RESUMO Objetivo: Descrever a implantação de um serviço de telemedicina de UTI durante a pandemia de COVID-19, assim como descrever e analisar os resultados dos primeiros quatro meses de funcionamento do programa. Métodos: Estudo observacional descritivo da implantação de um serviço de telemedicina de UTI seguido de análise retrospectiva dos dados clínicos de pacientes com COVID-19 internados em UTI entre abril e julho de 2020. Resultados: O serviço foi implantado em quatro semanas e mostrou-se viável em meio à pandemia. O treinamento foi desenhado para ser remoto e baseado em evidências, promovendo a padronização do atendimento aos pacientes com COVID-19. Mais de 100.000 visualizações foram registradas nas plataformas on-line de acesso livre e no aplicativo móvel. Durante o período do estudo, os casos de 326 pacientes com COVID-19 foram avaliados no programa. A mediana de idade foi de 60 anos (variação: 49-68 anos). Houve predomínio do sexo masculino (56%) e alta prevalência de hipertensão arterial (49,1%) e diabetes mellitus (38,4%). Na admissão na UTI, 83,7% dos pacientes estavam em ventilação mecânica invasiva, com uma mediana da relação PaO2/FiO2 < 150. Ventilação pulmonar protetora foi possível em 75% dos casos. A mortalidade na UTI foi de 65%, e a mortalidade hospitalar foi de 68%. Conclusões: A telemedicina de UTI forneceu treinamento multidisciplinar aos profissionais de saúde e acompanhamento clínico de centenas de pacientes críticos. A iniciativa na rede pública foi pioneira e mostrou-se viável em meio à pandemia de COVID-19, incentivando a criação de projetos semelhantes que combinem práticas baseadas em evidências, treinamento e telemedicina.

ABSTRACT Objective: To describe the implementation of a Tele-ICU program during the COVID-19 pandemic, as well as to describe and analyze the results of the first four months of operation of the program. Methods: This was a descriptive observational study of the implementation of a Tele-ICU program, followed by a retrospective analysis of clinical data of patients with COVID-19 admitted to ICUs between April and July of 2020. Results: The Tele-ICU program was implemented over a four-week period and proved to be feasible during the pandemic. Participants were trained remotely, and the program had an evidence-based design, the objective being to standardize care for patients with COVID-19. More than 100,000 views were recorded on the free online platforms and the mobile application. During the study period, the cases of 326 patients with COVID-19 were evaluated through the program. The median age was 60 years (IQR, 49-68 years). There was a predominance of males (56%). There was also a high prevalence of hypertension (49.1%) and diabetes mellitus (38.4%). At ICU admission, 83.7% of patients were on invasive mechanical ventilation, with a median PaO2/FiO2 ratio < 150. It was possible to use lung-protective ventilation in 75% of the patients. Overall, in-hospital mortality was 68%, and ICU mortality was 65%. Conclusions: Our Tele-ICU program provided multidisciplinary training to health care professionals and clinical follow-up for hundreds of critically ill patients. This public health care network initiative was unprecedented and proved to be feasible during the COVID-19 pandemic, encouraging the creation of similar projects that combine evidence-based practices, training, and Tele-ICU.

Abstract Constrictive pericarditis is a disease where loss of pericardial elasticity and restriction of filling of the cardiac chambers occurs. It is most often seen as an associated symptom of heart failure. Pericardiectomy provides effective treatment for patients with symptomatic constrictive pericarditis, although high rates of morbidity and mortality are related to the procedure. We present a case with extensive calcification, massive caseous necrosis and an important impairment of right ventricular function successfully operated in our institution.

Abstract Penetrating heart injuries present high mortality rates. Increasing rates of urban violence have contributed to a significant rise in the number of heart injuries by firearm projectiles. Such injuries are associated with the highest mortality rates among penetrating cardiac injuries and may involve one or more cardiac chambers. We present the case of a police officer who, in an approach to five robbers, suffered a transfixed cardiac injury by firearm with the projectile having been lodged inside the right ventricle. This patient was successfully operated, 65 days after the injury, at our institution.

