Abstract Background Patients with heart failure often experience depression, anxiety, and impacts on quality of life. Psychotherapeutic interventions have been used for chronic conditions, including cardiovascular diseases, showing improvement in mental health. However, no studies have assessed the effects of a psychological intervention using psychoanalysis on patients with heart failure. Objective To assess the effect of short-term psychotherapy on depressive symptoms, anxiety, and quality of life of patients seen at a specialty clinic. Method A randomized clinical trial with scales to assess outcomes before and after psychotherapy, under the perspective of psychoanalysis, with 12 weekly sessions. The Beck Depression Inventory, the Beck Anxiety Inventory, and the Minnesota Living with Heart Failure Questionnaire were used. The mean initial and final scores for quality of life, anxiety, and depression were compared using Student’s t-test for independent samples when distribution was normal, or Mann-Whitney test when distribution was non-normal. A bivariate p-value < 0.05 was considered statistically significant for all analyses. Results This study involved 32 patients, 50% were female, mean age was 64.3±11.6, and most participants were New York Heart Association (NYHA) functional class I (56.3%). For anxiety (p = 0.196), there was no statistically significant difference between groups. For quality of life and depression, there was a statistical difference (p = 0.009 and 0.035, respectively), with a medium effect (Cohen’s d = 0.593) on quality of life. Conclusion Short-term psychotherapy in outpatients with heart failure showed an impact on depression and quality of life but did not improve anxiety. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Abstract: Introduction: Solitary fibrous tumor is a rare neoplasm with particular characteristics. Initially described as a primary tumor of the pleura by Wagner in 1870, it has received various names including the hemangiopericytoma. The purpose of our study was to determine the number of solitary fibrous tumors operated in our institutions in the last 21 years. Material and methods: A retrospective cohort study is presented, which includes a review of the files of patients with lung masses diagnosed as solitary fibrous tumors by biopsy or surgical resection between 1996 and 2017. Results: Of the 1,192 patients operated on the thorax, 11 (0.92%) were diagnosed with a solitary fibrous tumor. The benign etiology was confirmed in 10 patients and 1 of malignant etiology. All showed a pleural origin, 10 of parietal pleura and 1 of visceral pleura. The average diameter of the masses was 16.8 cm. In 9 patients the resection was complete resulting in complete reexpansion of the lung whereas in two patients the tumor was unresectable. Both patients died during the follow-up. Conclusion: We present a series of patients with Solitary fibrous tumor of the pleura, mostly symptomatic, as a reflection of the large size and the conditions of practice in a developing country with multiple limitations; but which illustrates the presentation and behavior of these tumors and shows that despite its size, the possibility of a complete resection on a curative basis is possible.

Resumen: Introducción: El tumor fibroso solitario es una neoplasia poco frecuente con características particulares. Descrito inicialmente como tumor primario de pleura por Wagner en 1870 ha recibido diversos nombres incluyendo el de hemangiopericitoma. El propósito de nuestro estudio fue determinar el número de tumores fibrosos solitarios operados en nuestras instituciones en los últimos 21 años. Material y métodos: Se presenta un estudio de cohorte retrospectivo que incluye la revisión de los expedientes de pacientes con masas pulmonares diagnosticadas como tumores fibrosos solitarios por biopsia o resección quirúrgica entre los años 1996 y 2017. Resultados: Se presentan 11 de 1,192 pacientes operados del tórax (0.92%) con diagnóstico anatomopatológico de tumor fibroso. La etiología benigna se confirmó en 10 pacientes y uno de etiología maligna. Todos mostraron un origen pleural, 10 de pleura parietal y uno de pleura visceral. El diámetro promedio de las masas fue de 16.8 cm. En nueve pacientes la resección fue total, se observó reexpansión completa del pulmón y en dos pacientes con masas irresecables únicamente se realizó diagnóstico, uno por aguja tru-cut y otro caso por toracotomía limitada, ambos pacientes fallecieron durante el seguimiento. Conclusión: Se presenta una serie de pacientes con tumor fibroso solitario de la pleura, en su mayoría sintomáticos, como reflejo del gran tamaño y las condiciones de práctica en un país en vías de desarrollo con múltiples limitaciones; sin embargo, ilustra la presentación y comportamiento de estos tumores y pone de manifiesto que pese a su tamaño, la posibilidad de una resección completa a título curativo es posible.

