Traqueostomías en pacientes con SARS COV-2 Protocolo de seguridad del equipo de cabeza y cuello / TRACHEOSTOMY IN PATIENTS WITH SARS CoV-2 HEAD AND NECK EQUIPMENT SAFETY PROTOCOL

Introducción: El virus SARS-CoV-2, se presentó en la ciudad de Wuhan, una provincia de Hubei en China, a finales del mes de diciembre de 2019, como un brote de neumonía viral consecuencia de un nuevo tipo de coronavirus B, el cual fue denominado COVID-19; posteriormente, de manera oficial, se declarará al virus como SARS-Cov-2. Los cirujanos de cabeza y cuello realizan traqueostomías en pacientes con COVID-19, lo que supone mayor exposición de aerosolización para estos especialistas. El presente trabajo tiene como finalidad describir la técnica quirúrgica de la traqueostomía abierta con la adecuada protección del equipo de cirugía de cabeza y cuello en los pacientes con SAR-CoV-2-. Métodos: Este estudio se realizó en el Centro Médico Docente la Trinidad, a cargo del servicio de cabeza y cuello. El equipo multidisciplinario estuvo conformado por cirujanos de cabeza y cuello, intensivistas y enfermeros especialistas del área. La traqueostomía fue abierta y fue realizada en los pacientes ingresados en la unidad de cuidados intensivos con resultado positivo de la infección por SARS-CoV-2, en el periodo entre agosto de 2020 a agosto de 2021, previa discusión con el equipo multidisciplinario y con el consentimiento de los familiares del paciente, idealmente, entre el día 15 y 21. Resultados: Se realizaron 14 traqueotomías abiertas, la primera traqueostomía se llevó a cabo el 01/08/2020 y la ultima el 28/08/2021. Todas fueron realizadas en la unidad de terapia intensiva. El personal médico fue el mínimo posible y consto de: Cirujano de cabeza y cuello, primer y segundo ayudante, instrumentista, intensivista, residente de terapia intensiva y enfermera de terapia intensiva. En todos los casos se llevó a cabo la adecuada higiene de manos y colocación del equipo de protección personal. Conclusiones: Mantener a los pacientes relajados durante el procedimiento, desinflar el manguito del tubo endotraqueal y cerrar el circuito previo a la incisión y rápidamente luego de la incisión en tráquea, insertar el traqueostomo y conectar el sistema de circuito cerrado, parece ser una técnica que preserva la seguridad del equipo quirúrgico

Introduction: The SARS-CoV-2 virus appeared in the city of Wuhan, a province of Hubei in China, at the end of December 2019, as an outbreak of viral pneumonia because of a new type of coronavirus B, the was called COVID-19; later, officially, the virus will be declared as SARS-Cov-2. Head and neck surgeons perform tracheostomies in patients with CIVD-19, which results in increased aerolization exposure. The present work aims to describe the surgical technique of open tracheostomy with adequate protection of the head and neck surgery team in patients with SAR-CoV-2. Methods: This study was carried out at the La Trinidad Teaching Medical Center, in charge of the head and neck service. The multidisciplinary team was made up of head and neck surgeons, intensivists, and specialist nurses in the area. The technique was open tracheostomy in patients admitted to the intensive care unit with a positive result for SARS-CoV-2 infection, in the period between August 2020 to August 2021, after discussion with the multidisciplinary team and with the consent of the patient's relatives, ideally between the 15th and 21st. Results: 14 open tracheostomies were performed, the first tracheostomy was performed on 01 / 08/2020 and the last one on 08/28/2021. All tracheostomies were performed in the intensive care unit. The medical staff was the minimum possible and consisted of: Head and neck surgeon, first and second assistant, scrub nurse, intensivist, intensive care resident and intensive care nurse. In all cases, proper hand hygiene and placement of personal protective equipment was carried out. Conclusions: Keeping patients relaxed during the procedure, deflating the endotracheal tube cuff, and closing the circuit prior to the incision and quickly after the incision in the trachea and inserting the tracheostoma, connecting the closed-circuit system, seems to be a technique that preserves the safety of the surgical team

Comparación de máscaras laríngeas (I-gel Fastrach) para realización de intubación endotraqueal guiada con broncofibroscopio flexible / Comparison of I-gel Fastrach laryngeal masks in conducting flexible bronchofiberscope-guided

