Evaluation of a novel low-cost disposable endoscope for visual assessment of the esophagus and stomach in an ex-vivo phantom model

Background and study aims Our academic lab has developed a novel, low-cost, disposable endoscope for assessment of the esophagus and stomach without need for large equipment or complex electronics. Usability and intuitiveness of the platform are unknown. Methods The novel endoscope (NE) consists of a high-definition camera, LED module, and three bellows. Compressed air actuates the bellows, producing camera/LED articulation. Insufflation and lens cleaning ports are present. Video can be displayed on any monitor. Total material costs less than $ 35 US. Five novices, five fellows, and five attendings performed five trials using a conventional endoscope and the NE on an upper tract phantom with six gastric landmarks marked. Outcomes included successful identification and time to landmarks; and intuitiveness (NASA task load index; user comments). Results All landmarks were successfully identified with both endoscopes for all trials (n = 900). Attendings and fellows were quicker with the conventional endoscope when compared to the NE (24.48 v 37.13s; P < 0.01). There was no significant time difference between platforms for novices (P = 0.16). All users found the NE intuitive with low mental and physical demand. Novices reported lower temporal demand and effort when using the NE. Conclusions The NE was easy to maneuver, intuitive, and successful at visualizing gastric landmarks. All users were pleased with the NE drive mechanism and were successful at visualizing the gastric landmarks in a clinically acceptable time. The novel platform has the potential to facilitate rapid, low-cost, diagnostic assessment of the esophagus and stomach in non-traditional settings – facilitating patient management decisions, minimizing encumbrance, and avoiding cross-contamination

Estudo dos distúrbios causados pela má absorção da lactose

Este trabalho foi baseado em uma revisão de literatura, com intuito dedemonstrar a problemática dos distúrbios causados pela má absorção dalactose em humanos, que afeta uma parcela muito grande da populaçãomundial. A deficiência da absorção da lactose é conhecida comointolerância à lactose e pode ser classificada de quatro formas, deficiênciacongênita, ontogenética ou hipolactasia, adquirida ou secundária ealactasia congênita. Os sintomas normalmente são distensão abdominal,vômitos, diarréia líquida, volumosa de odor ácido. O diagnóstico é feito apartir de testes de acidez de fezes e do hidrogênio da respiração. Nãoexiste tratamento, somente uma dieta onde se deve excluir ou reduzirdrasticamente o uso deste carboidrato, logo existem vários produtos nomercado que são isentos ou apresentam a lactose hidrolisada que facilitama vida dos indivíduos que possuem esta síndrome

Effect of adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure: a randomized clinical trial

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Acute decompensated heart failure (ADHF) is the leading cause of hospitalization in patients aged 65 years or older, and most of them present with congestion. The use of hydrochlorothiazide (HCTZ) may increase the response to loop diuretics. Objective: To evaluate the effect of adding HCTZ to furosemide on congestion and symptoms in patients with ADHF. Methods: This randomized clinical trial compared HCTZ 50 mg versus placebo for 3 days in patients with ADHF and signs of congestion. The primary outcome of the study was daily weight reduction. Secondary outcomes were change in creatinine, need for vasoactive drugs, change in natriuretic peptides, congestion score, dyspnea, thirst, and length of stay. Results: Fifty-one patients were randomized — 26 to the HCTZ group and 25 to the placebo group. There was a trend towards additional weight reduction in the HCTZ group (HCTZ: -1.78 ± 1.08 kg/day vs placebo: -1.05 ± 1.51 kg/day; p = 0.062). In post hoc analysis, the HCTZ group demonstrated significant weight reduction for every 40 mg of intravenous furosemide (HCTZ: -0.74 ± 0.47 kg/40 mg vs placebo: -0.33 ± 0.80 kg/40 mg; p = 0.032) - figure. There was a trend to increase in creatinine in the HCTZ group (HCTZ: 0.50 ± 0.37 vs placebo: 0.27 ± 0.40; p = 0.05) but no significant difference in onset of acute renal failure (HCTZ: 58% vs placebo: 41%; p = 0.38). No differences were found in the remaining outcomes - table. Conclusion: There was a trend towards greater daily weight reduction in the HCTZ group. In analysis adjusted to the dose of intravenous furosemide, adding HCTZ 50 mg to furosemide resulted in a synergistic effect on weight loss. Study outcomesOutcomeHCTZPlacebop-valuePrimaryWeight change/day-1.78 ± 1.08-1.05 ± 1.510.062SecondaryLength of stay (days)9 ± 88 ± 90.37Change in creatinine (mg/dL)0.50 ± 0.370.27 ± 0.400.05Need for vasoactive drugs (%)19.212.00.70Congestion score-5.4 ± 4.6-4.8 ± 4.60.68Change in dyspnea scale-4.7 ± 2.7-3.2 ± 3.60.14Thirst scale-1.7 ± 4.50.5 ± 3.80.21Change in natriuretic peptides (%)-11.1 ± 100.3-33.3 ± 50.90.83Plus–minus values are means ± standard deviation.Abstract Figure. Diuretic response </jats:sec

