Resumen Objetivo: Identificar la asociación entre los factores de riesgo de hipertensión arterial sistémica y los niveles de presión arterial de la población carcelaria. Materiales y métodos: Estudio de corte transversal realizado con una muestra de reclusos entre febrero y septiembre de 2019. Un total de 240 hombres de un complejo penitenciario en el sur de Brasil participaron en la investigación. En la recolección de datos se utilizó un instrumento semiestructurado basado en las guías nacionales de enfermedades cardiovasculares. Resultados: El análisis univariado permitió identificar que la práctica de ejercicio físico tiene una asociación negativa con el desarrollo y el control de la hipertensión arterial sistémica (p = 0,034), mientras que el índice de masa corporal y la circunferencia de la cintura fueron asociados positivamente con el riesgo cardiovascular y la hipertensión arterial sistémica (p = 0,000). En el análisis multivariado se observó la significancia estadística del índice de masa corporal cuando este es controlado para todas las demás variables del modelo (OR ajustado = 2,33). Conclusiones: Los factores de riesgo para el desarrollo de hipertensión arterial sistémica están presentes en el entorno penitenciario en un grado similar al de la vida en libertad; particularmente, la falta de ejercicio físico y las alteraciones del índice de masa corporal y la circunferencia de la cintura. Vale la pena mencionar que el índice de masa corporal fue la variable de mayor significancia estadística, puesto que al presentarse alteraciones en esta, aumenta 2,33 veces la probabilidad de que los reclusos desarrollen hipertensión arterial sistémica.

Resumo Objetivo: Identificar a associação entre os fatores de risco para a hipertensão arterial sistémica e os níveis pressóricos de prisioneiros em regime fechado. Materiais e métodos: Estudo de corte transversal, realizado com prisioneiros em regime fechado, entre fevereiro e setembro de 2019. Participaram do estudo 240 homens de um complexo penitenciário do Sul do Brasil. Para coletar os dados, foi utilizado um instrumento semiestruturado, baseado nas diretrizes nacionais para doenças cardiovasculares. Resultados: Na análise univariada, identificou-se que a prática de exercício físico foi associada de forma negativa ao desenvolvimento da hipertensão arterial sistémica (p = 0,034). Entretanto, o índice de massa corporal e a circunferência abdominal foram associados positivamente com o risco cardiovascular e a hipertensão arterial sistémica (p = 0,000). Na análise multivariada, notou-se a significância estatística do índice de massa corporal quando controlado por todas as outras variáveis no modelo (OR ajustado = 2,33). Conclusões: Os fatores de risco para o desenvolvimento da hipertensão arterial sistémica estão presentes no meio carcerário em grau similar ao da população geral, em especial a ausência da prática de exercício físico e a alteração do índice de massa corporal e da circunferência abdominal. Vale dizer que o índice de massa corporal foi a variável de maior significância estatística, pois, ao apresentar-se alterado, aumentou em 2,33 vezes a chance de os prisioneiros desenvolverem hipertensão arterial sistémica.

Abstract Objective: To identify the association between risk factors for systemic arterial hypertension and blood pressure levels in prisoners under a closed regime. Materials and methods: Cross-sectional study conducted with prisoners under a closed regime between February and September 2019. A total of 240 men from a penitentiary complex in southern Brazil participated in the study. A semi-structured instrument based on the national guidelines for cardiovascular diseases was used for data collection. Results: Univariate analysis allowed us to identify that physical exercise was negatively associated with the development of systemic arterial hypertension (p = 0.034). However, body mass index and abdominal circumference were positively associated with cardiovascular risk and systemic arterial hypertension (p = 0.000). Through multivariate analysis, we noted the statistical significance of the body mass index when controlled for all other variables in the model (adjusted OR = 2.33). Conclusions: Risk factors for the development of systemic arterial hypertension are present in the prison environment to a similar degree as in the general population; particularly the absence of physical exercise and altered body mass index and abdominal circumference. It is worth mentioning that the body mass index was the variable of greater statistical significance, since, when altered, it increased 2.33 times the chance of inmates to develop systemic arterial hypertension.

