RESUMO
BACKGROUND: Postoperative sore throat is one of the main postoperative complaints in patients undergoing tonsillectomy. As the primary outcome, we aimed to determine whether endotracheal tube cuffs filled with alkalinized lidocaine are associated with a lower incidence of postoperative sore throat and anesthesia emergence phenomena in children undergoing tonsillectomy or adenotonsillectomy. We also assessed the potential additional benefits of IV dexamethasone in reducing postoperative laryngotracheal morbidity. METHODS: This is a clinical prospective, randomized, controlled trial. Patients were randomly allocated to one of four groups, as follows: air - endotracheal tube cuff filled with air; air/dex - endotracheal tube cuff filled with air and intravenous dexamethasone; lido - endotracheal tube cuff filled with alkalinized lidocaine; and lido/dex - endotracheal tube cuff filled with alkalinized lidocaine and intravenous dexamethasone. Perioperative hemodynamic parameters and the incidence of postoperative nausea and vomiting, coughing and hoarseness were recorded. Postoperative sore throat was assessed in the postanesthetic care unit and 24 hours post tracheal extubation. RESULTS: In total, 154 children aged 4-12 years, ASA physical status I or II, undergoing general anesthesia for elective tonsillectomy and adenotonsillectomy, were assessed for postoperative sore throat in this study. The incidence of postoperative sore throat 24 hours after tracheal extubation was significantly lower in the lido/dex group compared to groups air and air/dex (p = 0.01). However, no additional reduction in these symptoms was observed from the intravenous administration of dexamethasone when comparing the lido and lido/dex groups. Similarly, there were no differences among groups regarding perioperative hemodynamic variables or postoperative nausea and vomiting, coughing, and hoarseness during the study period. CONCLUSION: Intracuff alkalinized lidocaine, associated with intravenous dexamethasone, might be effective in reducing sore throat 24 hours post-tonsillectomy or adenotonsillectomy in children when compared to the use of air as the cuff insufflation media.
Assuntos
Anestesia Geral , Anestésicos Locais , Dexametasona , Intubação Intratraqueal , Lidocaína , Faringite , Complicações Pós-Operatórias , Tonsilectomia , Humanos , Dexametasona/administração & dosagem , Tonsilectomia/métodos , Tonsilectomia/efeitos adversos , Lidocaína/administração & dosagem , Criança , Masculino , Pré-Escolar , Feminino , Anestesia Geral/métodos , Faringite/prevenção & controle , Faringite/etiologia , Faringite/epidemiologia , Estudos Prospectivos , Intubação Intratraqueal/métodos , Intubação Intratraqueal/efeitos adversos , Anestésicos Locais/administração & dosagem , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Administração Intravenosa , Náusea e Vômito Pós-Operatórios/epidemiologia , Náusea e Vômito Pós-Operatórios/prevenção & controleRESUMO
Commercial fig tree cultivation in Brazil involves a single cultivar, 'Roxo-de-Valinhos'. The use of a single cultivar results in serious diseases and related problems. The aim of this study was to characterize fig accessions by analyzing the natural root-knot nematode and leaf rust incidence in relation to the epigenomic profile of the plant, since epigenetic variations affect plant-pathogen interactions. All plants were attacked by nematodes, indicating susceptibility; Meloidogyne incognita was the root-knot nematode species involved. Joint analysis of data showed that methylation and leaf rust incidence were correlated when observed in the same phenological phase, presenting initial evidence of the same factorial pressure loads in genotypes, suggesting similar behavior within these genotypes.
