ABSTRACT Objective: To investigate nonalcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH) and hepatic fibrosis in biopsies of people with obesity who underwent bariatric surgery and examine the possible association of different variables with a diagnosis of NAFLD and NASH. Materials and methods: Epidemiological, clinical and laboratory data from 574 individuals with obesity of both genders seen by the same physician between 2003 and 2009 who had a liver biopsy during bariatric surgery were examined. Results: Of the 437 patients included, 39.8% had some degree of liver fibrosis, 95% had a histologic diagnosis of NAFLD, and the risk factors were age ≥ 28 years and Homeostatic Model Assessment (HOMA) ≥ 2.5 (p = 0.001 and p = 0.016, respectively). In the NAFLD group, NASH was present in 26% of patients and the associated factors were aspartate aminotransferase and alanine aminotransferase index (AST/ALT) > 1, high-density lipoprotein cholesterol (HDL-c) < 40 mg/dL, total cholesterol (TC) ≥ 200 mg/dL, gamma-glutamyl transferase (GGT) > 38 U/L and triglycerides (TG) levels > 150 mg/dL. The independent risk factors were low HDL-c, elevated AST/ALT and high TG. Conclusion: The variables associated with a diagnosis of NAFLD were HOMA ≥ 2.5 and age ≥ 28 years. NASH was associated with low HDL-c, high TG and AST/ALT ≤ 1.

Resumo A prevalência de tubérculos fibulares varia de 24% a 98,58% - essa ampla variação pode ser atribuída ao uso de diferentes critérios na descrição do tubérculo fibular. A incidência do tubérculo hipertrofiado é de 20,5-24% da população. A porção do tendão fibular longo que está localizada entre os pontos ósseos fixos do tubérculo fibular e do cubóide pode se estirar de forma não natural na presença de um tubérculo fibular hipertrofiado e, com movimentos de inversão repentinos ou repetidos, o tendão pode romper. Raramente, o tubérculo hipertrofiado está associado a uma rotura do tendão do fibular curto. O tendão do fibular curto pode ser colidido entre o tubérculo e o maléolo lateral durante o movimento de eversão-abdução do pé, resultando em tenossinovite e degeneração do tendão. Relatamos uma tenossinovite dos fibulares decorrente de um tubérculo fibular hipertrofiado induzido pela atividade friccional dos tendões fibulares detectada pela ultrassonografia e pela ressonância magnética.

Abstract The prevalence of peroneal tubercles ranges from 24% to 98.58% - this wide range can be attributed to the use of different criteria in its description. The incidence of the hypertrophied tubercle is 20.5-24% of the population. The portion of the peroneus longus tendon that is located between the fixed bony points of the peroneal tubercle and the cuboid may stretch unnaturally in the presence of a hypertrophied peroneal tubercle and, with sudden or repeated inversion movements, the tendon may rupture. The peroneus brevis tendon can collide between the tubercle and the lateral malleolus during the eversion-abduction movement of the foot, resulting in tenosynovitis, tendon laceration, and degeneration. We report peroneal tenosynovitis due to a hypertrophied peroneal tubercle induced by frictional peroneal tendons activity detected by ultrasound and MRI.

Resumo Relatamos um homem de 55 anos de idade que foi submetido a tratamento para ressecção de lipossarcoma mixóide seguido de radioterapia e quimioterapia. O paciente apresentou miosite induzida pela radioterapia - trata-se de uma reação inflamatória localizada desencadeada pelo uso de agentes citotóxicos. Embora geralmente limitado aos tecidos superficiais e manifestando-se como reação cutânea, foram relatados casos de inflamação profunda envolvendo os músculos geralmente associada ao uso de gencitabina.

Abstract We report a 55-year-old man who underwent treatment for resection of myxoid liposarcoma with radiotherapy and chemotherapy sequences. The patient had what we call radiation recall - it is a localized inflammatory reaction triggered by the use of cytotoxic agents. While usually limited to the superficial tissues and manifesting as a cutaneous reaction, cases of deeper inflammation involving the muscles have been reported with gemcitabine.

