Hospital do Servidor Público Municipal

The authors describe a case involving a young male patient with an uncommon osteochondral lesion of the proximal phalanx of the hallux within the metatarsophalangeal joint, associated with a gouty tophus. The surgical approach included curettage of the subchondral cyst, filling the defect with autologous bone graft, and repairing the cartilage using autologous matrix-induced chondrogenesis (AMIC). The postoperative care protocol is detailed, and the results are discussed. Level of Evidence Level of evidence 4 — Case Report.

BackgroundThe prevalence of allergic contact dermatitis (ACD) differs across various populations, and the sensitization rate can change constantly as new products are introduced to the market. The current Brazilian standard series of patch tests has been used for over two decades. Therefore, the development of a new Brazilian standard series is important to ensure that contact tests remain a reliable diagnostic tool.MethodsA Brazilian multicenter, cross-sectional, prospective study was conducted using a modified series of patch tests between 2023 and 2025. The factors under study were the substances used in the contact tests, and the outcomes were the frequencies of positivity and relevance. Demographic and clinical variables of the participants, who had contact dermatitis without a defined etiology prior to the tests, were evaluated. The required sample size was defined as 523 patients, estimating the prevalence of positivity with a 1.8% confidence interval. Wald's test was considered a 95% confidence level and a 1% expected prevalence of positivity.ResultsA total of 567 participants were included, 77.3% female, with a mean age of 53.3 years, and most belonged to phototypes II, III, and IV. Cleaning services were the most frequent occupational activity, and 43.3% of patients had a personal history of atopy. The overall reactivity of the tests was 69.3%, with 70.2% relevance. Nickel sulfate was the most frequently reactive allergen (28.9%), and 29 substances reached at least 1% positivity.LimitationsLack of representatives from all regions of Brazil and absence of prospective follow-up.ConclusionThe authors propose a new Brazilian standard series of patch tests, with 40 substances, considering the 29 that achieved 1% positivity and another 11 with clinical importance and supported by current literature as emerging and current allergens.

In the osteochondral autograft transfer system (OATS) procedure, a wide accessible area is required to introduce the femoral plug at varying angles. This may not always be achievable with a simple arthrotomy using anteromedial, posteromedial, or anterolateral approaches. The aim of this case presentation was to describe the use of an anterior chevron-type tibial osteotomy as a technical approach for treating a centrolateral osteochondral lesion of the talus (OLT) with the OATS technique. We present a case of a 48-year-old female patient with a history of chronic right ankle pain following an ankle sprain 32 years ago. The anterior osteotomy was performed with dimensions of ∼3 cm in width, 2 cm in depth, and 4 cm in height. After removing the anterior tibial bone block, we identified and debrided the OLT. The lesion site was prepared using a trephine, and a bone plug obtained from the lateral femoral trochlea was inserted, congruent with the surrounding articular cartilage. Finally, the temporarily removed anterior tibial bone block was reattached and secured with 3 cannulated screws. At the 44-month follow-up, the patient was asymptomatic and fully active. Level of Evidence: Diagnostic Level 5. See Instructions for Authors for a complete description of levels of evidence.

Introdução: A pele, maior órgão do corpo humano, está sujeita a lesões agudas e crônicas, sendo estas últimas agravadas por doenças como diabetes e envelhecimento populacional. A Terapia por Pressão Negativa (TPN) surge como técnica eficaz na cicatrização, destacando o papel do enfermeiro e do estomaterapeuta. A Resolução COFEN nº 736/2024 legitima a autonomia da enfermagem na condução dessa prática especializada. Objetivo: Analisar a aplicação da terapia por pressão negativa no tratamento de lesões crônicas na perspectiva da estomaterapia Metodologia: Revisão integrada da literatura, sendo coletados e resumidos o conhecimento científico já desenvolvido. Análise e discussão dos resultados: A Terapia por Pressão Negativa (TPN) é uma tecnologia eficaz no tratamento de feridas complexas, promovendo cicatrização acelerada, controle de infecções e redução do tempo de internação. Seu uso depende de avaliação clínica criteriosa, tipo e profundidade da lesão, bem como da disponibilidade de materiais. Estudos mostram sua boa relação custo-benefício, mesmo com insumos caros, destacando a importância da atuação da enfermagem, principalmente do enfermeiro estomaterapeuta. A Resolução COFEN nº 736/2024 reforça a importância do Processo de Enfermagem para garantir segurança e qualidade assistencial. Conclusão: A TPN deve ser utilizada de forma complementar entre enfermeiros generalistas e especialistas, promovendo cuidado individualizado e baseado em evidências. A capacitação contínua da equipe de enfermagem e a articulação com a equipe multiprofissional são essenciais para o sucesso terapêutico. Assim, a TPN se consolida como uma abordagem inovadora e estratégica na recuperação de feridas.