O Brasil é o maior produtor de figos da América do Sul, porém o cultivo comercial brasileiro da figueira baseia-se na plantação de uma única cultivar, o Roxo-de-Valinhos, resultando em sérios problemas relativos a pragas e doenças. Uma vez que há variações epigenéticas na interação planta-patógeno, principalmente por meio da regulação gênica, o presente trabalho objetiva realizar a caracterização in vivo de acessos de figo, por meio da análise de incidência natural de nematoides formadores de galha e de incidência natural de ferrugem, correlacionada ao seu perfil epigenômico, a fim de subsidiar trabalhos de conservação, melhoramento genético e produção da cultura. A análise dos componentes principais dos dados da caracterização dos acessos foi realizada por meio da matriz de correlação residual obtida pela análise de variância conjunta utilizando o programa GENES. Pôde-se constatar que todas as plantas foram atacadas por este patógeno, evidenciando que são suscetíveis ao mesmo. Já a análise conjunta dos dados demonstrou que a metilação e a incidência de ferrugem em folhas, quando observadas na mesma fase fenológica da planta, se correlacionam, apresentando evidências iniciais de mesmas cargas fatoriais de pressão nos genótipos, com a premissa de comportamento semelhante nos mesmos, indicando que, além do fator genético, fatores abióticos também são responsáveis pelas alterações no fenótipo das plantas, evidenciando a plasticidade fenotípica das mesmas.
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Ficus/parasitologia , Melhoramento Genético , BrasilRESUMO
The use of enzyme hyaluronidase to treat the complications of different brands of hyaluronic acid (HA) dermal fillers is increasing in the same proportion as the number of nonsurgical cosmetic procedures. Guidelines for diagnosing and treating complications remain controversial and are primarily based on anecdotal reports and small case series. We proposed approaching HA-related complications based on our clinical research and observations of treating more than 200 patients and providing a practical guide for the thoughtful use of hyaluronidase according to adverse events. Standardization of hyaluronidase dose and concentration is beneficial for better outcomes and future comparative analyses of the results of this treatment worldwide. The use of hyaluronidase is increasing for the reversal of the clinical manifestations of complications caused by HA fillers, although a consensus is lacking. We propose using different doses and concentrations of hyaluronidase to focus on selected anatomic areas considering properties of the product and pathogenesis of each complication.
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The number of patients developing sterile abscesses because of hyaluronic acid (HA) filler procedures has increased for unknown reasons. We described this adverse reaction after filling with Juvederm Volux®, the latest innovative product in the Vycross range of technology. We presented five patients with recalcitrant sterile abscesses after filling with Juvederm Volux® who did not respond to the traditional therapy but whose lesions were resolved with the "Munhoz-Cavallieri lavage protocol" developed and recently published by the present authors. (SKINmed. 2023;21:27-33).
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Técnicas Cosméticas , Humanos , Abscesso/tratamento farmacológico , Ácido Hialurônico/efeitos adversosRESUMO
A 60-year-old black man, working in construction sector, was referred to dermatology clinic for having multiple hardened and asymptomatic tumors on the scalp, face, and trunk for more than 40 years. There was a progressive increase in the number and size of lesions, causing significant aesthetic and functional impairment. In his family history, a son had numerous normochromic papules on the centrofacial region with a diagnosis of multiple trichoepithelioma. The deceased mother of our patient presented lesions similar to those of her grandson but without a confirmatory diagnosis. (SKINmed. 2023;21:47-50).
