Evaluación de una intervención para mejora en la administración segura de medicación en el turno de noche / An Intervention to Improve Safe Administration of Medication in the Night Shift

Introducción: Uno de cada siete pacientes hospitalizados experimenta un evento adverso relacionado con la administración de medicación. Los errores de medicación son una de las causas más importantes de mortalidad y morbilidad prevenible. Objetivo: Evaluar la eficacia de una intervención formativa sobre la población de enfermeras de turno de noche de un hospital de agudos para mejorar el cumplimiento del protocolo de administración segura de medicación. Métodos: Ensayo experimental, pre-post intervención formativa, realizado en Hospital Clínic de Barcelona, durante 2015-2016. Población: 268 enfermeras en dos turnos de noche, muestra: 177 participantes (88 Grupo Control y 89 Grupo Experimental). La intervención consistió en sesiones informativas y acceso a Procedimiento escrito. El instrumento de medida fue el Procedimiento Normalizado de Trabajo de la institución mediante check-list de cumplimiento. Se realzó estudio uni-bivariable, mediante Chi2 y test de Fisher con significancia para p < 0,05. Resultados: Se realizaron 219 observaciones en Grupo Control y 207 en Grupo Experimental. De 17 variables analizadas, solo tres mostraron diferencias significativas: en Grupo Experimental mejoró el conocimiento del Procedimiento; se incrementó el uso del agua y jabón sobre la solución hidroalcohólica; y empeoró la identificación normalizada de fármacos pendientes de administrar. Ninguna de las 14 variables restantes mostró diferencias significativas. De 426 observaciones, solo se produjeron 3 errores de medicación en Grupo control, subsanados antes de su administración, y 0 en Grupo Experimental. Conclusiones: Las intervenciones formativas clásicas con receptores pasivos pueden no ser eficaces para mejorar la práctica enfermera en administración segura de medicación(AU)

Introduction: One in seven hospitalized patients experiences an adverse event related to administration of medication. Medication errors are one of the most important causes of preventable mortality and morbidity. Objective: To assess the efficacy of a training intervention with the population of night shift nurses in an acute care hospital, in order to improve compliance with the protocol for the safe administration of medication. Methods: Experimental trial, pre-post training intervention, carried out at Hospital Clínic of Barcelona, during 2015-2016. The population consisted of 268 nurses in two night shifts. The sample consisted of 177 participants (88 from the control group and 89 from the experimental group). The intervention consisted in information sessions and access to a written procedure. The measurement instrument was the Institution's Standard Work Procedure by means of a compliance check-list. Uni-bivariate study was performed, using chi-square and Fisher's test with a significance of P < 0.05. Results: 219 observations were carried out in the control group and 207, in the experimental group. Of seventeen variables analyzed, only three showed significant differences: in the experimental group, knowledge of the procedure improved, increase in the use of soap and water over hydroalcoholic solution, and worsening of standardized identification of drugs pending from being administered. None of the fourteen remaining variables showed significant differences. Of 426 observations, only three medication errors occurred in the control group, corrected before its administration, and zero occurred in the experimental group. Conclusions: Classic training interventions with passive receptors may not be effective to improve nursing practice in safe administration of medication(AU)

Síndrome de Fitz-Hugh-Curtis: hallazgo incidental durante el estudio de la infertilidad femenina / Fitz-Hugh-Curtis syndrome: incidental finding during the study of female infertility

RESUMEN La imposibilidad para concebir, después de un año de relaciones sexuales sin protección, es un término aceptado como infertilidad. Entre un 15 y un 20 % de parejas en Cuba requieren algún tipo de ayuda para lograr un hijo. La laparoscopia contrastada es uno de los estudios protocolizados que se debe realizar en la búsqueda de la etiología de esa incapacidad, sobre todo cuando se sospecha una posible causa tubo-peritoneal. El síndrome de Fitz-Hugh-Curtis o perihepatitis, consiste en una inflamación de la cápsula hepática, provocada por una infección (la más frecuente: clamidias), como manifestación extrapélvica de una enfermedad inflamatoria. Se informó el hallazgo insospechado de este síndrome durante la realización de una laparoscopia contrastada, asociada a una obstrucción bilateral de las trompas, sin síntomas clínicos, que hizo sospechar de un proceso pélvico infeccioso previo, como posible factor etiológico de la dificultad para concebir.

ABSTRACT The inability to conceive after one year of unprotected intercourse is a term accepted as infertility. In Cuba 15-20% of couples require some type of help to conceive a child. Hysterosalpingography is one of the established studies that should be performed when the etiology of this inability is sought, especially when a possible tubal-peritoneal cause is suspected. Fitz-Hugh-Curtis syndrome or perihepatitis, consists of an inflammation of the liver capsule, caused by an infection (chlamydial infection is the most common), as an extrapelvic manifestation of an inflammatory disease. The unsuspected finding of this syndrome was reported during the performance of hysterosalpingography, associated with a bilateral tubal obstruction, without clinical symptoms, which led us to suspect a previous pelvic infectious process, as a possible etiological factor of the difficulty to conceive.

