trials that compared LC in the two groups under study, neuraxial (subarachnoid or epidural) and general anesthesia., Measurements: The primary outcome was the prevalence of intraoperative pain referred to the shoulder in the NA group. Hemodynamic and respiratory outcomes and adverse effects in both groups were also collected., Main Results: Eleven comparative studies were considered eligible. The pooled prevalence of shoulder pain was 25%. Intraoperative hypotension and bradycardia occurred more frequently in patients who received NA, with a risk ratio of 4.61 (95% confidence interval [CI] 1.70-12.48, p=0.003) and 6.67 (95% CI 2.02-21.96, p=0.002), respectively. Postoperative nausea and vomiting was more prevalent in patients who submitted to GA. The prevalence of postoperative urinary retention did not differ between the techniques. Postoperative headache was more prevalent in patients who received NA, while the postoperative pain intensity was lower in this group. Performing meta-analyses on hypertension, hypercapnia and hypoxemia was not possible., Conclusions: NA as sole anesthetic technique, although feasible for LC, was associated with intraoperative pain referred to the shoulder, required anesthetic conversion in 3.4% of the cases and did not demonstrate evidence of respiratory benefits for patients with normal pulmonary function., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Unlabelled: Describe the results of proximal humeral fractures surgically treated with the Philos locking plate system., Method: Between March 2003 and October 2004 we prospectively reviewed 24 of 26 patients with proximal humerus fractures treated with a Philos plate. The mean follow-up time was 12 months and the mean age of patients was 57 years. Six patients had four-part proximal humerus fractures, 11 patients had three-part proximal humerus fractures, and nine patients had two-part proximal humerus fractures. Clinical evaluation was performed using the University of California at Los Angeles (UCLA) criteria., Results: The mean UCLA score was 30 points (17-34). All fractures showed union. Three patients showed fracture union at varus position. The mean UCLA score for these patients was 27 points., Conclusion: Osteosynthesis with Philos plate provides a stable fixation method with good functional outcome.

Considering the productive potential of arabica coffee in the Rio de Janeiro State and the shortage of breeding programs for this species in the state, this study aimed to evaluate the vegetative and productive characteristics of 25 arabica coffee genotypes to indicate 1 or more varieties for the northwest Rio de Janeiro region. The experiment was in Varre e Sai, RJ, Brazil, and plants were planted in 2007 with a spacing of 2.5 x 0.8 m. Five plots were used, consisting of 8 plants per plot to measure vegetative growth, height, stem diameter, and plagiotropic branch number characteristics and productivity in the biennia 2009/2010 and 2011/2012. The classification by sieve was performed at harvest in 2011. The variables were subjected to analysis of variance and means grouped by the Scott Knott test at 5% probability, and the productivity was subjected to joint analysis of variance. Pearson's correlation coefficients between growth and productivity variables were estimated. The best genotypes were Catucaí Amarelo 2 SL, Catiguá MG 02, Acauã, Palma II, Sabiá 398, IPR 103, IPR 100, Catucaí Amarelo 24/137, and Catucaí Amarelo 20/15.

Purposes: (a) To externally validate the Crippa and colleagues' nomograms combining PSA, percentage of positive biopsy cores (PPBC) and biopsy Gleason score to predict organ-confined disease (OCD) in a contemporary sample of patients treated at a tertiary teaching institution. (b) To adjust such variables, resulting in predictive nomograms for OCD and seminal vesicle invasion (SVI): the USP nomograms., Materials and Methods: The accuracy of Crippa and colleagues' nomograms for OCD prediction was examined in 1002 men submitted to radical prostatectomy between 2005 and 2010 at the University of São Paulo (USP). ROC-derived area under the curve (AUC) and Brier scores were used to assess the discriminant properties of nomograms for OCD. Nomograms performance was explored graphically with LOESS smoothing plots. Furthermore, univariate analysis and logistic regression models targeted OCD and SVI. Variables consisted of PSA, PPBC, biopsy Gleason score and clinical stage. The resulted predictive nomograms for OCD and SVI were internally validated with bootstrapping and the same abovementioned procedures., Results: Crippa and colleagues' nomograms for OCD showed ROC AUC = 0.68 (CI: 0.65-0.70), Brier score = 0.17 and overestimation in LOESS plots. USP nomograms for OCDand SVI showed ROC AUC of 0.73 (CI: 0.70-0.76) and 0.77 (CI: 0.73-0.79), respectively, and Brier scores of 0.16 and 0.08, respectively. The LOESS plots showed excellent calibration for OCD and underestimation for SVI., Conclusions: Crippa and colleagues' nomograms showed moderate discrimination and considerable OCD overestimation. USP nomograms showed good discrimination for OCD and SVI, as well as excellent calibration for OCD and SVI underestimation.