Abstract: The usefulness of open lung biopsy in obtaining tissue material for histological diagnosis is undeniable even when technological advances direct us towards minimally invasive methods. The aim of the study is to show the efficiency of open lung biopsy and to discuss the need for pleural drainage when the pleura has been transgressed. Material and methods: Prospective longitudinal study carried out from January 1, 2017 to December 31, 2018, in 41 patients undergoing open lung biopsy by mini-thoracotomy. Results: The study included 41 patients with open lung biopsies. The evolution was satisfactory in 97.5% of the cases and only one patient required the placement of immediate postoperative drainage due to pneumothorax greater than 10%. In 39 (95%) patients, histological diagnosis was obtained independent of the site of the biopsy and two (5%) the sample was reported without abnormalities. Conclusions: The choice of the lung parenchyma biopsy site and the anatomic location of the lesion is not an impediment to the mini-thoracotomy approach and allows obtaining adequate lung tissue for histological diagnosis in the majority of cases. The indication of pleural drainage can be selective according to transoperative criteria and the experience of the surgical team.

Resumen: La utilidad de la biopsia pulmonar abierta en la obtención de material tisular para diagnóstico histológico es innegable, aun cuando los avances tecnológicos nos encauzan hacia los métodos de mínima invasión. El objetivo del estudio es mostrar la eficiencia de la biopsia pulmonar abierta y debatir la necesidad del drenaje pleural cuando la pleura ha sido transgredida. Material y métodos: Estudio prospectivo longitudinal realizado del 01 de enero del 2017 al 31 de diciembre del 2018, en 41 pacientes intervenidos de biopsia pulmonar abierta por minitoracotomía. Resultados: El estudio incluyó 41 pacientes sometidos a biopsia pulmonar abierta. La evolución fue satisfactoria en el 97.5% de los casos y únicamente un paciente requirió la colocación de drenaje posoperatorio inmediato por neumotórax mayor del 10%. En 39 (95%) pacientes se obtuvo diagnóstico histológico independiente del sitio de la toma de biopsia y en dos (5%) se reportó la muestra sin anormalidades. Conclusiones: La elección del sitio de toma de biopsia del parénquima pulmonar y la localización anatómica de la lesión no es impedimento para el abordaje por minitoracotomía y permite obtener tejido pulmonar adecuado para diagnóstico histológico en la mayoría de los casos. La indicación del drenaje pleural puede ser selectiva de acuerdo con criterios transoperatorios y de la experiencia del equipo quirúrgico.

Abstract: The management of fractures rib should be individualized according to the severity of the injury and the extent of the trauma. The goal is fixing the fractured segment, the management of comorbidities and restoring lung function and ventilatory. Presents a personal method of fixation wire, which can be used in fractures costal simple, single or multiple, available and low cost. Presentation of case: It is a patient of 74 years of age with simple fractures from 3o to 9o arcs rights sacks, 21 days of evolution, with wall deformity of costal by collapse and retained hemothorax, who set the arches sacks 4o, 5o, 6o and 7o with wire through right postero-lateral thoracotomy. The immobilization of the arches costal, costal wall elevation and alignment of fractures, it allowed a rapid recovery and better control of pain. Conclusions: Fixation of fractures costal with wire using this technique, it has advantages its simplicity, the use of a material available in any hospital, its low cost and be reproducible without specific training. We believe that your knowledge and dissemination can be useful for the management of fractures multiple sacks with deformity and instability of the rib cage.

Resumen: El manejo de las fracturas costales debe ser individualizado de acuerdo con la severidad de las lesiones y la magnitud del trauma. La meta es la fijación del segmento fracturado, el manejo de las comorbilidades y el restablecimiento de la función pulmonar y ventilatoria. Se expone un método personal de fijación con alambre, que puede ser utilizado en fracturas costales simples, únicas o múltiples, disponible y de bajo costo. Presentación de caso: Se presenta un paciente de 74 años de edad con fracturas simples del 3o al 9o arcos costales derechos, de 21 días de evolución, con deformidad de la pared costal por hundimiento y hemotórax retenido, a quien se fijaron los arcos costales 4o, 5o, 6o y 7o con alambre a través de toracotomía posterolateral derecha. La inmovilización de los arcos costales, la elevación de la pared costal y la alineación de las fracturas, permitió una rápida recuperación y mejor control del dolor. Conclusiones: La fijación de fracturas costales con alambre utilizando esta técnica tiene como ventajas su simplicidad, el uso de un material disponible en cualquier hospital, su bajo costo y ser reproducible sin necesidad de entrenamiento específico. Consideramos que su conocimiento y difusión pueden ser de utilidad para el manejo de fracturas costales múltiples con deformidad e inestabilidad de la caja torácica.