Síndrome de Fitz-Hugh-Curtis: hallazgo incidental durante el estudio de la infertilidad femenina / Fitz-Hugh-Curtis syndrome: incidental finding during the study of female infertility

La imposibilidad para concebir, después de un año de relaciones sexuales sin protección, es un término aceptado como infertilidad. Entre un 15 y un 20 % de parejas en Cuba requieren algún tipo de ayuda para lograr un hijo. La laparoscopia contrastada es uno de los estudios protocolizados que se debe realizar en la búsqueda de la etiología de esa incapacidad, sobre todo cuando se sospecha una posible causa tubo-peritoneal. El síndrome de Fitz-Hugh-Curtis o perihepatitis, consiste en una inflamación de la cápsula hepática, provocada por una infección (la más frecuente: clamidias), como manifestación extrapélvica de una enfermedad inflamatoria. Se informó el hallazgo insospechado de este síndrome durante la realización de una laparoscopia contrastada, asociada a una obstrucción bilateral de las trompas, sin síntomas clínicos, que hizo sospechar de un proceso pélvico infeccioso previo, como posible factor etiológico de la dificultad para concebir.

Segurança e tolerabilidade de Nintedanibe em pacientes com fibrose pulmonar idiopática no Brasil / Safety and tolerability of nintedanib in patients with idiopathic pulmonary fibrosis in Brazil

RESUMO Objetivo Ensaios clínicos mostraram que 150 mg de Nintedanibe duas vezes ao dia reduzem a progressão da doença em pacientes com Fibrose Pulmonar Idiopática (FPI), com um perfil de efeitos adversos que é controlável para a maioria dos pacientes. Antes da aprovação do Nintedanibe como tratamento para a FPI no Brasil, um Programa de Acesso Expandido (PEA) foi iniciado para fornecer acesso precoce ao tratamento e avaliar a segurança e a tolerância do Nintedanibe para este grupo de pacientes. Métodos Foram elegíveis para participar da PEA pacientes com diagnóstico de FPI nos últimos 5 anos, com capacidade vital forçada (CVF) ≥ 50% do previsto e capacidade de difusão dos pulmões para monóxido de carbono (DLco) 30%-79% do previsto. Os pacientes receberam Nintedanibe 150 mg, 2 vezes ao dia (bid). As avaliações de segurança incluíram eventos adversos que levaram à suspensão permanente do Nintedanibe e eventos adversos graves. Resultados O PEA envolveu 57 pacientes em 8 centros. A maioria dos pacientes era do sexo masculino (77,2%) e brancos (87,7%). No início do estudo, a média de idade foi de 70,7 (7,5) anos e a CVF foi de 70,7 (12,5%) do previsto. A média de exposição ao Nintedanibe foi de 14,4 (6,2) meses; a exposição máxima foi de 22,0 meses. Os eventos adversos frequentemente relatados pelo pesquisador como relacionados ao tratamento com Nintedanibe foram diarreia (45 pacientes, 78,9%) e náusea (25 pacientes, 43,9%). Os eventos adversos levaram à suspensão permanente do Nintedanibe em 16 pacientes (28,1%) que passaram por um evento adverso grave. Conclusões No PEA brasileiro, o Nintedanibe apresentou um perfil aceitável de segurança e tolerância em pacientes com FPI, condizendo com dados de ensaios clínicos.

ABSTRACT Objective Clinical trials have shown that nintedanib 150 mg twice daily (bid) reduces disease progression in patients with idiopathic pulmonary fibrosis (IPF), with an adverse event profile that is manageable for most patients. Prior to the approval of nintedanib as a treatment for IPF in Brazil, an expanded access program (EAP) was initiated to provide early access to treatment and to evaluate the safety and tolerability of nintedanib in this patient population. Methods Patients with a diagnosis of IPF within the previous five years, forced vital capacity (FVC) ≥ 50% predicted and diffusing capacity of the lungs for carbon monoxide (DLco) 30% to 79% predicted were eligible to participate in the EAP. Patients received nintedanib 150 mg bid open-label. Safety assessments included adverse events leading to permanent discontinuation of nintedanib and serious adverse events. Results The EAP involved 57 patients at eight centers. Most patients were male (77.2%) and white (87.7%). At baseline, mean (SD) age was 70.7 (7.5) years and FVC was 70.7 (12.5) % predicted. Mean (SD) exposure to nintedanib was 14.4 (6.2) months; maximum exposure was 22.0 months. The most frequently reported adverse events considered by the investigator to be related to nintedanib treatment were diarrhea (45 patients, 78.9%) and nausea (25 patients, 43.9%). Adverse events led to permanent discontinuation of nintedanib in 16 patients (28.1%). Sixteen patients (28.1%) had a serious adverse event. Conclusion In the Brazilian EAP, nintedanib had an acceptable safety and tolerability profile in patients with IPF, consistent with data from clinical trials.