Few data are available on the morphology of the hemipenis of teiid lizards, especially those of the recently-defined genus Tupinambis, a widely-distributed group of large-bodied lizards. This study provides an illustrated description of the hemipenis of Tupinambis quadrilineatus, which is similar to that of other representatives of the Tupinambinae subfamily. New records of the species from the state of Piauí, in northeastern Brazil, are also presented.

Background and Objective: Thoracotomy is a procedure associated with postoperative severe pain. Epidural block (EB) is considered the gold standard for its control. Paravertebral block (PVB) is an option for the management of postoperative pain. The aim of this study was to evaluate by meta-analyses the effectiveness of continuous thoracic epidural and paravertebral blocks for pain management after thoracotomy and the incidence of adverse effects., Method: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. We analyzed primary (postoperative pain at rest) and secondary outcomes (urinary retention, nausea, vomiting, hypotension). We estimated the weighted mean difference for continuous variables and odds ratios for categorical variables., Results: We included eight prospective, randomized, controlled studies. Meta-analysis showed no statistically significant differences between the two techniques regarding the outcomes of postoperative pain at rest at four, eight, 12, 16, 20, 24, 36, and 48 hours. Incidence of urinary retention was higher in EP group (OR = 7.19, CI95 = 1.87 to 27.7). The occurrence of hypotension was higher in PVB group (OR = 10.28, 95 = 2.95 to 35.77). There was no statistically significant difference between both groups regarding the outcome nausea/vomiting (OR = 3.00, CI95 = 0.49 to 18.45)., Conclusion: There were no statistically significant differences in pain relief after thoracotomy between EB and PVB. PVB showed a lower incidence of side effects with reduced frequency of urinary retention and hypotension., (Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.)

Biannuality in coffee culture causes temporal variability in plant productivity. Consequently, it is essential to evaluate genotypes during various crop years to ensure selection of productive and stable genotypes. We evaluated the effectiveness of simultaneous selection of coffee genotypes along harvests, based on productivity, stability, and adaptability, via mixed models, for indication of varieties suitable for Rio de Janeiro State. We evaluated 25 genotypes during 4 crop seasons (2009-2012), in a randomized block design with 5 replications. The ranking of genotypes was obtained on the basis of the adaptability and temporal stability methods (harmonic average of genetic values, relative performance of genetic values, and harmonic mean of the relative performance of the genetic values), obtained via restricted maximum likelihood/best linear unbiased procedure analysis. The selection accuracy (0.8717), associated with the high magnitude of mean heritability, indicate good reliability and prospects for success in the indication of agronomically superior genotypes. There was little variation in the ordering of genotypes among the environments, indicating low influence of harvests in the performance of the genotypes. Five of the 25 genotypes were superior and could be recommended for planting in the northwestern region of Rio de Janeiro State, due to high predicted productivity and stability. We recommend that these methodologies for evaluation of productivity, stability, and adaptability be included in the selection criteria for recommendation of genotypes for commercial plantings.

