International Archives of Medicine (E-Journal)
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Rural-urban differences in the pattern of referrals to an asynchronous teledermatology service
Get PDFBackground
Telemedicine is particularly useful in rural areas where can facilitate access to specialised care in regions far from urban hospitals and can prevent unnecessary travel. The purpose of this research was to evaluate the degree of resolution of an asynchronous teledermatology service in the Bages County, comparing urban and rural primary care centres.
Methods and findings
A longitudinal descriptive study of referrals from 14 Primary Care Teams to a hospital dermatology service as a result of a previous referral to a teledermatology program was performed, comparing years 2015 and 2016 and urban with rural practices.
Both in urban and rural areas there was an increase in referrals to the teledermatology service in 2016 compared to the previous year (12.9% and 0.3% respectively). In the two years analysed, referral rates to the teledermatology service per thousand inhabitants from rural centres was statistically much higher than that of urban centres (p<0.001). The number of referrals to the face-to-face dermatology service after a teledermatology consultation decreased significantly in both urban [OR=0,81 (0,70-0,93) p=0,001] and rural centres [OR=0,64 (0,57-0,72) p<0,001].
Conclusions
The asynchronous teledermatology service established in the Bages County increases the resolution of primary care teams as reduces referrals to the face-to-face dermatology service. This effect is more pronounced in rural than in urban areas. Such finding may indicate the need to prioritize telemedicine services in rural primary care practices
Effectiveness in the performance of organ transplants in the State of Paraná, Brazil
Get PDFObjective: To analyze the effectiveness of organ transplants in the state of Paraná, Brazil.
Methods: A cross-sectional quantitative study was conducted with data from 2,036 solid organ transplants performed in the state between 2011 and 2015. Three indicators were calculated, per capita transplants, meeting the demands of the population and the demand for transplants, which demonstrated the effectiveness and the disparities in the process. The association between the variables was verified by Pearson's Chi-Square test and Fisher's exact test.
Results: Most transplants were performed in philanthropic hospitals, male, funded by public funding, and there was an annual increase in the number of transplants per capita and in the productivity of kidney, liver and heart transplantation teams. Although renal transplantation is the most performed in absolute numbers, it served a maximum of 2.2% of its demand.
Conclusion: It is necessary to devise strategies to meet the demand for organ transplants, above all, to consolidate the process of donating organs in the state under study
The role of Chlamydia trachomatis in the pathogenesis of female reproductive organs cancers
Get PDFChlamydia trachomatis (C. trachomatis) is an intracellular obligate bacterium. It is the most common cause of pelvic inflammatory disease (PID) amongst a spectrum of diseases. Chlamydia infection is of a major public health concern especially in developing countries. It is estimated that about 600 million people are infected worldwide annually yet its roles in the pathogenesis of gynecological cancers are poorly understood and has not been fully elucidated. An understanding of the mechanisms underlying cancer development following PID due to C. trachomatis will be essential in prevention and providing more rational treatments. This review discusses the mechanisms and sequence of events linking Chlamydial infections to carcinogenesis in the female reproductive organs. Possible links between C. trachomatis infection and cancer development in the female reproductive organs are proposed. C. trachomatis infection as a co factor is also re-examined in light of these possible mechanisms
Transverse myelitis associated with Zika virus infection: a Case Report
No full textTitle: Transverse myelitis associated with Zika virus infection: a Case Report.: The zika virus belongs to the family flaviviridae, and is transmitted by the arthropod Aedes aegypt. Its major importance is related to the several debilitating neurological manifestations associated with it, such as transverse myelitis.
Case: The authors report a case of transverse myelitis in a patient with a previous diagnosis of Zika virus infection. After the image exams and serology, the diagnosis was confirmed and treatment with prednisone was performed with an unsatisfactory clinical outcome.
Conclusion: Brazil is the country of greatest concern worldwide due to the thousands of Zika cases with associated neurological complications, causing sequels and physical disabilities. However, cases worldwide have increased substantially
Differential distribution patterns in cerebellar irrigation. A study with autopsy material
Get PDFAim: The aim of this investigation was characterize morphologically the cerebellar artery and its branches in a specimen of autopsy material.