GOALS: Determine the success rate of guided intubation with a flexible bronchofibroscope (BFC) through supraglottic devices: I-gel or Fastrach, establish the degree of fibroscopic visualization and determine the insertion time of the laryngeal mask airway (LMA) and endotracheal intubation. METHODS: Experimental, prospective, comparative and randomized study of 60 ASA I-II-III patients, older than 18 years, undergoing elective surgeries that required general anesthesia and endotracheal intubation. After anesthetic induction, the assigned LMA was placed and intubation with BFC was performed through it. Both the success of laryngeal mask insertion and intubation were recorded, as well as the time (in seconds) equired for these procedures. The vision of the laryngeal structures was classified according to the Brimacombe Scale. RESULTS: The groups analyzed presented similar general characteristics. Insertion time of he LMA was significantly lower with I-gel than Fastrach (median 12 s vs 16 s. Respectively, p = 0.001). Also, in the intubation time BFC guided through the laryngeal mask, differences in favor of I-gel were found, with a median of 72 s. vs 89 s. (p = 0.001). Regarding the degree of glottic visualization with BFC, no statistically significant differences were found between both groups.CONCLUSIONS: Although both devices had the highest success rate (both in their placement and in intubation through them), with I-gel the intubation was performed quicker.

OBJETIVOS: Determinar la tasa de éxito de intubación guiada con broncofibroscopio flexible (BFC) a través de los dispositivos supraglóticos: I-gel o Fastrach, establecer el grado de visualización fibroscópica y determinar el tiempo de inserción de la máscara laríngea y de intubación endotraqueal. MATERIALES Y MÉTODOS: Estudio experimental, prospectivo, comparativo y aleatorizado de 60 pacientes ASA I- II ­III, mayores de 18 años, sometidos a cirugías electivas que requerían anestesia general e intubación endotraqueal. Luego de la inducción anestésica, se procedió a colocar la máscara laríngea asignada y se realizó la intubación con BFC a través de la misma. Tanto el éxito de inserción de máscara laríngea como de intubación fueron registrados, así como el tiempo (en segundos) requerido para dichos procedimientos. La visión de las estructuras laríngeas fue clasificada de acuerdo a Escala de Brimacombe. RESULTADOS: Los grupos analizados presentaron características generales similares. El tiempo de inserción de la ML fue significativamente menor con I-gel que con Fastrach (medianas: 12 s. vs 16 s. respectivamente, p = 0,001). También en el tiempo de intubación guiada con BFC a través de la máscara laríngea, se encontraron diferencias en favor de I-gel, con una mediana de 72 s. vs 89 s. (p = 0,001). Respecto al grado de visualización glótica con BFC, no se encontraron diferencias estadísticamente significativas entre ambos grupos. CONCLUSIONES: Aunque ambos dispositivos tuvieron la máxima tasa de éxito (tanto en su colocación como en la intubación a través de ellos), con I-gel se realizó la intubación de manera más rápida.

Desempeño productivo y desarrollo ruminal en cabritos de tambo alimentados con diferentes dietas y faenados a distintas edades / Productive performance and ruminal development in dairy kids fed with different diets and slaughtered at different ages

El objetivo del presente trabajo fue evaluar el desempeño productivo y desarrollo ruminal de cabritos Saanen alimentados con alfalfa y/o grano (Alf, Alf + Gr, Gr) y faenados a distintas edades (50, 60 y 70 días). Se evaluó: ganancia diaria de peso vivo (GDPV), peso a faena (PF), peso de la canal caliente (PCC), rendimiento a faena (RF), peso de los estómagos y el largo de las pailas (LP). El diseño fue DCA con arreglo factorial y para la comparación de medias se utilizó LSD (p=0,05). Los animales fueron asignados al azar dentro de los tratamientos: Alf 50 (n=3), Alf 60 (n=4), Alf 70 (n=3), Gr 50 (n=3), Gr 60 (n=4), Gr 70 (n=3), Alf+Gr 50 (n=3), Alf+Gr 60 (n=4), Alf+Gr 70 (n=3). Los datos fueron analizados mediante ANOVA de Infostat 2018. No se detectó interacción entre dieta y edad de faena para ninguno de los parámetros. En cuanto a la dieta, los animales que consumieron Alf y Alf + Gr presentaron mayores GDPV (p= 0,0022). El PF fue superior para el grupo Alf+Gr respecto al Gr (p=0,0352). Similar fue lo relevado para el PCC (p=0,0298). El RF fue mayor para el grupo Gr respecto a las otras dietas (p <0,0001). La edad a faena impactó en el PF y PCC resultando superior en los animales faenados con 70 días, (p= 0,0002 y p= 0,0008 respectivamente), mientras que aquellos sacrificados a los 50 días presentaron el mayor RF (p=0,0413). El peso del rumen fue superior para el grupo 70 vs. 50 y 60 días (p=0,0410). El LP fue similar para todos los tratamientos. Se puede concluir que para las condiciones del presente ensayo tanto la dieta suministrada como la edad a faena afectaron el desempeño productivo de los animales.