O experimento foi desenvolvido em Campo Grande - MS, no período de março de 2008 a janeiro de 2009. O objetivo foi avaliar o desenvolvimento das mudas da Campomanesia adamantium (Cambess.) O. Berg. sob três condições de sombreamento e seis substratos. Os tratamentos foram três níveis de sombreamento (0%, 30% e 50% de sombra) e seis substratos [100% de solo Latossolo Vermelho distrófico textura argilosa - LVd (ta); 100% de solo de Latossolo Vermelho distrófico textura média LVd (tm); 75% de LVd (ta) + 15% de areia + 10% de cama de frango semidecomposta - LVd (ta) + CF; 75% de LVd(tm) + 15% de areia + 10 % de cama de frango semidecomposta - LVd (tm) + CF; 75% de LVd(ta) + 15% de areia + 10 % Organosuper® - LVd (ta) + OR; 75% de LVd (tm) + 15% de areia + 10% de Organosuper® - LVd (tm) + OR]. O delineamento experimental foi em blocos ao acaso, arranjado em parcelas subdivididas com medidas repetidas no tempo. Foram utilizadas três repetições e dez plantas por subparcela. Os níveis de sombreamento interferiram do desenvolvimento das mudas nas características de diâmetro do coleto (maior sob sol), área foliar (maior sob 50% de sombra) e massa seca de raízes (maior sob sol). Considerando o desenvolvimento da parte aérea das mudas, a observação de que sob sol pleno há necessidade de utilização de maior volume de irrigação e que houve menor sobrevivência de plantas, considera-se o nível de sombreamento de 50% como mais adequado para produção de mudas de guavira. Dos substratos testados, o LVd (ta) foi considerado o mais adequado ao desenvolvimento das mudas pela percentagem de plantas vivas (95,55%) sem diferir do LVd (tm) (98,88%), maior altura de plantas observada no desenvolvimento e na altura final, maior massa seca de raízes, diferindo estatisticamente dos demais substratos e maior IQD (2,62), sem diferir de LVd (tm) (1,50).

The experiment was conducted in Campo Grande - MS from March 2008 to January 2009. The objective was to evaluate the development of seedlings of Campomanesia adamantium (Cambess.) O. Berg. under three conditions of shading and six substrates. Treatments were three levels of shading ( 0 % , 30 % and 50 % shade ) and six substrates [ 100 % Oxisol soil clayey - LVd ( ta ) ; 100 % Oxisol soil medium texture LVd ( tm ), 75 % of LVd ( ta ) + 15 % + 10 % sand bed - of - semi-decomposed chicken - LVd ( ta ) + CF , 75 % LVd ( tm ) + 15 % + 10 % sand bed - from - semi-decomposed chicken - LVd ( tm ) + CF , 75 % LVd ( ta ) + 15 % sand + 10 % Organosuper® - LVd ( ta ) + OR , 75 % LVd ( tm ) + 15 % sand + 10% Organosuper® - LVd ( tm ) + OR ] . The experimental design was random blocks, arranged in a split-plot with repeated measures. There were three replicates and ten plants per subplot. The shading levels interfered in plant growth characteristics of the stem diameter (greater under the sun), leaf area (greater under 50 % shade) and dry weight of roots (higher under the sun). Considering the development of the seedlings, the observation that under full sun, there is the need to use higher volume irrigation and plant survival was lower, and considering the level of shading of 50 % more suitable for guavira seedling production. About the substrates, LVd ( ta ) was considered the most suitable for the seedling growth percentage of live plants (95.55 % ) without differing from LVd ( tm ) ( 98.88 % ) , higher plant height observed in the development and the final height, higher dry roots differing from the other substrates and greater IQD ( 2.62 ) without differing from the LVd (tm) (1.50).