Objective: Evaluate the clinical and radiological results of hemiarthroplasty for treatment of complex proximal humerus fractures., Methods: Sixty-seven patients were included, with follow-up of 12 to 62 months. Mean age was 65 years (44 to 88), and 47 patients were female (70%). Clinical assessment was performed using the University of California Los Angeles score (UCLA) and measurement of range of motion (ROM) according to the American Academy of Orthopaedic Surgeons criteria. A standardized radiological evaluation was conducted, with special attention to healing and position of tuberosities. Patients were divided into two groups: A (anatomical healing of tuberosities) and B (without anatomical healing of tuberosities). Statistical analyses were performed using the t test. Level of significance was set at p < 0.05., Results: Considering the entire sample, the mean UCLA score was 26 points, with 8 points for pain and 64 patients subjectively satisfied (96%). The mean values for active ROM were 104° of forward flexion and 36° of external rotation. In group A, with 33 patients, we found a mean of 122° forward flexion and 29.5 points on UCLA. In group B the mean forward flexion were 87° and 22.7 points for UCLA. Comparing these parameters in the two groups, we found statistically significant differences for both forward flexion (p < 0.0001) and UCLA. (p < 0.0001)., Conclusion: We conclude that hemiarthroplasty for treatment of complex proximal humerus fractures has a low incidence of complications and a high subjective satisfaction rate, with favorable results related to pain. A good functional result is less predictable and depends on anatomical reestablishment of proximal humerus anatomy, particularly healing of the greater tuberosity.

Background: Cannabis sativa (marijuana) can interfere with bone physiopathology because of its effect on osteoblast and osteoclast activity. However, its impact on periodontal tissues is still controversial. The present study evaluates whether marijuana smoke affects bone loss (BL) on ligature-induced periodontitis in rats., Methods: Thirty male Wistar rats were used in the study. A ligature was placed around one of the mandible first molars (ligated teeth) of each animal, and they were then randomly assigned to one of two groups: control (n = 15) or marijuana smoke inhalation ([MSI] for 8 minutes per day; n = 15). Urine samples were obtained to detect the presence of tetrahydrocannabinol. After 30 days, the animals were sacrificed and decalcified sections of the furcation area were obtained and evaluated according to the following histometric parameters: bone area (BA), bone density (BD), and BL., Results: Tetrahydrocannabinol was positive in urine samples only for the rats of the MSI group. Non-significant differences were observed for unligated teeth from both groups regarding BL, BA, and BD (P >0.05). However, intragroup analysis showed that all ligated teeth presented BL and a lower BA and BD compared to unligated teeth (P <0.05). The intergroup evaluation of the ligated teeth showed that the MSI group presented higher BL and lower BD (P <0.05) compared to ligated teeth from the control group., Conclusion: Considering the limitations of this animal study, cannabis smoke may impact alveolar bone by increasing BL resulting from ligature-induced periodontitis.

Background and Objectives: A trend toward the lack of interest in academic careers has been observed in Medicine, including in the area of Anesthesiology. The objective of the present study was to research the interest of physicians specializing in Anesthesiology in following an academic career, as well as identify the determinant factors of this choice., Method: The present was a prospective and cross-sectional study. A simple probabilistic sample of physicians specializing in Anesthesiology was selected and a questionnaire was sent to each participant. The answers were submitted to uni and multivariate analyses to determine the frequency of academic predisposition in the sample and to determine the independent predictive factors of academic predisposition., Results: A total of 155 questionnaires were analyzed (rate of response = 38.7%). Sixty-nine participants (44.5%) manifested their interest in following an academic career. The multivariate analysis identified the following as independent predictive factors of academic predisposition: attending the first year of specialization (OR = 2.52; 95% CI = 1.19 - 5.38); presenting a scientific work at medical event (OR = 3.78; 95% CI = 1.84 - 7.78) and being located in the southeast region (OR = 2.66; 95% CI = 1.31 - 5.39)., Conclusions: A significant number of Brazilian physicians attending a specialization course demonstrated interest in following an academic career after the end of the course. In comparison with the probability of not manifesting academic predisposition, the physicians attending the first-year specialization course presented a 2.5-fold higher chance of manifesting interest in an academic career; those presenting a scientific work at a medical event had a 3.78-fold higher chance; those associated to Teaching Centers in the southeast region had a 2.66-fold higher chance of manifesting academic interest., (© 2010 Elsevier Editora Ltda. All rights reserved.)

