ABSTRACT Mechanical liposuction of cervicomental fat is part of the aesthetic procedures of orofacial harmonization. Ultrasonography stands out for illustrating soft tissues with high-resolution images in the diagnostic and postoperative stages. The present study aimed to report the case of a female patient, 54 years old, in good general health, confirmed by all previously requested laboratory tests, whose main complaint was the presence of excess fat in the jowl region. The stages after the liposuction procedure were followed by high-resolution ultrasound examinations in order to assess the healing of the manipulated tissues, and ultrasound evaluations were performed in the postoperative follow-up periods of 30, 60 and 120 days. Through the present study, it was possible to conclude that ultrasonography is an important ally in the postoperative follow-up of neck liposuction, allowing to follow the evolution of the post-surgical repair process.

RESUMO A lipoaspiração mecânica da gordura cervical faz parte dos procedimentos estéticos de harmonização orofacial. A ultrassonografia se destaca por evidenciar tecidos moles com imagens de alta resolução nas fases diagnóstica e pós-operatória. O presente estudo teve como objetivo relatar o caso de uma paciente do sexo feminino, 54 anos, com bom estado geral de saúde, confirmado por todos os exames laboratoriais previamente solicitados, cuja queixa principal era a presença de excesso de gordura na região da papada. As etapas após o procedimento de lipoaspiração foram acompanhadas por exames ultrassonográficos de alta resolução para avaliar a cicatrização dos tecidos manipulados e as avaliações ultrassonográficas foram realizadas nos períodos de acompanhamento pós-operatório de 30, 60 e 120 dias. Através do presente estudo foi possível concluir que a ultrassonografia é uma importante aliada no acompanhamento pós-operatório de lipoaspiração cervical, permitindo acompanhar a evolução do processo de reparo pós-cirúrgico.

OBJECTIVES: Ischemic stroke (IS) or transient ischemic attack (TIA) history is present in 4-17% of patients with coronary artery disease (CAD). This subgroup of patients is at high risk for both ischemic and bleeding events. The aim of this study was to determine the role of platelet aggregability, coagulation and endogenous fibrinolysis in patients with CAD and previous IS or TIA. METHODS: A prospective case-control study that included 140 stable CAD patients divided into two groups: the CASE group (those with a previous IS/TIA, n=70) and the CONTROL group (those without a previous IS/TIA, n=70). Platelet aggregability (VerifyNow Aspirin® and VerifyNow P2Y12®), coagulation (fibrinogen and thromboelastography by Reorox®) and endogenous fibrinolysis (D dimer and plasminogen activator inhibitor-1) were evaluated. RESULTS: Patients in the CASE group presented significantly higher systolic blood pressure levels (135.84±16.09 vs 123.68±16.11, p<0.01), significantly more previous CABG (25.71% vs 10%, p=0.015) and significantly higher calcium channel blocker usage (42.86% vs 24.29%, p=0.02) than those in the control group. In the adjusted models, low triglyceride values, low hemoglobin values and higher systolic blood pressure were significantly associated with previous IS/TIA (CASE group). Most importantly, platelet aggregability, coagulation and fibrinolysis tests were not independently associated with previous cerebrovascular ischemic events (CASE group). CONCLUSION: Platelet aggregability, coagulation and endogenous fibrinolysis showed similar results among CAD patients with and without previous IS/TIA. Therefore, it remains necessary to identify other targets to explain the higher bleeding risk presented by these patients.

Resumo Fundamento: Síndrome metabólica é um importante fator de risco cardiovascular, e sua prevalência aumenta após a menopausa. Ainda é incerto, porém, se a menopausa é fator de risco independente para a síndrome metabólica. Uma das bases fisiopatológicas para síndrome metabólica é a resistência insulínica, que pode ser calculada pelo método Homeostatic Model Assessment-Insulin Resitance (HOMA-IR), sendo pouco conhecida a relação entre resistência insulínica e menopausa. Objetivos: Avaliar a relação entre síndrome metabólica e resistência insulínica em mulheres climatéricas. Métodos: Estudo descritivo, que avaliou 150 mulheres, com idades entre 40 e 65 anos, atendidas em um ambulatório de ginecologia em um hospital terciário público, entre maio e dezembro de 2013. A amostra foi dividida em dois grupos, sendo o Grupo I com pacientes na pré-menopausa e o II com pacientes na pós-menopausa. Foi avaliada a presença de síndrome metabólica, bem como de seus componentes, além da ocorrência de resistência insulínica nos dois grupos. A associação do estado menopausal e as variáveis estudadas foi realizada com os testes Mann-Whitney, qui quadrado e exato de Fisher. O nível de significância foi de 5%. A análise estatística foi feita por meio do STATA 12.0. Resultados: A síndrome metabólica foi mais prevalente nas mulheres pós-menopausa, bem como todos seus componentes tiveram maior frequência também nesse grupo. As mulheres pós-menopausa também apresentaram maior prevalência de resistência insulínica, mas não foi observada relação estatística entre os achados. Conclusão: O estado menopausal não se associou significativamente com síndrome metabólica e resistência insulínica. A resistência insulínica foi considerada fator de risco independente para o desenvolvimento de síndrome metabólica apenas no grupo pós-menopausa.

