ABSTRACT Visceral leishmaniasis (VL) is a chronic vector-borne zoonotic disease caused by trypanosomatids, considered endemic in 98 countries, mainly associated with poverty. About 50,000–90,000 cases of VL occur annually worldwide, and Brazil has the second largest number of cases in the world. The clinical picture of VL is fever, hepatosplenomegaly, and pancytopenia, progressing to death in 90% of cases due to secondary infections and multi-organ failure, if left untreated. We describe the case of a 25-year-old female who lived in the metropolitan area of Sao Paulo, who had recently taken touristic trips to several rural areas in Southeastern Brazil and was diagnosed post-mortem. During the hospitalization in a hospital reference for the treatment of COVID-19, the patient developed acute respiratory failure, with chest radiographic changes, and died due to refractory shock. The ultrasound-guided minimally invasive autopsy diagnosed VL (macrophages containing amastigote forms of Leishmania in the spleen, liver and bone marrow), as well as pneumonia and bloodstream infection by gram-negative bacilli. (VL vectorborne vector borne trypanosomatids 9 countries poverty 5000090000 50 000 90 50,000–90,00 worldwide world fever hepatosplenomegaly pancytopenia multiorgan multi organ failure untreated 25yearold yearold 25 year old Paulo postmortem. postmortem post mortem. mortem post-mortem COVID19, COVID19 COVID 19, 19 COVID-19 changes shock ultrasoundguided ultrasound guided macrophages spleen marrow, marrow , marrow) gramnegative gram negative bacilli 500009000 5 00 50,000–90,0 2 COVID1 1 COVID-1 50000900 0 50,000–90, COVID- 5000090 50,000–90 500009 50,000–9 50000 50,000– 5000 50,000 500 50,00 50,0 50,

ABSTRACT Introduction: Metacarpal fractures are common and can be treated surgically using Kirschner wires (K-wires) or intramedullary fixation with compression screws (IMCS). Objectives: Analyze the postsurgical results from treating the metacarpal extra-articular fractures through the retrograde Kirschner wire technique, and compare it with the intramedullary compression screw fixation. Methods: Retrospective and quantitative studies were to analyze patients’ medical records, and a postsurgical evaluation questionnaire was given to the patients, who were divided into K-wire and IMCS. Results: The period of immobilization with a splint took six weeks for the K-wire group and four weeks for the IMCS group. The average time for consolidation took, respectively, fifty-seven days and forty-seven days. The first group could restart their activities twenty-two days after the other, and the average force value of the treated hand, when compared with its contralateral, was 93.9% and 95.4%, respectively. Between the operated hand and its contralateral, there was a difference of 16° in the total measures of the metacarpophalangeal and interphalangeal joint's range of movement among the K-wire group and 5° among the IMCS group. Conclusion: The patients who participated in this study showed excellent results after surgery, and both treatments were proven to be safe and reliable. Evidence level III; Retrospective comparative study . Introduction Kwires K (K-wires (IMCS) Objectives extraarticular extra articular technique Methods records Kwire Results respectively fiftyseven fifty seven fortyseven forty twentytwo twenty two other contralateral 939 93 9 93.9 954 95 4 95.4% 16 joints joint s 5 Conclusion surgery reliable III (IMCS 93. 95.4 1 95.

RESUMO Introdução: Fraturas dos metacarpos são frequentes e podem ser tratadas de forma cirúrgica com os fios de Kirschner (FK) e Fixação Intramedular com Parafuso de Compressão (FIPC). Objetivo: Analisar os resultados pós-operatórios do tratamento das fraturas extra-articulares dos metacarpos pela técnica retrógrada com fios de Kirschner e comparar com a fixação intramedular utilizando parafuso de compressão. Métodos: Estudo retrospectivo, quantitativo, com análise de prontuários, utilizando questionários de avaliação pós-operatória em dez pacientes divididos em dois grupos: FIPC e FK. Resultados: O período de imobilização com tala nos grupos FK e FIPC foram de seis e quatro semanas respectivamente, já o tempo médio para consolidação foi de 57 e 47 dias respectivamente. O grupo FK retornou as atividades laborais após os FIPC. O valor médio de força na mão acometida comparada a contralateral foi de 93,9% no grupo FK, e no FIPC de 95,4%. Medidas da soma de amplitude de movimento das articulações metacarpofalangeanas e interfalangeanas no grupo FK obtiveram diferença média entre as mãos operada e a contralateral de 16°, já na FIPC observou-se 5°. Conclusão: Os pacientes estudados apresentaram excelentes resultados pós-operatórios e ambos os tratamentos provam ser seguros e confiáveis. Nível de evidência III; Estudo retrospectivo comparativo . Introdução (FK (FIPC) Objetivo pósoperatórios pós operatórios extraarticulares extra articulares compressão Métodos quantitativo prontuários pósoperatória operatória Resultados respectivamente 5 4 939 93 9 93,9 954 95 95,4% 16 16° observouse observou se 5° Conclusão confiáveis III (FIPC 93, 95,4 1 95,