Background and Objectives: Urinary retention is a common condition in the post-anesthetic care unit (PACU). Vesical overdistension and consequent damage of the detrusor muscle of the urinary bladder represent situations that can be prevented. The ultrasound allows the reliable measurement of the urinary volume, determining the prevalence of postoperative vesical distension. The objective of the present study was to determine the prevalence of postoperative urinary retention and identify independent predictive factors., Methods: Two-hundred and fifty-seven patients admitted to the PACU were included prospectively in this study. Parameters collected included: age, gender, physical status, site of surgery, type of anesthesia, time of the surgery and anesthesia, use of opioids, volume of fluids administered, and history of urinary symptoms. Vesical volumes were measured by ultrasound after admission and upon discharge from the PACU. The criteria to characterize urinary retention were: vesical volume equal or higher than 600 mL associated with incapacity of spontaneous micturition for 30 minutes after the diagnosis. Univariate and multivariate analyses were used to indentify independent predictive factors., Results: Urinary retention was observed in 19 patients (7.39%), independent predictive factors identified included urinary volume equal to or greater than 360 mL upon admission to the PACU (Mantel-Haenszel Chi-square test (1 dF) = 18.76; p < 0.01), with an odds ratio of 9.82 (95% confidence interval = 3.26-29.55) and surgeries of the lower limbs (Mantel-Haenszel Chi-square test (1 dF) = 5.33; p = 0.02), with odds ratio of 4.33 (95% confidence interval = 1.34-14.02)., Conclusions: Due to the prevalence of urinary retention, we suggest that a systematic evaluation of the urinary volume at the PACU should be done, especially in those patients with predictive factors., (Copyright 2010 Elsevier Editora Ltda. All rights reserved.)

Background and Objectives: The objective of the present study was to evaluate the use of the ultrasound on the determination of the depth of the epidural space., Methods: Sixty patients were included in this prospective study; the L(3)-L(4) space was initially identified by palpation followed by the ultrasound measuring the depth of the epidural space (PU). After the epidural puncture the measurements o the depth (PA) were recorded. The data underwent descriptive statistics, and the concordance correlation coefficient and Bland-Altman analysis, with 95% confidence interval were calculated., Results: Analysis of concordance between the palpation and ultrasound methods was 86.6%. Mean values of PU obtained were 4.97 +/- 0.51 cm and PA 4.97 +/- 0.71 cm, and Pearson correlation coefficient of 0.66 while Bland-Altman analysis revealed a mean difference of 0.0035 +/- 0.53 cm with 95% confidence interval between -0.228 and 0.221., Conclusions: The ultrasound is a precise tool to determine the depth of the epidural space., (Copyright 2010 Elsevier Editora Ltda. All rights reserved.)

Objective: To verify if the maximal inspiratory pressure values with 40 seconds occlusion time are greater than with the 20 seconds occlusion time, and the impacts on the following patient's physiological variables: respiratory rate, pulse oxygen saturation, heart rate and blood pressure, before and after the measurements., Methods: This was a transversal prospective randomized study. Fifty-one patients underwent maximal inspiratory pressure measurement, measured by one single investigator. The manometer was calibrated before each measurement, and then connected to the adapter and this to the unidirectional valve inspiratory branch for 20 or 40 seconds., Results: The values with 40 seconds occlusion (57.6 ± 23.4 cmH2O) were significantly higher than the measurements taken with 20 seconds occlusion (40.5 ± 23.4 cmH2O; p=0.0001). The variables changes between the before and after measurement respiratory and hemodynamic parameters monitoring showed: heart rate variation for the 20 seconds occlusion 5.13 ± 8.56 beats per minute and after 40 seconds occlusion 7.94 ± 12.05 beats per minute (p = 0.053), versus baseline. The mean blood pressure change for 20 seconds occlusion was 9.29 ± 13.35 mmHg and for 40 seconds occlusion 15.52 ± 2.91 mmHg (p=0.021). The oxygen saturation change for 20 seconds occlusion was 1.66 ± 12.66%, and for 40 seconds 4.21 ± 5.53% (p=0.0001). The respiratory rate change for 20 seconds occlusion was 6.68 ± 12.66 movements per minute and for 40 seconds 6.94 ± 6.01 (p=0.883)., Conclusion: The measurement of maximal inspiratory pressure using a longer occlusion (40 seconds) produced higher values, without triggering clinically significant stress according to the selected variables.