Foi avaliado o desenvolvimento de mudas de baru (Dipteryx alata Vog.) em vasos, sob três níveis de sombreamento e quatro classes texturais do solo, no período de março a outubro de 2010, em Campo Grande-MS. Os tratamentos consistiram em 0%, 30% e 50% de sombreamento e solos de textura arenosa, média, argilosa e muito argilosa. O delineamento experimental foi em blocos ao acaso, em parcelas subdivididas, com medidas repetidas no tempo. Foram utilizadas três repetições e dez plantas por subparcela. Os níveis de sombreamento corresponderam aos tratamentos, e as diferentes classes texturais do solo, aos subtratamentos. As plantas foram avaliadas em intervalos de 15 dias após a emergência (DAE) até 195 DAE, sendo avaliadas quanto à altura (cm) de plantas, número de folhas e diâmetro do coleto (mm). Aos 195 DAE, também foram avaliadas a percentagem de sobrevivência, a área foliar e a massa seca de folha, caule e das raízes das plantas. Sob sombreamento, foram observados maiores valores de altura e área foliar. A altura de plantas foi de 32,09 cm e 31,21 cm planta-1 , e a área foliar foi de 639,24 cm² e 580,49 cm² planta-1 para os níveis de sombreamento de 50% e 30%, respectivamente. No solo de textura argilosa, os valores foram superiores na maioria das características avaliadas, seguido do solo com textura muito argilosa. A maior produção de massa seca de folha foi no solo com textura argilosa, com média de 7,28 g planta-1. A percentagem de sobrevivência das mudas no solo com textura arenosa foi inferior aos demais. Houve interação entre níveis de sombreamento e classes texturais do solo na massa seca de raízes, que foi maior (1,43 g kg-1 de solo) no solo de textura muito argilosa, no nível de 50% de sombreamento. As mudas de baru atingiram medidas de altura e diâmetro de coleto adequadas em todos os níveis de sombreamento e classes texturais do solo.

It was evaluated the development of "Baru" seedlings (DipteryxalataVog.) in pots under three levels of shading and four textural classes, from March to October 2010, in Campo Grande-MS. Treatments consisted of 0%, 30% and 50% levels of shade and sandy, medium clay and heavy clay soil. The experimental design was randomized blocks in split plots with repeated measures. It was used three replicates of ten plants per plot. The shading levels corresponded to the treatments and the different textural classes to the subplot. Plant height, leaf number and stem diameter were evaluated 15 days after emergence (DAE) to 195 DAE. Survival rate, leaf area and dry mass of the leaf, the stem and the roots were also estimated at 195 DAE. Higher values were observed in height and leaf area under shading condition. Plant height was 32.09 cm and 31.21 cm plant-1, leaf area was 639.24 cm ² and 580.49 cm² for 50% and 30% shade levels respectively. In clay soil the values were higher in most traits followed by soil with loamy soil. The highest yield of dry mass of leaf was in the clayey soil with an average of 7.28 g plant-1.The percentage of seedling survival in sandy soil was lower than in the others. There was an interaction between levels of shading and texture classes of soil on dry mass of the roots which was higher (1.43 g kg-1 soil) on the loamy soil at 50% shading. "Baru" seedlings reached measurements of height and diameter suitable for all levels of shading and textural classes.

Apresentamos uma solução à base de gelatina, que preenche a medula esternal, oferecendo eficiente hemostasia, além de proteção para as extremidades do esterno.

We present a gelatin that fills the medullary of sternum providing effective hemostasis plus protection for each sternal end.

OBJECTIVE: To describe a surgical procedure utilizing a malleable bovine pericardium ring in mitral valve repair and clinical and echodopplercadiographic results. METHODS: Thirty-two (25 female and 7 male) patients, aged between 9 and 66 (M=36.4±17.2) years, were studied over a 16-month period, with 100% follow-up. In 23 (72%) of the patients, the mitral approach was the only one applied; 9 patients underwent associated operations. The technique applied consisted of measuring the perimeter of the anterior leaflet and implanting, according to this measurement, a flexible bovine pericardium prosthesis for reinforcement and conformation of the posterior mitral annulus, reducing it to the perimeter of the anterior leaflet with adjustment of the valve apparatus. RESULTS: The patient survival ratio was 93.8%, with 2 (6.2%) fatal outcomes, one from unknown causes, the other due to left ventricular failure. Only one reoperation was performed. On echodopplercardiography, 88% of the patients had functional recovery of the mitral valve (50% without and 38% with mild insufficiency and no hemodynamic repercussions). Of four (12%) of the remaining patients, 6% had moderate and 6% had seigre insufficiency. Twenty-eight percent of class II patients and 72% of class III patients passed into classes I (65%), II (32%), and III (3%), according to NYHA classification criteria. CONCLUSION: Being flexible, the bovine pericardium ring fit perfectly into the valve annulus, taking into account its geometry and contractility. Valve repair was shown to be reproducible, demonstrating significant advantages during patient evolution, which did not require anticoagulation measures.