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Sigmoid volvulus happens when the sigmoid wraps around itself and its mesentery. Sigmoid volvulus accounts for 2% to 50% of all colonic obstructions. This pathology generally affects adults, and it is more common in males. The etiology is multifactorial and controversial; the main symptoms are diffuse abdominal pain, distention and constipation, while the pregnant signs are abdominal distention and tenderness. Laboratory findings are not pathognomonic: abdominal X-ray radiographs show a dilated sigmoid colon and multiple intestinal air-fluid levels, abdominal CT and MRI demonstrate a whirled sigmoid mesentery. Flexible endoscopy reveals a spiral sphincter-like twist of the mucosa. The diagnosis of sigmoid volvulus is established by clinical, radiological, endoscopic, and sometimes operative findings. Although flexible endoscopic detorsion is advocated as the primary treatment choice, emergency surgery is required for patients who present with peritonitis, bowel gangrene, or perforation, or for patients whose non-operative treatment is unsuccessful. Although emergency surgery includes various non-definitive or definitive procedures, resection with primary anastomosis is the most commonly recommended procedure. After a successful non-operative detorsion, elective sigmoid resection and anastomosis is recommended. The overall mortality is 10% to 50%, while the overall morbidity is 6% to 24%.

Introduction. In the last five years (from 1st of January 2013 to 31st of December 2017), we noticed 6 cases of rectal cancer, developed in patients who underwent stoma reversal more than two years before, for different pathologies. The objective of the study. That was a starting point to analyze whether the restoration of a total digestive diversion, well known to improve life quality, also increases the risk of malignancy. Material and methods. We studied all the patients with colostomy reversal hospitalized in the General Surgery Clinic of the Emergency Clinical Hospital “Sfântul Pantelimon“, Bucharest, Romania, in a ten years interval (1st of January 2008 – 31st of December 2017), no matter the primary cause of colostomy was. Results. Our study showed that stoma reversal increase the risk of developing a rectal malignancy two years from restoration. Conclusions. We recommend annual control by recto‑sigmoidoscopy both in patients with terminal permanent colostomy and in those with stoma reversal, in order to early discover a subsequent rectal cancer.

Cecum diverticulosis is a benign, rare and generally asymptomatic disease that can manifest with acute diverticulitis or bleeding, thus complicating the differential diagnosis of the right iliac fossa pathology. The optimal management of this disease does not have a well-established treatment plan, as it may vary in some centers from conservative treatment, consisting of only antibiotics, to segmental colectomy or even right hemicolectomy. We present the case of a 45-year-old patient, prior diagnosed with chronic pain in the right iliac fossa after appendectomy, who was diagnosed with a single cecum diverticulum.

A doença de Castleman é um distúrbio linfoproliferativo raro. Há três tipos histológicos: hialino-vascular (mais comum), variante de células plasmáticas e forma mista. A forma hialino-vascular é caracterizada tipicamente por apresentar uma evolução clínica benigna, sem sintomas constitucionais (doença localizada). É geralmente tratada com cirurgia e/ou radioterapia. A doença multicêntrica apresenta sintomas sistêmicos. Ainda não há um consenso sobre qual a melhor abordagem terapêutica. Nós reportamos o caso de um homem de 47 anos de idade com uma massa abdominal e sintomas compressivos. Após ressecção cirúrgica parcial, os exames histopatológico e imuno-histoquímico revelaram doença de Castleman variante hialino vascular. Como as células foliculares eram CD20+, administramos rituximab (anticorpo monoclonal anti-CD20). A maioria dos casos revisados não consideram este tipo de abordagem, exceto no caso de doença de Castleman multicêntrica associada a infecção pelo HHV-8 e sarcoma de Kaposi. Geralmente considera-se o paciente curado após retirada cirúrgica da massa na doença localizada, mas realmente há um risco do paciente desenvolver um linfoma não-Hodgkin no seguimento a longo prazo. O objetivo deste relato é apresentar um caso raro que deve ser incluído no diagnóstico diferencial de desordens linfóides e discutir o tratamento desta doença.Castleman's disease is an uncommon lymphoproliferative disorder. There are three histologic types, hyaline vascular (the most common), plasma cell variant and mixed form. The hyaline vascular variant is typically characterized by a benign clinical course without constitutional symptoms (localized disease). It is usually managed with surgery and/or radiotherapy. Multicentric disease is a systemic disorder. An optimal management is still unknown. We report a case of a 47-year-old man with an abdominal mass and compressive symptom. After partial surgical resection, histopathological and immunohistological studies revealed the hyaline vascular variant of localized Castleman's disease. Because the follicular cells were CD20+ we administered rituximab (anti-CD20 monoclonal antibody). Most of the cases reviewed do not consider this approach, except for HHV-8 and sarcoma of Kaposi associated multicentric Castleman's disease. They usually consider the patient free from disease after surgical resection of localized Castleman's disease, but there is a risk of developing non-Hodgkin lymphoma in the long-term. The purpose of this report is to present this rare case, to stress that Castleman's disease should be included in the differential diagnosis of lymphoid disorders and to discuss the management of this disorder.