Methods: This descriptive cross-sectional study evaluated the anatomical characteristics of the cerebellar arteries and their branches in 93 brain stem and cerebellum blocks obtained from fresh cadavers. The specimens were perfused bilaterally channeling the proximal segments of the internal carotid and vertebral arteries with a semi-synthetic resin (Palatal GP40L 85%; styrene 15%) impregnated with mineral red dye. We evaluated the distribution patterns of the cerebellar artery and its branches.
Results: The calibers of the superior cerebellar artery (SCA), anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery (PICA) were 1.46 ± 0.2 mm, 1.02 ± 0.35 mm and 1.45 ± 0.37 mm, respectively. Agenesis of the SCA was observed in six specimens (3.2%), AICA in 30 (16.1%), and PICA in 14 (7.5%) specimens. Usual irrigation was observed in 44 (47.3%) cerebellar blocks, whereas 49 (52.7%) specimens showed irrigation variants, 23 (46.9%) of which appeared bilaterally. The dominant distribution of the cerebellar arteries corresponded to SCA in 9 (12.5%) cases, AICA in 46 (63.9%) and PICA in 7 (9.7%) specimens; shared dominance was found in 10 (13.9%) specimens.
Conclusion: The high variability of the cerebellar arteries observed in the present study is consistent with previous reports. The diverse anatomic expressions of the cerebellar arteries were typified in relation to their dominance and territories irrigated, useful for the diagnosis and clinical-surgical management of the cerebellum blood supply
Osteochondroma. An Osteological Study
Get PDFBackground: Osteochondroma is the most common tumor of bone, accounting for approximately one third of benign lesions in the skeleton is a broad (sessile) or narrow (pedunculated) skeletal protrusion comprised of marrow and cortical bone. Although it is benign, its biological behavior still has a malignant potential. Chondrosarcoma arising in osteochondroma has been recognized for many years. Osteochondromas might occur on any bone preformed in cartilage, they were especially seen on the long bones of the extremities, predominantly around the knee. In fact, the lower limb seemed to be at a higher risk of the tumor than the upper limb on the top two locations: distal part of the femur and proximal part of the tibia, however, the proximal humerus ranked the third place for solitary osteochondroma while the proximal fibula for multiples osteochondromas.
Methods and Findings: A total of 20 skeletons and 18 cadavers of both sex, 16 males and 2 females, with different age groups were used, this study was carried out by routine dissection classes for undergraduate medical student´s in the Morphology Laboratory of the University of Pamplona during the years 2013-2016. In only one sample was found the presence of osteochondroma. The measurement of the osseous mass was of 7 x 3.5 x 1.5 cm, attached to the posterolateral aspect of the middle third of the femur.
Conclusions: Osteochondroma is generally asymptomatic or discovered accidentally, but it can cause different symptoms depending on site of occurrence local swelling, bony deformities, fracture, bursa formation, arthritis and impingement on adjacent tendons, vascular or neurologic compromise, and dislocation The importance of correct treatment and follow-up of large osteochondromas to avoid complications such as further damage to neighboring neurovascular structures, and potential malignant degeneration. The present study describe a rare location from an osteochondroma in the femur diaphysis
Unusual Venous Drainage Of The Common Facial Vein. A Morphologycal Study
No full textBackground: Anatomical knowledge of the facial vasculature is crucial not only for anatomists but also for oral and maxillofacial surgery, plastic surgeon, otorhinolaryngologists. Access pathways, pedicled and free flap transfer, and explantation and transplantation of total faces are based on the proper assessment and use of the facial veins and arteries. The anatomical variations reported in the present study confirms the need for preoperative vascular imaging for sure good venous outflow for the free flap survival.
Aims: The aim of the present study was to describe a rare anatomical variation of the common facial vein which not been previously described.
Methods and Findings: Head and neck region were carefully dissected as per standard dissection procedure, studied serially during the years 2013-2017 in 15 males and 2 females, i.e. 34 sides, embalmed adults cadavers with different age group, in the laboratory of Morphology of the University of Pamplona. In 33 sides (97 %) of the cases the anterior facial vein (FV) terminated into the internal jugular vein via the common facial vein (CFV) as per standard anatomic description. The right common facial vein in one side (3%) was found to drain into the contralateral internal thoracic vein and contralateral pericardiophrenic vein. Remarkable communications with the external jugular vein, the internal jugular vein, the anterior jugular vein, and left brachiocephalic vein. The length of the right common facial vein from the level of its formation till its termination in the contralateral pericardiophrenic and internal thoracic vein was about 22.75 cm. The venous drainage pattern on the left side of the face was found to be normal.