The aim of this work was to evaluate performance and ruminal development of dairy kids fed with different diets (alfalfa and / or grains: Alf, Alf + Gr, Gr) and slaughtered at different ages (50, 60 and 70 days of life). Parameters evaluated were: daily live weight gain (GDPV), slaughter weight (PF), hot carcass weight (PCC), slaughter yield (RF), stomach weight and ruminal papillae length (LP). Animals were assigned by random in the treatments: Alf 50 (n=3), Alf 60 (n=4), Alf 70 (n=3), Gr 50 (n=3), Gr 60 (n=4), Gr 70 (n=3), Alf+Gr 50 (n=3), Alf+Gr 60 (n=4), Alf+Gr 70 (n=3). Data were analyzed with linear mixed model according to a repeated measures design by ANOVA of Infostat 2018 program. Means multiple comparisons were evaluated by LSD-Fisher test (P = 0.05). No interaction was detected for diet and slaughter age. Regarding diet, animals that consumed Alf and Alf + Gr presented higher GDPV (p = 0.0022). FP and PCC were higher for Alf + Gr than for Gr group (p = 0.0352 and p = 0.0298). RF was higher for the Gr group than for the others (p <0.0001). Age at slaughter affected PF and PCC, animals with 70 days had the highest values (p= 0.0002 and p= 0,0008). 50 days old kids had the maximum RF (p=0.0413). Rumen weight was higher for group 70 compared with groups 60 and 50 (p=0.0410). LP was similar for all treatments. It is possible to conclude that diet and age affected the productive performance of animals.

El papel de los mastocitos en la evaluación de la respuesta inflamatoria posoperatoria, al implantar mallas protésicas para la reparación de defectos de la pared abdominal en biomodelos rata Wistar / The role of mast cells in the assessment of postoperative inflammatory response to implanting prosthetic mesh for the repair of abdominal wall defects in Wistar rats

Resumen Objetivo: El objetivo de este estudio fue evaluar el papel de los mastocitos en la respuesta inflamatoria posoperatoria tras el implante de mallas protésicas para la reparación de defectos de la pared abdominal en biomodelos rata Wistar. Materiales y Métodos: Se fabricó una malla de fibroma entretejiendo sus hilos. Se utilizaron 25 ratas Wistar macho adultas, a las cuales se les creó un defecto quirúrgico de 30 × 20 mm en la pared abdominal anterior. Este defecto anatómico fue posteriormente reparado con uno de los dos tipos de mallas previamente esterilizadas, las cuales fueron la malla de fibroína, y la malla comercial ultrapo monocryl prolene composite (Johnson & Johnson-Ethicon). A los 28 días después del procedimiento quirúrgico se sacrificaron los biomodelos y se extrajeron las muestras que posteriormente fueron tratadas con técnicas histoquímicas para su análisis histológico. Resultados: El estudio reportó adherencia a omento en los dos tipos de malla utilizadas, sin embargo, la malla comercial mostró adherencias de amplio espesor a colon, intestino delgado e hígado, incluyendo también al omento menor. Se encontró que la malla comercial presentaba mayor cantidad de mastocitos en las regiones estudiadas (dermis, perimisio, y la serosa visceral). Discusión: Estudios refieren que los mastocitos y sus productos como la histamina, la serotonina, entre otras juegan un papel clave en el control de la inflamación local, la cicatrización de heridas, adherencias y las reacciones a cuerpos extraños in vivo. Conclusión: Con base en la literatura consultada se puede concluir que el presente estudio es vanguardista en lo que respecta al posible papel que juegan los mastocitos en el proceso de reparación de defectos anatómicos de la pared abdominal.

Objective: The objective of this study was to evalúate the role of mast cells in the postoperative inflammatory response after implantation of prosthetic mesh to repair abdominal wall defects in Wistar rat. Materials and Methods: An abdominal wall defect (30 × 20 mm) was created in the anterior abdominal wall of 25 adult male Wistar rats. The anatomical defect was then repaired with one of the two type's meshes. Fibroin and monocryl ultrapo prolene meshes. Fibroin meshes were manufactured by weaving its threads, the polypropylene mesh was bought to Johnson & Johnson-Ethicon. After 28 days of implantation Wistar rats were sacrificed and the mesh with abdominal tissue was extracted. Subsequently the samples were treated with histochemical techniques for histological analysis. Results: The study reported adherence to omentum in both types of meshes used, however, the polypropylene mesh showed widely adhesions to colon, slight to intestine and liver, also in a very lower amount, adhesions to omentum. It was found that mast cells were presented in all the studied regions for the polypropylene mesh (dermis, perimysium, and visceral serosa). Discussion: Studies indicate that mast cells and their products such as histamine, seroto- nin, and others play a key role in controlling local inflammation, wound healing, adhesions, and reactions to foreign bodies in vivo. Conclusion: We can conclude that this study is a good step to show the possible role of mast cells in the abdominal wall repair process.

