In children with tracheobronchomalacia, surgical management should be reserved for the most severe cases and be specific to the type and location of tracheobronchomalacia. The goal of this study is ...to describe the presentation and outcomes of children with severe tracheobronchomalacia undergoing surgery.
Retrospective case series of 20 children operated for severe tracheobronchomalacia at a tertiary hospital from 2003 to 2023. Data were collected on symptoms age at diagnosis, associated comorbidities, previous surgery, age at surgery, operative approach, time of follow-up, and outcome. Surgical success was defined as symptom improvement.
The most frequent symptoms of severe tracheobronchomalacia were stridor (50 %), cyanosis (50 %), and recurrent respiratory infections (45 %). All patients had one or more underlying conditions, most commonly esophageal atresia (40 %) and prematurity (35 %). Bronchoscopy were performed in all patients. Based on etiology, patients underwent the following procedures: anterior aortopexy (n = 15/75 %), posterior tracheopexy (n = 4/20 %), and/or posterior descending aortopexy (n = 4/20 %). Three patients underwent anterior aortopexy and posterior tracheopexy procedures. After a median follow-up of 12 months, 16 patients (80 %) had improvement in respiratory symptoms. Decannulation was achieved in three (37.5 %) out of eight patients with previous tracheotomy. The presence of dying spells at diagnosis was associated with surgical failure.
Isolated or combined surgical procedures improved respiratory symptoms in 80 % of children with severe tracheobronchomalacia. The choice of procedure should be individualized and guided by etiology: anterior aortopexy for anterior compression, posterior tracheopexy for membranous intrusion, and posterior descending aortopexy for left bronchus obstruction.
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•Metamorphosed paleoproterozoic manganese mineralization from the Borborema Province.•Manganese ores consists mainly of manganese-oxyhydroxides, spessartine and rhodonite.•Carbonate ...inclusions and garnet composition suggests marly protoliths.•Anoxic sediments' deposition on the seafloor.•Medium-grade manganese ores development during exposure to surface water.
The Paleoproterozoic Lagoa do Riacho manganese deposit in the Borborema Province is central to unravelling the genesis of Paleoproterozoic manganese deposits, Paleoproterozoic redox evolution and genetic relationship to the West African Craton. With manganese contents averaging 35 wt%, the Lagoa do Riacho manganese unit is lithologically subdivided into oxidized and silicate manganese ores and a garnetite (garnet-rich rocks) subgroup. The oxidized manganese ore consists mainly of pyrolusite, manganese-oxyhydroxide and spessartine. The silicate manganese ore has rhodonite, tephroite and spessartine. Garnetite contains spessartine and minor quartz and rhodonite. The main host rocks include garnet quartzite and graphite-bearing pelitic gneiss. The composition of carbonate inclusions in spessartine-rhodonite and Ca-Mn fractionation between garnet core and rim suggests all these manganese-rich rocks probably formed from protoliths of marl composition. Biogenic, syn-sedimentary graphite in the manganese-rich rocks and their host rocks indicates organic matter was deposited along with the marl protolith. Within this general context and through chemical-petrological relations, we outline an initial environment involving anoxic sediments' deposition (eg., organic matter-rich manganese marl and black shales, and wackes) on the seafloor. The presence of spessartine, rhodonite, and tephroite suggests peak metamorphic conditions reached amphibolite facies conditions (6–7 kbars and 550–700 °C). Amphiboles indicate later retrograde stages and carbonate veins suggest a possible hydrothermal stage after manganese deposition. The metamorphosed manganese-rich rocks were upgraded to medium-grade manganese ores during exposure to surface water. Our results indicated that the manganese-rich rocks and their host rocks were generated in a sedimentary context, possibly in a marine setting with carbonate and organic matter contribution.