Variables relacionadas con la tentativa suicida en una provincia de España durante tres años (2009-2011) / Variables related to suicide attempt in a Spanish province over a three-year period (2009-2011)

Resumen Se trató de detectar y describir variables socio-demográficas y clínicas en personas que han realizado una tentativa suicida. Se llevó a cabo un análisis de los registros telemáticos sobre personas admitidas en los servicios de Urgencias del distrito sanitario norte durante el periodo 2009-2011 por trastornos mentales. Se seleccionaron 826 registros de personas, donde 485 eran mujeres, entre 14 y 94 años. Del total, 412 habían realizado un intento de suicidio, y fueron comparadas con otras personas sin tentativa suicida previa. Se aplicó un análisis de regresión logística binaria para examinar los factores más predictivos del intento de suicidio. Los resultados muestran que el riesgo de realizar un intento de suicidio aumenta con la edad, donde el periodo de mayor riesgo es el de 34 a 53 años (p < 0,001; OR = 6,99), ser de género femenino (p < 0,05; OR = 2,70) y encontrarse desempleada (p < 0,05; OR = 4,98). Los diagnósticos psicopatológicos más predictivos para la tentativa suicida fueron los trastornos de ansiedad (p < 0,01; OR = 3,95) y los trastornos del control de impulsos/adicciones (p < 0,01; OR = 3,76). Se discute la importancia de crear perfiles de riesgo y protección concretos para la puesta en marcha de políticas sanitarias contextualizadas de prevención de la tentativa suicida.

Abstract The aim was to identify and describe socio demographic and clinical variables in individuals who have made a suicide attempt. An analysis of electronically stored records on persons admitted to the emergency departments of a northern health district during the period 2009-2011 for mental disorders was conducted. The records of 826 patients (30.1% of the total), where 485 (58.7%) were female, aged between 14 and 94 years (M = 49.3; SD = 12.7), were selected. This amounted to 412 individuals (49.9%) who had made a suicide attempt, and were compared with others without prior suicide attempt. A binary logistic regression analysis was performed to examine the strongest predictors of suicide attempt. The results show that the risk of making a suicide attempt increases with age, those most at risk being aged 34 to 53 years (p < 0.01; OR = 6.99), female (p < 0.05; OR = 2.70) and unemployed (p < 0.05; OR = 4.98). The most predictive psychopathological diagnoses for suicide attempt were anxiety disorders (p < 0.01; OR = 3.95) and impulse control disorders/addictions (p < 0.01; OR = 3.76). The importance of creating specific risk and protection profiles when implementing contextualized health policies on suicide attempt prevention is discussed.

Conocimientos, actitudes y comportamientos sexuales de riesgo en estudiantes universitarios costarricenses de educación / Knowledge, attitudes and risky sexual behavior of university teacher education students in Costa Rica

El objetivo de este estudio es identificar mitos en torno a la salud sexual (VIH y otras ITS), tipos de actitud (hacia la sexualidad, doble moral, hacia la orientación del deseo sexual y hacia la identidad de género) y conductas sexuales de riesgo en estudiantes universitarios de Educación costarricenses, indagando en las posibles diferencias entre varones y mujeres y las relaciones entre las distintas variables. Los resultados permitirán plantear acciones que faciliten la vivencia de una sexualidad saludable y satisfactoria, así como la incorporación de estrategias formativas en este ámbito. Con una muestra de 301 estudiantes, 228 (75.7%) mujeres y 73 (24.3%) varones, de entre 17 y 36 años (M = 21.5; DT = 3.08), el análisis de la información sugiere que el colectivo mantiene mitos en relación al VIH y otras ITS, así como actitudes de censura y erotofóbicas, en mayor medida en los varones. Por el contrario, las prácticas sexuales desprotegidas están más presentes entre las mujeres. Los resultados nos conducen a proponer estrategias sobre cómo fortalecer una educación sexual que permita formar docentes preparados para abordar una educación afectiva y sexual de calidad.

