Faculdade de Tecnologia de Presidente Prudente

We report the case of a patient with a saccular aneurysm of the hepatic artery with maximum diameter of 2.8 cm, no proximal neck, and involving the bifurcation of the proper hepatic artery, constituting a hostile anatomy for endovascular treatment, which would usually be the first choice for such cases. We performed open surgical treatment with resection and reconstruction using an autologous graft (internal saphenous vein). We illustrate the surgical technique used for adequate vascular exposure of the celiac trunk and hepatic hilum (which is often an area little explored by vascular surgeons) and of structures anatomically close to the hepatic artery. We also illustrate the anastomosis with telescoping technique. We demonstrate the need for vascular surgeons to master the anatomy and classical surgical technique for visceral branches, even in the era of minimally invasive procedures.

Resumo Apresentamos um relato de caso acerca de um paciente portador de aneurisma sacular de artéria hepática, com diâmetro máximo de 2,8 cm, sem colo proximal e com acometimento da bifurcação da artéria hepática própria, denotando anatomia hostil para tratamento endovascular, que geralmente é a primeira escolha para esses casos. Realizamos tratamento cirúrgico aberto com ressecção e reconstrução a partir de substituto autólogo (veia safena interna). Ilustramos a técnica cirúrgica empregada para a adequada exposição vascular do tronco celíaco e hilo hepático, que muitas vezes é uma área pouco explorada pelo cirurgião vascular, além dos cuidados necessários com estruturas anatomicamente próximas à artéria hepática e da técnica de anastomose com telescopagem. Demonstramos a necessidade de que o cirurgião vascular, mesmo na era dos procedimentos minimamente invasivos, domine a anatomia e a técnica cirúrgica clássica sobre ramos viscerais.

Introduction Dengue is a public health challenge worldwide. Brazil registered about 70% of cases in Latin America in 2023; in 2024, the country is experiencing an unprecedented increase in the number of infected individuals. By May 2024, more than 4 million people were infected. Our goal was to: (1) determine the epidemiology of dengue cases and their spatiotemporal distribution and (2) carry out a survey of the storm drains and through a geospatial analysis to determine their possible correlation with cases of dengue in Presidente Prudente, São Paulo, Brazil. Methods Cases and information on the habitat of mosquito in the storm drain underground drainage system from 2020 to 2021 were obtained from public agencies. Larvae, pupae, and Ae. aegypti were identified according to species and described in taxonomic keys. Kernel density maps were constructed. Results From 1996 to 2023, the prevalence of cases peaked in 2016 and 2019, and in 2023 reached alarming levels, and the city was considered hyperendemic. In 2021, 2,609 cases were registered with 2 clusters of high density. Of 5,492 storm drains analyzed, 18.0% were found to have water, 9.0% had larvae or pupae of Aedes aegypti and 91.0% were classified as dirty or damaged. A direct correlation between the kernel layer of cases in 2021 with the kernel layer of storm drains containing water (r = 0.651) and larvae and pupae (r = 0.576) was found, suggesting that storm drains are risk factors and have an impact on the maintenance of dengue endemicity. The high number of damaged units found demonstrated the lack of storm drain management, compromising the urban drainage system and possibly contributing to dengue outbreaks. Conclusion Policymakers may use these findings to improve existing dengue control strategies focusing on the control of storm drains and increase local and global perspectives on reducing dengue outbreaks.