The geodynamic understanding of the Riacho do Pontal Orogen, in the Borborema Province, NE-Brazil, has progressed substantially in the last decade, mainly from geochemical and isotopic studies. ...However, the role of the Neoproterozoic magmatism has not totally been unraveled and has left some crucial questions unanswered. In order to contribute to this debate, we present petrographic, geochemical and isotopic (U–Pb, Sm–Nd and Sr–Sr) data obtained for a set of granitoids and metavolcanic rocks from the Internal and Central domains of the Riacho do Pontal Orogen. The Neoproterozoic granitoids comprise a major alkaline pluton of the Serra da Aldeia suite; two syenitic plutons – Nova Olinda and Caboclo –, and high-K, sub-alkaline granitoids from the Betânia granite. The alkaline pluton from the Serra da Aldeia suite yielded a zircon U–Pb age of 578 ± 5 Ma, while the Nova Olinda and Caboclo syenites yielded ages of 613 ± 2 Ma and 620 ± 3 Ma, respectively. The Betânia granite, displaying a volcanic-arc geochemical signature, yielded the age of 627 ± 4 Ma. Tonian ages were also obtained between 956 ± 8 Ma and 965 ± 3 Ma for three unclassified orthogneisses from the Internal Domain of the Orogen. A sample of metarhyolite from the Paleoproterozoic basement yielded an age of 1631 ± 21 Ma. The isotopic data for the Nova Olinda and Caboclo syenites revealed εNd(620 Ma) values between −7.72 and −8.45 and TDM values from 1.76 to 1.97.87Sr/86Sr ratios of 0.71594 ± 2 and 0.74432 ± 1 suggest mixing of crustal and mantle materials during their evolution. In contrast, the Betânia granite presented a ratio of 0.70669 ± 1, reinforcing the correlation with mantle sources. The integrated analysis of the data indicate that the Betânia granite is part of an Ediacaran magmatic-arc system, with the Nova Olinda and Caboclo syenites characterized as products of the late-orogenic magmatism, while the alkaline rocks of the Serra da Aldeia suite represent the final of post-orogenic stages of one of the multiple collisions of the West Gondwana.
•Rhyolitic magmatism of ca.1.6 Ga was characterized.•The age of ca. 627 Ma was obtained for arc related magmatism.•U–Pb ages ranging from 620 to 578 Ma were obtained for late-to-post-magmatism.•Isotopic ratios suggest mixing of crustal and mantellic materials for the syenites.
The aim of this study was to quantify the effect of chemically induced diabetes mellitus (DM) on the mechanical properties of the Achilles tendon of rats and correlate it with metabolic and ...biomechanical findings. Adult rats were selected randomly and assigned to two groups, the diabetic group consisted of animals receiving a dose of streptozotocin to induce type I diabetes and the control group. The animals were placed in metabolic cages for analysis of metabolism. Ten weeks after diabetes induction, the Achilles tendon of both groups were collected and submitted to a traction test in a conventional testing machine. The measurements of mechanical properties indicated that the elastic modulus (MPa) was significantly higher in the control group (
p
< 0.01). In Maximum tension (MPa), the groups did not have differences (
p
> 0.01). Energy/tendon area (N mm/mm
2
), specific strain (%) and maximum specific strain (mm) were higher in tendon tests of the diabetic group (
p
< 0.01). We observed that the mechanical properties of tendons have correlations with metabolic properties of the diabetic animals. These results showed that induced DM in rats have an important negative effect on the mechanical properties of the Achilles tendon.
Abstract The aim of this study is to evaluate if the application of a moderate aerobic exercise protocol reverses the damage caused by diabetes on the mechanical properties of the Achilles tendon. ...Methods Forty-four rats were divided randomly into four groups as follows: Sedentary Control Group-SCG, Sedentary Diabetic Group-SDG, Trained Control Group-TCG and Trained Diabetic Group-TDG, the trained groups were submitted to a protocol of moderate physical training on a continuous treadmill. For mechanical testing the tendons were fixed in a conventional mechanical testing machine and pulled to the point of failure of the specimen, the cell load of 500 N. The parameters were: Elastic Modulus (MPa), Stress Maximum Strength (MPa), Strain Specific Maximum Force (mm), Energy / Tendon Area (N.mm/mm2 ) and Cross-sectional Area (mm2 ). Results The evaluation of the biomechanical properties of the Achilles tendon of the SDG indicated that the elastic modulus (MPa) is decreased when compared to the TDG and the other groups (p < 0.01). However, the specific deformation (%), the deformation at maximum force (mm), and energy / tendon area (N.mm/mm2 ) of the SDG were significantly higher than in the other groups (p < 0.01). Moreover, moderate aerobic training on a treadmill caused the biomechanical property values to move closer to the values shown by the control groups (p > 0.01). Conclusion In summary, our study indicates that moderate-intensity aerobic training restored the normal mechanical properties of tendons in diabetic animals, since the elastic modulus (MPa), the specific deformation (%), the deformation of the maximum force (mm) and energy / tendon area (N.mm/mm2 ) approached the values shown by the control groups.
the complications caused by diabetes increase fragility in the muscle-tendon system, resulting in degeneration and easier rupture. To avoid this issue, therapies that increase the metabolism of ...glucose by the body, with physical activity, have been used after the confirmation of diabetes. We evaluate the biomechanical behavior of the calcaneal tendon and the metabolic parameters in rats induced to experimental diabetes and submitted to pre- and post-induction exercise.
