Abstract Background: Percutaneous dilation tracheostomy is an aerosol-generating procedure carrying a documented infectious risk during respiratory virus pandemics. For this reason, during the COVID-19 outbreak, surgical tracheostomy was preferred to the percutaneous one, despite the technique related complications increased risk. Methods: We describe a new sequence for percutaneous dilation tracheostomy procedure that could be considered safe both for patients and healthcare personnel. A fiberscope was connected to a video unit to allow bronchoscopy. Guidewire positioning was performed as usual. While the established standard procedure continues with the creation of the stoma without any change in mechanical ventilation, we retracted the bronchoscope until immediately after the access valve in the mount tube, allowing normal ventilation. After 3 minutes of ventilation with 100% oxygen, mechanical ventilation was stopped without disconnecting the circuit. During apnea, the stoma was created by dilating the trachea and the tracheostomy cannula was inserted. Ventilation was then resumed. We evaluated the safeness of the procedure by recording any severe desaturation and by performing serological tests to all personnel. Results: Thirty-six patients (38%) of 96 underwent tracheostomy; 22 (23%) percutaneous dilation tracheostomies with the new approach were performed without any desaturation. All personnel (150 operators) were evaluated for serological testing: 9 (6%) had positive serology but none of them had participated in tracheostomy procedures. Conclusion: This newly described percutaneous dilation tracheostomy technique was not related to severe desaturation events and we did not observe any positive serological test in health workers who performed the tracheostomies.

Resumo Este artigo pretende expor os diferentes argumentos e posições quanto à possibilidade da declaração de inconstitucionalidade ex officio. Procuraremos demonstrar que a questão esconde complexidades que não podem ser ignoradas quando do tratamento do tema. Propomos, nesse sentido, que é possível cogitar a criação de um modelo que considere as diversas implicações de se proibir ou obrigar o controle de constitucionalidade de ofício. O trabalho utiliza a metodologia analítica, pois, através de estudos da doutrina e da jurisprudência, nacional e estrangeira, desenvolve os argumentos que hoje se colocam, estabelecendo (i) um panorama para a criação de um modelo capaz de absorver as diversas implicações da questão e (ii) uma base para uma crítica construtiva dos modelos que hoje se impõem. Ao final, concluímos que, de fato, o tema merece ser repensado no âmbito da doutrina e da jurisprudência brasileiras, pois se trata de problemática de alta relevância e complexidade, cujas implicações se observam na separação e equilíbrio entre os poderes.

Abstract This article intends to explore the arguments for and against the possibility of the declaration of unconstitutionality of norms ex officio. It intends to demonstrate that the problem at hand hides several complexities that cannot be ignored when the subject is broached. It proposes that it is possible to think of an adequate model that considers the numerous implications that stem from the prohibition or obligation of the ex officio control. The research employs an analytical methodology, given that, through careful examination of national and foreign jurisprudence and doctrine, it intends to develop on arguments that are currently asserted, establishing (i) a panorama for the creation of a model capable of absorbing the ramifications of the problem and (ii) a base for future constructive criticism of the models that currently reign supreme. It concludes that the possibility of ex officio judicial review does in fat deserve reconsideration in Brazilian doctrine and jurisprudence, because of its accentuated relevance, complexity and implications in the separation and balance between Powers.

ABSTRACT This study assessed the use of conformation and fatness scores of the EUROP sheep carcass grading system to predict weight and percentage of salable meat from Brazilian market lambs. Data were collected from in vivo, carcass, and retail production from 252 uncastrated lambs. Evaluated models included single regressions, two multivariate models, and one determined by the stepwise procedure. Conformation was moderately correlated with weight of salable meat. Fatness scores were correlated with rump perimeter, carcass width, and thoracic depth with coefficients of −0.33, −0.32, and −0.23, respectively. Body weight was the best single predictor for weight of salable meat and cold carcass yield for percentage of salable meat. All multivariate models for weight of salable meat prediction were significant. Stepwise regression with body weight, leg perimeter, thoracic depth, rump perimeter, and fatness scores predicted 98% of weight of salable meat variation. For percentage of salable meat prediction, stepwise regression with cold carcass yield, leg perimeter, and conformation score was significant. The EUROP conformation and fatness scores can be used in Brazil for the prediction of lamb meat production.