Occurrence of traumatic dental injury in cases of domestic violence

The purpose of this study was to investigate the prevalence and types of traumatic dental injuries in situations of domestic violence. A coross-sectional study was conducted and data were collected from the police occurrence records to domestic physical aggression between 2001 and 2005. Of the 1,844 subjects who underwent medical evaluation, 15 had information pertaining to traumatic dental injuries. From the medical records, the forensic medical reports completed by the forensic medical experts who examined the victims after the aggression were reviewed and data of individuals with dental injuries (e.g., fractures, luxation and avulsion) were collected. In the selected sample, there was a predominance of individuals with injuries to the head and neck region (38.7%), and the frequency of traumatic dental injuries among all injuries to the head and neck region was 2.0%. The most frequently injured teeth were the maxillary incisors (31.8%), followed by the mandibular incisors (27.3%) and the maxillary canines (9.1%). In 31.8% of the injured teeth, the forensic experts did not specify the nomenclature. Of the dental trauma cases, 59.1% were fractures, 27.2% were luxations and 13.7% were avulsions. In conclusion, domestic violence was an important etiologic factor of traumatic dental injury. The aggression in all cases occurred in the form of punches and slaps. Fracture was the most common type of traumatic dental injury, and the most frequently injured teeth were the incisors.Universidade Estadual Paulista (UNESP) Araçatuba Dental School, Rua José Bonifacio, 1193, Vila Mendonça, 16015-050 Araçatuba, SPUniversidade Estadual Paulista (UNESP) Araçatuba Dental School, Rua José Bonifacio, 1193, Vila Mendonça, 16015-050 Araçatuba, S

Violência denunciada: ocorrências de maus tratos contra crianças e adolescentes registradas em uma unidade policial

Esse estudo objetiva verificar o perfil da ocorrência de maus-tratos contra crianças e adolescentes. Foram analisados os dados registrados nas ocorrências policiais da Delegacia de Defesa da Mulher de Araçatuba-SP, no ano de 2008, relativos à agressão; relação vítima-agressor; características sociodemográficas de agressores e vítimas e procura das vítimas por serviço de saúde. Dentre as denúncias feitas, houve uma maior prevalência de maus tratos físicos, sendo a residência o local de maior incidência de agressões. Na maioria das vezes, o agressor era a mãe da criança, sendo o motivo não relatado, na maior parte dos casos. Desse modo, podemos delinear o perfil das ocorrências violentas contra criança, contribuindo para a visualização, conhecimento e enfrentamento do problema

Notification of intrafamily violence against elderly women in the city of São Paulo

Abstract Objective: the aim of the present study was to characterize the population of elderly women who have suffered sexual and physical violence and describe the characteristics of this aggression. Method: a cross-sectional study was carried out using secondary data from the Violence and Accident Surveillance Information System, which registers reports of physical and sexual violence against the female population aged 60 and older. Results: in 2013 289 acts of physical violence against elderly women in the city of São Paulo were recorded, and sexual violence was reported in ten cases. Conclusion: physical and sexual violence occurred mainly in the family environment, with the majority of aggressors male and a family member or known to the victim. In their direct and daily dealings with elderly health service users at all levels of complexity, doctors should know how to investigate and identify cases of violence, properly approach patients, act in coordination with other professionals and apply interventions that are effective for each case

Use of technology in endodontics by undergraduate dental students in a south‐eastern state of Brazil

Introduction: This study aimed to determine the level of incorporation of current technologies for endodontic treatment in undergraduate dentistry courses in a south-eastern state of Brazil. Methods: For data collection, a self-assessment-based online questionnaire was created using the “Google Forms” platform, consisting of 12 multiple-choice and a few open-ended questions. The questions were related to the use of current technologies for diagnosis, imaging, use of ultrasonics in endodontics, instrumentation, use of apex locator, microscopy, photodynamic therapy and thermoplastic techniques during endodontic treatment. The questionnaire was sent to 54 dental schools in Minas Gerais. Results: The results show low technological incorporation during the various stages of endodontic treatment by undergraduate students in dentistry courses in Minas Gerais. Conclusion: Despite the availability of several technologies to help perform different stages of endodontic treatment, it was observed that most universities do not teach the use of these technologies. Additional studies are needed to correlate how the lack of incorporation of these technologies could impact on the quality of the endodontic learning for undergraduate students