Situações Vivenciadas pela Equipe de Enfermagem de uma Unidade Oncológica / Situations Experienced by the Nursing Team of a Cancer Unit / Situaciones Vivenciadas por el Equipo de Enfermería de una Unidad Oncológica

Introdução: O câncer é uma doença complexa que demanda cuidados e tratamentos diversos.Tendo em vista a importância da equipe de enfermagem para pacientes que sofrem com o câncer e a complexidade da atenção e atuação nessa área, os processos de trabalho desses profissionais devem receber especial atenção. Objetivo: Compreender as situações vivenciadas por profissionais de enfermagem que cuidam de pacientes com câncer. Método: Pesquisa qualitativa realizada com 12 profissionais da equipe de enfermagem atuantes em uma unidade de oncologia de um hospital do interior do Estado de São Paulo, Brasil, durante os meses de setembro e outubro de 2017, utilizando-se um roteiro de entrevista semiestruturada contendo dados de caracterização e questões norteadoras. Foi realizada análise temática de conteúdo, da qual emergiram as categorias "Situações vivenciadas durante a prestação de cuidados na unidade oncológica" e "Sentimentos dos profissionais de enfermagem aos prestarem cuidados ao paciente com câncer". Resultados: Mesmo com situações de dificuldades e sofrimentos, os profissionais demonstraram sentimentos de satisfação e gratidão por prestarem cuidados aos pacientes com câncer. Conclusão: A motivação por parte das profissionais de enfermagem para a prestação de cuidados dignos aos pacientes com câncer supera as barreiras existentes.

Introduction: Cancer is a complex disease that requires diverse care and treatment. Considering the importance of the nursing team for patients suffering from cancer and the complexity of care and performance in this area, the work processes of these professionals should receive special attention. Objective: To understand the situations experienced by nursing professionals who care for patients with cancer. Method: Qualitative research carried out with 12 nursing team professionals working in an oncology unit of a hospital in the interior of the State of São Paulo, Brazil, during the months of September and October 2017, using a semi-structured interview script characterization data and guiding questions. A thematic content analysis was carried out, from which emerged the categories "Situations experienced during care delivery in oncology unit" and "Feelings of nursing professionals to care for patients with cancer". Results: Even with situations of difficulties and suffering, professionals showed feelings of satisfaction and gratitude for providing care to patients with cancer. Conclusion: The motivation of nursing professionals to provide decent care to cancer patients overcomes existing barriers.

Introducción: El cáncer es una enfermedad compleja, que demanda cuidados y tratamientos diversos. En vista de la importancia del equipo de enfermería para pacientes que sufren con el cáncer y la complejidad de la atención y actuación en esa área, los procesos de trabajo de estos profesionales deben recibir especial atención. Objetivo: Comprender las situaciones vivenciadas por profesionales de enfermería que cuidan de pacientes con cáncer. Método: Investigación cualitativa realizada con 12 profesionales del equipo de enfermería actuantes en una unidad de oncología de un hospital del interior del Estado de São Paulo, Brasil, durante los meses de septiembre y octubre de 2017, utilizando un itinerario de entrevista semiestructurada conteniendo datos de caracterización y cuestiones orientadoras. Se realizó un análisis temático de contenido, de la cual surgieron las categorías "Situaciones vivenciadas durante la prestación de cuidados en la unidad oncológica" y "Sentimientos de los profesionales de enfermería a prestar atención al paciente con cáncer". Resultados: Incluso con situaciones de dificultades y sufrimientos, los profesionales mostraron sentimientos de satisfacción y gratitud por prestar atención a los pacientes con cáncer. Conclusión: La motivación por parte de las profesionales de enfermería para la prestación de cuidados dignos a los pacientes con cáncer supera las barreras existentes.