Introduction Cancer causes an impact in the face of its news, whether due to feelings of anguish, stress and suffering due to the presence of the disease, which can be shared between patients, family members and loved ones. The news regarding the diagnosis generates, in addition to the psychological impact, financial difficulties, as the patient himself can often be responsible for a large part of the family income. Other complications are the difficulties in understanding the disease by the family members and/or the patient, denial of the disease in order to spare the patient from suffering and other loved ones, family conflicts related to the need to adapt to the new routine of daily life that the family should carry out aiming at the well-being of the patient and his treatment. Objectives To evaluate the psychological impact and interpersonal relationships in patients with breast cancer treated in the city of Presidente PrudenteSP by a support association. Methods This is an observational, quantitative, analytical and cross-sectional study, in which 200 patients with malignant breast cancer will be invited. Results The sociodemographic results found were: 62.5% white women, 65.6% aged between 45-65 years, 56.3% married, 46.9% have completed higher education, 56.3% had no family history of cancer, predominance of stages II, III and IV when discovered, 93.5% did not drink, 84.4% did not smoke. On the anxiety scale, 53.1% and 43.8% report getting tired easily and feeling like crying, respectively. On the social adequacy scale, 72.5% continued working only with some limitation during treatment, despite this, 41.4% had minor financial difficulties, 34.5% had difficulties expressing feelings with family members, 40.7% had a relationship well with family members with small arguments and finally 34.8% felt affection for the partner all the time, despite this 36.4% did not have sexual intercourse with them in the last month. Conclusions It was concluded, therefore, that when a family member gets sick, they all feel impacted, and each family will deal with the experience in a particular way, therefore, it is worth highlighting the encouragement of family participation in therapy sessions. Disclosure of Interest None Declared

Introduction This is a descriptive cross-sectional clinical study with professionals from the Nursing Team (Nursing Assistant, Nursing Technician and Nurse). Objectives To assess the psychological impact of the Covid-19 pandemic on nursing staff professionals. Methods A descriptive, quantitative, cross-sectional study will be applied to a structured interview aimed at collecting sociodemographic and occupational data, Mental Health Scales evaluating professional exhaustion - Oldenburg Burnout Inventory and Beck’s Anxiety Rating Scale to assess the state of anxiety. Results About 13,587 nursing professionals were interviewed, including nurses, technicians and nursing assistants. They were evidenced through the behavior indexes related to insomnia, the desire to cry and appetite variation may be related to the long working hours, the fear of contamination and the consequent absence from work, as well as the fear of getting sick may be related to the fact that the professional stops being a caregiver and starts to be cared for. Conclusions the study denotes the importance and need for interventions to promote and prevent mental well-being in health professionals exposed to COVID-19, these need to be implemented immediately, for nursing professionals, as they are on the front line, demanding attention Special. In this sense, the Nursing Council of the State of São Paulo created and implemented some bills such as the Obligation of Rest Rooms in Health Units, the Cuidando de Quem Cuida Program and the Yellow September Campaign in Allusion to actions for Nursing professionals for the prevention and promotion in mental health category. Disclosure of Interest None Declared

Introduction Eating disorders are characterized by a persistent disturbance in eating and/or eating-related behavior, resulting in altered food consumption or absorption, which can significantly compromise physical health as well as psychosocial functioning. These disorders are closely linked with stressful experiences which university students configure a group prone to development. Objectives The objective is to evaluate the impact of eating disorders on young people when entering and staying at university. Methods This is an observational, quantitative, analytical and cross-sectional study, in which 1300 (one thousand and three hundred) medical students were invited, of both sexes and over 18 years of age from the 1st (first) to the 12th (twelfth) year. period of the Medicine course at the University of Oeste Paulista (UNOESTE) with 91 students joining. A structured interview was applied via online, aiming at collecting sociodemographic and occupational data in conjunction with the application of the Periodic Eating Compulsion Scale - ECAP, assessing the existence and degree of eating disorders in medical students. Results Mean age 22.7 ± 3.9 years, predominantly female (76.9%) and white ethnicity (86.8%). Most live alone or with a parent (82.5%). With regard to eating habits, 81 (89.0%) said they did not follow a nutrition professional’s diet, and 84 (92.3%) have at least 3 meals a day. Lunch is eaten by 100% of the participants, while supper is the least consumed meal (17.6%). A total of 24 (26.4%) participants said they had little time to eat, and almost half (46.2%) did not prepare their own meals, with 12.5% choosing to eat salted or not. eating a certain meal. The ECAP binge eating score had a median of 9 (11.5) points, with a minimum score equal to 1 and a maximum equal to 41. Sixty-eight (74.7%) of the participants were classified as having no binge eating, with moderate binge eating 15 (16.5%), and severe, 8 (8.8%). Conclusions There is a need for changes in lifestyle aspects in order to present healthier meals in appropriate amounts, in addition to an adequate therapeutic approach to these disorders. Research funding agency We also declare that we received financial support from the Institutional Program for Scientific Initiation Scholarships (PROBIC). Disclosure of Interest None Declared