Resumen Se llevó a cabo un estudio bianual en un área protegida del Sistema serrano de Ventania donde la estepa pampeana y las cabeceras de los arroyos mantienen las condiciones cercanas a las naturales. Se analizó la composición y la estructura del ensamble de Chironomidae (Insecta: Diptera) en dos arroyos prístinos y su relación con las variables fisicoquímicas. Se identificaron 15444 especímenes, correspondientes a 37 especies distribuidas en 4 subfamilias. El ensamble presentó una estructura más similar a las reportadas para los arroyos de la región Andina o extra Andina, que la de otras áreas de la región pampeana. Orthocladiinae presentó la mayor riqueza taxonómica y densidad, mientras que Podonominae las menores. Chironominae estuvo mejor representada aguas abajo, presentando géneros con distribución amplia. De los 5 géneros de Podonominae reportados en la región Andina-Patagónica, 3 de ellos (Podonomus Philippi, ParochlusEnderlein y Podonomopsis Brundin) fueron colectados. La presencia de Podonomus y Podonomopsis representa el registro de menor altitud para ambos géneros. Las variables fisicoquímicas difirieron entre las estaciones, y la conductividad fue la única que mostró un gradiente altitudinal. Las especies que prevalecieron en los sitios pedemontanos, correlacionaron positivamente con la conductividad. Con pocas excepciones, las especies recolectadas se registraron en otoño y primavera. En el arroyo Toro, la densidad fue significativamente mayor en la primavera del segundo año. Nuestro estudio aporta información de base sobre la ecología y la sistemática de un grupo de insectos ampliamente utilizado en estudios de biomonitoreo de ambientes acuáticos, lo cual resulta muy importante para respaldar la importancia de preservar esta área.

Abstract A two-year study was conducted in a conservation area of the Ventania hill system where the Pampean grassy steppes and their headwater springs maintain conditions close to natural ones. The composition and the structure of Chironomidae (Insecta: Diptera) along two short hill pristine streams and their relationship with the physicochemical variables were analyzed. A total of 15444 individuals belonging to 37 species of four subfamilies were identified. An assemblage structure more similar to those described for Andean or Argentine extra-Andean hill streams than to those of the surrounding Pampas was observed. Orthocladiinae showed the highest and Podonominae the lowest taxonomic richness and density. Chironominae was best represented downstream by genera with wide distribution. From the five Podonominae genera reported in the Andean-Patagonic region, three of them (Podonomus Philippi, Parochlus Enderlein and PodonomopsisBrundin) were collected. The presence of Podonomus and Podonomopsis represent the reports at lower altitudes for both genera. The physicochemical variables differed between seasons, and only water conductivity showed an altitudinal gradient. Those species prevailing in piedmont sites correlated positively with conductivity. With few exceptions, the species collected were recorded in both seasons. In Toro stream, density was significantly highest in Spring of the second year. This study provides the ecological and systematic baseline knowledge of an insect group widely used in biomonitoring of aquatic environments, to provide biological information that supports the importance of preserving this area.