Abstract Bladder tumors occur more frequently between the fifth and seventh decades of life - they are rare before 40 years of age. Rhabdomyosarcoma is a rare embryonic tumor originating from skeletal muscle tissue. The tumor can appear anywhere in the body, even where there is no skeletal muscle. When located in the genitourinary tract, it can present with hematuria and anuria. The nevus sebaceous of Jadassohn (NSJ) is a congenital hamartoma of cutaneous structures, with epithelial and adnexal origin, present in approximately 0.3% of newborns, and may contain any component of the skin, including sebaceous and apocrine glands or hair. When associated with syndromic features such as mental retardation, central nervous system abnormalities, cardiovascular defects such as the cardiac arrhythmia reported in this case, ocular or skeletal abnormalities, it is called linear sebaceous nevus syndrome, or Schimmelpenning syndrome.

Resumo Os tumores de bexiga ocorrem com mais frequência entre a quinta e a sétima década de vida, sendo raros antes dos 40 anos de idade. O rabdomiossarcoma é um tumor embrionário raro originado do tecido muscular esquelético que pode aparecer em qualquer parte do corpo, mesmo onde não há músculo esquelético. Quando localizado no trato geniturinário, pode apresentar-se com hematúria e anúria. O nevo sebáceo de Jadassohn (NSJ) é um hamartoma congénito de estruturas cutâneas, de origem epitelial e anexial, presente em aproximadamente 0,3% dos recém-nascidos, podendo conter qualquer componente da pele, incluindo glândulas sebáceas e apócrinas ou cabelos. Quando está associado a características sindrómicas, como atraso mental, anomalias do sistema nervoso central, defeitos cardiovasculares (como a arritmia cardíaca relatada neste caso), anomalias oculares ou esqueléticas, é denominado síndrome do nevo sebáceo linear ou síndrome de Schimmelpenning.

ABSTRACT BACKGROUND: Developmental dysplasia of the hip (DDH) encompasses a broad spectrum of hip pathologies, including femoral or acetabular dysplasia, hip instability, or both. According to the medical literature, ultrasonography is the most reliable diagnostic method for DDH. Several techniques for the assessment of hips in newborns and infants, using ultrasonography, have been described. OBJECTIVE: To compare the accuracy of the Graf technique and other diagnostic techniques for DDH. DESIGN AND SETTING: A systematic review of studies that analyzed ultrasound techniques for the diagnosis of DDH within an evidence-based health program of a federal university in São Paulo (SP), Brazil. METHODS: A systematic search of relevant literature was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL, and LILACS databases for articles published up to May 5, 2020, relating to studies evaluating the diagnostic accuracy of different ultrasound techniques for diagnosing DDH. The QUADAS 2 tool was used for methodological quality evaluation. RESULTS: All hips were analyzed using the Graf method as a reference standard. The Morin technique had the highest rate of sensitivity, at 81.12–89.47%. The Suzuki and Stress tests showed 100% specificity. The Harcke technique showed a sensibility of 18.21% and specificity of 99.32%. CONCLUSION: All the techniques demonstrated at least one rate (sensibility and specificity) lower than 90.00% when compared to the Graf method. The Morin technique, as evaluated in this systematic review, is recommended after the Graf method because it has the highest sensitivity, especially with the three-pattern classification of 89.47%. REGISTRATION NUMBER: Identifier: CRD42020189686 at the International Prospective Register of Systematic Reviews (identifier: CRD42020189686).

Resumen La hernia muscular en extremidades es una patología poco frecuente e infradiagnosticada. La mayoría de las masas son indoloras y asintomáticas. Sin embargo, en algunos casos, la hernia muscular puede volverse dolorosa después de un ejercicio físico prolongado. En este reporte de caso, presentamos a un paciente de 18 años que consulta por abultamiento en la pierna izquierda después de la actividad física, con sospecha inicial de lipoma de la extremidad. La ecografía identificó una hernia muscular, destacando la importancia de la detección temprana y conducir un tratamiento adecuado sin complicaciones, gastos innecesarios y diagnósticos erróneos.