Objectives: To evaluate the effect of hyperbaric oxygen therapy (HBO2) as an adjunct to scaling and root planing (SRP) in the treatment of severe cases of chronic periodontitis., Materials and Methods: In 20 patients diagnosed with severe generalized chronic periodontitis (pockets>7mm) with bleeding on probing, SRP was rendered in all pockets. Additionally, five consecutive hyperbaric sessions were administered in 10 patients after random allocation (SRP + HBO2). Clinical parameters were assessed at baseline up to six months: plaque index, bleeding on probing, probing depth, clinical attachment level and benzoyl-DL-arginine-naphthylamide (BANA) test., Results: SRP + HBO2 resulted in greater probing reduction and attachment gain than SRP alone three months after treatment (p<0.001). The BANA test was negative after one week only for sites in the SRP + HBO2 group (p<0.05). However, SRP + HBO2 failed to show a significant difference from SRP group after 3 months, where all BANA sites became negative (p>0.05)., Conclusion: Our data suggest that hyperbaric oxygen therapy had a short-term beneficial effect on pocket reduction and bacterial elimination, and may be considered a potential adjunct therapeutic option to improve the clinical outcomes of scaling in severe cases of chronic periodontitis.

Background and Objectives: The volume and mass of local anesthetics (LA) affect the success rate of peripheral nerve blocks. Thus, the main objective of this study was to determine the volumes of local anesthetics in parasacral and infragluteal-parabiceps sciatic nerve block (SNB)., Methods: One hundred and one patients undergoing infragluteal-parabiceps or parasacral SNB with 0.5% ropivacaine or 0.5% bupivacaine with 5 microg.mL-1 of adrenaline were randomly divided into 4 groups. Success was defined as complete sensitive and motor blockades of the sciatic nerve 30 minutes after the administration of the LA. Volumes were calculated by the up-and-down method., Results: In the parasacral approach, the mean effective volume of ropivacaine was 17.6 mL (95% CI: 14.9-20.8) and of bupivacaine it was 16.4 mL (95% CI: 12.3-21.9). In the infragluteal-parabiceps approach, the mean effective volume of ropivacaine was 21.8 mL (95% CI: 18.7-25.5), and that of bupivacaine was 20.4 mL (95% CI: 18.6-22.5). Volumes were significantly lower (p < 0.01) in the parasacral than in the infragluteal-parabiceps approach. In Probit regression, the estimated effective volume in 95% of the patients in the parasacral approach was 21.8 mL for ropivacaine, and 20.5 mL for bupivacaine; in the infragluteal-parabiceps approach the volumes were 27.2 mL for ropivacaine and 25.5 mL for bupivacaine. The effective volume in 99% of the patients in parasacral SNB was 24 mL for ropivacaine, and 24 mL for bupivacaine; and in the infragluteal-parabiceps approach, 29.9 mL for ropivacaine, and 28.0 mL for bupivacaine., Conclusions: In sciatic nerve block, significantly smaller volumes were necessary in the parasacral than in the infragluteal-parabiceps approach, but volumes did not differ between both LAs.