54-male-Wistar rats were randomly divided into four groups: Control Group (CG), Swimming Group (SG), Diabetic Group (DG), and Diabetic Swimming Group (DSG). The trained groups were submitted to swimming exercise, while unexercised groups remained restricted to the cages. Metabolic and biomechanical parameters were assessed.
the clinical parameters of DSG showed no change due to exercise protocol. The tendon analysis of the DSG showed increased values for the elastic modulus (p<0.01) and maximum tension (p<0.001) and lowest value for transverse area (p<0.001) when compared to the SG, however it showed no difference when compared to DG.
the homogeneous values presented by the tendons of the DG and DSG show that physical exercise applied in the pre- and post-induction wasn't enough to promote a protective effect against the tendinopathy process, but prevent the progress of degeneration.
Avaliação do Prontuário Médico de um Hospital Universitário Garritano, Célia Regina de Oliveira; Junqueira, Felipe Holanda; Lorosa, Ely Felyppy Soares ...
Revista brasileira de educação médica,
2020, Letnik:
44, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Resumo: Introdução: Este trabalho analisa a qualidade dos prontuários médicos dos pacientes internados no Hospital Universitário Gafrée e Guinle. Métodos: Foram selecionados aleatoriamente 100 ...prontuários da clínica médica e da clínica cirúrgica de pacientes internados nesse Hospital. A análise dos prontuários consistiu na ausência ou presença, dos seguintes tópicos: ficha de identificação do paciente, laudo médico, boletim de internação e alta hospitalar, resumo de internação, evolução médica, evolução da enfermagem, prescrição médica, boletim operatório, boletim da anestesia, laudo do exame histopatológico. Quando havia estes tópicos, verificou-se ainda se eles estavam adequados ou inadequados. Nos prontuários da clínica médica excluíram-se o boletim operatório e da anestesia, laudo do exame histopatológico e os demais tópicos relacionados à cirurgia. Em cada prontuário foi observado se todos os itens citados estavam presentes, preenchidos corretamente, escritos de forma legível, e se havia abreviaturas, siglas e sinais impróprios. No caso de esses itens estarem presentes nos prontuários avaliou-se a adequação ou inadequação deles. Os resultados das ambas as clínicas foram comparados para a análise de qual serviço apresentou um melhor desempenho. Para avaliar o desempenho do hospital todos os itens foram analisados em relação à presença, ausência, adequação ou inadequação e não aplicabilidade. A análise dos dados foi realizada por meio de tabelas e gráficos e a análise estatística pelo teste não paramétrico Mann-Whitney. Resultados: Durante a pesquisa nem todos os itens foram encontrados e, alguns casos, estavam preenchidos inadequadamente. Além disso, constatou-se a falta de ordenação deles. Do total da amostra analisada, 85,5% estavam legíveis e 32% foram considerados inadequados, sendo 37 prontuários da clínica cirúrgica e 27 da clínica médica. Os resultados dos exames complementares foram encontrados em apenas 55,5% da amostra. Conclusão: A elaboração dos prontuários no Hospital Universitário Gaffrée e Guinle é deficiente com vários itens incompletos e/ou ausentes.