Abstract Muscular hernia in extremities is an uncommon and underdiagnosed condition. Most masses are painless and asymptomatic. However, in some cases, muscle hernia can become painful after prolonged physical exercise. In this case report, we present an 18-year-old patient complaining of bulging in the left leg after physical activity, with initial suspicion of lipoma of the extremity. Ultrasonography identified a muscle hernia, highlighting the importance of early detection and leading adequate treatment without complications, unnecessary expenses, and misdiagnoses.

Resumo A hérnia muscular em extremidades é uma condição incomum e subdiagnosticada. A maioria das massas é indolor e assintomática. No entanto, em alguns casos, podem se tornar dolorosas após exercícios físicos prolongados. Neste relato de caso temos um paciente de 18 anos, queixando-se de abaulamento na perna esquerda após atividade física, com suspeita inicial de lipoma de extremidade A ultrassonografia identificou uma hernia muscular, destacando a importância de uma detecção precoce para que haja um tratamento adequado sem complicações, gastos desnecessários e diagnósticos equivocados.

ABSTRACT BACKGROUND: Use of the web for radiological education is an obvious application. Many computer-based teaching materials have been developed over recent years, and e-learning is becoming increasingly popular in medical schools. OBJECTIVE: To assess whether the effectiveness of distance-learning and/or e-learning, m-learning and web-based methods are equivalent to traditional methods. DESIGN AND SETTING: Systematic review of comparative studies of teaching techniques guided by Best Evidence Medical Education. METHODS: A search was carried out in the MEDLINE, EMBASE, Cochrane Library, Tripdatabase, CINAHL and LILACS online databases in April 2020, for original publications in all languages. The following MeSH terms were used: Ultrasonography; Teleradiology; Telemedicine; Education, Medical; Teaching; and Simulation Training; along with the terms e-learning, m-learning and web-based. All eligible studies were assessed using the Kirkpatrick model and Buckley's quality indicators. RESULTS: The search in the databases and a manual search resulted in 4549 articles, of which 16 had sufficient methodological quality for their inclusion. From analysis of these data, it was observed that teaching of ultrasonography using telemedicine methods is similar to the traditional method, except for venous access procedures, for which the studies did not show agreement. CONCLUSION: We found that learning via telemedicine methodologies presents great acceptance among students, besides demonstrating quality similar to the traditional method. Thus, at least at the moment, this has the capacity to serve as an important adjunct in the teaching of ultrasonography. REGISTRATION NUMBER: DOI: 10.17605/OSF.IO/CGUPA at the OPENSCIENCE Framework.

Abstract Heterotaxy syndrome is a rare congenital condition with multifactorial inheritance in which the internal organs are abnormally arranged in the chest and abdomen. It can be classified into two main subcategories: heterotaxy syndrome with polysplenia (left isomerism) and heterotaxy syndrome with asplenia (right isomerism). Such a distinction between these subcategories offers better means of indicating the genetic alterations responsible for the syndrome. Individuals with this condition have complex congenital abnormalities, affecting various organs such as the heart - interferes in blood transport - and lung - altering the number of pulmonary lobes. We report a case of heterotaxy syndrome with polysplenia without abnormality in the thoracic organs in an adult patient.

Resumo A síndrome heterotáxica é uma condição congênita rara com herança multifatorial em que os órgãos internos estão arranjados anormalmente no tórax e abdome, podendo ser classificadas em duas subcategorias principais: síndrome heterotáxica com poliesplenia (isomerismo esquerdo) e síndrome heterotáxica com asplenia (isomerismo direito). Indivíduos com esta condição têm complexas anormalidades congênitas acometendo diversos órgãos, como o coração - dificultando o transporte sanguíneo - e o pulmão - alterando o número de lobos. Relatamos um caso de síndrome heterotáxica com poliesplenia sem anormalidade nos órgãos torácicos em paciente adulta.