The goal of this work is to identify sexual health myths (HIV and other STI's), types of attitude (related to sexuality, double standard, sexual orientation and gender identity) and risky sexual behaviors in university teacher education students of Costa Rica. This research also explores differences between men and women and the relationship among variables. The results allow to design actions regarding the promotion of healthy and satisfactory sexuality experience, as well as the addition of educative strategies concerning this field. The sample consisted of 301 students, 228 (75.7%) women y 73 (24.3%) men, aged between 17 y 36 (M = 21.5; SD = 3.08). The descriptive analysis pointed out a higher presence of myths associated with HIV and other STIs, along with attitudes of censorship and erotophobia in men. On the opposite, unprotected sexual behaviors were more prevalent among women. The results lead us to propose strategies in order to strengthen sexual education of future teachers, enabling them to address a quality emotional and sexual education.

Quantitative computed tomography analysis of the airways in patients with cystic fibrosis using automated software: correlation with spirometry in the evaluation of severity / Análise quantitativa por tomografia computadorizada das vias aéreas, usando programa automático, em pacientes com fibrose cística: avaliação da gravidade em correlação com a espirometria

Abstract Objective: To perform a quantitative analysis of the airways using automated software, in computed tomography images of patients with cystic fibrosis, correlating the results with spirometric findings. Materials and Methods: Thirty-four patients with cystic fibrosis were studied-20 males and 14 females; mean age 18 ± 9 years-divided into two groups according to the spirometry findings: group I (n = 21), without severe airflow obstruction (forced expiratory volume in first second [FEV1] > 50% predicted), and group II (n = 13), with severe obstruction (FEV1 ≤ 50% predicted). The following tracheobronchial tree parameters were obtained automatically: bronchial diameter, area, thickness, and wall attenuation. Results: On average, 52 bronchi per patient were studied. The number of bronchi analyzed was higher in group II. The correlation with spirometry findings, especially between the relative wall thickness of third to eighth bronchial generation and predicted FEV1, was better in group I. Conclusion: Quantitative analysis of the airways by computed tomography can be useful for assessing disease severity in cystic fibrosis patients. In patients with severe airflow obstruction, the number of bronchi studied by the method is higher, indicating more bronchiectasis. In patients without severe obstruction, the relative bronchial wall thickness showed a good correlation with the predicted FEV1.

Resumo Objetivo: Realizar a análise quantitativa das vias aéreas utilizando programa automático, em imagens de tomografia computadorizada de pacientes com fibrose cística, correlacionando com a espirometria. Materiais e Métodos: Foram estudados 34 pacientes com fibrose cística - 20 masculinos e 14 femininos; idade de 18 ± 9 anos -, divididos em dois grupos segundo a espirometria: grupo I (n = 21) - sem obstrução grave ao fluxo aéreo (volume expiratório forçado no primeiro segundo [VEF1] > 50% previsto); grupo II (n = 13) - com obstrução grave (VEF1 ≤ 50% previsto). Foram automaticamente obtidos: diâmetro, área, espessura e atenuação da parede da árvore traqueobrônquica. Resultados: Na média, foram estudados 52 brônquios por paciente. O número de brônquios analisados foi maior no grupo II. A correlação com a espirometria foi melhor no grupo I, principalmente entre a espessura relativa da parede da terceira a oitava geração brônquica e o VEF1 previsto. Conclusão: A análise quantitativa das vias aéreas em imagens de tomografia computadorizada pode ser útil na avaliação da gravidade da doença na fibrose cística. Nos pacientes com obstrução grave ao fluxo aéreo, o número de brônquios estudados pelo método é maior, indicando mais bronquiectasias. Nos pacientes sem obstrução grave, a espessura relativa da parede dos brônquios tem boa correlação com o VEF1 previsto.

Desarrollo del entorno personal de aprendizaje: valoración de una experiencia con estudiantes universitarios / Development of Personal Learning Environment: assessment of an experience with university students

En este trabajo se muestra los resultados de un estudio derivado de una experiencia cuyo objetivo es analizar el desarrollo del entorno personal de aprendizaje (PLE) de estudiantes universitarios de primer año. El colectivo participante queda compuesto por 96 estudiantes matriculados en el curso de Recursos Tecnológicos de Bachillerato en Orientación de la Universidad Nacional (Costa Rica). Tanto el diagnóstico inicial como la valoración final se obtienen por medio de un cuestionario en línea. De los principales resultados se deriva el poco desarrollo del PLE del estudiantado en el momento de ingresar a la universidad, la valoración positiva que realizan de desarrollo del PLE al finalizar el curso, así como la alta previsión de uso de las diferentes herramientas tanto a nivel personal como profesional.

This work presents the results of a study derived from an experience whose objective is to analyze the development of personal learning environment (PLE) in first-year university students. The participant group is composed of 96 students enrolled in the course of Technological Resources of Bachelor's Degree in Guidance of the Universidad Nacional de Costa Rica. The first diagnosis as well as the final assessment are obtained through an online questionnaire. The main results show the student body´s low development of PLE at the time of joining university, the positive assessment made about the development of PLE at the end of the course, as well as the high forecast use of the different tools, both at personal and professional level.