Abstract Background: Metabolic syndrome is an important cardiovascular risk factor, and its prevalence increases after menopause. However, it is still uncertain whether menopause is an independent risk factor for metabolic syndrome. One of the pathophysiological basis for metabolic syndrome is insulin resistance, which can be calculated by the Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) method, and the association between insulin resistance and menopause is little known. Objective: To evaluate the association between metabolic syndrome and insulin resistance in menopausal women. Method: Descriptive study, which evaluated 150 women, aged 40 to 65, treated at a Gynecology Outpatient Clinic of a tertiary public hospital, from May to December of 2013. The sample was divided into two groups: Group I, comprising women in the premenopausal period and Group II, comprising women in the post-menopausal period. The presence of metabolic syndrome and its components were evaluated, as well as occurrence of insulin resistance in both groups. The association of menopausal status and the assessed variables was assessed using the Mann-Whitney, Chi-square and Fisher's exact tests. The significance level was set at 5%. The statistical analysis was performed using STATA 12.0. Results: Metabolic syndrome and its components were more prevalent in postmenopausal women. Postmenopausal women also had a higher prevalence of insulin resistance, but no statistical association was observed between the findings. Conclusion: The menopausal status was not significantly associated with metabolic syndrome and insulin resistance. Insulin resistance was considered an independent risk factor for the development of metabolic syndrome only in the postmenopausal group.

Resumo Fundamentos: O aumento da incidência de doenças cardiovasculares em mulheres ocorre durante o período do climatério, especialmente após a menopausa. Objetivo: O objetivo deste estudo foi identificar fatores de risco cardiovasculares entre as mulheres climatéricas com e sem doença arterial coronariana (DAC). Métodos: Trata-se de estudo transversal realizado no Serviço de Hemodinâmica do Hospital Universitário da Universidade Federal do Maranhão, no período de março de 2012 a julho de 2013. Foram incluídas 31 mulheres climatéricas que compareceram ao setor para realização do cateterismo cardíaco, separadas em grupos após resultados do cateterismo, Grupo I (com DAC) e Grupo II (sem DAC). Análise estatística: as variáveis categóricas foram descritas por meio de frequências e porcentagem, as numéricas por meio de média ± desvio padrão ou mediana (Quartil.3 - Quartil.1); o teste Shapiro-Wilk para verificar a normalidade dos dados quantitativos, o teste Exato de Fisher para comparações de dados categóricos; para dados contínuos o Test-T para amostras não pareadas ou o Mann-Whitney; foi considerado estatisticamente significativo o valor de p < 0,05. Resultados: Avaliaram-se grupos com DAC (n = 13) e sem DAC (n = 18), os resultados apontaram média de idade entre os grupos de 57,92 ± 5,15 e 51,72 ± 4,63 anos, respectivamente; dentre os fatores de risco cardiovasculares, os mais prevalentes entre as mulheres com DAC foram: a menopausa (84,62%), a hipertensão arterial sistêmica (HAS) (69,23%) e o sedentarismo (69,23). Conclusão: Concluiu-se que, além da menopausa propriamente dita, a HAS e o sedentarismo foram os fatores de risco cardiovasculares mais prevalentes entre as mulheres com DAC. (Int J Cardiovasc Sci. 2017; [online].ahead print, PP.0-0)

