External Oblique Intercostal Block for Living Kidney Donor Open Nephrectomy: A Case Series

The external oblique intercostal (EOI) block is a novel regional technique that provides analgesia for upper abdominal incisions. We performed single-injection and continuous EOI blocks in living kidney donors who underwent open nephrectomy. In this case series, we report our experience with pain management using this technique in five patients at our centre. EOI block resulted in good pain relief in our patients. The median (IQR) numerical rating scale score was 3 (1-6) at rest immediately after the end of the surgery, predominantly visceral. We want to highlight the benefits regarding pain management of the association of EOI block with conventional therapy.

A case of self-improving collodion ichthyosis associated with a rare variant of the ALOX12B gene

Collodion baby is usually a manifestation of autosomal recessive congenital ichthyosis, a heterogeneous group of congenital hyperkeratotic genodermatoses with highly variable severity and genetic background. Herein, we report a case of self-improving collodion ichthyosis, a rare subtype of autosomal recessive congenital ichthyosis, characterized by an almost-complete spontaneous resolution of symptoms.

Familial multiple basaloid follicular hamartoma

Basaloid follicular hamartoma (BFH) is a rare follicular hamartoma of benign nature, which should be part of the differential diagnoses of basal cell carcinoma. Familial multiple BFH (FMBFH) is a hereditary subtype which typically presents early in life with multiple small, skin-colored papules primarily on the central face. Although these lesions are usually asymptomatic, they can be cosmetically disfiguring. Treatment options include surgery, cryotherapy, CO2 laser and imiquimod; no standard of care has been determined. We present a case of FMBFH presenting in adulthood, which was treated with CO2 laser with satisfactory results.

Postpartum lumbosacral radiculopathy: a neuraxial anaesthesia complication or an intrinsic obstetric palsy?

Postpartum peripheral nerve disorders are an uncommon obstetrical complication, with most cases resulting from intrinsic obstetric palsies. We present the case of a full-term nulliparous pregnant 33-year-old woman with a vacuum-assisted vaginal delivery due to a prolonged second stage of labour and occipitoposterior position of the fetal head. For analgesia, a combined spinal-epidural technique was used. Four hours after delivery, the patient experienced a painless asymmetric motor deficit and hypoesthesia in the lower limbs, followed by sphincter disturbance. Emergent MRI was unremarkable. Electromyography showed signs of a bilateral lumbosacral radiculopathy. The patient experienced a gradual recovery over the following 2 months. Although a definitive aetiological diagnosis could not be confirmed, a lumbosacral polyradiculopathy due to intrinsic obstetric complication was considered. The patient presented several risk factors known to be associated with intrinsic obstetric palsies. Obstetricians and anaesthesiologists have an important role in preventing and diagnosing postpartum peripheral nerve disorders.

Implications of violence experience in postpartum depression

Introduction

The violence against women is an exacerbating factor in public health that affects a third of the world's female population, and the intimate partner is the main perpetrator. Researches show the impact of violence in the victims' health, such as: postpartum depression (PPD). In this context, considering the importance and magnitude of the experience of violence and its impact on health, as well as depression negatively impacted on the health of the mother and baby, justify it to carry out this study.

Objective

To identify the prevalence of symptoms of PPD among puerperal women and to examine the association with violence experience.

Methods

This is a cross-sectional study, performed with 330 puerperal women admitted to a municipal maternity hospital in Cariacica - State of Espírito Santo, Brazil. Data collection was conducted by duly trained interviewers, using a form containing data on socioeconomic, behavioral and clinical characterization. In order to track violence acts, in life and in pregnancy, practiced by the intimate partner, we applied the World Health Organization instrument, which enables the identification of psychological, physical and sexual violence acts. The identification of the outcome under study, postpartum depression, was obtained by means of the Edinburgh Postnatal Depression Scale. The data collected were analyzed through the Stata 13.0 program, where the following tests were performed: Pearson chi-squared test and Poisson regression.

Results

a rate of 36.7% of participants (95% CI: 31.6-42.0) showed symptoms of postpartum depression. Women who experienced violence from their partners throughout their lives had 1.9 times more prevalence of symptoms of depression. Those who experienced aggression during pregnancy showed an increase of 38.0% of this illness (p = 0.037).

Conclusions

The data presented reveal the high prevalence of women with symptoms of PPD and that violence experience was associated with higher frequencies of this event.

Key messages

Women who experienced violence from their partners throughout their lives had 1.9 times more prevalence of symptoms of depression. The data presented reveal the high prevalence of women with symptoms of postpartum depression and that violence experience was associated with higher frequencies of this event.

The experiences of maternity in front of hospitalization in high risk pregnances

Introduction

The pregnancy-puerperal cycle is defined as a moment that involves physical, psychological and social changes. There are pregnancies that require specialized care and attention due to the presence of risk factors that may be prior to pregnancy and / or that may be associated with the pregnancy condition itself, which characterize them as high-risk pregnancies. Currently, prenatal care with risk stratification is the main care strategy for pregnant women, once the risk classification is identified, it is possible to promote interventions according to the health needs of each pregnant woman. For this, the risk assessment is carried out at each prenatal consultation, so that, depending on the course of pregnancy, hospitalization becomes necessary. The diagnosis of high-risk pregnancies accompanied by hospitalization has impacts on the woman's life, such as loss of autonomy, a sense of failure and the incidence of greater care and interventions by the health team and the family that can configure practices to control their bodies.