OBJECTIVES: Ultrasound-guided minimally invasive autopsies (MIA-US) are an alternative to conventional autopsies and have been used in our institution to investigate the pathophysiology of COVID-19 since the beginning of the pandemic. Owing to the limitations of post-mortem biopsies for evaluating cardiopulmonary events involving large vessels, we continuously improved the technique during this period. Objectives: To demonstrate the usefulness of an extended MIA-US technique (EMIA-US) for the study of thoracic involvement in COVID-19. METHOD: US-guided percutaneous tissue sampling was combined with a small thoracic incision (≤5 cm), allowing for the sampling of larger tissue samples or even the entire organ (lungs and heart). RESULTS: EMIA-US was performed for eight patients who died of COVID-19 in 2021. We demonstrate cardiopulmonary events, mainly thromboembolism and myocardial infarction, that could be evaluated using EMIA-US. CONCLUSIONS: Minimally invasive image-guided post-mortem tissue sampling is a flexible and practical method to conduct post-mortem studies of human diseases, mainly in areas that do not have autopsy facilities or, alternatively, when autopsy is not possible owing to financial constraints, cultural and religious values, or for safety reasons, such as in the case of highly contagious infectious diseases. We present evidence that EMIA-US is feasible and can be used as an alternative to increase the accuracy of MIA-US in detecting cardiopulmonary events involving large vessels, which may not be assessed through post-mortem biopsies.

Resumo Contexto A espectroscopia próxima ao infravermelho (NIRS) é uma técnica não invasiva que detecta as alterações hemodinâmicas teciduais. A NIRS pode monitorar de forma contínua as informações fisiológicas vasculares intracranianas. Por ser portátil, ela pode ser utilizada à beira do leito e no centro cirúrgico. Objetivos Avaliar as possíveis alterações hemodinâmicas cerebrais durante a endarterectomia em pacientes com estenoses maiores que 70% utilizando NIRS. Métodos Foram avaliados 10 voluntários portadores de doença carotídea aterosclerótica com indicação de endarterectomia. Após a seleção dos pacientes, que responderam um questionário com dados epidemiológicos e informações referentes à presença de comorbidades, a doença foi confirmada por métodos diagnósticos. No procedimento cirúrgico, utilizou-se a NIRS para monitorização. Foram avaliadas as variáveis saturação de oxigênio (SatO2), hemoglobina total (HbT), hemoglobina reduzida (HbR) e hemoglobina oxigenada (HbO) nos três tempos cirúrgicos pré-, trans e pós-clampeamento carotídeo. Utilizou-se p < 0,05 como nível de significância. Resultados A avaliação dos resultados obtidos por meio das medidas registradas pela NIRS permite afirmar que HbR e SatO2 variam ao longo das etapas da cirurgia. Durante o clampeamento, a variável HbR mostra valores mais elevados que nas outras duas etapas da cirurgia. Por outro lado, a variável SatO2 mostra redução durante o clampeamento. Conclusões A NIRS é um método viável e aplicável de monitorização intracerebral, não invasivo e em tempo real, durante a endarterectomia carotídea, capaz de medir de forma precisa as mudanças das condições hemodinâmicas capilares intracerebrais.

Abstract Backgrounds Near-infrared spectroscopy (NIRS) is non-invasive technique that detects hemodynamic alterations in tissues. It enables continuous monitoring of intracerebral vascular physiologic information. Due to its portable nature, NIRS may be used bedside or in the operating room. Objectives To evaluate use of NIRS for intraoperative monitoring of the brain hemodynamic response, during carotid endarterectomy. Methods 10 patients with atherosclerotic carotid disease scheduled for endarterectomy were evaluated. After patients had been selected, they answered a questionnaire on epidemiological data and information about comorbidities and then carotid disease was confirmed with diagnostic methods. NRIS monitoring was used during the surgical procedure. The variables analyzed before, during and after carotid clamping were oxygen saturation (SatO2), total hemoglobin (THb), reduced hemoglobin (RHb), and oxyhemoglobin (OHb). A p value of <0.05 was considered statistically significant. Results The results obtained from NIRS show that RHb and SatO2 vary during the different stages of surgery. RHb levels are higher during clamping, when compared with the other two surgical stages. On the other hand, SatO2 is lower during clamping. Conclusions During carotid endarterectomy, NIRS is a feasible, real-time, and non-invasive intracranial monitoring method that accurately and reliably measures the changes in intracerebral capillary hemodynamic conditions.