ABSTRACT The aim of the work was to analyze the influence of variables such as shading, temperature and humidity in the production and rooting of mini-cuttings of Sequoia sempervirens (D. Dom) Endl. in a clonal mini-garden. The experiment was conducted at the Forest Nursery at the University of Santa Catarina State - CAV/UDESC, Lages - SC. The minicuttings were obtained by vegetative rescue of a single clone (A228). The original S. sempervirens individuals studied are located in the National Forest of São Francisco de Paula -RS (FLONA). Sprouts were collected 90 days after the application of girdling rescue techniques. Subsequently, mini-stumps were obtained, which were submitted to three different treatments: T1 - Mini-stumps without shading protection, T2 - Mini-stumps with single layer of shading and T3 - Mini-stumps with double layer of shading. There was no significant difference for humidity and temperature in relation to the production of mini-cuttings by the mini-stumps, while for shading the treatments T2 and T3 showed greater efficiency. It is possible that the shading treatments on S. sempervirens mini-stumps allows the vegetative tissue to be more juvenile, obtaining excellent results in cutting.

ABSTRACT BACKGROUND: Augmented reality (AR) involves digitally overlapping virtual objects onto physical objects in real space so that individuals can interact with both at the same time. AR in medical education seeks to reduce surgical complications through high-quality education. There is uncertainty in the use of AR as a learning tool for interventional radiology procedures. OBJECTIVE: To compare AR with other learning methods in interventional radiology. DESIGN AND SETTING: Systematic review of comparative studies on teaching techniques. METHODS: We searched the Cochrane Library, MEDLINE, Embase, Tripdatabase, ERIC, CINAHL, SciELO and LILACS electronic databases for studies comparing AR simulation with other teaching methods in interventional radiology. This systematic review was performed in accordance with PRISMA and the BEME Collaboration. Eligible studies were evaluated using the quality indicators provided in the BEME Collaboration Guide no. 11, and the Kirkpatrick model. RESULTS: Four randomized clinical trials were included in this review. The level of educational evidence found among all the papers was 2B, according to the Kirkpatrick model. The Cochrane Collaboration tool was applied to assess the risk of bias for individual studies and across studies. Three studies showed an improvement in teaching of the proposed procedure through AR; one study showed that the participants took longer to perform the procedure through AR. CONCLUSION: AR, as a complementary teaching tool, can provide learners with additional skills, but there is still a lack of studies with a higher evidence level according to the Kirkpatrick model. SYSTEMATIC REVIEW REGISTRATION NUMBER: DOI 10.17605/OSF.IO/ACZBM in the Open Science Framework database.

ABSTRACT BACKGROUND: The speed of the spread of coronavirus disease 2019 (COVID-19) has put enormous pressure on hospitals and other healthcare facilities. This, together with blockages in several countries, has hindered the availability and accessibility of the necessary personal protective equipment (PPE). OBJECTIVE: To identify, systematically evaluate and summarize the available scientific evidence on the efficacy, safety, safe use and reuse of PPE for healthcare professionals, for preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. DESIGN AND SETTING: Systematic review of studies analyzing products for disinfecting and enabling reuse of PPE for coronavirus within the evidence-based health program of a federal university in São Paulo (SP), Brazil. METHODS: A systematic search of the relevant literature was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL, SCOPUS, Web of Science and LILACS databases, for articles published up to November 30, 2020. RESULTS: Ten studies were selected. These analyzed the use of N95, surgical and cotton masks, face shields, flexible enclosures with plastic covers or polycarbonate intubation boxes and plastic curtains; and also PPE disinfection using several substances. CONCLUSION: Combined use of a face shield with a N95 mask proved to be superior to other associations for protecting healthcare workers. Some products are useful for disinfecting PPE, such as 70% ethanol, 0.1% sodium hypochlorite and a mixture of quaternary ammonium and H2O2, and hydrogen peroxide. Ultraviolet light and dry heat at 70 °C can be used to decontaminate N95 masks. REGISTRATION NUMBER: DOI: 10.17605/OSF.IO/4V5FD at the OPENSCIENCE Framework.