ABSTRACT Descriptive, cross-sectional, prospective, observational, quantitative study that was aimed at assessing the quality of care, using indicators related to falls prevention and patient identification at a teaching hospital. The data were collected on 15 random days in August and September 2015 at two services of a hospital in the interior of Paraná-Brazil, using previously validated tools. Descriptive statistical analysis was applied, followed by the calculation of the Positivity Ratio. In total, 1068 observations were made. The quality of care, illustrated by the indicators of patient identification by the bed/wristband and presence of bedrails to prevent fall was classified as low (0%), borderline (76.60%) and appropriate (95.48%), respectively. In conclusion, improvements in patient identification are imminently necessary, which could be made feasible by the rational choice of the identification method and through the empowerment of the nurse for decision making on this indicator.

RESUMEN Estudio descriptivo, trasversal, prospectivo, observacional, cuantitativo, con objeto de evaluar la calidad de la atención con indicadores relacionados a la prevención de caídas e identificación del paciente de un hospital universitario. Los datos fueron recolectados en 15 días aleatorios de los meses de agosto y septiembre del 2015, en dos unidades de un hospital del interior de Paraná-Brasil, utilizándose instrumentos previamente validados. Fue aplicado análisis estadístico descriptivo, seguido del cálculo del Índice de Positividad. Fueron efectuadas 1068 observaciones. La calidad de la atención ilustrada por los indicadores de identificación del paciente por el lecho/la pulsera y presencia de grades en el lecho para prevención de caídas fue clasificada como sufrible (0%), limítrofe (76,60%) y adecuada (95,48%), respectivamente. Se concluyó la necesidad inminente de mejoras en la identificación del paciente, lo que posiblemente podría ser viabilizado por la elección racional del método de identificación y a través delempoderamiento del enfermero con relación a la toma de decisión respecto a este indicador.

RESUMO Estudo descritivo, transversal, prospectivo, observacional, quantitativo, que objetivou avaliar a qualidade da assistência com indicadores relacionados à prevenção de quedas e identificação do paciente de um hospital universitário. Os dados foram coletados em 15 dias aleatórios dos meses de agosto e setembro de 2015, em duas unidades de um hospital do interior do Paraná-Brasil, utilizando-se instrumentos previamente validados. Fez-se análise estatística descritiva, seguido do cálculo do Índice de Positividade. Foram realizadas 1068 observações. A qualidade da assistência ilustrada pelos indicadores de identificação do paciente pelo leito/pulseira e presença de grades no leito à prevenção de quedas foi classificada como sofrível (0%), limítrofe (76,60%), e adequada (95,48%), respectivamente. Concluiu-se a necessidade iminente de melhorias na identificação do paciente, o que possivelmente poderia ser viabilizado pela escolha racional do método de identificação e através do empoderamento do enfermeiro em relação à tomada de decisão quanto a este indicador.

