Rossano Fiorelli

Interrupções e distrações na sala de cirurgia do trauma: entendendo a ameaça do erro humano

OBJECTIVE To understand the human factor as a threat to the security of trauma patients in the operating room, bringing to the operating room some important rules already applied in the field of aviation. METHODS The sample included 50 cases of surgical trauma patients prospectively collected by observers in shifts of 12 hours, for six months in a Level I trauma center in the United States of America. Information regarding the type of trauma, severity score and mortality were collected, as well as determinants of distractions / interruptions and the volume of noise in the operating room during surgery. RESULTS There was an average of 60 interruptions or distractions during surgery, most often triggered by the movement of people in the room. In more severe patients (ISS> 45), subjected to damage control, the incidence of distractions was even greater. The average noise in the trauma surgery room was very high, close to the noise of a hair dryer. CONCLUSION Interruptions and distractions are frequent and should be studied by the trauma surgeon to develop prevention strategies and lines of defense to minimize them and reduce their effects.

Lessons learned from a landslide catastrophe in Rio de Janeiro, Brazil.

INTRODUCTION On January, 2011, a devastating tropical storm hit the mountain area of Rio de Janeiro State in Brazil, resulting in flooding and mudslides and leaving 30,000 individuals displaced. OBJECTIVE This article explores key lessons learned from this major mass casualty event, highlighting prehospital and hospital organization for receiving multiple victims in a short period of time, which may be applicable in similar future events worldwide. METHODS A retrospective review of local hospital medical/fire department records and data from the Health and Security Department of the State were analyzed. Medical examiner archives were analyzed to determine the causes of death. RESULTS The most common injuries were to the extremities, the majority requiring only wound cleaning, debridement, and suture. Orthopedic surgeries were the most common operative procedures. In the first 3 days, 191 victims underwent triage at the hospital with 50 requiring admission to the hospital. Two hundred fifty patients were triaged at the hospital by the end of the fifth day. The mortis cause for the majority of deaths was asphyxia, either by drowning or mud burial. CONCLUSION Natural disasters are able to generate a large number of victims and overwhelm the main channels of relief available. Main lessons learned are as follows: 1) prevention and training are key points, 2) key measures by the authorities should be taken as early as possible, and 3) the centralization of the deceased in one location demonstrated greater effectiveness identifying victims and releasing the bodies back to families.

Frontotemporal dementia in amyotrophic lateral sclerosis: from rarity to reality?

Marco Orsini,1 Ana Carolina Andorinho de Freitas Ferreira,2 Osvaldo J.M. Nascimento,2 Jano Alves de Souza,2 Thaís Nascimento Magalhães,2 Anna Carolina Damm de Assis,2 Larissa Kozow Westin,2 Bruno Pessoa,2 Acary Bulle Oliveira,3 Rossano Fiorelli,4 Marcos R.G. de Freitas,2 Juliana Bittencourt,1 Stenio Fiorelli,4 Maria Fernanda Freitas Ferreira Moreira,5 Pedro Ribeiro1 1Brain Mapping Laboratory and Electroencephalogram, Federal University of Rio de Janeiro and Severino Sombra University Center, Vassouras, RJ; 2Antonio Pedro University Hospital – HUAP – Federal Fluminense University, Niterói; 3Department of Neurology, Federal University of São Paulo;. 4Department of Neurology, Masters Program (Neurology) – UNIRIO; 5Estácio de Sá University, School of Medicine, Rio de Janeiro, Brazil

Cervical spondylotic myelopathy: what the neurologist should know

Cervical spondylotic myelopathy is a well-known cause of disability among older people. A significant amount of these patients is asymptomatic. Once the symptoms start, the worsening may follow a progressive manner. We should suspect of spondylotic myelopathy in any individual over 55 years presenting progressive changes in gait or losing fine motor control of the upper limbs. Despite its frequent prevalence, this condition is still neglected and many times confused with other supratentorial lesions regarding diagnostic. Here we address some of most important aspects of this disease, calling attention to pathophysiology, the natural history, presentation, differential diagnosis, clinical assessment, and treatment.

The effects of supraphysiological supplementation of b-carotene in spontaneously hypertensive rats (SHR and SHR-sp)

OBJECTIVE To investigate the effect of administration of supraphysiological β carotene on biological, laboratory and histological parameters of spontaneously hypertensive rats prone to stroke (SHR-sp). METHODS we used 36 male rats divided into three groups, each containing 12 rats of the types Wistar SHR and SHR-sp, subdivided into six control animals and six animals treated with supraphysiological doses of β carotene for two ten-week periods, interspersed by a one-week interruption. We carried out daily physical examination and blood pressure assessment. We collected blood for measurement of serum malondialdehyde; the liver and carotid arteries were subsequently harvested for histological examination. RESULTS there was a temporary change in the color of hair, a significant decrease (p <0.0001) in blood pressure (20 mg β carotene supplementation) and serum levels of malondialdehyde (p<0.05) and increased amount of elastic fibers in the carotid wall of SHR and SHR-sp. CONCLUSION β carotene supraphysiological supplementation caused no toxic effects, showed positive response in the modulation of blood pressure and lower serum malondialdehyde. No significant morphological changes were observed in the groups studied, except for an increase in the number of elastic fibers in the carotid muscular layer, suggesting elastosis in SHR and SHR-sp.