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Síndromes Neoplásicas Hereditárias , Neoplasias Cutâneas , Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Glândula Parótida/patologia , Neoplasias Cutâneas/patologia , Síndromes Neoplásicas Hereditárias/diagnóstico , Couro Cabeludo/patologiaRESUMO
The quantitative assessment of the carbonate system represents one of the biggest challenges toward the "Sustainable Development Goals" defined by the United Nations in 2015. In this sense, the present study investigated the Spatio-temporal dynamics of the carbonate system and the effects of the El Niño and La Niña phenomena over the Cabo Frio upwelling area. The physical characterization of the site was carried out through data on wind speed and sea surface temperature. Water samples were also collected during the oceanographic cruise onboard the Diadorim R/V (Research Vessel). From these samples, the parameters of absolute and practical salinity, density, pH, total alkalinity, carbonate, calcite, aragonite, bicarbonate dissolved inorganic carbon, carbon dioxide, partial pressure of carbon, calcium, and total boron were obtained. The highest average concentration of bicarbonate in S1 (2018 µmol/kg) seems to contribute to the dissolved inorganic carbon values (2203 µmol/kg). The values of calcite saturation state, aragonite saturation state, and carbonate were higher on the surface of each station (calcite saturation state = 4.80-5.48; aragonite saturation state = 3.10-3.63, and carbonate = 189-216 µmol/kg). The mean values of pH were similar in the day/night samples (7.96/7.97). The whole carbonate system was calculated through thermodynamic modeling with the Marine Chemical Analysis (AQM) program loaded with the results of the following parameters: temperature, salinity, total alkalinity, and pH parameters. This manuscript presents original data on the carbonate system and the "acidification" process influenced by the Cabo Frio upwelling, which directly depends on the El Niño and La Niña phenomena oscillations in the sea surface temperature.
RESUMO
BACKGROUND: The future of minimally invasive surgery in revisional surgery is experiencing changes with new equipment such as the magnetic assistance that can be used with single port devices in order to perform an incisionless surgery (Luengas R, Galindo J, Castro M, et al. Surg Obes Relat Dis. 2021;17(1):147-152). Magnetic assistance through an auxiliary grasper with two internal magnets serves beyond liver retraction in different steps of the surgery improving the surgical field by obtaining a better visualization and triangulation. PURPOSE: Expose the feasibility of using two internal magnetic graspers by single port performing a conversion surgery of sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB). METHODS: A 36-year-old female patient underwent a SG in 2015 and consults in 2021 because of severe GERD with a 33-point GERD-HRQL score. She has preoperative evaluation for a conversion surgery from SG to RYGB. Using a single port device through the umbilicus, an additional 5 mm trocar was placed in the left side of the abdomen. Two internal magnets were introduced through the umbilicus, and they were controlled by two external magnets placed over the abdomen with an articulated arm. The first magnet was used for liver retraction and the second one to perform both anastomoses, close the intermesenteric and Petersen defect, acting as an auxiliary grasper. The ethical committee approval was obtained through an informed consent from the participant included in the study.
Assuntos
Cirurgia Bariátrica , Derivação Gástrica , Refluxo Gastroesofágico , Laparoscopia , Obesidade Mórbida , Feminino , Humanos , Adulto , Obesidade Mórbida/cirurgia , Laparoscopia/efeitos adversos , Reoperação/efeitos adversos , Estudos Retrospectivos , Derivação Gástrica/efeitos adversos , Gastrectomia/efeitos adversos , Refluxo Gastroesofágico/etiologia , Fenômenos Magnéticos , Cirurgia Bariátrica/efeitos adversosRESUMO
Keloids and hypertrophic scars are abnormal responses to wound-healing. While hypertrophic scars remain limited to the areas of trauma, keloids most often develop over several years, growing out from the limits of the initial wound area. Both lesions may cause itching, burning, and pain, and they may lead to significant impairment of self-esteem, socialization, and quality of life. Although they might be observed in all races, they are far more common in Africans and African descendants than in Caucasians.We extensively reviewed their treatment, including compression with pressure garments, occlusion with siliconized and non-siliconized gel sheets, gels, corticosteroid and antineoplastic injections, and the use of lasers and intense pulsed light (IPL) therapy. We also reviewed new therapies, including botulinum toxin injection, and addressed outcomes of various studies. (SKINmed. 2022;20:432-443).