RESUMO Racional: A avaliação do colágeno na parede abdominal é cada vez mais estudada, em virtude da relevância dele no processo cicatricial após laparotomia. Objetivo: Avaliar a quantidade de colágeno na linha alba de pacientes submetidos à cirurgia bariátrica e compará-la com a de cadáveres não-obesos. Método: Foram avaliados dois grupos com total de 88 amostras da aponeurose da linha alba abdominal, divididas em 44 de pacientes obesos (grupo obesidade) com indicação de cirurgia bariátrica e 44 de cadáveres não-obesos (grupo controle). As amostras foram retiradas da linha alba abdominal no período de 2013 a 2014 e inicialmente foram separadas conforme faixas etárias (18-30, 31-45 e 46-60), gênero, medidas de IMC, circunferência abdominal e cervical e espessura do subcutâneo do indivíduo. Foi coletado material para biópsia da linha alba supraumbilical para análise imunoistoquímica, diferenciando o colágeno tipo I e III e sua relação de tipo I/III. Utilizou-se o programa de contagem de pixels Image-Pro Plus(r), que mensurou a quantidade do colágeno. Resultados: O grupo obesidade teve idade 44,11±9,90 anos, Na faixa etária de 18-30 anos foram incluídos três (6,8%) obesos; na de 31-45 anos 22 (50%) e na de 46-60 anos 19 (43,1%). O gênero feminino apresentou predomínio, com 36 (81,8%) pacientes. O IMC (kg/m²) foi de 48,81±6,5; a circunferência abdominal (cm) foi de 136,761±13,55; a espessura do subcutâneo (cm) foi de 4,873±0,916. A quantidade de colágeno tipo I foi de 134.683,3±206.657,4; a de colágeno tipo III foi de 413.137,2±283.656,1; a razão do colágeno tipo I/III foi 0,419±0,636. Considerando-se faixas de idade, gênero e IMC, foram constatadas diferenças estatísticas em todas as análises quando comparadas com às dos cadáveres. Conclusão: Os obesos mórbidos apresentaram quantidade de colágeno na linha alba supraumbilical menor que a do grupo controle de cadáveres não-obesos na mesma faixa etária.

ABSTRACT Background: The evaluation of collagen in the abdominal wall has been increasingly studied because of the relevance on collagen in the healing process after laparotomy. Aim: To evaluate the amount of collagen in the linea alba of patients undergoing laparotomic bariatric surgery and comparing with non-obese cadavers. Methods: Were evaluated 88 samples of aponeurosis from abdominal linea alba of 44 obese patients (obesity group) and 44 non-obese cadavers (control group). The samples were collected in 2013 and 2104, and were sorted according to age (18-30, 31-45 and 46-60), gender, BMI, waist and cervical circumference, and subcutaneous tissue thickness. Material for biopsy was collected from the supraumbilical region of the linea alba for immunohistochemical analysis differentiating collagen type 1 and type 3 and the 1/3 ratio. Image-Pro Plus pixel counting software was used to measure the amount of collagen. Results: The obesity group evidenced mean age 44.11±9.90 years; 18-30 age group had three (6.8%) obese individuals; 31-45 had 22 (50%) and 46-60 had 19 (43.1%). Females were present in 81.8% (n=36); BMI (kg/m²) was 48.81±6.5; waist circumference (cm) was 136.761±13.55; subcutaneous tissue thickness (cm) 4.873±0.916. Considering age groups, gender and BMI, there were statistical differences in all tests when compared with the cadavers. Conclusion: The amount of collagen in the linea alba above the umbilical region in the morbidly obese patients was smaller than in the non-obese cadavers in the same age group.

Abstract: Objective: To evaluate the use of β-blockers and to monitor heart rate in Mexican patients with coronary artery disease. Methods: CLARIFY is an outpatients registry with stable CAD. A total of 33,283 patients from 45 countries were enrolled between November 2009 and July 2010 from which 1342 were Mexican patients. Results: The mean HR pulse was 70 bpm (beats per minute). Patients in Mexico were compared with the remaining global CLARIFY population. Patients in Mexico had a higher incidence of acute myocardial infarction and percutaneous coronary intervention, and lower incidence of revascularization surgery compared with the remaining CLARIFY population. More often, Mexican patients presented with diabetes, but less often hypertension and stroke. These patients were split into three mutually exclusive groups of HR ≤60 (N = 263), HR 61-69 (N = 356) and HR ≥70 (N = 722). Patients with elevated HR had a higher incidence of diabetes and higher diastolic blood pressure on average than those with controlled HR. Regarding the use of β-blockers, they were used in 63.3% of patients, 2.7% showed intolerance or contraindication to treatment to monitor heart rate, and ivabradine was used in 2.3%. Out of approximately 849 patients receiving treatment of β-blockers, 52.1% had ≥70 bpm HR. Conclusions: In a large proportion of Mexican patients with stable coronary disease the HR remain elevated, >70 bpm, even with the use of β-blockers; this requires further attention.