Abstract Background: The increased incidence of cardiovascular disease in women occurs during the climacteric period, especially after menopause. Objective: The aim of this study was to identify risk factors among climacteric women with and without coronary artery disease (CAD). Method: This cross-sectional study was performed in the Catheterization Laboratory at the Federal University Hospital of Maranhão, in the Northeast region of Brazil, between March 2012 and July 2013. We included 31 climacteric women who went to the care center for cardiac catheterization. They were divided into groups after catheterization results: Group I (with DAC) and Group II (without CAD). Statistical analysis: Categorical variables were described by means of frequencies and percentages, numerical variables by mean ± standard deviation or median (Quartile.3 - Quartile.1); the Shapiro-Wilk test was used to verify the normality of quantitative data. Fisher's exact test was used for categorical data comparisons. For continuous data, we used Student's test or the Mann-Whitney for unpaired samples; statistical significance was set at p < 0.05. Results: We evaluated groups with CAD (n = 13) and without CAD (n = 18). The results showed a mean age between the groups of 57.92 ± 5.15 and 51.72 ± 4.63 years, respectively. Among the cardiovascular risk factors, the most prevalent among women with CAD were menopause (84.62%), systemic arterial hypertension (SAH) (69.23%) and sedentary life style (69.23%). Conclusion: We concluded that, in addition to menopause itself, SAH and sedentary lifestyle were the most prevalent cardiovascular risk factors among women with CAD.

ABSTRACT Objective to evaluate and analyze health product-related technical complaints and adverse events at Maranhão Federal University Hospital. Methods from January to December 2015, 171 notifications were identified through the Health Surveillance Notification System and the Care Risk Management Unit data base. Results most reports were technical complaints (90.06%) filed mainly by pharmacists (66.70%) and nurses (22.60%). Product fragility was the commonest type of quality deviation, with medium-risk products responsible for the most technical complaints, and gloves, the product most notified. Conclusion educational strategies are thus necessary for professional improvement, to help improve care and implementation of a technovigilance risk mitigation plan to assure product quality without affecting the service being offered.

RESUMEN Objetivo evaluar y analizar las quejas técnicas y los eventos adversos relacionados con los productos sanitarios utilizados en el Hospital Universitario de la Universidad Federal de Maranhão. Métodos 171 notificaciones fueron identificados a través de las notificaciones del sistema de Vigilancia de la Salud y la recogida de datos de Alivio de la Unidad de Gestión de Riesgos, de enero a diciembre de 2015. Resultados: la mayoría de los informes técnicos eran quejas (90,06%) que poseen, principalmente por los farmacéuticos (66.70%) y enfermeras (22.60%). La fragilidad del producto es el tipo más común de desviación de calidad, donde los productos de riesgo medio fueron los principales responsables de las quejas y técnicos de la manga el producto más notificado. Conclusión por lo tanto, es estrategias educativas necesarias para su mejora profesional, contribuyendo a mejorar la atención y también a la aplicación de un plan de mitigación de riesgos en la vigilancia técnica, proporcionando la calidad del producto sin afectar el servicio ofrecido. Palabras clave Evaluación de la tecnología biomédica; gestión de riesgos; notificación; seguridad del paciente.

RESUMO Objetivo avaliar e analisar queixas técnicas e eventos adversos relacionados a produtos de saúde utilizados no Hospital Universitário da Universidade Federal do Maranhão. Método foram identificadas 171 notificações através do Sistema de Notificações em Vigilância Sanitária e do acervo de dados da Unidade de Gestão de Riscos Assistenciais, no período de janeiro a dezembro de 2015. Resultados a maioria das notificações foram queixas técnicas (90,06%), realizadas, principalmente por farmacêuticos (66,70%) e enfermeiros (22,60%). A fragilidade do produto é o tipo de desvio de qualidade mais comum, onde os produtos de Médio Risco foram os maiores responsáveis pelas queixas técnicas e a luva o produto mais notificado com. Conclusão assim, faz-se necessário estratégias educativas voltadas para o aprimoramento profissional, contribuindo para a melhoria do cuidado prestado e também para a implantação de um plano de minimização dos risco em Tecnovigilancia, proporcionando qualidade do produto sem afetar o serviço ofertado.

Abstract Aim The Social Competence and Behavior Evaluation Scale (SCBE-30) is a 30-item questionnaire designed to assess preschoolers’ behavioral problems (externalizing and internalizing) and social competence. It is widely used in the developmental research. This study aims to contribute to the adaptation and validation of the Portuguese version of the teachers’ short form of the SCBE-30 (Psychol. Assess. 8:369–777, 1996). Method Participants were 361 children from 3 to 6 years old whose preschool teachers completed the SCBE-30. For external validation purposes children completed arithmetic and theory of mind tasks, and parents completed a socio-demographic questionnaire. Results Confirmatory factor analysis did not confirm the 10-item-subscale solution of the original SCBE-30 version. Instead, a five-item-subscale was found as a better solution. Discussion The reduced 15-item version replicates the three-factor structure, shows good psychometric properties and meets external validation criteria. Further research should focus on the invariance of the factor structure of the SCBE-30 between cultures.