ABSTRACT Visceral leishmaniasis (VL) is an opportunistic disease in immunosuppressed individuals, who may present severe clinical conditions, such as the ones described in this patient. She lived in an endemic region for VL, and was possibly infected with L. (L.) infantum chagasi through the bite of a contaminated sand fly. This initial infection has triggered a pemphigus vulgaris condition by immunogenic proteins present in the mosquito's saliva. The immunosuppression caused by the use of high doses of corticosteroids to control the disease promoted a severe VL condition, with hepatosplenomegaly, thrombocytopenia and hemorrhages, requiring hospitalization and the onset of a subsequent SARS-CoV-2 infection. Due to the intensity of clinical manifestations related to VL, aggravated by COVID-19, she died two days after admission to the Clinical Hospital of Marilia Medical School (HC–Famema).

Objective to analyze national and international publications on prenatal care offered to women deprived of their liberty. Method integrative literature review. Searches were conducted in databases, using descriptors and keywords separated by Boolean operators. Tthe search resulted in 548 studies. After analysis of inclusion and exclusion criteria with analytical reading, 11 primary studies were selected, which were organized in the categories national and international studies. Results adjustments and improvements in health care are needed for these women who, even though they have existing rights, are negligent in the care offered. Conclusion the prenatal experience in prison is full of difficulties and peculiarities depending on the penitentiary, requiring managers and health professionals an attentive look at the needs of women, children and their family members, in an attempt to minimize the impacts of the prison context on the quality of life of the people involved.

Objetivo analizar las publicaciones nacionales e internacionales sobre la atención prenatal ofrecida a las mujeres privadas de libertad. Método revisión integradora de la literatura. Las búsquedas se realizaron en bases de datos, utilizando descriptores y palabras clave separadas por operadores boleanos. La búsqueda dio como resultado 548 estudios. Tras analizar los criterios de inclusión y exclusión con lectura analítica, se seleccionaron 11 estudios primarios, que se organizaron en las categorías de estudios nacionales e internacionales. Resultados se necesitan ajustes y mejoras en el cuidado de la salud de estas mujeres que, a pesar de tener derechos existentes, son negligentes en el cuidado ofrecido. Conclusión la experiencia prenatal en la cárcel está llena de dificultades y peculiaridades según el centro penitenciario, lo que exige que los gestores y los profesionales de la salud examinen detenidamente las necesidades de las mujeres, los niños y sus familias, en un intento por reducir al mínimo los efectos del contexto carcelario en la calidad de vida de las personas implicadas.

Objetivo analisar as publicações nacionais e internacionais acerca da assistência ao pré-natal oferecida às mulheres privadas de liberdade. Método revisão integrativa da literatura. As buscas foram realizadas em bases de dados, usando descritores e palavras-chave separadas por operadores boleanos. A busca resultou em 548 estudos. Após análise dos critérios de inclusão e exclusão com leitura analítica, foram selecionados 11 estudos primários, que foram organizados nas categorias estudos nacionais e internacionais. Resultados são necessárias adequações e melhorias na assistência à saúde dessas mulheres que, mesmo tendo direitos vigentes, sofrem negligência na assistência oferecida. Conclusão a vivência do pré-natal no cárcere está repleta de dificuldades e peculiaridades a depender da penitenciária, exigindo dos gestores e dos profissionais de saúde um olhar atento às necessidades da mulher, da criança e de seus familiares, na tentativa de minimizar os impactos do contexto prisional na qualidade de vida das pessoas envolvidas.