Background/Objectives: Ventriculoperitoneal shunts are the standard treatment for adults diagnosed with several CSF disorders, but often face dysfunction, leading interest in non-invasive methods for diagnosing shunt issues. This study evaluates the potential of non-invasive intracranial pressure waveform monitoring (nICPw) with the brain4care (B4C) system to distinguish overdrainage, underdrainage, and normal shunt function in patients with CSF disorders. Methods: In this single-center, observational study at Hospital das Clínicas, Brazil, adult patients with CSF shunts were enrolled. Patients were categorized as Overdrainage or Underdrainage, based on clinical parameters, with an Asymptomatic group. The B4C system provided nICPw monitoring, and six parameters (including various P2/P1 ratios) were analyzed via MANOVA and ANOVA. Results: Among 30 patients (6 overdrainage, 6 underdrainage, 18 asymptomatic), five asymptomatic patients were excluded from the main analysis due to incomplete data collection, leaving 25 patients. Overdrainage patients had significantly higher ΔP2/P1 values (0.618 ± 0.210) than asymptomatic ones (0.227 ± 0.171). After excluding outliers, differences were more pronounced (H = 10.89; p < 0.01). Underdrainage patients had intermediate ΔP2/P1 values (0.387 ± 0.179) and consistently higher P2/P1 averages (>1.3). ROC analysis indicated that ΔP2/P1 > 0.3 suggested shunt dysfunction (AUC = 0.731), while the highest P2/P1 offered stronger discrimination (AUC = 0.782). A global average P2/P1 > 1.3 was linked to underdrainage, with the lowest P2/P1 values differentiating overdrainage (0.948 ± 0.321) from underdrainage (1.143 ± 0.156). Conclusions: nICPw monitoring with the B4C system demonstrated potential for detecting shunt dysfunction. Combining parameters, especially ΔP2/P1 and highest P2/P1, improves diagnostic accuracy, offering a non-invasive method that may aid in distinguishing normal from abnormal shunt function.

BackgroundWhether potent P2Y12 inhibitor monotherapy without aspirin initiated shortly after successful percutaneous coronary intervention (PCI) is effective and safe for patients with acute coronary syndromes is unclear.MethodsWe conducted a multicenter, open-label, randomized trial in Brazil involving patients with acute coronary syndromes who had undergone successful PCI. Patients were assigned in a 1:1 ratio within the first 4 days of hospitalization to stop treatment with aspirin and receive potent P2Y12 inhibitor monotherapy (ticagrelor or prasugrel) or to receive dual antiplatelet therapy (aspirin and a potent P2Y12 inhibitor) for 12 months. The two ranked primary outcomes, assessed through 12 months, were a composite of death from any cause, myocardial infarction, stroke, or urgent target-vessel revascularization (tested for noninferiority, with a noninferiority margin of 2.5 percentage points) and major or clinically relevant nonmajor bleeding (tested for superiority).ResultsA total of 3410 patients were included in the intention-to-treat population (1712 in the monotherapy group and 1698 in the dual antiplatelet therapy group). At 12 months, death from any cause, myocardial infarction, stroke, or urgent revascularization had occurred in 119 patients (Kaplan–Meier estimate, 7.0%) in the monotherapy group and in 93 patients (Kaplan–Meier estimate, 5.5%) in the dual antiplatelet therapy group (absolute risk difference, 1.47 percentage points; 95% confidence interval [CI], −0.16 to 3.10; P=0.11 for noninferiority). Major or clinically relevant nonmajor bleeding had occurred in 33 patients (Kaplan–Meier estimate, 2.0%) in the monotherapy group and in 82 patients (Kaplan–Meier estimate, 4.9%) in the dual antiplatelet therapy group (absolute risk difference, −2.97 percentage points; 95% CI, −4.20 to −1.73). Stent thrombosis occurred in 12 patients in the monotherapy group and in 4 in the dual antiplatelet therapy group.ConclusionsAmong patients who had undergone successful PCI for acute coronary syndromes, potent P2Y12 inhibitor monotherapy was not found to be noninferior to dual antiplatelet therapy with respect to a composite of death or ischemic events at 12 months. (Funded by the Brazilian Ministry of Health; NEO-MINDSET ClinicalTrials.gov number, NCT04360720.)