Variantes alélicas de CYP2D6: *4, *6 y *10 en una muestra de residentes del estado Aragua, Venezuela / Allelic variants of the CYP2D6: *4, *6 and *10 in a sample of resident from the Aragua state, Venezuela

El objetivo del estudio fue determinar la frecuencia de las variantes del gen CYP2D6: *4, *6 y *10 y predecir el fenotipo metabolizador en una muestra de 145 individuos no consanguíneos, aparentemente sanos, residentes del estado Aragua, Venezuela. Los genotipos fueron determinados mediante ensayos de reacción en cadena de la polimerasa seguidos de digestión con endonucleasas de restricción. La predicción del fenotipo metabolizador se realizó con base al sistema Activity score. Las frecuencias de CYP2D6 *4, *6 y *10 fueron de 14,5%, 0,3% y 1%, respectivamente; un porcentaje significativo de individuos fueron categorizados como metabolizador rápido heterocigoto/metabolizador intermedio (23,5%) y metabolizador lento (4,1%). Esta información tiene impacto clínico potencial, porque CYP2D6 interviene en el metabolismo de fármacos de prescripción frecuente como: carvedilol, captopril, cloroquina, codeína, fluoxetina, fluvastatina, haloperidol, idarrubicina, indinavir, imatinib, loperamida, nifedipina, ondansetrón y tamoxifeno...

The aim of this study was to determine the CYP2D6: * 4, * 6 and * 10 gene variants frequency and to predict the metabolizer phenotype in a sample of 145 unrelated apparently healthy individuals residing in the state of Aragua, Venezuela. Genotypes were determined by Polymerase chain reaction assays followed by restriction endonucleases digestion. The metabolizer phenotype prediction was made based on the activity score system. The frequencies of CYP2D6 * 4, * 6 and * 10 allelic variants were 14.5%, 0.3% and 1%. A significant percentage of individuals were categorized as heterozygote-extensive/intermediate (23.5%) and poor metabolizers (4.1%), this information has potential clinical impact, because the CYP2D6 protein is involved in the metabolism of drugs frequently prescribed as: carvedilol, captopril, chloroquine, codeine, fluoxetine, fluvastatin, haloperidol, idarubicin, indinavir, imatinib, loperamide, nifedipine, ondansetron and tamoxifen...

Uso del plasma rico en plaquetas autólogo en abdominoplastías / Using platelet rich plasma in abdominoplasty

Objective: Evaluation of the effectiveness of autologous platelet rich plasma administered topically in the healing and prevention of complications of abdominoplasty after bariatric surgery. Material and Methods: The data from 30 patients who underwent abdominoplasty were analyzed: Group I: Rich plasma was administered autologous platelets in the surgery. Group II: Control. Study variables: complications (seroma, local infection and bleeding), length of stay and cost. Results: No significant differences were observed in the frequency of complications or length of stay. The use of platelet rich plasma raises the cost of the procedure. Conclusion: Even considering the limitations of the study because of its small sample size and lack of blinding, the results do not support the use of this complementary technique. Further studies are needed in the field of adhesives, sealants and local hemostatic.

Objetivo: Evaluación de la eficacia del plasma rico en plaquetas autólogo administrado de forma tópica en la cicatrización y prevención de las complicaciones de la abdominoplastía y dermolipectomía tras cirugía bariátrica. Material y Método: Serie de 30 pacientes afectos de faldón abdominal tras cirugía bariátrica, a los que se practicó dermolipectomía y abdominoplastía, divididos en dos grupos de 15 casos con aletorización simple. Grupo I: Se administró plasma rico en plaquetas autólogo en el lecho quirúrgico. Grupo II: Control. Variables de estudio: complicaciones (seroma, infección local y hemorragia), tiempo de estancia y coste. Resultados: No se aprecian diferencias significativas en la frecuencia de complicaciones ni en estancia media. El uso de plasma rico en plaquetas eleva el coste del procedimiento. Conclusión: Aun considerando las limitaciones del estudio por su corto número de casos y no cegamiento, los resultados no apoyan el uso de esta técnica complementaria. Estudios más avanzados son necesarios en el campo de los adhesivos, sellantes y hemostáticos locales.