RESUMO Objetivo Avaliar o papel da tomografia computadorizada de tórax em pacientes com COVID-19 que apresentaram reação em cadeia da polimerase via transcriptase reversa (RT-PCR) inicial falsamente negativa. Métodos Estudo retrospectivo de centro único que avaliou 39 pacientes com RT-PCR negativa para COVID-19, submetidos à tomografia computadorizada de tórax e que tiveram diagnóstico final clínico ou serológico de COVID-19. A classificação tomográfica visual foi avaliada de acordo com o Consenso da Radiological Society of North America e o software desenvolvido com inteligência artificial para detecção automática de achados e estimativa de probabilidade de COVID-19. Resultados Na análise tomográfica visual, somente um deles (3%) apresentou tomografia computadorizada classificada como tendo resultado negativo, 69% foram classificados como típicos e 28% como indeterminados. Na avaliação com uso de software, somente quatro (cerca de 10%) tiveram probabilidade de COVID-19 <25%. Conclusão A tomografia computadorizada pode desempenhar papel importante no manejo de casos suspeitos de COVID-19 com RT-PCR inicialmente negativa, principalmente levando-se em consideração os pacientes que estão fora da janela ideal para coleta de amostra para RT-PCR.

ABSTRACT Objective To evaluate the role of chest computed tomography in patients with COVID-19 who presented initial negative result in reverse transcriptase-polymerase chain reaction (RT-PCR). Methods A single-center, retrospective study that evaluated 39 patients with negative RT-PCR for COVID-19, who underwent chest computed tomography and had a final clinical or serological diagnosis of COVID-19. The visual tomographic classification was evaluated according to the Consensus of the Radiological Society of North America and software developed with artificial intelligence for automatic detection of findings and chance estimation of COVID-19. Results In the visual tomographic analysis, only one of them (3%) presented computed tomography classified as negative, 69% were classified as typical and 28% as indeterminate. In the evaluation using the software, only four (about 10%) had a probability of COVID-19 <25%. Conclusion Computed tomography can play an important role in management of suspected cases of COVID-19 with initial negative results in RT-PCR, especially considering those patients outside the ideal window for sample collection for RT-PCR.

Abstract Fungal infections have become a concern for health professionals, and the emergence of resistant strains has been reported for all known classes of antifungal drugs. Among the fungi causing disease, we highlight those that belong to the genus Aspergillus. For these reasons, the search for new antifungals is important. This study examines the effects of a coumarin derivative, 4-acetatecoumarin (Cou-UMB16) both alone and together with antifungal drugs, and its mode of action against Aspergillus spp. Cou-UMB16 was tested to evaluate its effects on mycelia growth, and germination of Aspergillus spp. fungal conidia. We investigated its possible action on cell walls, on the cell membrane, and also the capacity of this coumarin derivative to enhance the activity of antifungal drugs. Our results suggest that Cou-UMB16 inhibits Aspergillus spp. virulence factors (mycelia growth and germination of conidia) and affects the structure of the fungal cell wall. When applying Cou-UMB16 in combination with azoles, both synergistic and additive effects were observed. This study concludes that Cou-UMB16 inhibits mycelial growth and spore germination, and that the activity is due to its action on the fungal cell wall, and that Cou-UMB16 could act as an antifungal modifier.

RESUMO: O objetivo deste trabalho foi avaliar a presença de microrganismos no mel produzido pela abelha sem ferrão jandaíra (Melipona subnitida). Trinta e cinco amostras foram avaliadas e todas foram positivas para bactérias mesofílicas, coliformes a 45 ºC, fungos e leveduras. Staphylococcus spp. foi identificado em 85,7% enquanto Bacillus foi detectado em 34,3% das amostras de mel. Clostridium perfringens e C. botulinum foram detectados em 40% e 2,8% das amostras respectivamente. Salmonella spp. e C. difficile não foram detectados. O presente trabalho revelou uma grande diversidade de microrganismos no mel produzido por jandaíra.

ABSTRACT: The aim of this study was to evaluate the presence of microorganisms in honey produced by the stingless bee (SB) jandaíra (Melipona subnitida) from the semiarid region of Brazil. Thirty-five samples were analyzed and all of them were positive for mesophilic bacteria, coliforms at 45°C, fungi, and yeast. Staphylococcus spp. were identified in 85.7%, while Bacillus spp. were detected in 34.3% of honey samples. DNAs of Clostridium perfringens and C. botulinum were detected in 40% and 2.8% of the samples, respectively. Salmonella spp. and C. difficile were not detected. The present research revealed a great diversity of microorganisms in honey produced by jandaíra.