Resumen: Objetivo: Evaluar en pacientes con enfermedad coronaria estable, el uso de beta-bloqueadores y la frecuencia cardiaca. Métodos: El estudio CLARIFY es un registro internacional de pacientes ambulatorios con enfermedad coronaria estable. Se incluyeron un total de 33,283 pacientes de 45 países durante el periodo de noviembre de 2009 a julio de 2010; de estos, 1342 pacientes fueron mexicanos. Resultados: La frecuencia cardiaca (FC) media fue de 70 lpm (latidos por minuto). Se compararon los pacientes mexicanos con la población internacional incluida en el estudio. Los primeros tuvieron una mayor incidencia de infarto agudo del miocardio e intervención coronaria percutánea y menor incidencia de cirugía de revascularización comparado con la población mundial. La población Mexicana presentó mayor incidencia de diabetes pero menor incidencia de hipertensión y EVC. A estos se les dividio en tres grupos mutuamente excluyentes FC ≤60 (N = 263), FC 61-69 (N = 356) y FC ≥70 (N = 722). Los pacientes con FC elevada presentaron mayor incidencia de diabetes, y un registro mayor de tensión arterial sistólica comparado con aquellos con FC controlada. Respecto al uso de beta bloqueadores estos se administraron a 63.3% de los pacientes; el 2.7% mostró intolerancia o contraindicación al tratamiento con estos fármacos. Se administró ivabradina al 2.3% de los pacientes. De los 849 pacientes que recibieron tratamiento con beta-bloqueadores, el 52.1% mostró FC de ≥ 70 lpm. Conclusiones: La gran mayoría de los pacientes mexicanos con enfermedad coronaria estable la FC permaneció elevada, >70 bpm, aun con el uso de beta bloqueadores.

A síndrome metabólica (SM) aumenta o risco de eventos cardiovasculares e o consumo adequado de frutas, verduras e legumes (FVL) está relacionado a sua prevenção. Objetivo: Identificar o consumo de FVL e sua relação com a SM e seus componentes em amostra populacional adulta. Estudo prospectivo de corte transversal com 636 indivíduos adultos, no período de 2004 a 2008. Foram realizadas avaliações antropométrica, clínica, dietética e bioquímica com todos participantes. A SM foi classificada pelo NCEP ATP-III, modificada para a glicose >100mg/dl. A regressão logística foi utilizada para verificar a razão de chance entre o consumo de FVL com a SM e seus componentes, e o nível de significância adotado foi de 5%. O consumo de frutas adequado se mostrou protetor para obesidade abdominal (OR: 0,77; IC: 0,38-0,93), hipertrigliceridemia (OR: 0,76; IC: 0,35-0,96) e presença de SM (OR: 0,78; IC: 0,39-0,96), e o consumo adequado de FVL apresentou efeito protetor para a presença de SM (OR: 0,79; IC: 0,41-0,95). A análise isolada do consumo adequado de verduras e legumes não mostrou efeitos de proteção/risco para a presença de SM e de seus componentes. O consumo adequado de FVL apresentou efeito protetor para a presença de SM e o consumo adequado de frutas exerceu efeito protetor tanto para a presença de SM e como de seus componentes.

Metabolic Syndrome (MS) increases the risk of cardiovascular events and the recommended intake of fruits and vegetables (FV) is related to its prevention. The scope of this study is to associate the intake of FV and its relation to MS and its components in an adult population sample. A prospective cross-sectional study was conducted with 636 adults in the period between 2004 and 2008. Anthropometric, clinical, dietary and biochemical profiles were recorded for all participants. MS was classified by the NCEP ATP-III, modified for glucose >100mg/dl. Logistic regression was used to determine the odds ratio (OR) between the consumption of FV with MS and its components, and the level of significance adopted was 5%. The intake of fruit had protective effects against obesity (OR: 0.77, CI: 0.38-0.93), hypertriglyceridemia (OR: 0.76, CI: 0.35-0.96) and presence of MS (OR: 0.78, CI: 0.39-0.96), and proper intake of FV showed a protective effect for the presence of MS (OR: 0.79, CI: 0.41-0.95). Vegetable intake did not show protective effects / risk for the presence of MS and its components. The conclusion drawn is that the recommended intake of FV revealed a protective effect against MS and recommended intake of fruit had a protective effect not only for MS but also for its components.