Polimorfismo 1494del6 del gen de la timidilato sintasa en población de la región central de Venezuela / Thymidylate synthase gen polymorphism 1494del6 in a population from the central region of Venezuela / Polimorfismo 1494del6 do gene timidilato sintetase na população da região central da Venezuela

La enzima Timidilato Sintasa (TS) codificada por el gen TYMS es inhibida por agentes quimioterapéuticos como 5-Fluorouracilo (5-FU) y Metotrexato (MTX). Varios estudios han postulado que existe una relación inversa entre los niveles de enzima y los beneficios terapéuticos de 5-FU y MTX. El gen TYMS presenta polimorfismos asociados con la expresión de TS; uno de ellos consiste en una inserción o deleción de 6 pb en la posición 1494 en 3’UTR (1494del6); la deleción se vincula con menor expresión enzimática. El objetivo del trabajo fue determinar el polimorfismo 1494del6 en 260 individuos sanos no consanguíneos de la región central de Venezuela. Luego de obtener el consentimiento informado, se tomó una muestra sanguínea para aislar ADN y amplificar mediante PCR una secuencia de 142/148 pb del gen TYMS. El producto fue digerido con Dra I y se realizó electroforesis en geles de poliacrilamida 8%, determinándose los genotipos y se compararon con los obtenidos en otras poblaciones. Se encontraron tres genotipos: -6pb/-6pb (15,8%), +6pb/-6pb (45,4%) y +6pb/+6pb (38,8%). Este último ha sido asociado con respuesta deficiente al tratamiento con 5-FU y MTX. Esta investigación es un paso inicial en la generación de datos de importancia farmacogenética en relación con gen TYMS en población venezolana...

Cirugía bariátrica en pacientes con esclerosis múltiple: ¿un mayor riesgo? / Bariatric surgery in patients with multiple sclerosis

Background: There is limited information about the role of bariatric surgery among patients with motor deficits. Case reports: We report a 38 years old woman with a body mass index (BMI) of 49 kg/m² and a 34 years old woman with a BMI of 40 kg/m², both with multiple sclerosis, subjected to a laparoscopic gastric bypass. Both were unable to lose weight with medical management. No postoperative complication was recorded, both patients lost weight and their quality of life improved.

Introducción: Hay escasa literatura acerca del papel de la cirugía bariátrica en el manejo de las enfermedades neurológicas con déficit motor. Este déficit motor supone una desventaja sobreañadida si además los pacientes son obesos mórbidos. Casos clínicos: Presentamos dos casos de obesidad mórbida y esclerosis múltiple intervenidas de by pass gástrico laparoscópico. El primer caso es una mujer de 38 años con IMC de 49 y el segundo es una mujer de 34 años con IMC de 40. Tras varios intentos fallidos de pérdida de peso e ingresos programados para dieta absoluta son remitidas por los servicios de Endocrinología y neurología para valorar cirugía bariátrica para pérdida de peso y facilitar la dosificación de tratamiento especifico. No se produjo ninguna complicación postquirúrgica inmediata. La pérdida de peso fue favorable al año de seguimiento, mejorando la calidad de vida de estas pacientes.

Escala CARE de empatia: tradução para o Português falado no Brasil e resultados iniciais de validação / CARE scale of empaty: translation to the Portuguese spoken in Braziland initial validation results

Objetivos: Traduzir e adaptar para uso no Brasil a escala de avaliação de empatia clínica Consultation and Relational Empathy (CARE). Fornecer resultados preliminares de validação concorrente dessa escala. Métodos: A escala em inglês foi traduzida e adaptada seguindo metodologia recomendada. Vinte pacientes atendidos em ambulatório de pneumologia em hospital público ligado ao Sistema Único de Saúde foram entrevistados quanto ao grau de compreensão da versão final do instrumento. Em uma segunda fase, doze pacientes do mesmo ambulatório responderam a versão brasileira da escala CARE e a Escala de Percepção de Empatia Pelo Paciente (EPEP), logo após término de consulta de rotina. Os médicos responsáveis pelo atendimento desses pacientes também foram convidados, após a consulta, a responder questionário contendo a versão brasileira do Interpersonal Reactivity Index (IRI) e o Inventário de Empatia (IE). Resultados: Dezenove dos 20 pacientes referiram grau elevado de compreensão dos itens da versão brasileira da escala CARE. O escore mediano da escala CARE para outros 12 voluntários foi 44,5 (20-63). O coeficiente alfa de Cronbach para as respostas dos últimos foi 0,867. Os escores CARE correlacionaram-se de maneira significante com os escores EPEP (r=0,699; p=0,01) e com o subitem altruísmo do IE (r=0,744, p=0,01). A escala CARE não mostrou correlações significantes com os escores globais das medidas de empatia IRI e IE informados pelos médicos. Conclusão: A versão brasileira da escala CARE é de fácil compreensão e exibe evidências aceitáveis de validade concorrente e consistência interna. Medidas de empatia referidas pelos médicos tendem a não se correlacionar com as percepções dos pacientes.