After the report of a second case of canine visceral leishmaniasis (CVL) in São Bento da Lagoa, Itaipuaçu, in the municipality of Maricá, Rio de Janeiro State, an epidemiological survey was carried out, through active search, totaling 145 dogs. Indirect immunofluorescence assay (IFA), enzyme-linked immunosorbent assay (ELISA), and rapid chromatographic immunoassay based on dual-path platform (DPP(r)) were used to perform the serological examinations. The parasitological diagnosis of cutaneous fragments was performed by parasitological culture, histopathology, and immunohistochemistry. In the serological assessment, 21 dogs were seropositive by IFA, 17 by ELISA, and 11 by DPP(r), with sensitivity of 66.7%, 66.7% and 50%, and specificity of 87.2%, 90.2% and 94%, respectively for each technique. The immunohistochemistry of bone marrow using the cell-block technique presented the best results, with six positive dogs found, three of which tested negative by the other parasitological techniques. Leishmania sp. was isolated by parasitological culture in three dogs. The detection of autochthonous Leishmania infantum in Itaipuaçu, and the high prevalence of seropositive dogs confirm the circulation of this parasite in the study area and alert for the risk of expansion in the State of Rio de Janeiro.

Introduction Guillain-Barre syndrome is an acute neuropathy that rarely compromises bladder function. Conservative management including clean intermittent catheterization and pharmacotherapy is the primary approach for hypocompliant contracted bladder. Surgical treatment may be used in refractory cases to improve bladder compliance and capacity in order to protect the upper urinary tract. We describe a case of pure laparoscopic augmentation ileocystoplasty in a patient affected by Guillain-Barre syndrome. Presentation A 15-year-old female, complaining of voiding dysfunction, recurrent urinary tract infection and worsening renal function for three months. A previous history of Guillain-Barre syndrome on childhood was related. A voiding cystourethrography showed a pine-cone bladder with moderate post-void residual urine. The urodynamic demonstrated a hypocompliant bladder and small bladder capacity (190mL) with high detrusor pressure (54 cmH2O). Nonsurgical treatments were attempted, however unsuccessfully. The patient was placed in the exaggerated Trendelenburg position. A four-port transperitoneal technique was used. A segment of ileum approximately 15-20cm was selected and divided with its pedicle. The ileal anastomosis and creation of ileal U-shaped plate were performed laparoscopically, without staplers. Bladder mobilization and longidutinal cystotomy were performed. Enterovesical anastomosis was done with continuous running suture. A suprapubic cystostomy was placed through a 5mm trocar. Results The total operative time was 335 min. The blood loss was minimal. The patient developed ileus in the early days, diet acceptance after the fourth day and was discharged on the seventh postoperative day. The urethral catheter was removed after 2 weeks. At 6-month follow-up, a cystogram showed a significant improvement in bladder capacity. The patient adhered well to clean intermittent self-catheterization and there was no report for febrile infections or worsening of renal function. We did not experience any complication related to the intestinal anastomosis fully prepared intracorporeally. Conclusions Albeit technically challenging, pure laparoscopic enterocystoplasty was feasible and safe. Preparing the enteral anastomosis and the pouch intracoporeally may prolong surgical time and contribute to postoperative ileus. Surgical staplers can assist in the procedure, however they are not essential.

