Objectives To validate an experimental non-animal model for training of vasectomy reversal.Materials and Methods The model consisted of two artificial vas deferens, made with silicon tubes, covered by a white resin, measuring 10 cm (length) and internal and external diameters of 0.5 and 1.5 mm, respectively. The holder of the ducts is made by a small box developed with polylactic acid, using a 3D print. The objective of the invention is to simulate the surgical field of vasovasostomy, when the vas deferens are isolated from other cord structures. For validation, it was verified the acquisition of microsurgical skills during its use, in a capacitation course with 5 urology residents from a Hospital of the region. Along the training sessions, it was analyzed the time (speed) of microsurgical sutures, and quantification of the performance using a checklist. Collected data were analyzed using de BioEstat®5.4 software.Results Medium time for the completion of microsurgical sutures improved considerably during the course, and reached a plateau after the third day of training (p=0.0365). In relation to the checklist, it was verified that during capacitation, there was significant improvement of the scores of each participant, that reached a plateau after the fourth day of training with the model (p=0.0035).Conclusion The developed model was able to allow the students that attended the course to gain skills in microsurgery, being considered appropriate for training vasectomy reversal.

sobre os casos notificados de LTA. Os dados foram agrupados segundo as variáveis idade, sexo, raça/cor e município de residência e analisados por meio do qui-quadrado, utilizando o programa BioEstat v5.3, observando o p-valor < 0,05. Para a confecção do mapa, utilizou-se o TabWin v.4.15. RESULTADOS: Foram notificados 34.609 casos confirmados. A incidência foi de 43,89 casos/100.000 habitantes. Houve predominância do sexo masculino (79,88%), idade entre 20 a 39 anos (48,82%) e pardos (71,77%). Registrou-se ocorrência significativa em mulheres, crianças menores de 10 anos de idade e idosos. A forma cutânea foi predominante em 97,39% dos casos, e 72,19% evoluíram para cura. CONCLUSÃO: A LTA ainda é um grave problema de saúde pública no Pará, apresentando alta incidência na população. A distribuição espacial dos casos não é homogênea no território paraense, possuindo maior concentração em áreas distantes da capital do estado. Sugere-se a existência de transmissão peri e intradomiciliar relacionada ao acometimento de crianças menores de 10 anos de idade e idosos.

Purpose: To study the anatomorphometry of the plexus brachialis (PB) of rats under a high-definition video system. Methods: Ten male Wistar rats discarded from other research that did not interfere in the morphology of the animal, respecting the principle of reduction, were used. All animals were submitted to the same protocol. Initially, the cervical region was shaved. The animals were placed in a dorsal position. A single elbow-to-elbow incision was performed and dissection started at the deltopectoral sulcus. The procedures were performed under a video system. To measure the structures, the Image J software was used. Results: All the PB evaluated originated from the C5-T1 spinal nerves. C5 and C6 converged to form the truncus superior, the root of C7 originated the truncus medius, and the confluence of C8 and T1 originated the truncus inferior. It was found the union of C7, C8, and T1 to form truncus inferomedialis instead of separate medial and inferior truncus. C8 (1.31 mm) was the thickest root, the truncus inferior (1.80 mm) and the nerve radialis (1.02 mm), were the thickest. Conclusions: The anatomy of the PB is comparable to humans, admitting variations. The videomagnification system is useful to perform microsurgical dissection.

Se pudo comprobar 884 óbitos maternos, correspondientes a la Razón de Mortalidad Materna 60,7 por 100 mil nacidos vivos de no indígenas y 135,8 de 100 mil nacidos vivos de indígenas. El edema, la proteinuria y los trastornos de hipertensión en el embarazo, parto y puerperio corresponden a 30,5% (n = 270). Conclusión e implicaciones para la práctica: La mortalidad materna es aún un grave problema de salud pública en el estado, demostrando claramente que las indígenas requieren de una mayor atención, ya que presentaron índices más elevados de mortalidad materna si lo compara con no indígenas.

Background There is a dearth of studies conducted to understand the socio-professional profile of the vascular surgery specialty and the population demands of specific regions, which are needed to support creation of care policies and direct infrastructure improvements in healthcare. Objectives The purpose of this study was to describe the socio-professional profile of vascular surgeons in the state of Pará, Brazil, to guide creation of tools for professional improvement. Methods A cross-sectional, self-report survey was conducted in Pará using a questionnaire comprising 30 questions covering six main topics. Results All vascular surgeons actively practicing in the state participated in this study. The total number of specialists was 59, with 71.2% working in the greater Belém area and 16.9% exclusively practicing in the interior of the state. The mean age of these professionals was 48 ± 11.1 years, 86.4% of respondents were men, 64.4% of surgeons had completed medical residency, and 96.6% (n=57) of the surgeons would like to improve their skills in venous surgery, echo-guided vascular access, and endovascular surgery. The method of professional improvement of greatest interest was simulation courses (hands-on), endorsed by 93% of the participants. Conclusions Pará has 59 vascular surgeons. These professionals mainly work in the greater Belém (71.2%), in hospitals (100%) or in private clinics or offices (94.9%), performing a wide range of procedures, including venous and arterial surgery, amputations, and provision of hemodialysis access. More than 90% of these surgeons were satisfied professionally and reported that they would choose the specialty again. However, 22% had a pessimistic view of the specialty’s future. The vast majority of professionals (96.6%) consider that training or a continuing education program are necessary.