Objectives: To translate and to adapt the scale Consultation and Relational Empathy (CARE) for using in Brazil. To obtain preliminary results about concurrent validation of this scale. Methods: The scale was translated and adapted from English by appropriated recommended methodology. Twenty patients from the pulmonology clinic of a public hospital, associated with the Brazilian public health system, were interviewed about the degree of understanding of the scale final version. The second step of the study enrolled twelve patients from the same clinic who answered the Brazilian version of CARE and the Perception Scale of Empathy By Patients (EPEP), shortly after the end of aroutine consultation The physicians responsible for the care of these patients were also approached andasked to answer a questionnaire containing the Brazilian version of the Interpersonal Reactivity Index (IRI) and the Inventory of Empathy (IE). Results: Nineteen of 20 patients reported a high degree of understanding about the items of the Brazilian version of CARE. The median CARE score for other 12 volunteers was 44.5 (20-63). The Cronbach’s alpha coefficient for the answers of these patients was 0.867. CARE scores significantly correlated with EPEP scores (r = 0.699, p = 0.01) and with subsection altruism of the IE (r = 0.744, p = 0.01). CARE scale showed no significant correlations with global scores of IE and IRI reported by physicians. Conclusion: The Brazilian version of CARE is easy to understand and displays acceptable evidences of concurrent validity and internal consistency. Measures of empathy reported by doctors tend to not correlate with perceptions of patients.

Lesão pulmonar aguda induzida pela administração endovenosa de extrato da fumaça do cigarro / Acute lung injury induced by the intravenous administration of cigarette smoke extract

OBJETIVO: Investigar os efeitos agudos da administração endovenosa de extrato da fumaça do cigarro (EFC) em parâmetros funcionais respiratórios, inflamatórios e histológicos em ratos e comparar esse potencial modelo de lesão pulmonar aguda (LPA) com aquele com o uso de ácido oleico (AO). MÉTODOS: Foram estudados 72 ratos Wistar machos divididos em quatro grupos: tratados somente com soro fisiológico (SF; grupo controle); tratados com EFC e SF (grupo EFC); tratados com SF e AO (grupo AO); e tratados com EFC e AO (grupo EFC/AO). RESULTADOS: As médias de complacência foram significantemente menores nos grupos AO e EFC/AO (2,12 ± 1,13 mL/cmH2O e 1,82 ± 0,77 mL/cmH2O, respectivamente) do que no controle (3,67 ± 1,38 mL/cmH2O). A proporção de neutrófilos e a atividade das metaloproteinases 2 e 9 em lavado broncoalveolar foram significantemente maiores nos grupos AO e EFC/AO que no controle. O acometimento pulmonar avaliado por morfometria foi significantemente maior nos grupos AO e EFC/AO (72,9 ± 13,8% e 77,6 ± 18,0%, respectivamente) do que nos grupos controle e EFC (8,7 ± 4,1% e 32,7 ± 13,1%, respectivamente), e esse acometimento foi significantemente maior no grupo EFC que no grupo controle. CONCLUSÕES: A administração endovenosa de EFC, nas doses e tempos deste estudo, associou-se à LPA mínima. O EFC não potencializou a LPA induzida por AO. Estudos adicionais são necessários para esclarecer o papel potencial desse modelo como método de estudo dos mecanismos de agressão pulmonar pelo tabaco.

OBJECTIVE: To investigate the acute effects of intravenous administration of cigarette smoke extract (CSE) on histological, inflammatory, and respiratory function parameters in rats, as well as to compare this potential acute lung injury (ALI) model with that with the use of oleic acid (OA). METHODS: We studied 72 Wistar rats, divided into four groups: control (those injected intravenously with saline); CSE (those injected intravenously with CSE and saline); OA (those injected intravenously with saline and OA); and CSE/OA (those injected intravenously with CSE and OA). RESULTS: Mean lung compliance was significantly lower in the OA and CSE/OA groups (2.12 ± 1.13 mL/cmH2O and 1.82 ± 0.77 mL/cmH2O, respectively) than in the control group (3.67 ± 1.38 mL/cmH2O). In bronchoalveolar lavage fluid, the proportion of neutrophils was significantly higher in the OA and CSE/OA groups than in the control group, as was the activity of metalloproteinases 2 and 9. Pulmonary involvement, as assessed by morphometry, was significantly more severe in the OA and CSE/OA groups (72.9 ± 13.8% and 77.6 ± 18.0%, respectively) than in the control and CSE groups (8.7 ± 4.1% and 32.7 ± 13.1%, respectively), and that involvement was significantly more severe in the CSE group than in the control group. CONCLUSIONS: The intravenous administration of CSE, at the doses and timing employed in this study, was associated with minimal ALI. The use of CSE did not potentiate OA-induced ALI. Additional studies are needed in order to clarify the potential role of this model as a method for studying the mechanisms of smoking-induced lung injury.

