Cirurgia paliativa do ombro em paralisia obstétrica do plexo braquial

A paralisia obstétrica do plexo braquial é rara originando disfunção grave e défice marcado da rotação externa e da abdução do ombro. Reviram-se retrospectivamente 11 casos de paralisia obstétrica do plexo braquial (sete com paralisia alta e quatro com paralisia completa) tratados cirurgicamente pela técnica de L’Épiscopo modificada por Hoffer. Estes resultados foram padronizados segundo o tipo de lesão (grupo A – lesão alta; grupo B – lesão completa) e a idade (grupo I ≤ 4 anos; grupo II > 4 anos). O seguimento médio foi de 35 meses. A idade média aquando da cirurgia era de 6,5 anos (r= 2–11). Todos, excepto um, apresentaram melhoria funcional, com aumento da pontuação média de Mallet de 4,6 pontos. Os dois subtipos de paralisia tiveram pontuação média de Mallet sobreponível (grupo A – 4.6; grupo B – 4.7); a idade aquando da cirurgia não influenciou o resultado clínico (pontuação média (grupo I) – 4.8; (grupo II) – 4.4). Não foram registadas complicações. A técnica de L’Épiscopo modificada por Hoffer é eficaz no tratamento paliativo do ombro em paralisia obstétrica do plexo braquial, permitindo recuperação da abdução e rotação externa do ombro. Está indicada em paralisias altas e completas, quando associada a outras cirurgias de recuperação da função do cotovelo, punho e/ou mão. Idade superior a 4 anos não contra-indica a cirurgia desde que sejam excluídas alterações da articulação glenoumeral.

New variant and expression studies provide further insight into the genotype-phenotype correlation in YAP1-related developmental eye disorders

YAP1, which encodes the Yes-associated protein 1, is part of the Hippo pathway involved in development, growth, repair and homeostasis. Nonsense YAP1 mutations have been shown to co-segregate with autosomal dominantly inherited coloboma. Therefore, we screened YAP1 for variants in a cohort of 258 undiagnosed UK patients with developmental eye disorders, including anophthalmia, microphthalmia and coloboma. We identified a novel 1 bp deletion in YAP1 in a boy with bilateral microphthalmia and bilateral chorioretinal coloboma. This variant is located in the coding region of all nine YAP1 spliceforms, and results in a frameshift and subsequent premature termination codon in each. The variant is predicted to result in the loss of part of the transactivation domain of YAP1, and sequencing of cDNA from the patient shows it does not result in nonsense mediated decay. To investigate the role of YAP1 in human eye development, we performed in situ hybridisation utilising human embryonic tissue, and observed expression in the developing eye, neural tube, brain and kidney. These findings help confirm the role of YAP1 and the Hippo developmental pathway in human eye development and its associated anomalies and demonstrate its expression during development in affected organ systems.

Reliability assessment of measuring active wrist pronation and supination range of motion with a smartphone

This study aimed to improve clinical examination techniques by determining the reliability of different methods to evaluate forearm movements. Two methods using the iPhone™ 5 and its gyroscope application (alone [I5] or attached to a selfie stick [ISS]) were compared with two conventional measurement devices (a plastic goniometer with a hand-held pencil [HHP] and a bubble goniometer [BG]) to evaluate the active range of movement (AROM) of the wrist during pronation and supination. Two independent groups of subjects took part in this prospective single-center diagnostic study: 20 healthy subjects and 20 patients. The four evaluation methods had high intra-observer consistency after three measurements (intra-class correlation coefficient [ICC] [3, 1] of 0.916 for the HHP; 0.944 for ISS; 0.925 for BG; 0.933 for I5) and excellent inter-observer reliability (ICC [2, k] of 0.926 for HHP; 0.934 for ISS; 0.899 for BG; 0.894 for I5), with an agreement of plus or minus 2°. When these devices are used with rigorous methodology, they are reliable for the goniometric evaluation of AROM of wrist pronation and supination.

The human otitis media with effusion: a numerical-based study

Otitis media is a group of inflammatory diseases of the middle ear. Acute otitis media and otitis media with effusion (OME) are its two main types of manifestation. Otitis media is common in children and can result in structural alterations in the middle ear which will lead to hearing losses. This work studies the effects of an OME on the sound transmission from the external auditory meatus to the inner ear. The finite element method was applied on the present biomechanical study. The numerical model used in this work was built based on the geometrical information obtained from The visible ear project. The present work explains the mechanisms by which the presence of fluid in the middle ear affects hearing by calculating the magnitude, phase and reduction of the normalized umbo velocity and also the magnitude and phase of the normalized stapes velocity. A sound pressure level of 90 dB SPL was applied at the tympanic membrane. The harmonic analysis was performed with the auditory frequency varying from 100 Hz to 10 kHz. A decrease in the response of the normalized umbo and stapes velocity as the tympanic cavity was filled with fluid was obtained. The decrease was more accentuated at the umbo.

Insomnia and sleep state misperception: Clinical features, diagnosis, management and implications

Background

Insomnia is a highly prevalent complaint, largely associated with mental disease. Clinical evidence classifies insomnia in 2 subtypes: with sleep misperception (WSM) and without sleep misperception (wSM). That presents distinctive pathophysiologic pathways and different public health implications.

