Biocor Institute

The anatomical arrangement of the atrioventricular node has been likened to a riddle wrapped up in an enigma. There are several reasons for this alleged mystery, not least the marked variability in structure between different species. Lack of detailed knowledge of the location of the node relative to the atrial and ventricular septal structures has also contributed to previous misunderstandings. Recent studies comparing the findings of gross dissection with virtual dissection of living datasets, combined with access to a large number of serially sectioned human and animal hearts, have served to provide the evidence to solve the riddle. We summarise these findings in this review. We explain how the node is located within the atrial walls of the inferior pyramidal space. It becomes the non-branching component of the atrioventricular conduction axis as the axis extends through the plane of atrioventricular insulation to enter the infero-septal recess of the left ventricular outflow tract. The node itself is formed by contributions from the tricuspid and mitral vestibules, with extensive additional inputs from the base of the atrial septum. We show how knowledge of development enhances the appreciation of the arrangements and offers an explanation as to why, on occasion, there can be persisting nodoventricular connections. We discuss the findings relative to the circuits producing atrioventricular re-entry tachycardia. We conclude by emphasising the significance of the variation of the anatomical arrangements within different mammalian species.

Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome is a rare disorder of unknown etiology with heterogeneous clinical manifestations. We describe two cases of patients diagnosed with SAPHO syndrome mimicking spinal bone metastases. A literature review was conducted to identify similar previously reported cases. The first patient was a 56-year-old woman with progressive back pain for six months who was referred to the neurosurgery department for suspected spinal metastases. A spinal CT scan revealed hyperdense lesions at T10 and hyperdense changes in the lumbar vertebrae. Spinal MRI demonstrated bone marrow edema that was hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging in multiple thoracic vertebrae, and the PET/CT showed multiple skeletal lesions affecting the spine with low-to-moderate 18F-FDG uptake. Scintigraphy showed the characteristic "bull's head" sign with increased uptake in the manubrium and bilateral sternoclavicular joints. The second patient was a 66-year-old woman with a four-month history of back pain, who was admitted with multiple spinal lesions. The diagnosis was made after bone scintigraphy demonstrated the characteristic findings of the syndrome. Both patients lacked cutaneous lesions on presentation but reported previous skin lesions. SAPHO syndrome is a rare condition, and bone lesions associated with the disease may be misdiagnosed as bone metastases. Knowledge of the syndrome and its imaging findings is essential for accurate diagnosis and treatment.

A etiologia da prematuridade é multifatorial, influenciada por diversos fatores, incluindo histórico materno e gestacional, além de aspectos biológicos, genéticos e sociais. A saúde materno-infantil é uma prioridade, refletida em políticas públicas específicas que contribuíram para a redução da mortalidade materna e infantil. A taxa de mortalidade infantil é um indicador das condições socioeconômicas e da qualidade dos recursos de saúde materno-infantil. O presente estudo consistiu em uma revisão bibliográfica descritiva e qualitativa. Foram analisados artigos disponíveis em plataformas de busca online de estudos científicos e no Manual do Ministério da Saúde. A coleta de dados ocorreu entre março e abril de 2024, utilizando os descritores mencionados. A análise dos títulos e resumos resultou em 24 trabalhos científicos, dos quais 13 foram considerados irrelevantes e excluídos. Assim, foram utilizadas 11 publicações para a elaboração do estudo. A falta de interesse e estímulo por parte dos profissionais, tanto para a implantação quanto para a continuidade do MC. Essa falta de interesse está relacionada à insegurança técnica, à desarticulação entre a equipe multiprofissional, à valorização excessiva da visão biológica, às resistências e limitações impostas por alguns médicos, e à dificuldade de trabalhar em equipe. Os profissionais também destacaram a influência positiva do Método Canguru na prática do aleitamento materno precoce, o que contribui significativamente para o ganho de peso diário dessas crianças. No entanto, relataram dificuldades para a implantação e continuidade do método em suas instituições, relacionadas a problemas estruturais e condutas dos profissionais de saúde, como espaço inadequado, falta de interesse e capacitação insuficiente.

Introdução: A cultura na qual o indivíduo está inserido relaciona-se com seus objetivos e preocupações. Uma das formas de mensurar a qualidade de vida é através do Manual WHOQOL, que analisa capacidade funcional, estado geral de saúde, vitalidade, aspectos sociais, emocionais e saúde mental. Abordar a qualidade de vida entre acadêmicos da saúde permite reflexões que somam para uma melhora das ações estratégicas de promoção de saúde nesse público. Objetivo: Analisar a qualidade de vida entre os acadêmicos dos cursos da saúde através de uma pesquisa de campo quantitativa, não experimental e descritiva realizada em uma faculdade privada. Método: Para avaliar a satisfação dos estudantes foi utilizado um questionário Fsociodemográfico associado ao WHOQOL-BREF, manual desenvolvido para avaliar a relação entre espiritualidade, religião e crenças pessoais à qualidade de vida. As variáveis numéricas foram apresentadas como média ± desvio-padrão e as categóricas, como frequências absolutas e relativas. Resultados: Participaram do questionário 355 alunos de graduação–sendo 84 da Enfermagem, 37 da Fisioterapia, 177 da Medicina e 57 da Psicologia–com idade média de 22,4 ± 5,4 anos e em sua grande maioria do sexo feminino; da cor branca; solteiros; residindo com pais em imóvel próprio; com religião; sem trabalhar simultaneamente a graduação; em período integral de estudo. Analisando os dados, a maioria dos acadêmicos avalia sua qualidade de vida como boa. Conclusão: As diferenças nas condições socioeconômicas entre os cursos de Fisioterapia, Enfermagem, Medicina e Psicologia, demonstraram-se determinantes para a disparidade na percepção da qualidade de vida.