Post-fire reproduction of herbs at a savanna-gallery forest boundary in Distrito Federal, Brazil / Reprodução pós-fogo de espécies do estrato herbáceo em área de transição Cerrado-Mata de Galeria no Distrito Federal, Brasil

Abstract In Cerrado, studies of post-fire vegetation recovery show that some herbaceous species are able to flower shortly after fires. However, these were mainly short-term studies that focused on grasslands and savannas. Little is known about the effects of fire on ground layer of forests that border the savannas in Central Brazil. Thus, an accidental burning gave us the opportunity to describe the reproductive activity of the ground layer vegetation after a fire event along a savanna-forest boundary at the IBGE Ecological Reserve, Brasília, Brazil. During the 16-month of the inventory, we registered 170 herbaceous species flowering or fruiting, of which 52 species (31%) may have been influenced by fire that changed their times of reproduction. In the savanna plots reproduction peaked at the end of the rainy season. Of the total number of reproducing species, 90 species occurred only in the savanna and four in the forest. Five herbs were recorded in the forest, savanna and border environments. Late dry season fire probably lead the majority of herbaceous species to have their reproduction spread throughout the study time.

Resumo No Cerrado, estudos de recuperação da vegetação pós-fogo mostram que algumas espécies herbáceas são capazes de florescer logo após queimadas. No entanto, esses foram principalmente estudos de curto prazo, que se concentraram em áreas campestres e savânicas. Pouco se sabe sobre os efeitos do fogo no sub-bosque de matas que margeiam as savanas do Brasil Central. Assim, uma queima acidental nos deu a oportunidade de descrever a atividade reprodutiva pós-fogo do estrato herbáceo ao longo de ecótono cerrado-mata na Reserva Ecológica do IBGE, Brasília, Brasil. Durante os 16 meses do inventário, foram registrados 170 espécies herbáceas com flores ou frutos, das quais 52 espécies (31%) podem ter sido influenciadas pelo fogo, que alterou suas épocas reprodutivas. Nas parcelas de cerrado, a reprodução teve seu pico ao final da estação chuvosa. Do número total de espécies, 90 ocorreram exclusivamente no cerrado e quatro na floresta. Cinco espécies herbáceas foram registradas na floresta, cerrado e borda. O fogo ao final da estação seca pode ter levado a maioria das plantas a se reproduzir através do período de estudo.

Características de los casos de violencia contra la mujer de Asunción y Gran Asunción, Paraguay (2008-2012) / Characteristics of cases of violence against women from Asunción and Gran Asunción, Paraguay (2008-2012)

La violencia contra la mujer constituye"todo acto de violencia basado en el género que tiene como resultado posible o real un daño físico, sexual o psicológico", constituyendo un problema de violación de los derechos humanos y de salud pública. El objetivo fuedescribir las características de los casos de violencia contra las mujeres provenientes de Asunción y Gran Asunción, registrados en el Museo de la Justicia, desde el 1 de enero del 2008 al 30 de junio del 2012. Fueron analizadas 1.722 fichas de los juzgados de paz de Asunción y Gran Asunción, remitidos al Museo de la Justicia.Elpromedio de edad de la víctima fue de 35 ± 11,5 años (rango 15 a 87); victimarios 37 ± 10,6 años (rango 14 a 87).Tanto las víctimas como los agresores eran de Asunción, casados, estudios primarios. Las víctimas eran amas de casa 55,1%, (949) y los agresores dependientes (44,9%, 773). El 56,1% (966) tenían hijos y de estos 39,7% (683) sufrieron algún tipo de agresión. El 63,4%(1.092) recibió más de un tipo de violencia, siendo la psíquica las más frecuente (25%, 430). El 50,3%(867) recibió agresiones con una frecuencia de 1 a 5 veces en el último año, 50,2% (864) realizó denuncias previas. Otros factores fueron el alcohol 24,9% (428) y factores culturales como los celos, el machismo, etc. Se encontraron diferencias estadísticamente significativas con la profesión y la violencia. La violencia contra la mujer constituye un grave problema que debe ser visualizado para su prevención. Palabras claves: Violencia contra la mujer; Violencia; mujer; Asunción; Gran Asunción.