OBJETIVO: Descrever o perfil epidemiológico das internações ocorridas na Cidade de Divinópolis (MG), Brasil, estimar a prevalência de internações por condições sensíveis à atenção primária (ICSAP) e avaliar os fatores associados com a ocorrência de ICSAP. MÉTODOS: Foi conduzido um estudo de transversal nos dois serviços públicos de internação do município: um hospital geral e uma unidade de pronto atendimento. Os dados foram coletados de julho a outubro de 2011. Foram triadas todas as internações mediante análise de informações do sistema SUS Fácil, autorizações para internação hospitalar e prontuários. Foram conduzidas análises descritivas e estimada a prevalência de internações de acordo com os grandes grupos da décima revisão do Código Internacional de Doenças e Causas de Morte (CID-10). A classificação das ICSAP foi baseada na Lista Brasileira publicada pelo Ministério da Saúde. A força da associação entre internações por ICSAP e variáveis selecionadas foi estimada pela razão de prevalência. RESULTADOS: Foram identificadas 2 775 internações. As principais causas foram neoplasias (18%), doenças do aparelho circulatório (16%), gravidez e parto (15%) e causas externas (12%). A prevalência de ICSAP foi 36,6% e os principais diagnósticos foram doenças dos aparelhos circulatório e respiratório. Um terço das internações ocorreu na unidade de pronto atendimento, que atendeu mais da metade das ICSAP. Ser mulher, menor de 13 anos e maior de 40 anos e residir em Divinópolis foram associados com maior chance de internação por ICSAP (P < 0,01). CONCLUSÕES: Foi encontrada alta prevalência de ICSAP, atendidas principalmente na unidade de pronto atendimento. Isso indica uma sobrecarga dos serviços de urgência em detrimento da longitudinalidade da atenção primária à saúde.

OBJECTIVE: To describe the epidemiological profile of hospitalizations in the city of Divinópolis, state of Minas Gerais, Brazil, to estimate the prevalence of hospitalizations for primary care-sensitive conditions (HPCSC), and to evaluate the factors associated with the occurrence of HPCSC. METHODS: A cross-sectional study was conducted of the two public health care institutions in Divinópolis qualified to hospitalize individuals; that is, a general hospital and an urgent care unit. The data were collected between July and October 2011. Admissions were screened based on information available through the state of Minas Gerais data exchange software SUS Fácil, hospital admission authorizations, and patient records. Descriptive analyses were carried out, with estimation of the prevalence of admissions according to the groups of the 10th revision of the International Classification of Diseases (ICD-10). The identification and classification of HPCSC was based on the Brazilian List of primary-care sensitive conditions published by the Ministry of Health. The strength of the association between HPCSC and selected variables was estimated based on the prevalence ratio. RESULTS: Two thousand seven hundred seventy five admissions were identified. The main causes were neoplasms (18%), diseases of the circulatory system (16%), pregnancy and childbirth (15%), and external causes (12%). The prevalence of HPCSC was 36.6%, with the main diagnoses being diseases of the circulatory and respiratory systems. One third of the admissions occurred through the urgent care unit, which was also responsible for more than half of the HPCSC. Female sex, age younger than 13 years and older than 40 years, and living in Divinópolis were associated with higher chance of admission due to HPCSC (P < 0.01). CONCLUSIONS: The results show a high prevalence of HPCSC, especially through the urgent care unit. This indicates an overburdening of urgent care services, hindering the implementation of a longitudinal continuum of care at the primary level.

OBJETIVO: Pesquisar a prevalência de disfunção sexual em mulheres com as seguintes doenças reumáticas: lúpus eritematoso sistêmico, artrite reumatoide, esclerose sistêmica, síndrome antifosfolípide e fibromialgia acompanhados no Ambulatório de Reumatologia do Hospital Universitário de Brasília e do Hospital das Clínicas da Universidade de São Paulo. MÉTODOS: Utilizou-se o índice de função sexual feminina (Female Sexual Function Index - FSfi), questionário que contém 19 itens que avaliam 6 domínios: desejo sexual, excitação sexual, lubrificação vaginal, orgasmo, satisfação sexual e dor. RESULTADOS: Foram avaliadas 163 pacientes. A média de idade foi de 40,4 anos. A prevalência de disfunção sexual foi de 18,4%, porém 24,2% das pacientes não apresentaram atividade sexual nas últimas 4 semanas. Entre os subgrupos, as pacientes com fibromialgia e esclerose sistêmica foram as com maior índice de disfunção sexual (33%). Se excluirmos as pacientes sem atividade sexual, a taxa de disfunção sobe para 24,2%. CONCLUSÃO: A prevalência de disfunção sexual encontrada neste estudo foi menor em relação à literatura. Entretanto, 24,2% das pacientes entrevistadas negaram atividade sexual nas últimas 4 semanas, o que pode ter contribuído para o baixo índice de disfunção sexual.