Unlabelled: Conceição DB, Helayel PE, Oliveira Filho GR - A Comparative Study between Ultrasound- and Neurostimulation-Guided Axillary Brachial Plexus Block., Background and Objectives: The use of ultrasound in Regional Blocks is increasingly more frequent. However, very few studies comparing ultrasound and neurostimulation have been conducted. The objective of this study was to compare neurostimulation-guided axillary brachial plexus block with double injection and ultrasound-guided axillary plexus block for hand surgeries. The time to perform the technique, success rate, and complications were compared., Methods: After approval by the Ethics on Research Committee of the Hospital Governador Celso Ramos, 40 patients scheduled for elective hand surgeries under axillary plexus block were selected. Patients were randomly divided into two groups with 20 patients each: Neurostimulation (NE) and Ultrasound (US) groups. The time to perform the technique, success rate, and complication rate were compared., Results: Complete blockade, partial failure, and total failure rates did not show statistically significant differences between the US and NE groups. The mean time to perform the technique in the US group (354 seconds) was not statistically different than that of the NE group (381 seconds). Patients in the NE group had a higher incidence of vascular punctures (40%) when compared with those in the US group (10%, p < 0.05). The rate of paresthesia during the blockade was similar in both groups (15%)., Conclusions: The success rate and time to perform the blockade were similar in ultrasound- and neurostimulation-guided axillary plexus block for hand surgeries. The rate of vascular puncture was higher in neurostimulation-guided axillary plexus block.

Background and Objectives: Learning curves have proved to be useful tools to monitor the performance of a worker on a new assignment. Those curves have been used to evaluate several medical procedures. The objective of this study was to evaluate the learning of orotracheal intubation (OTI) with the Truview EVO2 laryngoscope with the CUSUM learning curve., Methods: Four trainees underwent OTI training with the Truview EVO2 laryngoscope in a mannequin. They received orientation on the successful and failure criteria of OTI and alternated during the attempts, for a total of 300 OTI for each one. Four learning curves were plotted using the CUSUM cumulative addition method., Results: It was calculated that the 105 OTIs were necessary to achieve proficiency. The four trainees crossed the line of acceptable failure rate of 5% before completing 105 OTIs; the first trainee reached proficiency after 42 OTIs, the second and third after 56 OTIs, and the fourth after 97 OTIs, and from then on their performance remained constant. Differences in the success rate between residents and experienced anesthesiologists were not observed., Conclusions: The CUSUM learning curve is a useful instrument to demonstrate objectively the ability when performing a new task. Laryngoscopy with the Truview EVO2 in a mannequin proved to be an easy procedure for physicians with prior experience in OTI; however, one should be cautious when transposing those results to clinical practice.

Background and Objectives: The use of regional blocks especially peripheral nerve blocks (PNB) has been increasing in anesthesiology due to the reduced need to manage the airways, lower cost, and excellent postoperative analgesia. However, its use has restrictions due to the lack of training, that it takes longer to be done, fear of neurological complications, and systemic toxicity. The objective of this study was to measure the attitude of anesthesiologists and anesthesiology residents at Teaching and Training Centers (CET/SBA) regarding PNBs., Methods: A 25-item questionnaire was developed and it was available, via the Internet and by mail, to those responsible for the 80 CETs, their instructors and residents., Results: Forty-two CETs (52.5%) returned 188 questionnaires, 62 (32%) from anesthesiology residents and 126 (68%) from anesthesiologists. The Cronbach's alpha coefficient of the questionnaire was 0.79. Factor analysis revealed six factors that explain 53% of scores variance: factor 1 - positive attitude, responsible for 18.34% of the variance; factor 2 - training/use, responsible for 11.73% of the variance; factor 3 - negative aspects, responsible for 7.11% of the variance; factor 4 - limiting factors, responsible for 6.39% of the variance; and factor 5 - regional block as a competence differential, responsible for 5.79% of the variance; and factor 6 - respect for the patient, responsible for 5.4% of the variance., Conclusions: The questionnaire proved to be a reliable tool to measure the attitude regarding regional blocks. Anesthesiologists demonstrated greater interest for patient-related aspects, while the main focus of residents was the acquisition of technical abilities.