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Cicatriz Hipertrófica , Queloide , Humanos , Cicatriz Hipertrófica/terapia , Queloide/terapia , Qualidade de Vida , Corticosteroides , ParestesiaRESUMO
A 47-year-old woman who lived in the metropolitan area of Rio de Janeiro and had abandoned her Acquired Immune Deficiency Syndrome (AIDS) therapy 3 years prior, was admitted to our hospital due to weight loss, cough, and fever for 2 weeks. The dermatologic examination established normochromic papules with molluscum-like central umbilication on the face (Figure 1) and hands, erythema and infiltration in the oral cavity (Figure 2), desquamative patches on the legs, and ulceration on right calcaneus (Figure 3). Her CD4 (T-cells) count was 47 cells/ mm.3 Direct mycology examination and cultures for several agents were performed. The mycology culture done from her skin and sputum grew Sporothrix 1 week after admission (Figure 4).
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Síndrome da Imunodeficiência Adquirida , Sporothrix , Esporotricose , Feminino , Humanos , Pessoa de Meia-Idade , Esporotricose/diagnóstico , Esporotricose/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/complicações , Brasil , AntifúngicosRESUMO
BACKGROUND: Acute Generalised Exanthematous Pustulosis (AGEP) is a rash with multiple sterile intraepidermal or subcorneal non-follicular pustules on edematous papules, with a sudden development and rapid evolution, triggered by drugs, vaccination, insect bites, exposure to mercury, and allergens. OBJECTIVES AND METHODS: We describe a female patient who developed extensive and abnormally prolonged AGEP following exposure to terbinafine and SARS-CoV vaccine. A detailed review of terbinafine-induced-AGEP cases was performed, with the aim of evaluating if the AGEP criteria would follow a different pattern when the disease is triggered by this drug. A PubMed search helped retrieve all terbinafine-induced AGEP case reports. AGEP-specific Sideroff criteria were analysed in terbinafine-induced cases and compared to other trigger causes. CONCLUSIONS: When the AGEP causative drug was terbinafine, a delay in recovery was observed, compared to the existing AGEP criteria when other causes are considered. Terbinafine frequently leads to delayed resolution AGEP probably due to the presence of the drug in the skin for several weeks after exposure, even after discontinuation, and the disease severity may be potentialised by additional factors such as concomitant viral infections or vaccination.
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Pustulose Exantematosa Aguda Generalizada , Mercúrio , Pustulose Exantematosa Aguda Generalizada/etiologia , Feminino , Humanos , Pele , Terbinafina/efeitos adversosRESUMO
Commercial fig tree cultivation in Brazil involves a single cultivar, 'Roxo-de-Valinhos'. The use of a single cultivar results in serious diseases and related problems. The aim of this study was to characterize fig accessions by analyzing the natural root-knot nematode and leaf rust incidence in relation to the epigenomic profile of the plant, since epigenetic variations affect plant-pathogen interactions. All plants were attacked by nematodes, indicating susceptibility; Meloidogyne incognita was the root-knot nematode species involved. Joint analysis of data showed that methylation and leaf rust incidence were correlated when observed in the same phenological phase, presenting initial evidence of the same factorial pressure loads in genotypes, suggesting similar behavior within these genotypes.
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Ficus , Tylenchoidea , Animais , Incidência , Metilação , Raízes de Plantas , Plantas , Árvores/genéticaRESUMO
This manuscript presents an inventory of the carbonate system from the main water masses comprising the marine current system on Brazil's northeast coast (South Atlantic Ocean). For this purpose, four transects were conducted with an approximate length of 357 km (each one) through the platform and continental slope of the Sergipe-Alagoas sedimentary basin. Water samples were then collected in vertical profiles measuring from 5 to 1,799 meters depth, totaling 34 stations. Total alkalinity, calcium, and total boron were obtained analytically from these samples and by relationships with salinity. Speciation and concentration of the carbonate system were obtained by means of thermodynamic modeling. The results revealed that the empirical models used to calculate the concentrations of TA, calcium and total boron showed relevant variation when compared to the analytical values (TA: 5.0-6.5%; Ca: 0.4-4.8%; BT: 7.0-18.9%). However, the speciation and concentration of the carbonate system (CA, DIC, [Formula: see text], CO2(aq), ΩCalc, and ΩArag) obtained from the empirical values of TA, calcium and total boron did not differ significantly from those obtained analytically (0.0-6.1%). On the other hand, the parameters of pH, [Formula: see text], [Formula: see text], CO2(aq), ρCO2, ΩCalc, and ΩArag varied significantly within the different water masses (p < 0.05). This study supports and encourages acidification monitoring projects in the South Atlantic Ocean, based on modeling the carbonate system parameters generated in real-time.