Inhibición conductual y su relación con los trastornos de ansiedad infantil / Behavioral inhibition and relationship with childhood anxiety disorders

La literatura científica ha mostrado que la inhibición conductual (IC) se caracteriza por la presencia de ansiedad ante estímulos desconocidos, lo que conlleva conductas de retraimiento y evitación social. El presente estudio realiza una revisión bibliográfica sobre la IC y su relación con los trastornos de ansiedad en la infancia. Dado que la IC puede observarse en edades muy tempranas, la literatura ha examinado su papel predictor en el desarrollo de trastornos de ansiedad. Pese a ello, los estudios revisados apuntan a que no todos los niños ansiosos muestran un comportamiento inhibido ni todos los niños con IC sufren trastornos de ansiedad. Dada esta disparidad, sería necesario estudiar qué otros factores están implicados. Asimismo, los datos apuntan a que una detección precoz de la IC permitiría desarrollar programas de prevención de los trastornos de ansiedad en la infancia.

The literature has revealed that Behavioral inhibition (BI) is characterized by the presence of anxiety to unknown stimuli, which leads to withdrawal behaviors and social avoidance. The present study is aimed at revising the state-of-the-art on BI and examining its role that plays of childhood anxiety disorders. As the IB can be observed at very early ages, the literature has examined its predictive role in the development of anxiety disorders. Despite this, the reviewed studies suggest that not all anxious children show comorbid BI nor all inhibited children have anxiety disorders. Given this disparity, it would be necessary to consider what other factors are involved in the anxiety disorders. Furthermore, the data suggest that early detection of the BI would contribute to develop prevention programs for anxiety disorders in childhood.

Competência glótica na doença pulmonar obstrutiva crônica / Glottal competence in chronic obstructive pulmonary disease

OBJETIVO: Correlacionar a medida do tempo máximo de fonação (TMF) com o volume de ar pulmonar expirado no primeiro segundo do sopro (VEF1) e comparar o TMF, emissão do "s", "z" e relação s/z em indivíduos saudáveis e indivíduos com doença pulmonar obstrutiva crônica (DPOC). MÉTODOS: Foram avaliados 14 voluntários saudáveis, com média de idade de 65 anos, e 16 indivíduos com DPOC, com média de idade de 68 anos. O diagnóstico da doença foi clínico e também obtido por exames da função pulmonar. Os participantes foram submetidos à espirometria para apreciação dos parâmetros VEF1, capacidade vital forçada (CVF) e o índice de Tiffeneau (VEF1/CVF). Registrou-se a emissão prolongada das vogais "a", "i", "u" para análise do tempo máximo de fonação na condição normal e forçada e aferiu-se a relação s/z após a sustentação dos fonemas /s/ e /z/. RESULTADOS: Nos dois grupos, o TMF com a fonação normal foi menor do que o tempo máximo de fonação, com a fonação forçada. A mediana do TMF do grupo controle foi maior do que a do grupo com DPOC, com a fonação normal e a fonação forçada. Não houve correlação entre o tempo máximo de fonação e os valores de VEF1 nos grupos. CONCLUSÃO: Pacientes com DPOC tem diminuição do tempo máximo de fonação e a relação s/z sugere falta de coaptação glótica. Não houve correlação do TMF e a medida do VEF1.

PURPOSE: This study correlates the extent of maximum phonation time (MPT) with the volume of air exhaled in the first second pulmonary (FEV1) and compares the MPT emission of /s/, /z/ and s/z ratio in healthy subjects and those with chronic obstructive pulmonary disease (COPD). METHODS: We studied 14 normal volunteers (control group), mean age 65 years, and 16 patients with COPD, mean age 68 years. The diagnosis of COPD was done by clinical and pulmonary function evaluation. Participants underwent spirometry for analysis of the parameters FEV1, forced vital capacity (FVC) and Tiffeneau index (FEV1/FVC). The maximum phonation time, along with phonemes /s/ and /z/, s/z ratio correlation, and maximum phonation time in both normal and forced phonation were collected and recorded. RESULTS: In both groups, the maximum phonation time with normal phonation was lower than the maximum phonation time with forced phonation. The median of the maximum phonation time in the control group was higher than in the COPD group. There was no correlation between the maximum phonation time and FEV1, in normal volunteers and patients with COPD. CONCLUSION: Patients with COPD have decreased maximum phonation time, while the s/z ratio does not suggest changes in the level of the vocal folds, since the values found were within the normal range. There was no correlation of the TMF and the measure of FEV1.