Violence against women constitutes in "any genderbased act of violence that results in physical, sexual or psychological harm" resulting in the violation of human rights and public health. The objective was to describe the characteristics of cases of violence against women from Asunción and Gran Asunción, registered in the Museum of Justice, from January 1, 2008 to June 30, 2012. 1,722 files sent to the Museum of Justice were analyzed from Asuncion and Gran Asunción's peace courts. The average age of the victims was between 35 ± 11.5 years (range 15-87); perpetrators 37 ± 10.6 years (range 14 to 87). Both the victims and the perpetrators were of Asunción, married, primary studies. The victims were housewives (55.1%, 949) and the dependent aggressors (44.9%, 773). 56.1% (966) had children and of these, 39.7% (683) suffered some form of aggression. 63.4% (1,092) received more than one type of violence, being the psychic the most frequent one (25%, 430). 50.3% (867) received assaults with a frequency of 15 times in the last year, 50.2% (864) made previous complaints. Other factors were alcohol 24.9% (428) and cultural factors such as jealousy, male chauvinism, etc. Statistically significant differences were found with the profession and violence. Violence against women is a serious problem that must be visualized for its prevention. Key words: Violence against women; violence; woman; Asuncion; Gran Asunción.

Distribution and genetic diversity of the human polyomaviruses JC and BK in surface water and sewage treatment plant during 2009 in Porto Alegre, Southern Brazil / Distribuição e diversidade genética dos poliomavírus humanos JC e BK em águas superficiais e de estação de tratamento de esgoto durante 2009 em Porto Alegre, sul do Brasil

Abstract The human polyomaviruses JC and BK (JCPyV and BKPyV) are ubiquitous, species-specific viruses that belong to the family Polyomaviridae. These viruses are known to be excreted in human urine, and they are potential indicators of human wastewater contamination. In order to assess the distribution of both JCPyV and BKPyV in urban water samples collected from a sewage treatment plant (STP) and from a canalized water stream of Porto Alegre, Brazil, two nested-PCR assays were optimized and applied to the samples collected. The amplicons obtained were submitted to sequencing, and the sequences were analyzed with sequences of human polyomaviruses previously deposited in GenBank. Twelve out of 30 water samples (40%) were JCPyV positive, whereas six samples (20%) were BKPyV positive. The sequencing results confirmed the presence of JCPyV subtypes 1 and 3, whereas only BKPyV Ia and Ib were found. This study shows for the first time the presence of human polyomaviruses in surface water and in samples collected in a sewage treatment plant in southern Brazil.

Resumo Os poliomavírus humanos JC e BK (JCPyV e BKPyV) são virus ubíquos, espécie-específicos, pertencentes à família Polyomaviridae. Estes vírus são conhecidos por serem excretados pela urina humana, sendo considerados potenciais indicadores de contaminação por águas residuais urbanas. Buscando acessar a distribuição de JCPyV e BKPyV em amostras de águas coletadas de uma estação de tratamento de esgoto e de um arroio canalizado de Porto Alegre, Brasil, duas técnicas de nested-PCR foram otimizadas e aplicadas às amostras coletadas. Os amplificados obtidos foram submetidos ao sequenciamento e suas sequências analisadas com base em sequências de poliomavírus humanos previamente depositadas no GenBank. Doze de 30 amostras de água (40%) foram positivas para JCPyV, enquanto 6 amostras (20%) foram positivas para BKPyV. Os resultados do sequenciamento confirmaram a presença dos subtipos 1 e 3 de JCPyV, enquanto apenas os BKPyV Ia e Ib foram encontrados. Este estudo demonstra pela primeira vez a presença de poliomavírus humanos em águas superficiais e em amostras coletadas em uma estação de tratamento de esgoto na região sul do Brasil.

Interdisciplinarity and nursing research: opportunities and challenges / Interdisciplinaridade e pesquisa em enfermagem: oportunidades e desafios / La interdisciplinariedad y la investigación en enfermería: oportunidades y desafíos

Interdisciplinary collaboration is widely recognized and considered essential for optimizing the development of knowledge and practice. However, interdisciplinarity is commonly accepted as an unquestioned good; rarely examined as both a source of benefit as well as difficulty for nursing and other disciplines. The aim of this article is to critically examine the opportunities and challenges that interdisciplinarity can provide for research in nursing and other disciplines. Based on a North American perspective, I describe the emergence of uni-disciplinary nursing research and the knowledge exchanges that occurred between nursing and other disciplines. I discuss the rise of interdisciplinary research, outline several examples of nursing participation in interdisciplinarity, and highlight the prominent benefits and difficulties associated with interdisciplinary research. I argue that authentic collaboration is required to conduct meaningful interdisciplinary research and describe how this can be promoted.