Thoraco-lumbar fracture-dislocations represent one of the most instable lesions and are frequently associated with neurological deficit. We present a patient with a T11 – T12 fracture-dislocation with complete neurological deficit – ASIA - A, who underwent partial vertebrectomy, shortening of the spine and posterior instrumentation 21 days after a motor vehicle accident.

Pheochromocytoma is a catecholamine-secreting tumor of the adrenal glands, usually with benign manifestations, whose typical clinical presentation includes the triad of headache, palpitations and diaphoresis. However, a wide range of signs and symptoms may be present. In the cardiovascular system, the most common signs are labile hypertension and sinus tachycardia. Systolic heart failure and ST-segment deviations mimicking myocardial infarction have also been reported, as well as QT interval prolongation and, rarely, ventricular tachycardia. We describe a challenging diagnosis of pheochromocytoma with many cardiovascular manifestations, which could have been missed due to the absence of typical symptoms.

Thermal Wave Interferometry (TWI) technique was used to access the thermal diffusivity and thermal conductivity of soils with sandy and clayey textures from Paraná land, specifically from horizons HA (5 to 25 cm) and HB (25 to 76 cm). Experimental setup involved focusing white light on soil samples in titanium wells (100-1200 µm thick), modulated at frequencies from 0.6 to 45 Hz. Results showed that sandy soils had higher thermal diffusivity and conductivity than clayey soils. Open Photoacoustic Cell (OPC) also measured the thermal diffusivity, while TWI determined thermal conductivity ranged from 0.3 to 1 Wm K, and thermal diffusivity from 1 to 9 x 10-7 m²/s. Specific heat was measured using Non-Adiabatic Thermal Relaxation Calorimetry (NATRAC), revealing values between 820 to 920 J/kg·K for HA soils and 940 to 1140 J/kg·K for HB soils. Gravimetric measurements provided soil particle and bulk density data. [ABSTRACT FROM AUTHOR]

Resumo Fundamento A consolidação de novos paradigmas educacionais exige a implantação de estratégias inovadoras com potencial de transformar estudantes em profissionais competentes. Objetivos Analisar o conhecimento e a satisfação de estudantes antes e após a utilização de uma nova metodologia ativa de ensino médico de modelo digital humanizado chamada Virtual Case-Based Learning (VCBL). Métodos Estudo descritivo com análise documental sobre o processo de ensino-aprendizagem de estudantes de medicina. Dados obtidos da avaliação de conhecimento teórico e do instrumento de satisfação dos alunos nos anos de 2018 e 2019 foram analisados, e a nova metodologia proposta VCBL foi comparada com a metodologia ativa de ensino tradicional, o Problem-Based Learning (PBL). As análises descritivas e de associação foram realizadas utilizando o programa Statistical Package for the Social Sciences. Resultados Foram analisados 167 documentos aplicados a estudantes de medicina. Em relação à avaliação do conhecimento teórico, os alunos avaliados em 2018 obtiveram média 41,7%, comparados aos alunos de 2019 que alcançaram 73,3% (p