The coronavirus disease (COVID-19) outbreak </mac_aq>started in Wuhan, China, in December 2019, and evolved into a global problem in a short period. The pandemic has led to many social and health-care challenges. In this context, surgery is an area that is facing the need for many adaptations. In this systematic literature review, we analyzed different perspectives concerning this situation, aiming to provide recommendations that could guide surgeons and </mac_aq>entities toward screening, elective and emergency surgeries, decision making, and operating room management. A computerized search in PubMed, Scopus, and Scientific Electronic Library Online (SciELO) for relevant literature up to April 4, 2020, was performed. Articles were included if they were related to surgery dynamics in the context of the COVID-19 pandemic. Of the 281 articles found in our initial search and 15 articles from alternative sources, 39 were included in our review after a systematic evaluation. Concerning preoperative testing </mac_aq>for severe acute respiratory syndrome coronavirus 2 infection, 29 (74.4%) articles recommended some kind of </mac_aq>screening. Another major suggestion was postponing all (or at least selected) elective operations (29 articles, </mac_aq>74.4%). Several additional recommendations with respect to surgical practice or surgical staff were also assessed and discussed, such as performing laparoscopic surgeries and avoiding the use of electrocauterization. On the basis of the current literature, we concluded that any surgery that can be delayed should be postponed. COVID-19 screening is strongly recommended for all surgical cases. Moreover, surgical staff should be reduced to the essential members and provided with institutional psychological support.

SUMMARY: Cell culture is an important tool in medical, odontological and biological research laboratories, supporting cell therapies and tissue bioengineering strategies. Gingival fibroblasts present structural function, being able to modulate their metabolic capacity, which is reflected in the tissue morphology. The possibility of culturing fibroblasts in vitro, in monolayer or on three-dimensional scaffolds, for subsequent transplants in vivo opens important perspectives for the periodontal surgical clinic. The objective of the present article is to present a method of obtaining and cultivating viable human gingival fibroblasts for in vitro research. Explants derived from periodontal surgical discards were used, grown in 25 cm2 bottles to obtain a primary cell culture. After observing the proliferation and growth of the fibroblasts that interconnected and formed a monolayer network, involving the periphery of the explants, it was possible to remove the explants, to make the passage and the new subcultures were obtained in a ratio of 1:1. After 7 days, the amount of viable cells was analyzed in triplicate, using the Neubauer chamber technique, in cell culture bottles of 25 mm2 (T25) and 75 mm2 (T75). Fibroblasts were described and subclassified morphologically. The results showed a growth pattern in both bottles, but with a larger number in bottles of 75 cm2. Cells with fibroblastic morphology were subclassified into reticular and fusiform, being predominant those with fusiform morphology. In conclusion, culture of explant of human gingival connective tissue is a viable method for obtaining gingival connective tissue cells suitable for laboratory tests in cell culture, aiming at obtaining constructs for gingival tissue engineering.

RESUMEN: El cultivo celular es una herramienta importante en los laboratorios de investigación médica, odontológica y biológica, que apoyan las terapias celulares y las estrategias de bioingeniería de tejidos. Los fibroblastos gingivales presentan una función estructural, pudiendo modular su capacidad metabólica, que se refleja en la morfología tisular. La posibilidad de cultivar fibroblastos in vitro, en monocapa o en andamios tridimensionales, para trasplantes posteriores in vivo abre perspectivas importantes para la clínica de cirugía periodontal. El objetivo del presente artículo es presentar un método para obtener y cultivar fibroblastos gingivales humanos viables para investigación in vitro. Se utilizaron explantes derivados de los descartes quirúrgicos periodontales, crecidos en frascos de 25 cm2 para obtener un cultivo de células primarias. Después de observar la proliferación y el crecimiento de los fibroblastos que se interconectaron y formaron una red de monocapa, que involucraba la periferia de los explantes, fue posible eliminar los explantes, hacer el pasaje y los nuevos subcultivos se obtuvieron en una proporción de 1:1. Después de 7 días, la cantidad de células viables se analizó por triplicado, utilizando la técnica de cámara de Neubauer, en botellas de cultivo celular de 25 mm2 (T25) y 75 mm2 (T75). Los fibroblastos fueron descritos y sub-clasificados morfológicamente. Los resultados mostraron un patrón de crecimiento en ambas botellas, pero con un número mayor en botellas de 75 cm2. Las células con morfología fibroblástica se subclasificaron en reticulares y fusiformes, predominando aquellas con morfología fusiforme. En conclusión, el cultivo de explante de tejido conectivo gingival humano es un método viable para obtener células de tejido conectivo gingival adecuadas para pruebas de laboratorio en cultivos celulares, con el objetivo de obtener construcciones para la ingeniería del tejido gingival.