Abstract: Introduction: To analyze the quality of the medical records of patients admitted to the Gafrée e Guinle University Hospital. Methods: A total of 100 medical records were randomly selected from the Medical and Surgical Clinics of hospitalized patients at Gaffrée and Guinle University Hospital. The analysis of medical records consisted in the absence or presence and, if present, whether the following items are adequate or inadequate: patient identification file; medical report; hospitalization and discharge reports; hospital admission summary; medical evolution report; nursing evolution report; medical prescriptions; operative report; anesthesia report; histopathological test report. In the Medical Clinic records the operative and anesthesia reports, histopathological test report and other topics related to surgery were excluded. In each medical report it was verified whether the aforementioned items were present, correctly filled out, using legible handwriting, and whether there were inadequate abbreviations, symbols and signs. The results were compared in both clinics to analyze which service showed the best performance. To evaluate the performance of the hospital, all items were analyzed for their presence or absence, whether were adequate or inadequate and not applicable. Data analysis was performed using tables and graphs, and the statistical analysis was performed by the non-parametric Mann-Whitney Test. Results: Not all items were found nor filled out, in addition to their lack of order. Of the total analyzed sample 85.5% were legible and 32% were considered inadequate, being 37 medical records from the Surgical Clinic and 27 from the Medical Clinic. The results of the additional tests were found in only 55.5% of the sample. Conclusion: The formulation of Gaffrée and Guinle University Hospital medical records is inadequate, showing multiple incomplete and/or absent items.
Accelerated precipitation of Mn-rich rocks in the early Paleoproterozoic ocean is considered to reflect the irreversible rise of oxygen in the atmosphere during the Great Oxidation Event (GOE), ...2.501–2.220 billion years ago. But the precipitation conditions, pathways, mechanisms, and linkages to ocean redox, broadly remain unresolved. The Lagoa do Riacho Mn deposit in Borborema Province, northeastern Brazil, Ceará state, consists mainly of manganese-rich and manganese-poor silicates deposited during the GOE epoch. Negative Ce anomalies in the manganese-poor silicates point to the scavenging of Ce3+ onto Mn-oxyhydroxide reactive surfaces in the oxygenated surface waters. In contrast, samples with positive Ce anomalies, predominantly associated with the manganese-rich silicates, indicate a reductive dissolution of Mn-oxyhydroxides across a redoxcline, enriching the anoxic bottom water with Ce and Mn2+. A paleoredox reconstruction based on couple Mn, Mo, and U systematics supports the existence of the proposed Mn-oxide redox shuttle that enriched the anoxic sediment pile with Mn precipitated from the oxygenated shallow surface waters. This study uncovers a unique pathway in Paleoproterozoic Mn mineralization involving the transfer of Mn oxides from an oxygenated upper ocean reservoir to a predominantly deep anoxic silicate reservoir that was subsequently metamorphosed. The proposed Mn oxide sink switch mechanism is different from the commonly reported reductive transfer of Mn to a diagenetic carbonate sink during the Paleoproterozoic.
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•Paleoproterozoic manganese-bearing rocks from the Borborema Province, northeastern Brazil.•Positive Ce anomalies indicate a redox-stratified water column.•Reductive dissolution of Mn-oxyhydroxides take place across the redoxcline.•Paleoredox proxies indicate a Mn-oxide shuttle from oxic surface waters to the deep anoxic sediment-water interface.
The Borborema Province hosts several Mn-rich metasedimentary sequences, containing up to 40 wt% MnO
(total)
. These sequences are composed of Mn oxide and Mn silicate lenses that alternate with ...spessartite quartzite layers. They are also spatially associated with graphite-bearing gneissic and granitic rocks. Here, we use the Lagoa do Riacho manganese deposit, a Mn-rich sequence of the northern Borborema Province (within the Canindé do Ceará Complex), to constrain the time of deposition of the Mn-rich sedimentary protolith, discuss its tectonic setting, and draw correlations between African and Brazilian manganese deposits. The age of the youngest detrital zircon population from a meter-sized spessartite quartzite bed, interlayered with oxidized Mn ore, was close to 2130 Ma. Similarly, a gneiss hosting the Mn mineralization yielded a maximum depositional age close to 2156 Ma. U–Pb dating of zircon metamorphic overgrowths from the Mn-bearing sequences and host rocks coupled to a zircon U–Pb crystallization age of an intrusive leucocratic granite provided a minimum age interval for the Mn-rich succession (ca. 2106–2023 Ma). These constraints point to a Rhyacian depositional age (ca. 2200–2100 Ma) for the Mn-rich precursors, which were most likely deposited as syn-orogenic sediments. The results also allow us to conclude that the age range of 2200–2100 Ma is coeval with the timing of deposition of other world-class manganese deposits, such as those from the Francevillian and Birimian groups in Gabon and Ghana, respectively, besides those from the South American Platform (e.g., Serra do Navio, Carajás, and Minas Gerais).
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