Humberto José Alves

Quantification of bone mass gain in response to the application of biphasic bioceramics and platelet concentrate in critical-size bone defects

Biphasic bioceramics have been widely indicated for bone reconstruction; however, the real gain in bone mass due to the presence of such biomaterials has not been established yet nor the advantages of its association with platelet concentrate. This study aims at quantifying the volume of bone matrix, osteoblasts, osteocytes, blood vessels and adipose tissue after the application of a biphasic bioceramics composed of 65% hydroxyapatite and 35% β-tricalcium phosphate. Critical-size bone defects were produced in rabbit femora and reconstructed with bioceramics only, with bioceramics combined with platelet concentrate, with platelet concentrate alone, and with no treatment (blood clot). The quantitative evaluation was performed on histological sections using histomorphometry. Our data provide original evidence that consolidates the indication of bioceramics for clinical bone loss reconstruction. The application of biphasic bioceramics alone led to major bone mass gain and was followed by its association with platelet concentrate. On the other hand, platelet concentrate can contribute to the augmentation and maintenance of the adipose tissue, representing a new field for future applications in plastic surgery.

Sympathetic Innervation of the Reproductive Organs of the Male Opossum, Didelphis albiventris (Lund, 1841)

The dissection of nerves and ganglia anatomically related to the pelvic organs revealed one inferior mesenteric ganglion, two testicular ganglia, two hypogastric nerves, two pelvic ganglia and two pelvic nerves. The histochemical demonstration of catecholamines by a glyoxylic acid fluorescence method revealed a rich sympathetic innervation in the ductus deferens, in the three segments of the prostate and in the convoluted ductuli efferentes. The testis, epididymis and all three pairs of bulbourethral glands presented fluorescent nerve fibers only around blood vessels. Removal of the inferior mesenteric and testicular ganglia, and hypogastric neurectomy with our without ligature and sectioning of testicular arteries, had no effect on the density of the nonvascular fluorescent fibers. Removal of the periprostatic tissue caused complete denervation of the prostate and marked denervation of the ductuli efferentes and ductus deferens. Small ganglia containing fluorescent nerve cell bodies were found close to the capsule of the prostate. The results indicate that short adrenergic neurons are responsible for the sympathetic innervation of the reproductive organs of the male opossum.

Kinetics of neovascularisation of splenic autotransplants in mice

The aim of this study was to examine the kinetics of neovascularisation of splenic autoimplants into the abdominal cavity after splenectomy in mice. Sixty‐eight female Swiss mice were submitted to splenectomy. The spleen from each animal was sliced and the slices were implanted into the abdominal cavity. Groups of animals were killed after 1, 2, 3, 5, 7, 15, 21, 28, 42, 56, 70 and 84 d. Fluorescent polystyrene microspheres were injected via the orbital venous plexus before killing and the splenules were removed 5 min later for light and electron microscopy. Mesenteric blood vessels were injected with coloured latex to study the origin of the nutrient vessels. Three days after the implant the microspheres were observed at the periphery and then migrating to the internal parts of the implant in the subsequent days. The blood supply to the implants originated from branches of the splenic, short gastric, mesenteric and gastroepiploic arteries. It is concluded that revascularisation of splenic autografts proceeds centripetally, starting as early as 3 d after implantation.

Teleconsultations in Public Primary Care Units of the City of Belo Horizonte, Brazil: Profile of Patients and Physicians