Background Low‐value care is the use of substitutive/ineffective/harmful strategies based on available evidence, and it is considered one of the main contributors to the burden related to low back pain in health care systems. The use of routine imaging for patients with low back pain is the main example of inappropriate care. Therefore, understanding the perceptions of medical doctors and patients from Brazil about this practice may help propose strategies to reduce imaging rates. Objective To investigate the perceptions of medical doctors and patients about imaging for the diagnosis of nonspecific low back pain. Design A qualitative study using the framework analysis method. Settings Primary and secondary care. Participants Fifteen patients with low back pain and 15 doctors participated in this study. Data Collection Sociodemographic data were collected from all participants, and the interviews were performed using a set of questions created based on the literature. Main Results Patients and doctors believe that the main reason for ordering imaging tests is to identify the source of pain, and imaging could be useful for tracking disease progression over time or if there is a lack of improvement after treatment. Patients' expectations and pressures play a role in the decision to order imaging tests, but clinicians believe that education is the preferred strategy to reduce imaging rates. Conclusion Identifying the source of pain, tracking the disease progression, and patients' expectations and pressures were the main drivers of imaging requests for low back pain. Educational strategies were suggested to reduce the use of routine imaging.

Introduction: Glioblastoma (GBM) is a primary tumor of the central nervous system (CNS). It is one of the most aggressive tumors affectinghumans, hasno cure, and has an extremely inverse prognosis, with an average survival ranging from 7 to 15 months. The role of opioids, either in stopping or stimulating tumor progression, has been demonstrated. The main objective of this study was to investigate the effect of intraoperative opioid use on patient survival. Methods: This retrospective study included 133 patients who underwent 167 surgical procedures for glioblastoma resection. The inclusion and exclusion criteria were as follows: patients older than 18 years, of both sexes, and those with confirmed GBM. Patients who died in the postoperative period due to causes unrelated to the underlying disease were excluded, as were those who did not have specific data on the medications used in the perioperative period in their records. The following outcomes were analyzed: age, preoperative and postoperative Karnofsky scale (KPS) scores, duration of the surgical procedure, opioid dose, overall survival, disease-free survival, sex, and race. Correlation tests were performed using the Spearman test, a T1-robust ANOVA test was used to assess variance between the opioid dosage groups, and Cox proportional hazard models were used to evaluate the association between opioid dosage and patient survival. Results: Analysis of the correlation between total opioid dosage and the investigated variables showed that surgical duration and age at surgery were significantly correlated with the total opioid dosage. There was no association between the total opioid dosage and the survival times of patients. Conclusion: This study suggests that there is no relationship between intraoperative opioid dosage and overall ordisease-free survival in patients receiving glioblastoma treatment.

One of the major limitations to proper weed management is the lack of knowledge about the biology of the species. The aim of this study was to understand the influence of temperature and light on the germination and emergence of Commelina benghalensis and Richardia brasiliensis, as well as the influence of burial depth in the soil and the presence of mulch. The experiment regarding the influence of light and temperature on germination was conducted using a 2x4 factorial design, with two light conditions (presence for 12 hours and absence for 24 hours) and four temperature alternations every 12 hours (20-25 ºC, 20-30 ºC, 20-35 ºC, and 15-35 ºC), with four replications. The second experiment was conducted in a completely randomized design with four replications, testing seven sowing depths (0.0; 0.5; 1.0; 2.0; 4.0; 6.0; 10.0 cm) in clay-textured soil. In the third experiment, millet, black oat, and sun hemp straw were placed on the surface of the pot where the weeds were sown. R. brasiliensis showed high germination rates at 15°-35°C and in the presence of light, indicating positive photoblastism, as the germination percentage was 63.50% in the presence of light and 1% without light. C. benghalensis showed higher germination rates at 20-35ºC, with a germination percentage of 46.5% under light treatment and 44% in the absence of light. R. brasiliensis exhibited the highest germination percentage at a depth of 0.5 cm, with 72.50%. C. benghalensis showed better germination at depths of 1 and 4 cm, with 48.33% and 49.16%, respectively. Both crotalaria and millet caused significant inhibition of germination in both weed species. R. brasiliensis and C. benghalensis exhibit higher seed germination under alternating temperatures, with R. brasiliensis displaying positive photoblastism and C. benghalensis being neutral. Greater seeding depths negatively influence germination, and cover crops such as crotalaria and millet can be used to suppress these weeds.