A síndrome metabólica (SM) aumenta o risco de eventos cardiovasculares e o consumo adequado de frutas, verduras e legumes (FVL) está relacionado a sua prevenção. Objetivo: Identificar o consumo de FVL e sua relação com a SM e seus componentes em amostra populacional adulta. Estudo prospectivo de corte transversal com 636 indivíduos adultos, no período de 2004 a 2008. Foram realizadas avaliações antropométrica, clínica, dietética e bioquímica com todos participantes. A SM foi classificada pelo NCEP ATP-III, modificada para a glicose >100mg/dl. A regressão logística foi utilizada para verificar a razão de chance entre o consumo de FVL com a SM e seus componentes, e o nível de significância adotado foi de 5%. O consumo de frutas adequado se mostrou protetor para obesidade abdominal (OR: 0,77; IC: 0,38-0,93), hipertrigliceridemia (OR: 0,76; IC: 0,35-0,96) e presença de SM (OR: 0,78; IC: 0,39-0,96), e o consumo adequado de FVL apresentou efeito protetor para a presença de SM (OR: 0,79; IC: 0,41-0,95). A análise isolada do consumo adequado de verduras e legumes não mostrou efeitos de proteção/risco para a presença de SM e de seus componentes. O consumo adequado de FVL apresentou efeito protetor para a presença de SM e o consumo adequado de frutas exerceu efeito protetor tanto para a presença de SM e como de seus componentes.

Metabolic Syndrome (MS) increases the risk of cardiovascular events and the recommended intake of fruits and vegetables (FV) is related to its prevention. The scope of this study is to associate the intake of FV and its relation to MS and its components in an adult population sample. A prospective cross-sectional study was conducted with 636 adults in the period between 2004 and 2008. Anthropometric, clinical, dietary and biochemical profiles were recorded for all participants. MS was classified by the NCEP ATP-III, modified for glucose >100mg/dl. Logistic regression was used to determine the odds ratio (OR) between the consumption of FV with MS and its components, and the level of significance adopted was 5%. The intake of fruit had protective effects against obesity (OR: 0.77, CI: 0.38-0.93), hypertriglyceridemia (OR: 0.76, CI: 0.35-0.96) and presence of MS (OR: 0.78, CI: 0.39-0.96), and proper intake of FV showed a protective effect for the presence of MS (OR: 0.79, CI: 0.41-0.95). Vegetable intake did not show protective effects / risk for the presence of MS and its components. The conclusion drawn is that the recommended intake of FV revealed a protective effect against MS and recommended intake of fruit had a protective effect not only for MS but also for its components.

OBJETIVO: Comparar fixação cirúrgica de telas de polipropileno (PP) e telas de polipropileno revestido (PCD), usando fio de sutura de polipropileno e cola biológica, quanto à formação de aderências intraperitoneais. MÉTODOS: Amostra de 46 ratas Wistar, randomizadas em seis grupos: dois grupos-controle, com cinco ratas cada, que foram submetidos um à incisão medial (IM) e o outro à uma incisão em forma de U (IU); nenhum desses grupos recebeu tela. Dois grupos com tela de PP, um com dez ratas, fixada com sutura (PPF), e o outro, com seis ratas, fixada com cola biológica (PPC). E Dois grupos com tela de PCD, no primeiro, com dez animais, a tela foi fixada com sutura (PCDF), e no segundo, com dez animais, com cola biológica (PCDC). RESULTADOS: Após o prazo de 21 dias, os grupos-controle não apresentaram aderências significantes. O grupo PPC apresentou menor grau de aderência do que o grupo PPF (p=0,01). Não houve diferença entre as fixações nos grupos com PCD. CONCLUSÃO: A comparação da fixação apresentou diferença estatística significativa apenas à tela de PP, com menor grau de aderência utilizando a cola. As aderências se localizaram predominantemente nas extremidades das telas estudadas.