Colaboração interdisciplinar é amplamente reconhecida e considerada essencial para a otimização do desenvolvimento do conhecimento e prática. No entanto, a interdisciplinaridade é comumente aceita como um bem inquestionável, raramente examinado tanto como uma fonte de benefícios, bem como dificuldade para a enfermagem e outras disciplinas. O objetivo deste artigo é analisar criticamente as oportunidades e desafios que a interdisciplinaridade pode oferecer para a pesquisa em enfermagem e outras disciplinas. Com base em uma perspectiva norte-americana, descreve-se o surgimento de pesquisas em enfermagem unidisciplinar e as trocas de conhecimento que ocorreram entre a enfermagem e outras disciplinas. Discute-se a ascensão da pesquisa interdisciplinar, delineiam-se vários exemplos de participação da enfermagem na interdisciplinaridade, e destacam-se os benefícios proeminentes e dificuldades associadas com a pesquisa interdisciplinar. Defende-se que a colaboração autêntica é necessária para conduzir a pesquisa interdisciplinar significativa e descreve-se como isso pode ser promovido.

La colaboración interdisciplinaria es ampliamente reconocida y considerada esencial para optimizar el desarrollo del conocimiento y la práctica. Sin embargo, la interdisciplinariedad es comúnmente aceptada como un bien incuestionable; rara vez examinada tanto como una fuente de beneficio, así como de dificultad para la enfermería y otras disciplinas. El objetivo de este artículo es examinar críticamente las oportunidades y desafíos que la interdisciplinariedad puede proporcionar para la investigación en enfermería y otras disciplinas. Sobre la base de una perspectiva norteamericana, describe-se el surgimiento de la investigación en enfermería unidisciplinaria y los intercambios de conocimientos que se produjeron entre la enfermería y otras disciplinas. Se discute el aumento de la investigación interdisciplinaria, esbozan-se varios ejemplos de la participación de enfermería en la interdisciplinariedad, y destacan-se los beneficios y las dificultades asociadas con la investigación interdisciplinaria. Argumenta-sé que se requiere auténtica colaboración para llevar a cabo la investigación interdisciplinaria significativa y describe-se la forma en que esto puede ser promovido. .

Seventh cervical nerve perforating the middle scalene muscle: a possible clinical and surgical application

Introduction: In most of cases, the emergency of the nervous roots of the brachial plexus in the posterior cervical triangle occur between the anterior and middle scalene muscles. However, anatomic variations in the brachial plexus are not rare. Methods: In the laboratory of Human Anatomy of the "Faculdade de Ciências Médicas de Minas Gerais" 106 cadavers were dissected. There were dissected the cervical region of all of the cadavers bilaterally. Results: In routinely dissection in the laboratory of human anatomy of the "Faculdade de Ciências Médicas de Minas Gerais" we've found in the left cervical region of a male cadaver the ventral branch of the seventh cervical nerve (C7) perforating the substance of the middle scalene muscle. Conclusion: Professionals that work with this region on the practice must pay attention to this and other variations in the constitution of the brachial plexus in the clinic and surgical procedures to avoid complications.(AU)

Confronting moral distress in Nursing: recognizing nurses as moral agents / Fazendo frente ao sofrimento moral na Enfermagem: reconhecendo as enfermeiras como agentes morais / Enfrentando la angustia moral en Enfermería: reconociendo las enfermeras como agentes morales

The concept of moral distress has brought forth a substantively different way of understanding some of the difficulties confronted by nurses in their practice. This concept highlights that nurses' distress can be an indication of nurses' conscientious moral engagement with their professional practice that has confronted practices or an environment that impedes them from acting according to their own ethical standards. Moral distress can be an indicator of problems in nurses' practice environments. This concept is described and related to moral agency in nursing practice. Selected research on moral distress is reviewed, followed by a discussion of recommendations for addressing this problem.

O conceito de sofrimento (ou angústia) moral trouxe à luz uma maneira substancialmente diferente de compreender algumas das dificuldades enfrentadas pelos enfermeiros em sua prática. Este conceito destaca que o sofrimento dos enfermeiros pode ser um indicador de um engajamento moral consciencioso dos enfermeiros com sua prática profissional, que têm confrontado práticas ou um ambiente que os impede de agir de acordo com seus próprios padrões éticos. Sofrimento moral pode ser um indicador de problemas nos ambientes de prática dos enfermeiros. Este conceito é descrito e relacionado a agência moral na prática da Enfermagem. É revista uma pesquisa selecionada sobre sofrimento moral, seguida de uma discussão de recomendações para enfrentar este problema.