Abstract: Introduction: The mediastinum, located in the center of the chest contains organs and tissues of vital importance and it requires precise surgical gestures for the solution of what is concerned. The objective of the study is to present the epidemiology of the Mediastinal Masses and different modalities of treatment indicated according to the diagnosis of the patient. Design, place and participants: All patients over the age of 13 with a diagnosis of mass mediastinal evaluated during the period from November 2002 to October 2015 were admitted. Demographic variables, anatomic location, clinical and pathological diagnosis and surgical treatment modalities were included. Results: A total of 844 patients with thoracic surgical pathology was operated of which 65 (7.7%) patients had diagnosis of mediastinal mass; being the most frequent diagnoses, the cells germinal tumors 15.38%, lymphomas 13.84%, Schwannoma 12.30% and tumors of the thymus gland 10.76%. Most affected mediastinal compartment was the anterosuperior in 63% of cases and exploratory thoracotomy, which includes all procedures of resection, was the procedure carried out mostly in the 50.76%. Conclusions: Mediastinal pathology represented 7% of the thoracic surgical procedures performed. The anterosuperior mediastinum was the most affected compartment prevailing diagnosis of teratoma and exploratory thoracotomy with resection of the mass prevailed over other surgical options.

Resumen: Introducción: El mediastino, localizado en el centro del tórax contiene órganos y tejidos de vital importancia y requiere de gestos quirúrgicos precisos para la solución de aquello que le concierne. El objetivo del estudio es presentar la epidemiología de las masas mediastinales y las diferentes modalidades de tratamiento indicado de acuerdo con el diagnóstico del paciente. Diseño, lugar y participantes: Se admitieron todos los pacientes mayores de 13 años con diagnóstico de masa mediastinal evaluados durante el período de noviembre de 2002 a octubre de 2015. Se incluyeron variables demográficas, localización anatómica, diagnóstico clínico y patológico y modalidades de tratamiento quirúrgico. Resultados: Se intervino un total de 844 pacientes con patología quirúrgica torácica, de los cuales 65 (7.7%) tuvieron diagnóstico de masa mediastinal. Los diagnósticos más frecuentes fueron: tumores de células germinales, 15.38%; linfomas, 13.84%; Schwannoma, 12.30%; y tumores del timo, 10.76%. El compartimento mediastínico más afectado fue el anterosuperior en el 63% de los casos y la toracotomía exploratoria, en la que se incluyen todos los procedimientos de resección, fue el procedimiento mayormente efectuado en el 50.76%. Conclusiones: La patología mediastinal representó el 7% de los procedimientos quirúrgicos torácicos realizados. El mediastino anterosuperior fue el compartimento más afectado prevaleciendo el diagnóstico de teratoma, la toracotomía exploratoria con resección de la masa predominó sobre las otras opciones quirúrgicas.

Introduction Urinary incontinence remains a major concern for patients undergoing radical prostatectomy. Its prevalence can reach 20% in the late postoperative period. Materials and Methods This clinical study investigated the differences of a dynamic evaluation of the urethra and pelvic floor contraction using perineal ultrasound in men without prostate surgery and in men submitted to radical prostatectomy with and without stress urinary incontinence. Ninety two male patients were included, which 70% of them underwent radical prostatectomy (RP) for more than one year. Thirty one men with clinically post prostatectomy incontinence were compared by two-dimensional (2D) perineal ultrasound to 34 patients without post prostatectomy incontinence and to 27 men without surgery in two centers in Brazil. Results Our results showed that the continent group presented the urethral angle at rest significantly lower than the prostate group (p = 0.0002). We also observed that the incontinent group showed the displacement of the anterior bladder neck during contraction significantly lower than the continent group (p = 0.008). Conclusions We found that the continent group presented the urethral angle at rest significantly lower than the prostate group. The incontinent group also showed the anterior bladder neck displacement during contraction significantly lower than the continent group. It was more evident when the severe incontinent group and the continent group were compared.

El número de casos de leishmaniasis visceral en Brasil ha ido en aumento, y una de las estrategias para reducir la transmisión de esta enfermedad tiene como base el control de sus vectores. Por tanto, es de gran importancia epidemiológica desarrollar métodos más refinados para monitorear y controlar sus vectores, que son los flebotominos. El presente estudio compara la atracción ejercida por la luz UV en comparación con luz incandescente convencional, o luz blanca, en la captura de flebotominos. Las trampas adaptadas con luz UV capturaron un mayor número de mosquitos que las trampas adaptadas con luz blanca, lo que indica el uso potencial de la luz ultravioleta, especialmente en las localidades de baja densidad de flebotominos.