OBJECTIVE: To compare surgical fixation of polypropylene mesh (PP) and coated polypropylene mesh (PCD) using polypropylene suture and fibrin glue, as for the formation of intraperitoneal adhesions. METHODS: A sample of 46 female Wistar rats were randomized into six groups: two control groups, with five rats each, were subjected to one medial incision (MI) and the other to a U-shaped incision (UI), none of these groups received the mesh. Two groups of PP mesh, with ten rats, fixed with suture (PPF), the other with six rats, fixed with biological glue (PPC). And two groups of PCD mesh, at first, with ten animals, the mesh was fixed with sutures (PCDFs) and the second with ten animals with biological glue (PCDC). RESULTS: After 21 days, the control groups showed no significant adhesions. The PPC group showed a lower degree of adhesion than the PPF group (p = 0.01). There was no difference between the groups with PCD. CONCLUSION: Comparison of fixation was statistically different only with PP mesh, with lesser degrees of adherence when using the glue. Adhesions were predominantly located at the extremities of the meshes studied.

FUNDAMENTO: A dieta influencia diretamente a hipertensão arterial (HAS), que é um dos principais fatores de risco da doença cardiovascular. OBJETIVO: Associar a HAS com fatores dietéticos de adultos clinicamente selecionados para programa de mudança de estilo de vida. MÉTODOS: Estudo transversal composto por 335 indivíduos, com idade entre 44 e 65 anos, clinicamente selecionados para um programa de mudança de estilo de vida. Foram avaliados os dados antropométricos (IMC, % de gordura e circunferência abdominal), os componentes bioquímicos (concentrações plasmáticas de glicose, triglicerídeos, colesterol total, HDL-c e LDL-c) e a dieta, por meio do recordatório de 24 horas. A qualidade da dieta foi avaliada pelo Índice de Alimentação Saudável. A pressão arterial foi mensurada de acordo com a V Diretriz Brasileira de Hipertensão Arterial e classificada de acordo com o NCEP-ATPIII. A regressão logística foi realizada para determinar a probabilidade de alterações na PAS e PAD de acordo com a ingestão dietética. Adotou-se como significante o valor de p < 0,05. RESULTADOS: Observou-se correlação positiva da pressão arterial diastólica com o consumo de colesterol e açúcar; e negativa com a ingestão de fibras, porções de óleo e qualidade da dieta. A variedade da dieta ≥ 8 itens alimentares apresentou efeito protetor para alterações da pressão arterial sistólica; OR = 0,361 (0,148-0,878). CONCLUSÃO: A maior variedade da dieta ofereceu efeito protetor para alteração da pressão arterial sistólica.

BACKGROUND: Diet directly influences systemic arterial hypertension (SAH), which is one of the main risk factors for cardiovascular disease. OBJECTIVE: To associate hypertension with dietary factors in adults clinically selected for a change-of-lifestyle program. METHODS: Cross-sectional study comprising 335 individuals, aged between 44 and 65 years, clinically selected for a change-of-lifestyle program. We evaluated anthropometric data (BMI, %body fat and waist circumference), biochemical components (plasma glucose, triglycerides, total cholesterol, HDL-C and LDL-c) and diet, through the 24-hour recall method. The quality of the diet was assessed by the Healthy Eating Index. Blood pressure was measured according to the V Brazilian Guidelines on Hypertension and classified according to NCEP-ATPIII. Logistic regression was performed to determine the likelihood of changes in SBP and DBP according to dietary intake. The level of significance was set at p <0.05. RESULTS: There was a positive correlation between diastolic blood pressure and sugar and cholesterol intake, and a negative one with intake of fiber, portions of oil and fats and diet quality. Dietary variety with ≥ 8 food items showed a protective effect for alterations in systolic blood pressure, OR = 0.361 (0.148 to 0.878). CONCLUSION: A greater dietary variety had a protective effect on the systolic blood pressure.