OBJECTIVE: To assess the prevalence of sexual dysfunction in women followed up at the Rheumatology Outpatient Clinic of the Hospital Universitário de Brasília and of the Hospital das Clínicas da Universidade de São Paulo with the following rheumatic diseases: systemic lupus erythematosus; rheumatoid arthritis; systemic sclerosis; antiphospholipid antibody syndrome; and fibromyalgia. METHODS: The Female Sexual Function Index (FSfi), obtained by applying a 19-item questionnaire that assesses six domains (sexual desire, arousal, vaginal lubrication, orgasm, sexual satisfaction and pain), was used. RESULTS: This study assessed 163 patients. The mean age was 40.4 years. The prevalence of sexual dysfunction was 18.4%, but 24.2% of the patients reported no sexual activity over the past 4 weeks. Patients with fibromyalgia and systemic sclerosis had the highest sexual dysfunction index (33%). Excluding patients with no sexual activity, the sexual dysfunction rate reaches 24.2%. CONCLUSION: The prevalence of sexual dysfunction found in this study was lower than that reported in the literature. However, 24.2% of the patients interviewed reported no sexual activity over the past 4 weeks, which might have contributed to the low sexual dysfunction index found.

Erucism is a skin reaction to envenomation from certain poisonous caterpillar bristles. In Brazil, most reports of erucism provoked by Lonomia caterpillars are from the southern region. Most manifestations of erucism are local and include burning pain, itching, local hyperthermia and, rarely, blisters (benign symptoms with spontaneous regression in a few hours). General symptoms such as nausea and vomiting, headache, fever, myalgia, abdominal pain and conjunctivitis may also occur. Uncommon symptoms include arthritis, coagulation disorders (manifested as bruising and bleeding), intracerebral hemorrhage and acute renal failure, which comprise serious complications. The present study reports the case of 60-year-old patient from Rio de Janeiro state, Brazil, who came into contact with a caterpillar and developed, a few days later, chronic renal disease.

The estimation of measurement uncertainty of an analytical result is an important tool to be applied for compliance to ISO IEC 17025. Through the available guides it is possible to establish procedures and criteria for the estimation of measurement uncertainty. This paper presents a case study on the estimation of measurement uncertainty in migration the test of ε-caprolactam from the polyamide 6 packages to fatty foods with determination by GC-FID. The calculation methodology used for the estimation of measurement uncertainty for the migration test was developed based on the guides EURACHEM / CITAC and ISO GUM, taking into account relevant aspects of the migration test. The expanded uncertainty estimated was approximately 23% of the concentration of migration.

FUNDAMENTO: A injeção de células-tronco no contexto do infarto agudo do miocárdio (IAM) tem sido testada quase exclusivamente pela via anterógrada intra-arterial coronariana (IAC). A via retrógrada intravenosa coronariana (IVC) pode ser uma via adicional. OBJETIVO: Comparar o padrão de distribuição e retenção celular nas vias anterógrada e retrógrada. Investigar o papel da obstrução microvascular pela ressonância magnética na retenção de células pelo tecido cardíaco após a injeção de células mononucleares da medula óssea (CMMO) no IAM. MÉTODOS: Estudo prospectivo, aberto, randomizado. Foram incluídos pacientes com IAM que apresentassem: (1) reperfusão mecânica ou química com sucesso em até 24 horas do início dos sintomas e (2) infarto acometendo mais de 10% da área do ventrículo esquerdo (VE) pela cintilografia miocárdica. Cem milhões de CMMO foram injetadas na artéria relacionada ao infarto pela via IAC ou veia, pela via IVC. Um por cento das células injetadas foi marcado com Tc99m-hexametil-propileno-amina-oxima(99mTc-HMPAO). A distribuição das células foi avaliada 4 e 24 horas após a injeção da cintilografia miocárdica. Ressonância magnética cardíaca foi realizada antes da injeção de células. RESULTADOS: Trinta pacientes foram distribuídos aleatoriamente em três grupos. Não houve eventos adversos graves relacionados ao procedimento. A retenção precoce e tardia das células marcadas foi maior no grupo IAC do que no grupo IVC, independentemente da presença de obstrução da microcirculação. CONCLUSÃO: A injeção pela abordagem retrógrada mostrou-se viável e segura. A retenção de células pelo tecido cardíaco foi maior pela via anterógrada. Mais estudos são necessários para confirmar esses achados.