Prueba de supresión con Dexametasona 1mg en una población de individuos con normopeso, sobrepeso y obesidad: Estudio multicéntrico / The Overnight 1mg Dexamethasone Test in Healthy Subjects with Normal Weight, Overweight and Obesity: a Multicentric Study

La prueba de supresión con dexametasona-1mg oral nocturna evalúa la conservación del mecanismo de retroalimentación negativa normal ejercido por los glucocorticoides sobre el eje hipotálamo-hipófiso-adrenal (HH-A), siendo ampliamente utilizada en el algoritmo diagnóstico de sospecha de síndrome de Cushing (SC). Pero la concentración de cortisol sérico matinal postinhibición que define la supresiblidad normal ha sido motivo de controversia, con valores variables desde el original =5 ug/dl (=138 nmol/L) hasta una cifra =1,8 ug/dl (=50 nmol/L) últimamente. Asimismo, es controvertida la respuesta en la obesidad, donde está descripta una alteración del eje H-H-A. Por lo tanto, el Departamento de Suprarrenal de SAEM llevó a cabo este estudio multicéntrico con el objetivo de definir la concentración de cortisol sérico obtenida luego de la administración de dexametasona 1mg nocturna, en una población de sujetos sanos de nuestro país con peso normal; concomitantemente, se evaluaron individuos con sobrepeso y con obesidad simple para comparar su respuesta respecto de los sujetos normopeso. Se estudiaron 80 individuos sanos, 60 mujeres y 20 hombres, de 15 a 66 años de edad, que fueron divididos en tres grupos según el índice de masa corporal (IMC): Normopeso, IMC=19-24,9 kg/m2, n=39; Sobrepeso, IMC=25-29,9 Kg/m2, n=21; y Obesos, IMC = 30 kg/m2, n=20. Se administró dexametasona 1 mg vía oral a las 23 hs. y se determinó la cortisolemia a las 8hs. de la mañana siguiente. Las determinaciones se centralizaron en un solo laboratorio y fueron realizadas por el equipo de radioinmunoensayo (RIA) de DSL, sensiblidad analítica de 0,5 ug/dl. Paralelamente en 10 sujetos, se determinó la cortisolemia postinhibición en las mismas muestras con otro equipo analítico, RIA-DPC. Resultados: Los resultados de la cortisolemia postsupresión en los tres grupos estudiados se expresan como X± DS (rango): en el grupo normopeso fue de 2,10± 0,77 ug/dl (0,78-3,40); en el sobrepeso, 1,94± 0,66 ug/dl (0,962,90); y en los obesos, 1,86 ± 0,63 ug/dl (0,85-3,30), no observándose diferencias significativas entre los tres grupos estudiados (test de Kruskall Wallis Dunn, p=0,319). En los 10 sujetos cuyas muestras fueron simultáneamente analizadas por RIA-DSL y por RIA-DPC, se observaron marcadas diferencias en 8/10, siendo la mediana de cortisol sérico obtenida por RIA-DPC de 0,5µg/dl, significativamente menor a la obtenida por RIA-DSL, de 2,2 µg/dl (test de Wilcoxon, p=0,002). Conclusiones: Debemos destacar que este es el primer estudio multicéntrico que evalúa la respuesta a la inhbibición con dexametasona 1 mg en nuestro medio. En esta primera etapa, demostramos que una concentración de cortisol sérico post 1 mg de dexametasona oral nocturna = 3,4 µg/dl (= 93,8nmol/l), determinada por RIA-DSL, caracteriza la respuesta normal de nuestra población de sujetos sanos. Ello es independiente del peso corporal, ya que los sujetos con normopeso, sobrepeso y obesidad suprimieron a valores similares. No se observó falta de supresión en ningún caso estudiado. Por otra parte, dadas las marcadas diferencias de valores halladas en las mismas muestras cuando son analizadas por equipos diferentes de RIA, es fundamental referir los resultados al método y equipo utilizados y estandarizar las pruebas clínicas con la metodología específica empleada en cada laboratorio.