OBJECTIVES: Mitochondrial dysfunction has been reported in the central nervous system, hepatocytes and peripheral blood lymphocytes from patients with sporadic amyotrophic lateral sclerosis (SALS). However, the status of skin mitochondria has not been reported, in spite of the fact that SALS patients present skin abnormalities. The objective of the present study was to compare mitochondrial ultrastructural parameters in keratinocytes from patients with SALS and healthy controls. METHODS: Our study was based on the analysis of 112 skin mitochondria from 5 SALS patients and 99 organelles from 4 control subjects by electron microscopy. RESULTS: Computerized image analysis showed that mitochondrial major axis length, area and perimeter of the organelle were significantly smaller in SALS respect of healthy control subjects. Morphologically, SALS mitochondria presented cristolysis and breakage of the outer membrane. CONCLUSIONS: Mitochondrial dysfunction in the skin may possibly reflect changes occurring in mitochondria of the central nervous system. The analysis of mitochondrial morphology in this tissue may be of value to follow disease progression and, eventually, the effectiveness of current therapies for SALS.

OBJETIVOS: Existen alteraciones en la función mitocondrial en el sistema nervioso central, en hepatocitos y en linfocitos de sangre periférica en SALS. Aunque, no se ha estudiado si existen cambios estructurales en las mitocondrias de la piel. Nuestro objetivo fue comparar la ultraestructura de mitocondrias en queratinocitos de enfermos con SALS con la de controles sanos. MÉTODO: Fueron analizadas en el microscopio electrónico 112 mitocondrias dérmicas de 5 pacientes y 99 provenientes de 4 controles. RESULTADOS: EL análisis computarizado mostró que el eje mayor mitocondrial, el área y el perímetro de las organelas fueran significativamente menor que en controles. Morfológicamente, las mitocondrias de SALS presentaron cristólisis y ruptura de la membrana externa. CONCLUSIÓN: La alteración mitocondrial en la piel posiblemente refleje cambios que también ocurran en las mitocondrias neuronales. Este análisis morfológico de las mitocondrias podría tener valor en el seguimiento de la enfermedad y eventualmente en la evaluación de la efectividad de futuras terapias.

Fraturas da coluna vertebral associadas à lesão medular raramente acometem pacientes gestantes. Os autores apresentam o caso de uma mulher de 20 anos de idade, com gestação de 20 semanas, que sofreu fratura-luxação da coluna torácica (T4-T5) e foi submetida a descompressão, redução e artrodese posterior com parafusos pediculares. Apesar de apresentar lesão medular completa, a gestação evoluiu sem intercorrências e resultou no nascimento, por parto normal, de uma criança saudável a termo. Algumas particularidades, como o cuidado com o uso de radiação ionizante, via de acesso cirúrgico e de parto, corticoterapia e complicações gestacionais em pacientes nessas condições são discutidas neste artigo. Somente uma equipe multidisciplinar, formada por médicos de diferentes especialidades (cirurgiões de coluna, obstetras e fisiatras), enfermeiras e fisioterapeutas é capaz de assistir a essas pacientes de modo satisfatório.

Spinal fractures associated with spinal cord injury rarely affect pregnant patients. The authors present the case of a 20-year-old woman in her 20th week of pregnancy, who suffered fracture-dislocation of the thoracic spine (T4-T5) and underwent decompression, reduction and posterior fusion with pedicle screws. Despite the complete spinal cord injury presented, the pregnancy progressed uneventfully and resulted in birth via normal delivery of a healthy newborn at term. Some particular features of this case, like the care needed in using ionizing radiation, the surgical approach and delivery, use of steroids and pregnancy complications in such patients are discussed here. Only a multidisciplinary team composed by physicians from different specialties (spinal surgeons, obstetricians and physiatrists), nurses and physiotherapists is capable of assisting pregnant patients with spinal cord injuries satisfactorily.