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Dióxido de Carbono , Água do Mar , Oceano Atlântico , Boro , Brasil , Cálcio , Carbonato de Cálcio/análise , Dióxido de Carbono/análise , Carbonatos/análise , Concentração de Íons de Hidrogênio , ÁguaRESUMO
INTRODUCTION: The use of hyaluronic acid (HA) as a dermal filler is considered safe. However, as new brands come to the market, reports of adverse events are becoming more and more common. OBJECTIVE: To describe a particular type of adverse effect that, unlike the erythematous, indurated, and painful nodules described in the literature as "angry red bumps," is characterized by noninflammatory, stony-like nodules that appear in sites previously treated with HA. METHODS: The report of four patients who presented this complication, and the occurrence of two HA syringes from the same batch that had hardened the product inside at the time of filling. CONCLUSION: The authors propose the nomenclature "happy bump" to group adverse reactions to HA that translate into noninflammatory nodules, with a stony consistency, appearing up to 4 weeks (recent) or after one month (late) in sites previously treated with AH.
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Técnicas Cosméticas , Preenchedores Dérmicos , Humanos , Ácido Hialurônico/efeitos adversos , Técnicas Cosméticas/efeitos adversos , Dor/etiologia , Seringas , Preenchedores Dérmicos/efeitos adversosRESUMO
BACKGROUND: Melasma is a common hypermelanosis characterized by symmetrical brownish macules, especially on the face. Histologic analysis demonstrates increased epidermal and dermal melanin. Dermoscopy is useful to estimate the depth of the melanin and may help in the diagnosis and classification of melasma, with therapeutic importance. OBJECTIVES: To evaluate the diagnostic concordance of dermoscopic classification of epidermal or mixed subtypes of melasma and the correlation between dermoscopic and histopathological findings. METHODS: Twenty-eight women with facial melasma, phototypes III to V, ages between 30 and 61 years were selected. Based on the evaluation of clinical and dermoscopic images, two independent observers classified melasma into epidermal or mixed subtypes. The intra and interobserver concordances were calculated. Histopathological analysis of epidermal melanin extension and maximum number of melanophages per high-power field (400×; HPF) have been assessed. Association between the melanophages count and the dermoscopic classification was evaluated. RESULTS: Intraobserver agreement was 82.1%, and between observers, from 78.6% to 89.3%, according to the Kappa index. Histopathology revealed increased intraepidermal melanin and the presence of dermal melanophages in all the samples. Ten or more melanophages/HPF was significantly associated with mixed melasma. CONCLUSIONS: Moderate to substantial concordance in the dermoscopic classification of melasma was found, and the correlation between this classification and the dermal melanophages count have been suggested. Intradermal component of every case of melasma should be considered for therapeutic and prognostic purposes.
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Hiperpigmentação , Melanose , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Melaninas , Melanose/tratamento farmacológico , Epiderme/diagnóstico por imagem , Epiderme/patologia , Hiperpigmentação/patologia , DermoscopiaRESUMO
BACKGROUND: In recent years, fillers procedures with hyaluronic acid (HA) have grown significantly. Despite HA relative safety, the number of cases of complications after injections has grown, and in many of which, we are not aware of or have little control over. AIMS: In this article, the authors describe a new adverse reaction after filling with HA injection, the sterile abscess. PATIENTS/METHODS: We present eight patients with similar clinical, laboratory, and ultrasound characteristics for sterile abscess and report a new therapeutic modality for it. RESULTS: All cases were treated with "Munhoz-Cavallieri Lavage Protocol" procedure with complete resolution. CONCLUSIONS: "Munhoz-Cavallieri Lavage Protocol" serves as a guideline in diagnosis and management of sterile abscess.