OBJECTIVE: The aim of this study was to identify the participation of the coagulation system in the differential diagnosis of pleural effusions. INTRODUCTION: Imbalance between immunologic and metabolic factors triggers a sequence of events resulting in pleural reactions and accumulation of fluid. The coagulation system, which is fundamental for the maintenance of homeostasis, contributes to the inflammatory process responsible for pleural effusions, and participates in cellular proliferation and migration as well as in the synthesis of inflammatory mediators. METHODS: We evaluated the laboratory profile of coagulation and fibrinolysis in 54 pleural fluids (15 transudates and 39 exudates). RESULTS: The coagulation system acts according to the pathophysiologic mechanisms involved in the development of pleural effusions. In inflammatory effusions (exudates), there is activation of coagulation with increased levels of fragment 1+2 and thrombin-antithrombin complex in addition to reduction of fibrinogen levels due to fibrinolysis and fibrin tissue incorporation. As a consequence, there is activation of the fibrinolytic system with increased levels of fibrin degradation products, including the D-dimer. These changes are not sufficient for differentiation of different subgroups of exudates. In transudates, these events were observed to a lesser degree. CONCLUSION: The coagulation system plays an important role in the development of pleural diseases. Coagulation tests show differences between transudates and exudates but not among exudate subgroups. Understanding the physiopathological mechanisms of pleural disorders may help to define new diagnostic and therapeutic approaches.

A riqueza e a amplitude da dermatologia integrativa despertam o desejo de buscar novos conhecimentos, dos quais, neste texto, os autores destacam a psicoterapia integrativa e ecológica que, acreditam, acrescenta idéias e práticas muito significativas, que ajudam a aprimorar o relacionamento médico/paciente. Ao atender o paciente, a dermatologia integrativa privilegia as dimensões do funcionamento humano, baseando-se em seis abordagens: fisiológica, comportamental, cognitiva, afetiva, sistêmica e ecológica. Nesse atendimento integrativo considera-se o paciente como um todo, procurando-se atingir a excelência no relacionamento interpessoal médico/paciente.

The wealth and breadth of integrative dermatology has motivated the search for further knowledge, regarding which the authors draw attention to integrative and ecological psychotherapy that they consider contributes highly significant concepts and techniques, which help optimize the physician/patient relationship. In attending patients, integrative dermatology underscores the dimensions of human function based on six approaches: physiological, behavioral, cognitive, affective, systemic and ecological. Integrative Dermatology views patients as a whole, and excellency is sought in the physician-patient interpersonal relationship.

Para este trabalho foram utilizados 18 ratos albinos da raça Wistar com lesões eletrolíticas crônicas da formação reticular mesencefálica, sendo 11 unilaterais e 7 bilaterais. Todas as lesões foram suficientemente amplas para interromper completamente o sistema ativador ascendente de uma ou de ambas as metades do mesencéfalo. Aumento da sincronização do eletrocorticograma provocado pelo sono espontâneo foi observado mesmo nos animais com lesão bilateral; este fato fala a favor da existência de mecanismos ativadores corticais situados acima do nível mesencefálico, que são deprimidos durante o sono. Progressivamente observa-se recuperação da atividade elétrica cortical dessincronizada e da atividade motora (comportamentos de alerta e de vigília), tanto nos animais com lesão unilateral como nos com bilateral. Nos primeiros, contudo, a recuperação é mais precoce e rápida. O sono fisiológico se desenvolve com todas as suas fases normais a partir do 4.° ou 5.° dias depois da lesão. A atividade dessincronizada do neocórtex observada durante a fase paradoxal do sono independe de qualquer estrutura em particular existente no tegmento do mesencéfalo.

This study was performed on 18 albino rats subjected to either unilateral (11) or bilateral (7) electrolytic destruction of the midbrain reticular formation. In all preparations a complete unilateral or bilateral interruption of the ascending activating system was achieved. The electrocorticographic pattern of synchronized sleep ocurred in both unilaterally and bilaterally lesioned rats. This was found as soon as the animal recovered from the surgical trauma, when slow waves still predominated. Such finding support the hypothesis that activating systems other than the midbrain reticular activating system exist whose functional block during sleep furthers the synchronization of the cortical electrical activity. An increasing recovery of desynchronization and motor activity as a function of time was shown by all rats. However, recovery occurred earlier and more quickly in the animal with unilateral lesions. Physiological sleep evolved with all its phases by the fourth or fifth day after the lesion was made. It seems that desynchronization of the paradoxical phase of sleed does not involve any particular struture arising from and/or passing through the midbrain tegmentum.