The overnight oral dexamethasone test assesses the normal negative feedback of cortisol on the hypothalamic-pituitary-adrenal axis (H-P-A) 1. It is widely used in the screening of Cushing’s Syndrome (CS) 3,4,5. But the cut-off values for the normal response remains controversial: originally it was considered as 5 ug/dl and in the last years it was reported as 1.8 ug/dl 4. Likewise, there is no agreement about the suppression values in obesity, where a hyperactivity of the H-P-A axis has been reported. Therefore, the Adrenal Department of the Argentine Society of Endocrinology and Metabolism (SAEM) studied 80 healthy subjects recruited from ten hospitals of Buenos Aires in order to assess the normal response in our population. Sixteen women and twenty men, aged 15-66 years old (X = 39.2ys), were classified into three groups, according to their body mass index (BMI): normal weight, BMI- 19-24.9 kg/m2 (n= 39); overweight, BMI- 25-29.9 kg/m2 (n=21) and obese subjects, BMI> 30 kg/m2 (n=20). They had to be euthyroid and free of corticosteroid treatment, contraceptive pills, hormone replacement therapy, rifampicin and psychotropic drugs at the time of the study. Subjects referring drug abuse, alcoholism, depression, cardiovascular, and renal disorders and,obviously, adrenal diseases were excluded from the study. Dexamethasone 1mg per os was administered at 11p.m. and blood was withdrawn at 8 a.m. on the next morning to determine plasma cortisol concentration. Determinations were centralized in one laboratory and the RIA-DSL (Diagnostic System Laboratories-radioimmunoassay) was used. Additionally, in ten subjects plasma cortisol was also determined in the same blood samples by another radioimmunoassay kit, RIA-DPC (Diagnostic Products Corporation). The Kruskall-Dunn test was used to compare the plasma cortisol levels post-1mg dexamethasone among the three groups studied. In the 10 patients whose determinations were made in the same blood samples by two different RIA-kits (DSL and DPC),the Wilcoxon test was used to compare the results of plasma cortisol between RIA-DSL and RIA-DPC. Results: The results are expressed as X ± SD ug/dl (range). Plasma cortisol levels after 1mg-dexamethasone were: 2.10 ± 0.77 ug/dl ( 0.78- 3.40 ug/dl) in the normal weight goup; 1.94 ± 0.66 ug/dl (0.96-2.90) in the overweight group and 1.86 ± 0.63 ug/dl (0.85-3.30) in the obese subjects (Table I); no significant differences were observed among the three groups (p=0.319). According to these results, the cut-off value for plasma cortisol post-dexamethasone in the normal weight subjects was considered as = 3.4 ug/dl (93.8 nmol/L) using RIA-DSL. Similar suppression values were obtained in the overweight and obese subjects - 2.9 and 3.3 ug/dl, respectively. No false positive results were observed, either individually or in each group (Fig 1). In the 10 subjects whose blood cortisol was simultaneously determined in the same samples by RIA-DSL and RIA-DPC, the median for plasma cortisol was 2.2 ug/dl for the first and 0.5 ug/dl for the latter, respectively, with a significant difference between both RIA kits (p=0.002). (Table II). Conclusions: In this first stage, the present multicentric study shows that a plasma cortisol level post - 1mg dexamethasone suppression of = 3.4 ug/dl ( 93.8 nmol/L) defines our normal population response, with no significant differences among normal weight,overweight and obese subjects. Furthermore, we wish to point out that the cortisol values must be referred to the method and commercial kits used in each laboratory, since significant differences can be observed in the same blood samples when different kits are used, such as we and other authors have observed. We wish to remark the importance of our study, which is the first in its characteristics in Argentina. Furthermore, in a second stage, we plan to enlarge the sample number and to determine blood cortisol in the same samples by using different methods, in order to obtain a standardized cortisol suppression level. We also plan to study patients with confirmed CS and pseudocushing states in order to assess the sensitivity and specificity of the 1mg-dexamethasone suppression test in our population.