Objective

This work aims to identify the hospitalization process during high-risk pregnancy as a space for the production of projects, resistance and protagonism through the protocols and regulations that configure the hospital context.

Methodology

This is an exploratory analysis of a qualitative approach in public health. A reference maternity hospital in high-risk pregnancy located in a teaching hospital in Greater Vitória was chosen. It will be used to define sampling for convenience. The data will be collected through semi-structured interviews and on-site observations by the researcher. The data analysis methodology used will be content analysis.

Expected Results

It is expected to understand the various practices of protagonism and resistance that permeate the care of hospitalized pregnant women.

Key messages

This work has an impact on the improvement of the maternal and child care network of the public health system in Brazil. This work allows to evaluate the quality of the assistance provided in the public maternity.

Aberrant Trajectory Of A Central Venous Catheter

During placement of a central venous catheter into the right subclavian vein it was found to be impossible to extract the guidewire. An Angio-Computed Tomography was performed, showing an aberrant guidewire path, as the image shows. An urgent mini-sternotomy was performed to extract both catheter and guidewire under direct visualization.

[The multidisciplinary challenge of anesthesia for ex utero intrapartum treatment: a case report]

The Ex- Utero Intrapartum Treatment (EXIT) is a surgical procedure performed in cases of expected postpartum fetal airway obstruction, allowing the establishment of patent airway while maintaining placental circulation. Anesthesia for EXIT procedure has several specific features such as adequate uterine relaxation, maintenance of maternal blood pressure fetal anesthesia and fetal airway establishment. The anesthesiologist should be aware of these particularities in order to contribute to a favorable outcome. This is a case report of an EXIT procedure performed on a fetus with a cervical lymphangioma with prenatal evidence of partial obstruction of the trachea and risk of post-delivery airway compromise.

How vision governs the collective behaviour of dense cycling pelotons

In densely packed groups demonstrating collective behaviour, such as bird flocks, fish schools or packs of bicycle racers (cycling pelotons), information propagates over a network, with individuals sensing and reacting to stimuli over relatively short space and time scales. What remains elusive is a robust, mechanistic understanding of how sensory system properties affect interactions, information propagation and emergent behaviour. Here, we show through direct observation how the spatio-temporal limits of the human visual sensory system govern local interactions and set the network structure in large, dense collections of cyclists. We found that cyclists align in patterns within a ± 30° arc corresponding to the human near-peripheral visual field, in order to safely accommodate motion perturbations. Furthermore, the group structure changes near the end of the race, suggesting a narrowing of the used field of vision. This change is consistent with established theory in psychology linking increased physical exertion to the decreased field of perception. Our results show how vision, modulated by arousal-dependent neurological effects, sets the local arrangement of cyclists, the mechanisms of interaction and the implicit communication across the group. We furthermore describe information propagation phenomena with an analogous elastic solid mechanics model. We anticipate our mechanistic description will enable a more detailed understanding of the interaction principles for collective behaviour in a variety of animals.

Progression of rabbit haemorrhagic disease virus 2 upon vaccination in an industrial rabbitry: a laboratorial approach

<p>Rabbit haemorrhagic disease virus 2 (RHDV2) emerged recently in several European countries, leading to extensive economic losses in the industry. In response to this new infection, specific inactivated vaccines were developed in Europe and full and rapid setup of protective immunity induced by vaccination was reported. However, data on the efficacy of these vaccines in an ongoing-infection scenario is unavailable. In this study we investigated an infected RHDV2 indoor industrial meat rabbitry, where fatalities continued to occur after the implementation of the RHDV2 vaccination, introduced to control the disease. The aim of this study was to understand if these mortalities were RHDV2-related, to discover if the dead animals showed any common features such as age or time distance from vaccination, and to identify the source of the outbreak. Anatomo-pathological analysis of vaccinated animals with the virus showed lesions compatible with systemic haemorrhagic disease and RHDV2-RNA was detected in 85.7% of the animals tested. Sequencing of the <em>vp60</em> gene amplified from liver samples led to the recognition of RHDV2 field strains demonstrating that after the implementation of vaccination, RHDV2 continued to circulate in the premises and to cause sporadic deaths. A nearby, semi-intensive, RHDV2 infected farm belonging to the same owner was identified as the most probable source of the virus. The main risk factors for virus introduction in these two industries were identified. Despite the virus being able to infect a few of the vaccinated rabbits, the significant decrease in mortality rate observed in vaccinated adult rabbits clearly reflects the efficacy of the vaccination. Nonetheless, the time taken to control the infection also highlights the importance of RHDV2 vaccination prior to the first contact with the virus, highly recommendable in endemic areas, to mitigate the infection’s impact on the industry.</p>