Objectives

Describe the main differences between primary insomnia WSM and wSM regarding:

– clinical features;

– diagnosis;

– management;

– implications.

Methods

We conducted a systematic review. PubMed, Embase and PsycInfo were searched from 2000–2016. The reference lists of systematic reviews, narrative synthesis and some important articles were included. Following the inclusion criteria, we selected 25 studies from 59 articles.

Results

The prevalence of sleep-state misperception in primary insomniacs (total sleep time > 6.5 h and sleep efficiency > 85%) is around 26%. Insomniacs with normal sleep duration showed a profile of high depression and anxiety and low ego strength, whereas insomniacs with short sleep duration showed a profile of a medical disorder.

Cortical hyperarousal is higher in insomniacs and could be related to an alteration in sleep protection mechanisms. The sleep architecture was relatively normal for the WSM comparing with the group wSM. Risk of cardiometabolic, neurocognitive morbidity and mortality, and responses to treatment are different between these two insomnia phenotypes. Patients with short sleep duration may respond better to biological treatments, whereas insomnia with normal sleep duration may respond primarily to psychological therapies.

Conclusions

The clinical characteristics of patients with sleep-state misperception differed from those without this condition. Available research related to these conditions is expanding rapidly, but many questions remain unanswered.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

New psychiatric service – fresh nurses experiences

The year 2015 started a new assistance in the cycle of mental health care ending the gap that existed in the district of Beja in the last twenty years, in this area. The aim of this presentation is to give the data of nursing activity in the first six months inpatient psychiatric service. The population studded was 98 inpatients, 53%male and 47% females aged between 16 and 87-years-old, diagnosed with depression, schizophrenia, personality disorders, bipolar disorders, dementias and others. Descriptive statistic of collected data. We rated the gender, marital status, aged and main disorders as well as the nursing therapeutic activities preformed with the patients. Six different kinds of activities were done. The total of interventions were 148: relaxation, ludic activities, physical activity, art therapy, health education and music therapy. Nursing intervention in the treatment of people with mental disorders improves the compliance to the treatment (adherence, self-care, useful occupation, stress career and insight of the illness) during the hospitalization time, aiming to avoid the worsening situation and the social isolation of the patient, and promote the recovery and quality of life. These objectives begin on hospital stay during the acute crisis. We are aware of the fact that this is just the beginning of this approach and for more and better results we have to have a bigger sample and a longer time of intervention as well as better methodology, namely the use of scales to measure some parameters that can provide more consistent and objective findings.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Pb low doses induced genotoxicity in Lactuca sativa plants

Soil and water contamination by lead (Pb) remains a topic of great concern, particularly regarding crop production. The admissible Pb values in irrigation water in several countries range from ≈0.1 to ≈5 mg L-1. In order to evaluate putative effects of Pb within legal doses on crops growth, we exposed Lactuca sativa seeds and seedlings to increasing doses of Pb(NO3)2 up to 20 mg L-1. The OECD parameter seed germination and seedling/plant growth were not affected by any of the Pb-concentrations used. However, for doses higher than 5 mg L-1 significant DNA damage was detected: Comet assay detected DNA fragmentation at ≥ 5 mg L-1 and presence of micronuclei (MN) were detected for 20 mg L-1. Also, cell cycle impairment was observed for doses as low as 0.05 mg L-1 and 0.5 mg L-1 (mostly G2 arrest). Our data show that for the low doses of Pb used, the OECD endpoints were not able to detect toxicity, while more sensitive endpoints (related with DNA damage and mitotic/interphase disorders) identified genotoxic and cytostatic effects. Furthermore, the nature of the genotoxic effect was dependent on the concentration. Finally, we recommend that MN test and the comet assay should be included as sensitive endpoints in (eco)toxicological assays.

Genotoxicity of citrate-coated silver nanoparticles to human keratinocytes assessed by the comet assay and cytokinesis blocked micronucleus assay

Silver nanoparticles (AgNPs) are widely used in industrial, cosmetic, and biomedical products, and humans are frequently exposed to these products through the skin. It is widely recognized that the characteristics of AgNPs (e.g., size, coating) may influence their cytotoxic effects, but their correlation with DNA damage and mitotic disorders remains poorly explored. In this study, human keratinocytes (HaCaT cell line) were exposed to well-characterized 30 nm AgNPs coated with citrate, and their effects on viability, DNA fragmentation (assessed by the comet assay), and micronuclei (MNi) induction (assessed by the cytokinesis-block micronucleus cytome assays, CBMN) were investigated. The results showed that 10 and 40 μg/mL AgNPs decreased cell proliferation and viability, and induced a significant genetic damage. This was observed by an increase of DNA amount in comet tail, which linearly correlated with dose and time of exposure. Also, cytostaticity (increase of mononucleated cells) and MNi rates increased in treated cells. In contrast, no significant changes were observed in nucleoplasmatic bridges (NPBs) or nuclear buds (NBUDs), although NBUDs tended to increase in all conditions and periods. The cytostatic effects on HaCaT cells were also shown by the decrease of their nuclear division index. Thus, both comet and CBMN assays supported the observation that citrate-AgNPs induced genotoxic effects on HaCaT cells. Considering that AgNPs are present in a vast number of consumer products and also in multiple nanomedicine skin applications and formulations, more research is needed to determine the properties that confer less toxicity of AgNPs to different cell lines.