Standardization of a simple method to study whole saliva: clinical use in different pathologies

En este trabajo se describe la normatización de un método paradeterminar flujo salival en humanos utilizando saliva total obtenida del piso de la boca mediante un eyector dental descartable y una bomba de vacío (equipo dental). En este estudio se evaluaron 40 sujetos sanos de ambos sexos y 51 pacientes con diversas patologías (Síndrome de Sjõgren, disfunción Tiroidea, Diabetes Mellitus).Se demostró que el flujo salival basal era estable a partir de los primeros 5 minutos de colocado el eyector en la cavidad bucal. No se encontraron diferencias significativas en el flujo salival basal comparando los sexos, siendo independiente de la intensidaddel vacío efectuado por la bomba. El flujo de saliva total estimulada fue determinado durante 3 minutos, luego de los primeros 5 minutos de colocado el eyector en la boca. El estímulo se efectuó adosando en la cara dorsal de la lengua discos de papel absorbente, embebidos en ácido cítrico al 2 por ciento. El uso de este método en pacientes con Síndrome de Sjõgrenconfirmó la reducción del flujo salival respecto a los sujetos sanos. Los pacientes hipotiroideos y con neuropatía diabética demostraron disminución del flujo salival

The present study describes a methodology to assess the salivary flow rate in humans. Whole saliva was obtained from the floor of the mouth with a plastic dental ejector and a vacuum pump. Forty healthy subjects of both sexes and 51 patients with different pathologies (Sjögren Syndrome, Thyroid Dysfunction, Diabetes Mellitus) were included in the study. It was demonstrated that basal salivary flow rate was stable five minutes after the insertion of the oral ejector. Salivary flow rate did not show significant differences between sexes and was independent of the negative pressure level of the vacuum pump Stimulated salivary flow rate was quantified over a period of 3 minutes, starting 5 minutes after the introduction of the oral device. The stimulus was paper filter disks soaked in citric acid (2%) placed on the tongue dorsum. The use of this method confirmed the reduction of salivary flow rate in patients with Sjögren Syndrome. In addition, a significant reduction in salivary flow rate was observed in patients with primary thyroid insufficiency and peripheral neuropathy secondary to Diabetes Mellitus.

A contribuição da fonoaudiologia na compreensão da síndrome de Waardenburg / Speech and language pathology's contribution to the comprehension of Waardenburg syndrome

Tema: a contribuição da Fonoaudiologia na compreensão da síndrome de Waardenburg. Objetivo: demonstrar a importância do fonoaudiólogo na avaliação de pacientes com síndrome de Waardenburg. Material e Método: uma criança foi atendida por equipe multidisciplinar, sendo submetida à avaliação fonoaudiológica e encaminhada para avaliações complementares, para esclarecimento das hipóteses diagnósticas. Resultados: observou-se dificuldades de compreensão e expressão oral, deficiência auditiva e alterações fenotípicas características da síndrome. Conclusão: para compreensão desta síndrome, é ressaltada a contribuição do fonoaudiólogo e para maior eficiência em relação ao diagnóstico, ao tratamento e ao prognóstico de indivíduos acometidos, é enfatizada a importância da atuação multidisciplinar.

Improvement of semen quality in infected asymptomatic infertile male after bacteriological cure

Bacteriological etiology was investigated in 29 infected asymptomatic infertile males. The localization of the infection and the effect of a long term antibiotic therapy on semen parameters were evaluated. The most frequent etiological agent isolated was Enterococcus faecalis. Positive bacteriological culture was obtained in prostatic fluid in 16 patients and in semen in 13. Bacteriological cure was achieved in 24 cases and it was associated with improved seminal parameters: sperm concentration, motility, viability and total motile sperm per ejaculate. In 5 patients without bacteriological cure there was no change in semen analysis after antibiotic therapy. In 45 percent of the infected patients there were less than 0.5 x 10(6)/ml seminal polymorphonuclear leukocytes. In view of these findings granulocyte concentration seems to be a poor marker to predict infection.