Resumo Objetivo: Testar a precisão e a reprodutibilidade da ultrassonografia (US) e da tomografia computadorizada (TC) para a quantificação da gordura abdominal, em correlação com as avaliações antropométricas e clinicolaboratoriais. Materiais e Métodos: Foram determinadas, por meio da US e da TC, as espessuras subcutâneas e intra-abdominais em 101 indivíduos, sendo 39 homens (38,6%) e 62 mulheres (61,4%), com idade média de 66,3 anos (60-80 anos). Os dados obtidos pela US foram correlacionados com os parâmetros antropométricos, clinicolaboratoriais e com as áreas abdominais medidas pela TC. Resultados: A espessura da gordura intra-abdominal foi a variável que obteve maior coeficiente de correlação com as áreas adiposas abdominais. A TC mostrou maior reprodutibilidade nas mensurações da gordura abdominal, apresentando maior taxa de concordância intraexaminador e interexaminador em comparação com a US. Observou-se índice de correlação de 71% entre a US e a TC. Conclusão: Houve maior concordância intraexaminador e interexaminador na avaliação da gordura abdominal por TC, comparativamente à US, porém ambos os métodos mostraram alta precisão e boa reprodutibilidade.

Abstract Objective: To test the accuracy and reproducibility of ultrasound and computed tomography (CT) for the quantification of abdominal fat in correlation with the anthropometric, clinical, and biochemical assessments. Materials and Methods: Using ultrasound and CT, we determined the thickness of subcutaneous and intra-abdominal fat in 101 subjects-of whom 39 (38.6%) were men and 62 (61.4%) were women-with a mean age of 66.3 years (60-80 years). The ultrasound data were correlated with the anthropometric, clinical, and biochemical parameters, as well as with the areas measured by abdominal CT. Results: Intra-abdominal thickness was the variable for which the correlation with the areas of abdominal fat was strongest (i.e., the correlation coefficient was highest). We also tested the reproducibility of ultrasound and CT for the assessment of abdominal fat and found that CT measurements of abdominal fat showed greater reproducibility, having higher intraobserver and interobserver reliability than had the ultrasound measurements. There was a significant correlation between ultrasound and CT, with a correlation coefficient of 0.71. Conclusion: In the assessment of abdominal fat, the intraobserver and interobserver reliability were greater for CT than for ultrasound, although both methods showed high accuracy and good reproducibility.

Resumo Contexto A endarterectomia carotídea (EC) e a angioplastia carotídea (AC) são propostas para o tratamento de estenoses críticas localizadas na bifurcação carotídea. O monitoramento dos sinais de microembolias (SMs) pela ultrassonografia Doppler transcraniana (UDT) é considerado um método de controle de qualidade para ambas as técnicas. Objetivos Analisar a distribuição temporal dos SMs ao longo de diferentes estágios da EC por semieversão e da AC, e avaliar o significado das mudanças nas médias das velocidades médias do fluxo na artéria cerebral média ipsilateral (ACM). Método Trinta e três procedimentos (17 ECs e 16 ACs) foram monitorados com UDT, e os dados foram coletados prospectivamente para diferenciar os diferentes estágios cirúrgicos (pré, durante e pós-proteção cerebral). Para análise estatística foram usados os testes qui-quadrado, Mann-Whitney, análise de variância (ANOVA) e contraste. Resultados Em ambos os grupos, os SMs foram distribuídos uniformemente (p = 0,208). Em todos os tempos, o número de SMs foi superior no grupo AC. A média das velocidades médias do fluxo na ACM foi menor durante o tempo de proteção em ambos os grupos. Conclusão A EC teve uma menor incidência de SMs que a AC em todos os estágios. A média das velocidades médias na ACM teve comportamento similar em ambos os grupos.