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Técnicas Cosméticas , Preenchedores Dérmicos , Humanos , Ácido Hialurônico/efeitos adversos , Abscesso/diagnóstico por imagem , Abscesso/etiologia , Injeções , Preenchedores Dérmicos/efeitos adversos , Técnicas Cosméticas/efeitos adversosRESUMO
BACKGROUND: Psoriatic disease (PD) is a chronic inflammatory disorder often associated with cardiovascular risk (CVR) factors such as obesity, hypertension, diabetes, dyslipidaemia and smoking. It is estimated that 2%-4% of the population worldwide has PD. Cutaneous lesions of psoriasis (PsO) may be associated with psoriatic arthritis (PsA) in up to 40% of patients. Studies have been carried out around the world with the aim of evaluating CVR in such patients. AIM: To determine CVR in a multiracial population with PsA or PsO from southeastern Brazil, which has a predominantly tropical climate, compared with controls. METHODS: A cross-sectional study was carried out in outpatients with PsO or PsA followed up at a quaternary referral hospital in Rio de Janeiro. The Framingham Risk Score (FRS) was used to predict cardiovascular events (CVEs) over 10 years in patients with PsO and PsA compared with controls. RESULTS: FRS was significantly higher at 10 years in patients with PsO (mean ± SD 16.3 ± 14) and PsA (18.0 ± 15) compared with controls (10.6 ± 9.5) (P = 0.01) and also increased with age. The chance of having a high FRS in the PsO and PsA groups increased by 0.30 and 0.23 times per year, respectively, compared with controls (PsO vs. controls 95% CI 0.090-1.00; PsA vs. controls 95% CI 0.08-0.75). CONCLUSION: In this multiethnic Brazilian population, both PsO and PsA were associated with higher CVR compared with controls. The frequency of high FRS was highest in the sixth decade of life for all three groups of participants. Annual assessment of patients with PD is necessary in order to prevent CVEs.
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Artrite Psoriásica , Doenças Cardiovasculares , Psoríase , Artrite Psoriásica/complicações , Artrite Psoriásica/epidemiologia , Brasil/epidemiologia , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/etiologia , Estudos Transversais , Fatores de Risco de Doenças Cardíacas , Humanos , Psoríase/complicações , Psoríase/epidemiologia , Fatores de RiscoRESUMO
Assessing the body condition of wild animals is necessary to monitor the health of the population and is critical to defining a framework for conservation actions. Body condition indices (BCIs) are a non-invasive and relatively simple means to assess the health of individual animals, useful for addressing a wide variety of ecological, behavioral, and management questions. The Antillean manatee (Trichechus manatus manatus) is an endangered subspecies of the West Indian manatee, facing a wide variety of threats from mostly human-related origins. Our objective was to define specific BCIs for the subspecies that, coupled with additional health, genetic and demographic information, can be valuable to guide management decisions. Biometric measurements of 380 wild Antillean manatees captured in seven different locations within their range of distribution were obtained. From this information, we developed three BCIs (BCI1 = UG/SL, BCI2 = W/SL3, BCI3 = W/(SL*UG2)). Linear models and two-way ANCOVA tests showed significant differences of the BCIs among sexes and locations. Although our three BCIs are suitable for Antillean manatees, BCI1 is more practical as it does not require information about weight, which can be a metric logistically difficult to collect under particular circumstances. BCI1 was significantly different among environments, revealing that the phenotypic plasticity of the subspecies have originated at least two ecotypes-coastal marine and riverine-of Antillean manatees.