This article briefly describes the already known clinical features and pathogenic mechanisms underlying sporadic amyotrophic lateral sclerosis, namely excitoxicity, oxidative stress, protein damage, inflammation, genetic abnormalities and neuronal death. Thereafter, it puts forward the hypothesis that astrocytes may be the cells which serve as targets for the harmful action of a still unknown environmental agent, while neuronal death may be a secondary event following the initial insult to glial cells. The article also suggests that an emergent virus or a misfolded infectious protein might be potential candidates to accomplish this task.

El artículo presente describe, brevemente, las características clínicas y los mecanismos patogénicos de la esclerosis lateral amiotrófica esporádica, tales como la excitotoxicidad, el stress oxidativo, el daño proteico, la inflamación, las anormalidades genéticas y la muerte neuronal. Luego de ello, sugiere la posibilidad hipotética de que los astrocitos podrían ser el blanco primario de la acción de una agente ambiental, externo, aún desconocido, y que la muerte neuronal aconteciera secundariamente a ese daño astrocitario inicial. El artículo concluye discutiendo la posibilidad de que un virus ambiental o endógeno o una proteína mal plegada, que adquiriera características de infectividad, puedan ser la causa de la enfermedad.

OBJECTIVE: The aim of this systematic review was to assess the role of microsurgical reconstruction of the jaws in patients with bisphosphonate-related osteonecrosis, and biological complications after an observation period of at least 12 months. Material and methods: An electronic MEDLINE search supplemented by manual searching was conducted to identify studies reporting data of at least 12 months observation on the microsurgical reconstruction of the jaws in patients with bisphosphonate-related osteonecrosis. RESULTS: Four studies resulted eligible for the analysis yielded. Three out of five studies were free of complications, with a success rate of 100% as no recurrence of osteonecrosis was registered. CONCLUSIONS: Microsurgical reconstruction of the jaws represents a valid treatment modality in patients with bisphosphonate-related osteonecrosis at 3rd stage of the disease.

European eel and chub samples were analyzed to determine the levels of non-dioxin-like polychlorobiphenyls (NDL-PCBs), polychlorodibenzodioxins (PCDDs) and polychlorodibenzofurans (PCDFs), dioxin-like PCBs (DL-PCBs), and brominated polybromodiphenyl ethers (PBDEs) in order to evaluate the extent of contamination of the river Tiber along the urban tract through the city of Rome (Italy). All samples presented detectable levels of the chemicals analyzed, and exhibited species-specific differences in terms of congener composition and total concentrations. On average the European eel presented the highest values. In this species the dioxin-like compound sums (WHO-TEQs) exceeded the pertinent maximum levels (MLs). Non-ortho PCBs constituted approximately 80% of WHO-TEQ toxicological potential whereas NDL-PCB and PBDE concentrations appeared to match values determined in other polluted aquatic ecosystems where non-point contamination sources were present. The contamination patterns determined in fish tissues seemed to reflect the impact of generic contamination source(s).

In questo studio sono stati analizzati esemplari di anguilla europea e cavedano per la determinazione dei livelli di policlorobifenili ad azione non diossina-simile (NDL-PCBs), policloridibenzo-p-diossina (PCDDs) e policlorodibenzofurani (PCDFs), PCB ad azione diossina-simile (DL-PCB), difenil eteri bromurati (PBDE), al fine di valutare la contaminazione del fiume Tevere lungo il tratto urbano della città di Roma. Tutti i campioni presentano livelli distinguibili delle sostanze chimiche analizzate, ed esibiscono differenze specie-specifiche in termini di composizione di congeneri e livelli totali. In media, l'anguilla europea presenta i valori più elevati. In questa specie la somma dei composti ad azione diossina-simile supera il livello massimo previsto dalla normativa comunitaria. I PCBs non-orto costituiscono approssimativamente l'80% del potenziale tossicologico.