Abstract Background The length of time between symptom onset and reperfusion therapy in patients with ST-segment elevation acute myocardial infarction (STEMI) is a key determinant of mortality. Information on this delay is scarce, particularly for developing countries. The objective of the study is to prospectively evaluate the individual components of reperfusion time (RT) in patients with STEMI treated at a University Hospital in 2012. Methods Medical records were reviewed to determine RT, its main (patient delay time [PDT] and system delay time [SDT]) and secondary components and hospital access variables. Cognitive responses were evaluated using a semi-structured questionnaire. Results A total of 50 patients with a mean age of 59 years (SD = 10.5) were included, 64% of whom were male. The median RT was 430 min, with an interquartile range of 315–750 min. Regarding the composition of RT in the sample, PDT corresponded to 18.9% and SDT to 81.1%. Emergency medical services were used in 23.5% of cases. Patients treated in intermediate care units showed a significant increase in SDT (p = 0.008). Regarding cognitive variables, PDT was approximately 40 min longer among those who answered “I didn’t think it was serious” (p = 0.024). Conclusions In a Brazilian tertiary public hospital, RT was higher than that recommended by international guidelines, mainly because of long SDT, which was negatively affected by time spent in intermediate care units. Emergency Medical Services underutilization was noted. A patient’s low perception of severity increased PDT.

Starting from sociological perspectives on complexity, we show how the social capital of boards and owners networks affects the implied cost of capital of companies listed on Brazilian stock exchange. We specifically show arguments and evidence that the effect of the relational resources found in the direct, indirect, and heterogeneous board’s ties reduces the cost of capital while relational resources embedded in shareholder networks increase the cost of capital. Our results show that while the increase in the relational resources of the board reduces the implied cost of capital, an increase in these shared resources in the ownership relationships of the firm increases the cost of financial capital.

A violência no trabalho é um fator atualmente preocupante nos hospitais. Este estudo teve como objetivos caracterizar os problemas de violência ocupacional, detectados pelos trabalhadores da equipe de saúde do serviço de urgência hospitalar. Estudo exploratório e transversal, com abordagem quantitativa dos dados, foi realizado no serviço de urgência de um hospital geral da Cidade de Londrina, Paraná, Brasil. População composta por 33 trabalhadores da equipe de enfermagem e 14 médicos. Dados coletados por meio de entrevistas realizadas com os trabalhadores e com os gestores do serviço médico e de enfermagem, e consulta aos registros de violência dos últimos sete anos. Os resultados mostraram que 100% dos enfermeiros, 88,9% dos técnicos, 88,2% dos auxiliares de enfermagem e 85,7% dos médicos referiram ter sido vítimas de atos de violência no trabalho, embora não registradas. Tipo de violência sofrida: 95,2% agressão verbal; 33,3% por assédio moral e assédio sexual, respectivamente. Medidas preventivas para a violência ocupacional devem ser implementadas.

Reflectance hyperspectroscopy is recognised for its potential to elucidate biochemical changes, thereby enhancing the understanding of plant biochemistry. This study used the UV-VIS-NIR-SWIR spectral range to identify the different biochemical constituents in Hibiscus and Geranium plants. Hyperspectral vegetation indices (HVIs), principal component analysis (PCA), and correlation matrices provided in-depth insights into spectral differences. Through the application of advanced algorithms-such as PLS, VIP, i PLS-VIP, GA, RF, and CARS-the most responsive wavelengths were discerned. PLSR models consistently achieved R 2 values above 0.75, presenting noteworthy predictions of 0.86 for DPPH and 0.89 for lignin. The red-edge and SWIR bands displayed strong associations with pivotal plant pigments and structural molecules, thus expanding the perspectives on leaf spectral dynamics. These findings highlight the efficacy of spectroscopy coupled with multivariate analysis in evaluating the management of biochemical compounds. A technique was introduced to measure the photosynthetic pigments and structural compounds via hyperspectroscopy across UV-VIS-NIR-SWIR, underpinned by rapid multivariate PLSR. Collectively, our results underscore the burgeoning potential of hyperspectroscopy in precision agriculture. This indicates a promising paradigm shift in plant phenotyping and biochemical evaluation.