Topographic anatomical study of the sciatic nerve relationship to the posterior portal in hip arthroscopy

OBJECTIVE To evaluate the anatomic topographic relation between the sciatic nerve in relation to the piriform muscle and the posterior portal for the establishment of hip arthroscopy. METHODS We dissected 40 hips of 20 corpses of adult Brazilians, 17 male and three female, six black, six brown and eight white. We studied the anatomical relationship between the sciatic nerve and the piriform muscle with their variations and the distance between the lateral edge of the sciatic nerve and the posterior portal used in hip arthroscopy. We then classified the anatomical alterations found in the path of the sciatic nerve on the piriform muscle. RESULTS Seventeen corpses had bilateral relationship between the sciatic nerve and the piriform muscle, i.e., type A. We found the following anatomical variations: 12.5% of variant type B; and an average distance between the sciatic nerve and the portal for arthroscopy of 2.98cm. One body had type B anatomical variation on the left hip and type A on the right. CONCLUSION the making of the posterior arthroscopic portal to the hip joint must be done with careful marking of the trochanter massive; should there be difficult to find it, a small surgical access is recommended. The access point to the portal should not exceed two centimeters towards the posterior superior aspect of the greater trochanter, and must be made with the limb in internal rotation of 15 degrees.

Tamponamento cardíaco por cateter central de inserção periférica em prematuros: papel da ultrassonografia à beira do leito e abordagem terapêutica

OBJECTIVE to determine the incidence of pericardial effusion with cardiac tamponade in preterm infants in a pediatric intensive care unit, with emphasis on the relationship between pericardial effusion and peripherally inserted central catheter, and to evaluate the role of bedside ultrasound in approaching these cases. METHODS we conducted a retrospective analysis of patients admitted to a pediatric intensive care unit between July 2014 and December 2016, who presented pericardial effusion with hemodynamic repercussion, evaluated by ultrasonography. RESULTS we studied 426 patients admitted to the five beds of the neonatal unit. In the period, there were 285 bedside ultrasound exams. We found six cases of pericardial effusion, four of which with obstructive shock and need for pericardial drainage. There was no procedure-related mortality, and all patients evolved with hemodynamic improvement after the procedure. The incidence of pericardial effusion was 2.4 cases per year. CONCLUSION the incidence of pericardial effusion is low in neonates, but early diagnosis is fundamental due to high morbidity and mortality, especially in cases of abrupt onset. All cases were diagnosed by bedside ultrasonography, demonstrating its importance in the screening of these cases, especially in shocks of uncertain etiology and neonates with sudden onset hemodynamic instability who are using central venous access.

Prevalence of neurological complications associated with Zika virus in a brazilian metropolis

The aim of this paper is to study the prevalence of Zika Virus (ZIKV) and the index of its neurological complications. This is a quantitative, cross-sectional epidemiological study. Data were collected through the compulsory notification of suspected ZIKV and its neurological alterations cases. 113 suspected ZIKV cases were reported, most of them in the summer, with a higher prevalence of females and in the fourth decade of life. Among the neurological changes, 15 Guillain-Barré Syndrome cases were reported, with one registered death. As neurological manifestations, most of them started 30 days after a ZIKV infection. No case has been confirmed laboratory. It is necessary to combat the vector, mainly in the summer, to reduce ZIKV infection and its neurological complications, besides instruction to the health professionals about these complications and serological tests requests for an accurate diagnosis.

Cognitive impairment in neuromuscular diseases: A systematic review

Neuromuscular diseases are multifactorial pathologies characterized by extensive muscle fiber damage that leads to the activation of satellite cells and to the exhaustion of their pool, with consequent impairment of neurobiological aspects, such as cognition and motor control. To review the knowledge and obtain a broad view of the cognitive impairment on Neuromuscular Diseases. Cognitive impairment in neuromuscular disease was explored; a literature search up to October 2017 was conducted, including experimental studies, case reports and reviews written in English. Keywords included Cognitive Impairment, Neuromuscular Diseases, Motor Neuron Diseases, Dystrophinopathies and Mitochondrial Disorders. Several cognitive evaluation scales, neuroimaging scans, genetic analysis and laboratory applications in neuromuscular diseases, especially when it comes to the Motor Neuron Diseases, Dystrophinopathies and Mitochondrial Disorders. In addition, organisms model using rats in the genetic analysis and laboratory applications to verify the cognitive and neuromuscular impacts. Several studies indicate that congenital molecular alterations in neuromuscular diseases promote cognitive dysfunctions. Understanding these mechanisms may in the future guide the proper management of the patient, evaluation, establishment of prognosis, choice of treatment and development of innovative interventions such as gene therapy.

Virtual Reality in the Physical-Functional Recovery of Patients after Stroke: A Short Communication

Vitória Pereira1,2, Francisco Vinícius Fontenele1,2, Jordeane Araujo1, Elivelton Montelo1, Kaline Melo3,4 , Silmar Teixeira3,4, Luan Correia1,5* and Victor Hugo Bastos1,5 1Brain Mapping and Functionality Laboratory (LAMCEF/UFPI), Federal University of Piauí, Brazil 2Mauricio of Nassau University Center, Parnaíba, Brazil 3The Northeast Biotechnology Network (RENORBIO), Federal University of Piauí, Teresina, Brazil 4Brain Mapping and Plasticity Laboratory (LAMPLACE/UFPI), Federal University of Piauí, Parnaíba, Brazil 5Biomedical Sciences Program, PPGCBM, Federal University of Piauí, Parnaíba, Brazil *Corresponding author: Luan Correia, Biomedical Sciences Program, PPGCBM, Federal University of Piauí, Parnaíba, Brazil, Tel: +55-86-9-8829-1971; Email: luancorreiafisio@gmail.com