Conclusion: The existence of this anatomical variation among others supposes a double edge sword in the medical practice with its own opportunities and risks, especially in the surgical treatment; therefore, we need to study with more strictness these possibilities with the aim of facilitate this practices, and improve the life quality of our patients
Facial Vein Variation: A Cadaveric Study
Get PDFBackground: The veins of the head and neck have a complex developmental pattern which predisposes them to variations in formation and drainage. Superficial veins of the head and neck are utilized for central venous cannulation, oral reconstruction and parenteral nutrition in debilitated patients. Clinical and sonological examinations of these veins may provide clues toward underlying cardiac pathology.
Aims: The aim of the present study was to describe anatomical variation and determined the position of the facial vein in relation to neighboring structures.
Methods and Findings: Head and neck region were carefully dissected as per standard dissection procedure, studied serially during the years 2013-2017 in 16 males and 2 females, i.e. 36 sides, embalmed adults cadavers with different age group, in the laboratory of Morphology of the University of Pamplona. In 34 sides (94.5 %) of the cases the facial vein (FV) terminated into the internal jugular vein via the common facial vein (CFV) as per standard anatomic description. The facial vein on two sides (5.5 %) was found to drain into the external jugular vein with different degree of angulations and variable distance from the angle of the mandible. On the right side, the facial vein was draining into external jugular vein (EJV), 63.6 mm below the angle of the mandible. On the left side, the facial vein was draining into EJV, 42.4 mm below the angle of the mandible. The length of the neck was 137.8 mm. The mean distance of the superior and inferior labial veins, deep facial vein, and angular vein from the inferior orbital margin was 41.89 ± 3.01, 52.31 ± 3.72, 26.85 ± 3.55 and 6.25 ± 0.65 mm, respectively.
Conclusion: A sound knowledge on variation of the course and termination of facial vein is very useful for oral and maxillofacial surgeons, plastic surgeons, otorrhinologists and radiologists, is essentially important in the clinical examination and surgical procedures of the head and neck region
Unusual Combination Of Vascular Variations In The Retroperitoneal Region. A Morphological Study
No full textBackground: Blood supply of kidney and gonads is characterized by the presence of variations, which are usually silent and unnoticed until they are found by retroperitoneal surgery, radiologic examination or necropsy. Multiple renal vessels are no longer relative contraindication for laparoscopic donor nephrectomy, however of their presence may help avoid possible complication on a patient with these variations. The purpose of this morphological study was to analyze the frequency of supernumerary renal and testicular vessels and describe an unusual combination of vascular variations in the retroperitoneal region.
Methods and Findings: A total of 18 cadavers with different age group and 10 visceral blocks were used for the study in the Morphology Laboratory of the University of Pamplona. Multiple anatomical variations bilateral of testicular vessels and renal were found during routine dissection in a 65-year-old male cadaver. The variations found were: bilateral presence of three renal arteries and three renal veins. The three left renal arteries are divided and gave rise to seven branches: the left main renal artery originates two branches; the upper branch originates four branches and the lower branch originates one branch. Retro-aortic left renal vein. Three left testicular artery and double right testicular artery all originating from accessory renal arteries.
Conclusions: Awareness of renal and testicular vessels anomalies is essential for decreasing the rate of accidental injuries in surgical procedures in the retroperitoneal region as well as aid in diagnosis of diseases associated with vascular variation in the posterior abdomen. An understanding of the morphology of renal and testicular vessels is necessary in uroradiology, Doppler imaging and computed tomography studies
Clinical and Epidemiological Profile of Cirrhotic Patients at a Reference Center in Belém-PA, Analysis of 10 years
Get PDFBackground: The aim of this study was to analyze the demographic, ethyological and clinical aspects of patients with liver cirrhosis treated in the Chronic Liver Disease Center.
Methods: a descriptive, cross-sectional and retrospective study based on the analysis of 580 pacients’ medical records with the diagnosis of hepatic cirrhosis treated from 2004 to 2014 in Belém, Brazil.
Conclusions: the profile was predominantly of male patients, aged between 51 and 60 years, coming from the capital Belem, whose main etiologies of cirrhosis were C hepatitis and alcohol. Ascites was the most frequent clinical manifestation and Child-Pugh score A was the most prevalent