TO THE EDITOR: We read with interest the study by Shah et al. 1 describing the surgical results of central or axial atlantoaxial dislocation (CAAD), an entity recently described by the senior author (Shah A, Vutha R, Prasad A, et al. Central or axial atlantoaxial dislocation and craniovertebral junction alterations: a review of 393 patients treated over 12 years. Neurosurg Focus. 2023;54[3]:E13). They proposed that CAAD could be divided into three main groups: group A, cases involving musculoskeletal changes and neural alterations related to the craniocervical junction, such as basilar invagination, Chiari malformation, syringomyelia, atlas assimilation, C2-3 fusion, bifid arch of the atlas, torticollis, and dorsal kyphoscoliosis; group B, CAAD related to subaxial spinal instability and cervical myelopathy; and group C, cases identified by minor clinical observations without other defined pathology entity. With their compiled data and updated material results, the authors identified 393 patients with group A CAAD. All of them were treated with atlantoaxial fixation without bone decompression. After a mean follow-up of 73 months (range 6-155 months), they reported that no patient had additional surgery, symptom recurrence, implant failure, or infection. As surgeons, we know that complications and some degree of patient dissatisfaction are inherent to our surgical procedures. In our humble opinion, there are no surgical procedures without inherent complications and with perfect results. It is almost impossible that in 393 atlantoaxial fusions there were no additional surgeries, symptom recurrences, implant failures, or infections. To attest to our opinion, we can see clearly in the same journal issue that all the other studies reported complication rates, and none of them were 100% successful procedures. 2-5 Another important point is that the authors recommended the same treatment strategy for a wide range of different craniocervical junction pathologies, despite differences in symptoms and radiological findings. This is contrary to the knowledge obtained by many surgeons around the world who have dedicated decades to the treatment of these entities. To corroborate our point regarding this incongruence, there was no reference in the paper to the amount of knowledge obtained over decades. It seems

BackgroundHow to start optimal antibiotic therapy before the results of cultures and antimicrobial susceptibility tests are available? Here, we use the law of total probability to present a probabilistic approach based on antibiograms of bacterial isolates from healthcare and community-acquired infections to optimizing empiric antibiotic therapy.MethodsData on the microbiology of healthcare and community-acquired infections were analyzed from hospitals in Belo Horizonte, a three million inhabitants city from Brazil. Healthcare infections were defined by the National Healthcare Safety Network (NHSN)/CDC protocols. Only data obtained from infections with positive culture, both hospital and community, were considered. The success rate of an antibiotic (ATB) regimen, considering just one drug individually (monotherapy), was calculated by Law of Total Probability (Fig 1). In this sense, if a microorganism has not been tested for a specific antimicrobial, then, by definition, it was considered an antibiotic failure. For a regimen with more than one antibiotic, if the microorganism is sensitive to one of them, then it was considered a success of the scheme. For calculating the success probability of two or three antimicrobials A, B, and C, simultaneously (Fig 2), i.e., P(A and B) or P(A and B and C), the sensitivity to an antimicrobial was considered independent of sensitivity to any other. Then, P(A and B) = P(A) * P(B), and P(A and B and C) = P(A)*P(B) *P(C).Figure 1– Law of total probability: success rate of an antibiotic considering just one drug individually (monotherapy).Figure 2– Probability of the union of two events, success of ATB A or ATB B, and union of three events, success of ATB A or ATB B or ATB C.ResultsMicrobiologic data from hospital acquired infections (HAI) and community-acquired infections (CAI) are analyzed once a year. Empiric antibiotic therapy to HAI were proposed for urinary tract infections (UTI), bloodstream infections (BSI), and pneumonia (Figures 2 and 3). Empiric antibiotic therapy to community-acquired infections were developed for UTI, pneumonia, gastrointestinal system infection, bone and joint infection, and skin and soft tissue infection.Figure 3– Success rate of each antibiotic alone, considering just one drug individually (monotherapy): analysis of hospital-acquired pneumonia.Figure 4– Success rate of one, two or three antibiotics: analysis of hospital-acquired pneumonia.Fig 5- Probability of the antimicrobial regimen being successful in treating an infection according to the length of stay at hospital.ConclusionWe presented here a probabilistic approach to empiric antibiotic therapy. The next step is to validate all proposed regimens, that can be used to improve the success likelihood of empiric antibiotic decision making.DisclosuresAll Authors: No reported disclosures.

To take full advantage of the knowledge of cardiac anatomy, structures should be considered in their correct attitudinal orientation. Our aim was to discuss the triangle of Koch in an attitudinally appropriate fashion. We reviewed our material prepared by histological sectioning, along with computed tomographic datasets of human hearts. The triangle of Koch is the right atrial surface of the inferior pyramidal space, being bordered by the tendon of Todaro and the hinge of the septal leaflet of the tricuspid valve, with its base at the inferior cavotricuspid isthmus. The fibro-adipose tissues of the inferior pyramidal space separate the atrial wall from the crest of the muscular interventricular septum, thus producing an atrioventricular muscular sandwich. The overall area is better approached as a pyramid rather than a triangle. The apex of the inferior pyramidal space overlaps the infero-septal recess of the subaortic outflow tract, permitting the atrioventricular conduction axis to transition directly to the crest of the muscular ventricular septum. The compact atrioventricular node is formed at the apex of the pyramid by union of its inferior extensions, which represent the slow pathway, with the septal components formed in the buttress of the atrial septum, thus providing the fast pathway. To understand its various implications in current cardiological catheter interventions, the triangle of Koch must be considered in conjunction with the inferior pyramidal space and the infero-septal recess. It is better to consider the overall region in terms of a pyramidal area of interest.