Abstract Background Carotid endarterectomy (CEA) and carotid artery stenting (CAS) have both been proposed for treatment of critical atherosclerotic stenosis located at the carotid bifurcation. Monitoring of hyperintense microembolic signals (MES) by transcranial Doppler ultrasound (TCD) is considered a method of quality control, both in CEA and in CAS. Objective To analyze temporal distribution of MES throughout both semi-eversion CEA and CAS procedures and to evaluate changes in mean velocity of blood flow through the ipsilateral middle cerebral artery (MCA). Method Thirty-three procedures (17 CEA and 16 CAS) were prospectively monitored using TCD and the data were related to three different stages of surgery (pre-cerebral protection, during cerebral protection and post-cerebral protection). Chi-square, Mann-Whitney, ANOVA and contrast tests were used for statistical analysis. Results The MES were uniformly distributed in the CEA group, but not in the CAS group (p = 0.208). The number of MES was higher in the CAS group in all stages. The average flow in the MCA was similarly lower in both groups during the protection stage. Conclusion CEA provoked a lower incidence of MES per procedure than CAS in all stages. The behavior of the averages of the mean of blood flow through the MCA was similar in both groups.

A falta de planejamento no processo de urbanização das grandes metrópoles tem produzido numerosas externalidades negativas, entre elas a supressão de sua cobertura vegetal e de áreas verdes. Inúmeros benefícios têm sido reportados sobre como a presença da vegetação no meio ambiente urbano favorece fatores ambientais, sociais e econômicos, influenciando na saúde da população. O presente trabalho busca apresentar uma série de estudos com enfoque na associação entre áreas verdes e saúde e também uma sucinta reflexão sobre a importância do assunto no município de São Paulo.

The lack of planning in the urbanization process of big cities worldwide has produced numerous negative externalities, including the suppression of vegetation and green spaces. Multiple benefits have been reported on how urban vegetation promotes and influences environmental, social and economic factors, as well as people's health. This paper presents a series of studies focusing on the association between urban vegetation and human health, as well as a brief reflection on the importance of this issue in the city of São Paulo.

ResumoOs autores revisam os principais conceitos relativos à importância da limpeza/desinfecção das sondas ecográficas, visando sua melhor compreensão e possibilitando, assim, estabelecer estratégias para uma prática segura sem comprometer a qualidade do exame e a produtividade do operador. No contexto da biossegurança, é imperativo assumir que o contato com sangue ou fluidos corporais representa uma potencial fonte de infecção. Dessa forma, para que as práticas de limpeza/desinfecção possam ser instituídas, é necessário entender os princípios do controle de infecção, ponderar se os benefícios das medidas a serem instituídas são compatíveis com seus custos e consequências, e principalmente compreender que tais medidas não beneficiam apenas o profissional de saúde e o paciente, mas a sociedade como um todo.

AbstractThe authors review the main concepts regarding the importance of cleaning/disinfection of ultrasonography probes, aiming a better comprehension by practitioners and thus enabling strategies to establish a safe practice without compromising the quality of the examination and the operator productivity. In the context of biosafety, it is imperative to assume that contact with blood or body fluids represents a potential source of infection. Thus, in order to implement cleaning/disinfection practice, it is necessary to understand the principles of infection control, to consider the cost/benefit ratio of the measures to be implemented, and most importantly, to comprehend that such measures will not only benefit the health professional and the patient, but the society as a whole.

Antiretroviral therapy has been associated with side effects, either from the drug itself or in conjunction with the effects of human immunodeficiency virus infection. Here, we evaluated the side effects of the protease inhibitor (PI) indinavir in hamsters consuming a normal or high-fat diet. Indinavir treatment increased the hamster death rate and resulted in an increase in triglyceride, cholesterol and glucose serum levels and a reduction in anti-oxLDL auto-antibodies. The treatment led to histopathological alterations of the kidney and the heart. These results suggest that hamsters are an interesting model for the study of the side effects of antiretroviral drugs, such as PIs.