El concepto de angustia moral ha iluminado una forma sustancialmente diferente de entender algunas de las dificultades enfrentadas por los enfermeros en su práctica. Este concepto pone de relieve que el sufrimiento de los enfermeros puede ser una indicación de conciencia de compromiso moral con su práctica profesional, en que han enfrentado prácticas o un entorno que les impide de actuar de acuerdo con sus propias normas éticas. Angustia moral puede ser un indicador de problemas en los entornos de la práctica de los enfermeros. Este concepto es descrito y relaciona con la agencia moral en la práctica de Enfermería. Investigación seleccionada en la angustia moral es revisado, seguido de un debate sobre las recomendaciones para hacer frente a este problema.

Clinical Implications caused by the agenesis of the RectusAbdominal Muscle’s (MRA) inferior venter

The rectus abdominal muscle is part of the anterior abdominal wall, having three to six bellies. In only oneof the 106 dissections already made in the “Faculdade de Ciências Médicas de Minas Gerais” AnatomyLaboratory was found a male cadaver who did not have inferior venter of this muscle bilaterally. Instead, at theleft side, was found a tendon that measured 5.5 cm laterally and 12 cm medially, and at the right side, therewas the same variation with a 15.5 cm length tendon, rising in the upper branch of the pubis and crest pubis.Despite being a rare variation, individuals who have showed it have increased potential for physiological andsurgical complications, in case they need interventions using inferior rectus abdominis muscle venter’s snips.

Anomalous origin of the Abductor Pollicis Longus (APL): clinical and surgical applications

The Abductor Pollicis Longus (APL) is known to have a big variety in its number of insertion tendons.Because of that, studies about variations in its origin are not frequently achieved like studies about its insertionforms. This study describes an anatomic variation of the Abductor Pollicis Longus, with an anomalous venteroriginated of the inferior portion of the lateral border of the radio. Surgical and clinical implications are inrelation principally with the big number of tendons of insertion of the APL, but there are related cases inthe literature in that additional venter of this muscle also can be involved in the physiopathology of clinicalsyndromes, like the tenosynovitis of de Quervain

Herpesvírus bovinos (BoHV-1.1 e BoHV-1.2b) em forma infecciosa em encéfalos de bovinos submetidos ao diagnóstico de raiva no estado do Rio Grande do Sul / Bovine herpesviruses (BoHV-1 and BoHV-1.2b) in infectious form in brains of cattle submitted to rabies diagnosis in the State of Rio Grande do Sul, Brazil

Verificou-se a incidência de herpesvírus bovinos (BoHVs) em encéfalos de bovinos submetidos ao diagnóstico de raiva no estado do Rio Grande do Sul. Para tanto, amostras coletadas durante dois anos (n=70) foram submetidas ao isolamento viral em cultivos celulares. Os BoHVs foram isolados em dois (2,9 por cento) encéfalos. Após serem submetidas à caracterização antigênica e molecular, as amostras foram subtipadas como BoHV-1.1 e BoHV-1.2b. A BoHV-1.1 foi isolada de um encéfalo que foi também positivo para raiva. O vírus da raiva foi identificado em 11 amostras (15,7 por cento). Estes achados revelam que a incidência de BoHVs em forma infecciosa em bovinos com encefalite foi baixa, embora represente 16,7 por cento (2/12) dos encéfalos nos quais um agente viral foi identificado. Tal fato confirma a já reportada associação entre BoHV-1 e encefalites. Esse é o primeiro relato da ocorrência de BoHV-1.2b, um subtipo considerado menos patogênico, em um caso de doença neurológica em bovinos.

The incidence of bovine herpesviruses (BoHVs) was determined in brains of cattle submitted to rabies diagnosis in the State of Rio Grande do Sul, Brazil. Brain samples collected in a two-year interval (n=70) were submitted to virus isolation in cell culture. The BoHVs were isolated from two (2.9 percent) of the brains. After the antigenic and molecular characterization, the isolated strains were subtyped as BoHV-1.1 and BoHV-1.2b. The BoHV-1.1 isolate was recovered from a brain sample that was also positive for rabies. Rabies virus was identified in 11 (15.7 percent) samples. These findings reveal that the incidence of infectious BoHVs in brains of cattle with encephalitis was low, although these represented 16.7 percent (2/12) of samples from which at least one viral agent was identified. This confirms the previously reported link between BoHV-1 and bovine encephalitis. However, it is the first report on the association of BoHV-1.2b, a putatively less pathogenic BoHV subtype, with neurological disease in cattle.