The number of visceral leishmaniasis cases has been gradually increasing in Brazil. One of the strategies to reduce the disease transmission is based on vector control. It is therefore of great epidemiological importance to develop more refined methods for monitoring and controlling its vectors, which are the phlebotomine sand flies. The present study evaluates the performance of traps using UV light or conventional incandescent, or white, light in sand flies captures. Traps baited with UV light caught higher numbers of sand flies than traps baited with white light, indicating the potential use of UV light, especially in locations of low sand flies densities.

INTRODUÇÃO: Nos últimos anos, a leishmaniose visceral, um importante problema de saúde pública, vem apresentando expansão das áreas rurais para as urbanas de muitas regiões do Brasil, incluindo-se Aracaju, capital do Estado de Sergipe. No entanto, não existem estudos sobre a fauna de flebotomíneos presente nesse município ou de sua distribuição ao longo do ano. MÉTODOS: As coletas de flebotomíneos foram realizadas em uma área rural de Aracaju, capital do Estado de Sergipe no periodo de setembro de 2007 a julho de 2009. Armadilhas CDC modificadas acopladas com luz ultravioleta (UV) foram utilizadas para avaliar a distribuição mensal e a presença de flebotomíneos nos ambientes doméstico e peridoméstico. RESULTADOS: Lutzomyia longipalpis foi a espécie mais abundante (90,4%), seguida por Evandromyia lenti (9,6%). Os locais com as maiores quantidades de L. longipalpis (51,1%) foram um galinheiro e as casas mais próximas a ele. Houve uma correlação positiva entre a precipitação mensal e a abundância de L. longipalpis. CONCLUSÕES: Lutzomyia longipalpis é a espécie mais abundante e, provavelmente, o principal vetor do agente da leishmaniose visceral na área rural de Aracaju. Foi observado um aumento na frequência de L. longipalpis nos meses chuvosos. As coletas realizadas no ambiente externo e interno dos domicílios reforçam a relevância dos galinheiros para a presença de L. longipalpis no ambiente peridoméstico. O grande número de L. longipalpis dentro das casas confirma o comportamento endofílico dessa espécie e a possibilidade de transmissão intradomiciliar da leishmaniose visceral.

INTRODUCTION: In recent years, visceral leishmaniasis, a major public health problem, has been spreading from the rural to urban areas in many areas of Brazil, including Aracaju, the capital of the State of Sergipe. However, there are no studies of the sandfly fauna in this municipality or its variation over the year. METHODS: Phlebotomine sandflies were collected from a rural area of Aracaju from September 2007 to July 2009. Modified CDC ultra-violet (UV) light traps were used to evaluate sandfly monthly distribution and their presence in the domestic and peridomestic environments. RESULTS: The most abundant species was Lutzomyia longipalpis (90.4%) followed by Evandromyia lenti (9.6%). A chicken shed trap site had the highest proportion of L. longipalpis (51.1%) and large numbers of L. longipalpis were also collected in the houses closest to the chicken shed. There was a positive correlation between monthly rainfall and L. longipalpis abundance. CONCLUSIONS: Lutzomyia longipalpis is the most abundant species and is probably the main vector of the visceral leishmaniasis agent in the rural area of Aracaju. An increase in L. longipalpis frequency was observed during the rainy season. The peridomicile-intradomicile observations corroborate the importance of chicken sheds for the presence of L. longipalpis in the peridomestic environment. The great numbers of L. longipalpis inside the houses confirm the endophilic behaviour of this species and the possibility of visceral transmission in the intradomicile.

The analysis of DNA damage by mean of Comet or single cell gel electrophoresis (SCGE) assay has been commonly used to assess genotoxic impact in aquatic animals being able to detect exposure to low concentrations of contaminants in a wide range of species. The aims of this work were 1) to evaluate the usefulness of the Comet to detect DNA strand breakage in dolphin leukocytes, 2) to use the DNA diffusion assay to determine the amount of DNA strand breakage associated with apoptosis or necrosis, and 3) to determine the proportion of DNA strand breakage that was unrelated to apoptosis and necrosis. Significant intra-individual variation was observed in all of the estimates of DNA damage. DNA strand breakage was overestimated because a considerable amount (~29%) of the DNA damage was derived from apoptosis and necrosis. The remaining DNA damage in dolphin leukocytes was caused by factors unrelated to apoptosis and necrosis. These results indicate that the DNA diffusion assay is a complementary tool that can be used together with the Comet assay to assess DNA damage in bottlenose dolphins.