OBJECTIVE The aim of this study is to report patient and physician profiles of those who used the teleconsultation system in the primary care health units of a health district in the city of Belo Horizonte, MG, Brazil. MATERIALS AND METHODS Data were collected from the telehealth attendance records of nine Primary Health Units (Unidade Básica de Saúde [UBS] in Portuguese) and from interviews carried out with the referring physicians. The criteria for inclusion required that data come from users seen by means of telehealth in the period between December 2004 and August 2010 and from the practitioners who saw them. The following were excluded: physicians who were not working in the UBS when the data were collected and a physician who did not agree to take part in the study. RESULTS Two hundred sixty-three teleconsultations were analyzed, and 20 referring physicians were interviewed. The offline method was the most common. The physicians were predominantly female and had graduated over 11 years ago. The patients were predominantly adult women. After teleconsultation, a prescription was not necessary for 9.8% of patients. When required, 83.2% of the medication was available in the UBS. In 68.3% of cases, additional tests were required. The incorporation of these technologies prevented the physical referral of patients in 64.2% of cases. CONCLUSIONS Telehealth resources can help to improve the provision of primary healthcare, reducing the number of physically referred patients. The number of teleconsultations is still small, and there is a need to encourage physicians to use the system.

Incorporation of Telehealth Resources in Belo Horizonte's SAMU: Qualifying and Improving Care

In Brazil the use of information communication technologies increased considerably in this last few years, but there are still very incipient experiments using telemedicine for pre-hospital care. This article reports the deployment of resources of telehealth on SAMU (Emergency Mobile Assistance Service) of Belo Horizonte and the preliminary results of the project, involving European partners, the Federal University of Minas Gerais School of Medicine and the City of Belo Horizonte Department of Health. It is applied to the Brazilian reality, through the appropriation of good practices existing in Europe and the integration of technology development. We have been using multiparametric monitors, videos of the patient and ultrasound, and 3G technology to enhance transfer of pre-hospital data, from ambulances, to data banks in hospitals, to improve patient care.

The Brazilian National Telehealth Program in the State of Minas Gerais - Brazil

The Brazilian National Telehealth Program was setup by the Brazilian Ministry of Health. In Minas Gerais state, the Federal University of Minas Gerais School of Medicine has joined the State Department of Health and 50 towns for this project development. This paper describes the implementation of the service and partial results and services available. The Nucleus of Telehealth of Minas Gerais has been developing teleducation and teleassistence. From 2007 to 2008 278 teleconsultations and 6295 ECG’s took place. A total of 1339 health professionals participated in the videoconferences. The professionals involved in this project were interviewed and talked about the difficulties and benefits. The Telehealth has improved patient’s assistance and decreased the patient’s needs for dislocation and for consultations with a specialist in big centers. Moreover it was noticed that there is a high cultural resistance concerning the use of information and communication technologies.

Telemonitoring of Neonatal Intensive Care Units: Preliminary Experience in the State of Minas Gerais, Brazil

Objective This article describes the implementation and functioning of a telemonitoring center of neonatal intensive care units (NICUs) organized by the Telehealth Center of the Medical School of the Federal University of Minas Gerais who signed an agreement with the Minas Gerais State Department of Health (SES/MG, in Portuguese), Brazil. Study Design This is a descriptive retrospective study from December 2012 to June 2014 of a NICU telemonitoring project. Results Twelve Web conferences have been performed. Six thousand, eight hundred and thirty nine (6,839) online teleconsultations of pediatricians and nurses with experience in neonatology and intensive care have been performed, of which 174 were with subspecialists, with an average response time of 6 hours. Discussion The project has demonstrated to be satisfactory, with fast response in relation to the demands of subspecialists, promoting care, and management support to the NICU. The qualification via Web conferences prevents the displacement of the professionals to big centers for continuous medical education. Conclusion The telemonitoring of NICU can contribute in the process of management, regulation of beds, reduction of displacements and transferences, adhesion to best practices, care support, and qualification of the involved professionals.

Telehealth: General Aspects in Primary Care

The World Health Organization (WHO, 2007) is confident that the major expectations regarding public health will be met in the 21st century as a result of improved access to resources – both qualitatively and quantitatively, which will then be available to most of the world population. Building on the assumption that the technological development has yielded significant contributions to the health field, particularly by facilitating knowledge sharing and promoting care education and training either in remote and isolated areas, WHO encourages its members to adopt telehealth as a politic and strategic tool to plan and implement health actions worldwide.