Condrossarcoma primário de língua em cão / Primary chondrosarcoma in the tongue of a dog

A 10 year old female Boxer was taken dead to veterinary hospital for a necropsy without any clinical history, showing a growth on the dorsal part of the tongue. Based on the histopathological findings mesenchymal chondrosarcoma was diagnosed. This report describes the first case of chondrosarcoma on the base of the tongue in veterinary medicine.

Pentoxifilina: una aproximación terapéutica en el manejo de necrólisis epidérmica tóxica. Reporte de un caso / Pentoxifiline: a therapeutic approach in the management of toxic epidermal necrolysis. Case Report

Hombre de 21 años, con aparición de lesiones ampollosas en más de 30porciento de la superficie corporal total (SCT), con antecedente de consumo de sulfas en los 15 días previos a la aparición de los síntomas. Se hizo diagnóstico de necrólisis epidérmica tóxica (NET) y se inició manejo con pentoxifilina y soporte hidroelectrolítico, con evolución satisfactoria y ausencia de complicaciones. El caso presentado a continuación reviste especial interés considerando el no acuerdo general en el momento para el manejo de esta entidad y los resultados ampliamente favorables que ofrece la pentoxifilina en su manejo, perfilándola como una opción terapéutica de alto costo-efectividad en nuestro medio...

Co-infections with bovine herpesvirus type 5 and bovine viral diarrhoea virus

During a series of experiments attempting to reproduce clinically apparent bovine herpesvirus type 5 (BoHV-5) infections, a group of calves was inadvertently infected with bovine viral diarrhoea virus (BVDV). Another group of calves was infected with BoHV-5 only. This paper reports the outcome of such infections. Two out of six calves solely infected with BoHV-5 displayed moderate to severe clinical signs. Three out of four calves of the group co-infected with BoHV-5 and BVDV developed severe clinical signs, two of them died. BoHV-5 virus was isolated to higher titres and for a longer period from the group of calves infected with both viruses. These results suggest that BVDV may enhance clinical signs induced by BoHV-5 and may also play a role in extending the period of BoHV-5 shedding.

Durante a realização de experimentos envolvendo inoculações experimentais com herpesvírus bovino tipo 5 (BoHV-5), um grupo de bovinos foi acidentalmente também inoculado com vírus da diarréia viral bovina (BVDV). Os dados obtidos nesta co-infecção foram então comparados a aqueles observados em animais inoculados exclusivamente com BoHV-5. No grupo infectado com BoHV-5 somente, dois dos seis animais inoculados mostraram sinais clínicos de moderados a graves. No grupo co-infectado com BoHV-5 e BVDV, três dos quatro animais desenvolveram doença grave, e dois deles morreram. BoHV-5 foi isolado em títulos maiores e por um período de tempo mais longo no grupo co-infectado. Os resultados sugerem que o BVDV pode exacerbar os sinais clínicos induzidos pelo BoHV-5 e, ainda, aumentou os níveis de excreção deste último.

Cuidadores familiares de ancianos: quienes son y como asumen este rol / Relatives as caregivers of the elderly: who they are and how they assume their role

Objetivo: caracterizar el perfil sociodemográfico de cuidadores familiares de ancianos con dependencia funcional y describir cómo asumen su rol. Materiales y métodos: estudio descriptivo de corte transversal; 39 cuidadores familiares de ancianos con dependencia funcional, con seis o más meses como cuidadores, sin retribución económica, que viven en Envigado. Muestreo por conveniencia. Resultados: 100 por ciento mujeres, edad promedio 53,9 años, 64,1 por ciento hijas de quien cuidan; 89,7 por ciento comparten vivienda con el anciano; 38,5 por ciento solteras y 38,5 por ciento casadas, 51,3 por ciento tienen hijos. Baja escolaridad: 28,1 por ciento primaria incompleta. Situación socioeconómica así: ingreso familiar promedio del 89,7 por ciento es menor de dos salarios mínimos legales mensuales. El 79,5 por ciento comparten el papel de cuidadora con otro; 64,1 por ciento sin actividad remunerada previamente. Con referencia al cuidado: 30,8 por ciento lleva entre 3 y 6 años, 12,9 por ciento más de 12 años; 76,9 por ciento dedica más de ocho horas día; 56,3 por ciento reciben apoyo fundamentalmente de familiares y, del sistema formal, el 7,7 por ciento . Conclusiones: en Colombia es incipiente el reconocimiento del cuidado familiar; hay similitud del perfil de cuidadores con otros países; la situación del perfil de las cuidadoras se acentúa por el escaso tiempo para enriquecimiento personal y poco apoyo sistemático; se percibe ausencia de políticas de salud para fortalecer el cuidado familiar y los cuidadores.