Our aim was to determine the secondary antibody deficiency (SAD) profiles of patients in a mesoregion of São Paulo state, Brazil, focusing on infectious diseases. Demographic characteristics, and clinical and laboratory data were obtained from electronic files; infections were classified as organ-specific and graded as mild, moderate, life-threatening, and fatal. Non-Hodgkin’s lymphoma (NHL) accounted for 30% of patients, nephrotic syndrome (NS) 25%, chronic lymphocyte leukemia 20%, and multiple myeloma 15%. Patients with NS were younger than those in other groups, and hypo-γ-globulinemia was detected in 94.1%, IgG < 400 mg/dL in 60.0%, IgA < 40 mg/dL in 55.0%, and CD19 < 20 cells/mm3 in 30.0%. One hundred and one infections were found; 82.1% were classified as mild or moderate, 7.9% as life-threatening, and 3.0% as fatal. Respiratory tract infections were more prevalent (41.5%), and pneumonia accounted for 19.8%. Lower levels of infections were found in patients with NS compared with NHL (p = 0.0001). Most patients progressed to hypo-γ-globulinemia and SAD after treatment with immunosuppressants, and mild and moderate infections were predominant. These therapies are increasing in patients with different diseases; therefore, monitoring hypo-γ-globulinemia and infections may help to identify patients at high risk for severe complications, antibiotic prophylaxis or treatment, and immunoglobulin replacement.

Objective Hypertension and the aging process result in changes to the endothelial-related muscular system that may negatively impact exercise capacity. Research has shown that high-intensity interval training(HIIT) may be beneficial for individuals with hypertension.However, there are currently no studies that compare the effects of this type of exercise on endothelial markers in the skeletal muscles of aging rats.In order to examine the effects of HIIT on muscular microcirculation markers in hypertension, we assessed the genes encoding proteins related to vasomotor function (NOS3 and ET-1) and angiogenesis (VEGF and PIK3R2) in the soleus and diaphragm muscles of old spontaneously hypertensive rats. To corroborate our results, we analyzed the expression of these genes in samples from individuals who participated in HIIT for 6 weeks (GSE 109657). Design and method Male 12-month-old spontaneously hypertensive rats were randomly assigned to either a sedentary group (n=10) or a high-intensity interval training (HIIT) group (n=10). The HIIT group underwent training on a rodent treadmill for 50 minutes per day, five times per week, for a period of eight weeks. Systolic blood pressure (SBP), functional capacity, and expression of endothelial gene-encoding proteins associated with NOS3, ET-1, VEGF, and PIK3R2 were analyzed. We retrieved a transcriptomic dataset (GSE109657) of human muscle biopsies collected from the vastus lateralis pre- and post-HIIT (a total of 22 samples, 11 pre-HIIT and 11 post-HIIT) for differential expression analysis. The relative expressions of NOS3, PIK3R2, VEGF were displayed through a heatmap using the MORPHEUS tool. In this dataset, ET-1 expression was not detected thus, we only represented the ET-2 transcriptional variant in the heatmap Results Our findings indicated that that 8-week of HIIT led to a statistically significant reduction in SBP (p=0.001) and improvement in functional capacity (p<0.001) without affecting the expression of NOS3, PIK3R2, VEGF, or ET-1 in the soleus and diaphragm muscles. Additionally, our reanalysis of vastus lateralis muscle biopsy revealed no differences in the genes of interest, corroborating our results. Conclusions These findings suggest that 8-week of HIIT may promote decreased arterial pressure and enhanced physical condition without interfering with the expression of mRNA-encoding vasomotor and angiogenic factors in different skeletal muscles.