Background Microsurgery training is critical to the practice of microvascular procedures in many surgical areas. However, even simple procedures require different levels of complex skills. Therefore, simulation-based surgical training, mainly in the area of vascular anastomosis, is of great importance. In this paper, we present a new microsurgery training model for the development of basic to advanced microsurgical skills. Methods Porcine kidneys were purchased from a legal butchery slaughterhouse. First, kidneys were washed with water to remove blood and clots inside vessels. Then, dissection was performed throughout the vascular pedicle from the renal arteries to the segmentary branches. Finally, the longitudinal sectioning of the kidney parenchyma was performed to expose the vessels necessary for training. Sixty end-to-end anastomoses were performed. Specific instruments and materials were used to perform anastomoses and dissections with magnification by a video system. We evaluated the diameter of vessels, time to perform anastomosis, and patency of anastomosis. Results There was no great anatomical variation among the porcine kidneys. The total length for dissection training was 25.80 ± 7.44 cm using the arterial and venous vessel. The average time to perform arterial anastomoses was 23.79 ± 4.55 minutes. For vessel diameters of ≤ 3, 4 to 6, and 7 to 10 mm, the average procedure times were 27.68 ± 3.39, 22.92 ± 4.12, and 20.77 ± 3.44 minutes, respectively. Regarding venous anastomosis, the average duration of the procedure was 26.17 ± 4.80 minutes, including durations of 31.61 ± 3.86, 25.66 ± 4.19, and 21.24 ± 3.79 minutes for vessel diameters of ≤ 7, 8 to 10, and >10 mm, respectively. Positive patency was achieved in all surgeries. Conclusion The porcine kidney provides an inexpensive and convenient biological model for modeling microanastomosis with high fidelity to vascular structures.

Introdução: A meningite é a ocorrência de processo inflamatório das meninges, podendo ser desencadeado por diversos agentes infecciosos ou não infecciosos; a etiologia bacteriana possui elevado potencial de morbimortalidade, o que contribui para a significância epidemiológica e a validade de esforços que busquem descrevê-la e quantificá-la. Objetivos: realizar estudo epidemiológico acerca dos casos notificados de meningite bacteriana no Brasil durante os anos de 2009 a 2018. Metodologia: estudo quantitativo e retrospectivo a partir de dados coletados no Sistema de Informações e Agravos de Notificação (SINAN) referentes ao período de 2009 a 2018, disponível nos Departamento de Informática do Sistema Único de Saúde (DATASUS); informações obtidas: sexo, idade raça, evolução e estado de origem. Resultados: Foram notificados 52.926 casos confirmados por meio do SINAN no Brasil, entre 2009 e 2018, havendo tendência à redução no número de casos com o decorrer dos anos; as etiologias mais frequentes foram a pneumocócica (19,9%), a meningocócica (14,8%) e a tuberculosa (7,0%). Predominou o sexo masculino (59,6%), com maior acometimento em indivíduos menores de 10 anos de idade (35,2%), seguido de indivíduos entre 20 a 39 anos (21,1%), majoritariamente em brancos (44,5%), com evolução para alta (70,7%) e originários dos Estados do Sul e Sudeste brasileiro. Conclusão: Observou-se tendência à redução dos casos de meningite bacteriana, com discreto padrão oscilatório na incidência de meningite por pneumococo, e predominância em crianças menores de 10 anos, do sexo masculino, raça/cor branca, advindas do Sul e Sudeste brasileiro, que evoluíram para alta.

Purpose:To develop a new low-cost, easy-to-make and available training model using chickens’ intestine for infant intestinal anastomosis.Methods:Segments of chicken intestine were used to create an intestinal anastomosis simulator. We tried to perform an end-to-end, end-to-side and side-to-side anastomosis. Handsewn sutured anastomosis were performed in single layered with interrupted prolene 5-0 suture. The parameters analyzed were cost, intestine's diameter and length, anastomosis patency and flow-through and leakage amount.Results:In all cases it was possible to make the anastomosis in double layered without difficulties, different from the usual ones. There was a positive patency at all anastomoses after the end of the procedure, with no need for reinterventions.Conclusion:The new training model using chickens’ intestine for infant intestinal anastomosis is low-cost, easy-to-make and easy available.