BACKGROUND: The injection of stem cells in the context of acute myocardial infarction (AMI) has been tested almost exclusively by anterograde intra-arterial coronary (IAC) delivery. The retrograde intravenous coronary (IVC) delivery may be an additional route. OBJECTIVE: To compare the cell distribution and retention pattern in the anterograde and retrograde routes. To investigate the role of microvascular obstruction by magnetic resonance imaging in cell retention by cardiac tissue after the injection of bone marrow mononuclear cells (BMMC) in AMI. METHODS: This was a prospective, open label, randomized study. Patients with AMI who presented: (1) successful chemical or mechanical reperfusion within 24 hours of symptom onset and (2) infarction involving more than 10% of the left ventricle (LV) at the myocardial scintigraphy were included in the study. One hundred million BMMC were injected into the infarction-related artery through IAC route, or vein through the IVC route. One percent of the injected cells were labeled with 99mTc-hexamethyl-propylene-amine-oxime (99mTc-HMPAO). Cell distribution was evaluated at 4 and 24 hours after the myocardial scintigraphy injection. Cardiac magnetic resonance imaging was performed before cell injection. RESULTS: Thirty patients were randomized into three groups. There were no serious adverse events related to the procedure. The early and late retention of labeled cells was higher in the IAC group than in IVC group, regardless of the presence of microcirculation obstruction. CONCLUSION: The injection using the retrograde approach was feasible and safe. Cell retention by cardiac tissue was higher using the anterograde approach. More studies are needed to confirm these findings.

O conjunto insular de Trindade e Martin Vaz (CITMV) está localizado a aproximadamente 1.120 km da costa brasileira. Apesar de sua importância, salientada pela presença de diversas espécies endêmicas de peixes, não existem informações detalhadas sobre as assembléias de peixes e bentos do CITMV. É apresentada aqui a primeira caracterização quantitativa das assembléias de peixes e bentos do CITMV em um gradiente de profundidade entre 5 e 45 m. Informações qualitativas adicionais sobre assembléias recifais entre 45 e 100 m foram obtidas utilizando-se técnicas avançadas de mergulho (TRIMIX) e um veículo de operação remota (VOR). Assim como outras ilhas oceânicas brasileiras, a CITMV possui assembléias depauperadas de peixes e bentos, possivelmente devido ao seu isolamento e pequeno tamanho em comparação ao continente. A profundidade foi o fator que mais afetou a estrutura das assembléias de peixes, com a densidade da maioria das espécies declinando com o aumento da profundidade. Os recifes profundos (> 45 m) foram caracterizados pela presença de bancos extensivos de rodolitos e recifes rochosos esparsamente cobertos por algas coralináceas incrustantes, corais negros (Cirripathes sp.) e alguns corais massivos e em de forma de placa. Peixes parcialmente ou obrigatoriamente planctívoros (e.g. Cephalopholis furcifer and Clepticus brasiliensis) também dominaram em recifes profundos. Características similares foram registradas para recifes mesofóticos ao longo do Atlântico Ocidental. Evidências de sobrepesca (obtidas aqui e em outros estudos recentes), a presença de quatro espécies de peixes endêmicas e com distribuição restrita, e o aumento no número de espécies novas ainda não descritas, indicam que a adoção de medidas de conservação baseadas no princípio da precaução é urgentemente necessária para garantir a manutenção dos ecossistemas frágeis e únicos do CITMV.