The role of manganese in photo‐induced organometallic‐mediated radical polymerization (photo‐OMRP) under LED (light‐emitting diode) irradiation has not been previously explored. In this study, four manganese (II) complexes, namely [Mn(6‐tert‐butyl‐N,N′‐propanebis [salicylimine])] (Mn‐Bu), [Mn(6,3‐di‐tert‐butyl‐N,N′‐propanebis [salicylimine])] (Mn‐Bu2), [Mn(6‐ethoxy‐N,N′‐propanebis [salicylimine])] (Mn‐Ethoxy), and [Mn(6,3‐di‐ethoxy‐N,N′‐propanebis [salicylimine])] (Mn‐Ethoxy2), were synthesized using both symmetrical and non‐symmetrical tetradentate N2O2 Schiff base ligands. The Schiff base ligands were characterized by Fourier transform infrared spectroscopy (FTIR), ultraviolet–visible spectroscopy (UV–Vis), and nuclear magnetic resonance spectroscopy (NMR). The Mn (II) complexes were characterized by FTIR, UV–Vis, elemental analysis, molar conductivity, cyclic voltammetry, MALDI‐TOF mass spectrometry, electron paramagnetic resonance, and rationalized with density functional theory (DFT) studies. All complexes were evaluated as photo‐OMRP mediators under LED irradiation at 390 nm and in the 400–800 nm range. The photopolymerization utilized methyl acrylate (MA) and diphenyl(2,4,6‐trimethylbenzoyl)phosphine oxide (TPO) in varying molar ratios of [MA]/[MnII]/[TPO] (900/1/1, 600/1/1, and 600/1/0.5). The photo‐OMRP of MA mediated by Mn‐Bu2 showed the best control over molecular weight (Mn matching Mn,th) and dispersity (Ð < 1.30) at a [MA]/[MnII]/[TPO] = 600/1/0.5 M ratio. The polymerization system demonstrated a living character, as evidenced by reversible “on/off” light source switching. Furthermore, a block copolymer of poly (methyl acrylate)‐b‐poly (butyl acrylate) was successfully synthesized employing a sequential visible‐light‐induced process, with the Mn‐Bu2 system showing the best results.

Introduction Rabies is a zoonosis caused by viruses of the family Rhabdoviridae. Prophylaxis with the rabies vaccine and immunoglobulins, depending on the severity of the case, is recommended. After vaccination, mild, moderate, or severe adverse events (AE) are described. Although rare, severe skin reactions may occur, increasing the risk of anaphylaxis. Case report An 84-year-old woman was attacked by a stray unknown cat, leaving her with bites and scratches in the neck region and multiple injuries. The case was classified as severe. About 3 h after the first dose of the rabies vaccine, disseminated purplish spots appeared on her lower limbs, worsening significantly after the second dose, requiring hospitalization for the application of the third dose under observation, dermatology evaluation, and collection of skin tissue for biopsy. She was discharged 24 h after the third vaccination, and the purple spots cleared gradually. The biopsy suggested an adverse reaction to the vaccine components. Immunohistochemistry of the rabies virus antigen in dermal nerve fillets was negative. The seroconversion post rabies vaccine showed IgG antibody values below the reference levels. Conclusion Vaccination against rabies is extremely important; however, AEs may occur. Our patient developed an important AE and required hospitalization. After complete vaccination, the serum was not converted. A similar case was not previously described, and the case report is important for the creation of jurisprudence on rabies vaccination in elderly patients in Brazil.