The Trindade and Martin Vaz island group (TMVIG) is located at about 1,120 km off the Brazilian coast. Despite its importance, highlighted by the presence of several endemic fish species, the TMVIG lacks detailed information on the structure of fish and benthic assemblages. Presented here is the first quantitative assessment of reef fish and benthic assemblages of the TMVIG in a depth gradient ranging from 5 to 45 m. Additional qualitative information on reef assemblages between 45 and 100 m was obtained using advanced gas diving techniques (TRIMIX) and a remotely operated vehicle (ROV). Similarly to other Brazilian oceanic islands, the TMVIG possesses depauperated fish and benthic assemblages, possibly due to its isolation and small size in comparison to the mainland. Depth was the most important factor affecting the structure of fish assemblages, with the density of most fish species declining with depth. Deep reefs (> 45 m) were characterized by the presence of extensive rhodolith beds and rocky reefs sparsely covered with crustose coralline algae, black coral (Cirripathes sp.) and a few massive or plate-like reef corals. Part-time or obligatory planktivorous fishes (e.g. Cephalopholis furcifer and Clepticus brasiliensis) also dominated deep reefs. Similar characteristics were recorded in mesophotic reef ecosystems across the Western Atlantic. Evidence of overfishing (obtained here and in other recent studies), the presence of four endemic and restricted range fish species, as well as the increase in number of new (and still undescribed) endemic taxa, indicates that the adoption of precautionary conservation measures are urgently needed in order to maintain the fragile and unique ecosystems of the TMVIG.

INTRODUÇÃO: As sequelas da parede torácica após mastectomia requerem reconstrução por meio de conduta segura e eficiente. Nos casos de recidiva local, sobretudo bilateral, a intervenção cirúrgica deverá ser indicada considerando o estado geral do paciente e a expectativa de vida. A tração intraoperatória é uma técnica de baixa morbidade e rápida execução, reduzindo as cicatrizes decorrentes da utilização de retalhos. RELATO DO CASO: Paciente do sexo feminino, 45 anos que, após diagnóstico de recidiva tumoral em mama direita e novo tumor em mama esquerda, foi submetida à mastectomia bilateral higiênica com esvaziamento axilar à esquerda. Optou-se pela realização de tração cutânea intraoperatória dos bordos da ferida para fechamento primário da parede torácica devido ao estado geral da paciente. A tração foi realizada conforme a técnica de Góes et al., utilizando-se fios de prolene 2, tracionando a pele por dez minutos, com descanso de dois minutos, até que se obtivesse proximidade suficiente dos bordos das lesões para realização de sutura primária, o que foi alcançado após três ciclos de tração e relaxamento. O procedimento teve duração de duas horas, e foi colocado dreno portovac 3.2, que foi retirado após 7 dias. A paciente evoluiu sem queixas álgicas, sem deiscência ou qualquer outra complicação. CONCLUSÃO: A tração intraoperatória demonstrou ser uma técnica segura, funcionalmente eficaz, com menores custo e morbidade, para fechamento de ferida resultante de mastectomia bilateral higiênica.

INTRODUCTION: The post-mastectomy chest wall defects require reconstruction by a safe and efficient procedure. In cases of local recurrence, especially bilateral, surgical intervention should be indicated given the patient's general condition and life expectancy. The intraoperative traction is a technique with low morbidity and rapid execution, reducing the scars from the use of flaps. CASE REPORT: Female patient, 45 years old, after diagnosis of recurrence in right breast and a new tumor in left breast, was submitted to hygienic bilateral mastectomy with dissection of left axillary lymph nodes. Opted for intraoperative skin traction of the chest wall wound edges for primary closure due to the general state of the patient. Traction was performed according to the Góes et al. technique, using prolene 2 sutures, stretching the skin for ten minutes, resting for two minutes, until they gain sufficient proximity of the edges of the wound to perform primary suture. This was achieved after three cycles of tension and relaxation. The procedure lasted two hours and was used aspiratory drainage with portovac 3.2 drain, which was removed after 7 days. The patient had no pain complaints, suture without dehiscence or any other complication. CONCLUSION: The intraoperative traction proved to be a safe, functionally efficient, with lower costs and lower morbidity, to close wounds resulting from hygienic bilateral mastectomy hygienic.