Aim: To examine and compare the autonomic responses, as assessed through the non-linear and chaotic global metrics of heart rate variability in two groups: the Parkinson's Disease Group (PDG) and the Control Group (CG), both at rest and during an active tilt test. Methods: The study encompassed 46 participants (PDG: n = 23; 73.73 ± 7.28 years old; CG: n = 23; 70.17 ± 8.20 years old). Initial data collection involved the acquisition of participant's characteristics. The autonomic modulation was estimated both at rest and during the active tilt test. For this assessment, we computed non-linear indices derived from five entropies (Approximate, Sample, Shannon, Renyi, Tsallis), Detrended Fluctuation Analysis and the seven chaotic global metrics (hsCFP1-hsCFP7). Results: At rest, the PDG exhibited lower values of hsCFP3 (0.818 ± 0.116 vs. 0.904 ± 0.065; p < 0.05) and Sample Entropy (0.720 ± 0.149 vs. 0.799 ± 0.171; p < 0.05). During the test, the PDG demonstrated lower values of ApEn, while the CG presented lower values of SampEn, hsCFP1, hsCFP3, hsCFP7, and higher values of hsCFP5. An interaction was observed, indicating that hsCFP1 and hsCFP3 exhibit differential behavior for the CG and PDG in response to the test. Conclusion: subjects with PD exhibited reduced complexity of the RR interval series at rest, and a diminished autonomic response to the active tilt test when compared with the CG. The test, together with non-linear indices, may serve for assessing the Autonomic Nervous System in individuals with PD in a clinical setting. The interpretation of these data should be approached with caution, given the possible influences of pharmacotherapies and the inclusion of diabetic participants.

BACKGROUND Contamination of the breathing circuit and medication preparation surface of an anesthesia machine can increase the risk of cross-infection. OBJECTIVE To evaluate the contamination of the anesthetic medication preparation surface, respiratory circuits, and devices used in general anesthesia with assisted mechanical ventilation. DESIGN AND SETTING Cross-sectional, quantitative study conducted at the surgical center of a philanthropic hospital, of medium complexity located in the municipality of Três Lagoas, in the eastern region of the State of Mato Grosso do Sul. METHODS Eighty-two microbiological samples were collected from the breathing circuits. After repeating the samples in different culture media, 328 analyses were performed. RESULTS A higher occurrence of E. coli, Enterobacter spp., Pseudomonas spp., Staphylococcus aureus, and Streptococcus pneumoniae (P < 0.001) were observed. Variations were observed depending on the culture medium and sample collection site. CONCLUSION The study findings underscore the inadequate disinfection of the inspiratory and expiratory branches, highlighting the importance of stringent cleaning and disinfection of high-touch surfaces. KEY WORDS (MeSH terms): Infection control; Anesthesia, general; Equipment contamination; Patient safety AUTHORS’ KEY WORDS: Colonization; Microorganisms; Mechanical ventilation; Cleaning and disinfection; Breathing circuit

There is limited contemporary prospective real-world evidence of patients with chronic arterial disease in Latin America. The Network to control atherothrombosis (NEAT) registry is a national prospective observational study of patients with known coronary (CAD) and/or peripheral arterial disease (PAD) in Brazil. A total of 2,005 patients were enrolled among 25 sites from September 2020 to March 2022. Patient characteristics, medications and laboratorial data were collected. Primary objective was to assess the proportion of patients who, at the initial visit, were in accordance with good medical practices (domains) for reducing cardiovascular risk in atherothrombotic disease. From the total of patients enrolled, 2 were excluded since they did not meet eligibility criteria. Among the 2,003 subjects included in the analysis, 55.6% had isolated CAD, 28.7% exclusive PAD and 15.7% had both diagnoses. Overall mean age was 66.3 (± 10.5) years and 65.7% were male patients. Regarding evidence-based therapies (EBTs), 4% were not using any antithrombotic drug and only 1.5% were using vascular dose of rivaroxaban (2.5 mg bid). Only 0.3% of the patients satisfied all the domains of secondary prevention, including prescription of EBTs and targets of body-mass index, blood pressure, LDL-cholesterol, and adherence of lifestyle recommendations. The main barrier for prescription of EBTs was medical judgement. Our findings highlight that the contemporary practice does not reflect a comprehensive approach for secondary prevention and had very low incorporation of new therapies in Brazil. Large-scale populational interventions addressing these gaps are warranted to improve the use of evidence-based therapies and reduce the burden of atherothrombotic disease. ClinicalTrials.gov NCT04677725