Manejo anestésico de una gestante con síndrome de Morquio / Anesthetic Management for a pregnant woman with Morquio syndrome Sobre los autores:

Introducción: El síndrome de Morquio es una enfermedad hereditaria autosómica recesiva con distintos grados de afectación al metabolismo de los glúcidos, lo que genera incapacidad para romper los enlaces de las cadenas largas de glucosamiglicanos, esto provoca acumulación de mucopolisacáridos en distintos tejidos del cuerpo humano. Objetivo: Describir el manejo anestésico de una gestante con síndrome de Morquio. Presentación del caso: Gestante primigesta de 30 años de edad, de raza negra, de 103 cm de estatura y 33 Kg de peso. Acude a consulta preoperatoria por presentar embarazo a término, baja talla y se realizó interrupción del embarazo por vía alta. Se procede a la valoración preanestésica donde se recoge antecedentes de enfermedad genética e ingreso previo por presentar cifras elevadas de tensión arterial. La paciente padecía de alergia a la dipirona. Conclusiones: Los pacientes con mucopolisacaridosis tienen una alta incidencia de dificultad para la ventilación y la intubación endotraqueal asociada con insuficiencia cardiopulmonar. La afectación de la columna presenta dificultades adicionales para los anestesiólogos. Cualquier cirugía electiva requiere una evaluación preoperatoria de los factores de riesgo anestesiológicos y la disponibilidad de un espectro de equipos para el manejo de las vías respiratorias. La anestesia debe ser realizada por un equipo con experiencia en el manejo de la vía aérea(AU)

Introduction: Morquio syndrome is an autosomal recessive hereditary disease that affects, to different extents, carbohydrate metabolism, which obstructs the ability to break bonds of long chains of glycosaminoglycans, causing mucopolysaccharides accumulation in different tissues of the human body. Objective: To describe the anesthetic management of a pregnant woman with Morquio syndrome. Case presentation: This is the case of a 30-year-old primigravid pregnant woman, of black skin, 103 cm of height and 33 kg of weight. She came for preoperative consultation because she was pregnant at term and had low body size; the pregnancy was terminated through the abdominal route. A preanesthetic assessment was performed, which permitted to observe a history of genetic disease and previous admission for high blood pressure. The patient was allergic to dipyrone. Conclusions: Among patients with mucopolysaccharidosis, there is a high incidence of difficulty for ventilation and endotracheal intubation associated with cardiopulmonary insufficiency. Spinal involvement represents additional difficulties for anesthesiologists. Any elective surgery requires preoperative assessment of anesthesiologic risk factors and the availability of a spectrum of airway management equipment. Anesthetic managment should be performed by a team experienced in airway management(AU)

Prevalencia y resultados de cultivos positivos inesperados en revisiones de reemplazo total de cadera presumiblemente asépticas / Prevalence and outcomes of unexpected positive cultures in presumed aseptic revision total hip arthroplasty

Introducción: Las tasas de infección periprotésica, a veces, son subestimadas, ya que muchos casos de presunta falla aséptica pueden deberse a una infección no reconocida. Los objetivos de este estudio fueron: 1) estimar la prevalencia de cultivos positivos intraoperatorios inesperados, 2) determinar si las comorbilidades o los factores de riesgo de los pacientes tuvieron relación con la presencia de cultivos positivos inesperados, 3) determinar la supervivencia del implante en un seguimiento mínimo de 12 meses. Materiales y Métodos: Se realizó un estudio retrospectivo y observacional. En las historias clínicas electrónicas, se identificaron todas las revisiones de artroplastia total de cadera de una única institución entre 2014 y 2021. Resultados: De las 49 revisiones de artroplastia total de cadera en un tiempo, 9 pacientes (18,4%) tuvieron un resultado positivo inesperado. Los microorganismos aislados fueron: Staphylococcus aureus (3), Pseudomonas aeruginosa (1), Staphylococcus lugdunensis (1), Staphylococcus epidermidis (2), Staphylococcus haemolyticus (1), Streptococcus epidermidis (1). Ninguna comorbilidad tuvo significancia estadística para favorecer cultivos positivos inesperados en las revisiones asépticas. El 2% de la muestra, con un período de seguimiento de 49 meses, se reinfectó. Conclusiones: Nuestro estudio arrojó una prevalencia de cultivos positivos inesperados del 18,4%. Ninguno de los factores de riesgo reportados en la bibliografía se asoció con un mayor riesgo de cultivos positivos inesperados, excepto los niveles altos de velocidad de sedimentación glomerular. Nuestros hallazgos son compatibles con los publicados y sugieren que los cultivos positivos inesperados en revisiones presumiblemente asépticas no tienen consecuencias significativas en la supervivencia del implante. Nivel de Evidencia: III

Introduction: Periprosthetic infection rates are sometimes underestimated, given that many cases of presumed aseptic failure may be due to unrecognized infection. The objectives of this study were: (1) to estimate the prevalence of unexpected positive intraoperative cultures; (2) to determine if any of the patient's comorbidities or risk factors were related to the presence of unexpected positive cultures; (3) to determine the implant survival during a follow-up of at least 12 months. Materials and Methods: A retrospective and observational study was carried out where, through electronic medical records, all revision total hip arthroplasties (THAs) from a single institution between 2014 and 2021 were identified. Results: Out of 49 single-stage revision THAs, 9 patients (18.4%) had an unexpected positive culture. The isolated microorganisms were Staphylococcus aureus (3), Pseudomonas aeruginosa (1), Staphylococcus lugdunensis (1), Staphylococcus epidermidis (2), Staphylococcus haemolyticus (1), Streptococcus epidermidis (1). In addition, when we evaluated the comorbidities of the patients, none had statistical significance in favoring unexpected positive cultures in aseptic revisions. We discovered that 2% of our sample with a follow-up period of 49 months developed reinfection. Conclusion: Our study showed a prevalence of unexpected positive cultures of 18.4%. None of the risk factors reported in the literature was associated with a higher risk of unexpected positive cultures, except for high ESR values. Our findings in the analyzed sample suggest that unexpected positive cultures in presumably aseptic revisions do not have significant consequences on implant survival, as found in the literature. Level of Evidence: III

Análisis de publicidades sobre medicamentos neurológicos recibidos durante la consulta médica / Analysis of advertising on neurological drugs received during the medical consultation

Resumen La publicidad y promoción de medicamentos por parte de la industria farmacéutica ejerce influencia sobre la prescripción médica y, en algunos casos, la información provista es incompleta o sesgada. El objetivo fue analizar las publicidades entregadas por representantes médicos y determinar si la información era apropiada para la prescripción racional. Es un estudio prospectivo (marzo a noviembre 2018) mediante la recolección de publicidades impresas recibidas aleatoriamente en centros de neurología. Se evaluó si cumplían los criterios éticos establecidos por la OMS, utilizando como referencia prospectos de la Administración Nacional de Medicamentos, Alimentos y Tecnología médica (ANMAT), la Food and Drugs Administration (FDA) y libros de farmacología. Un comité de médicos farmacólogos analizó si el contenido de los folletos era engañoso según la OMS. Se analizaron 60 publicidades, siendo antiepilépticos y antidepresivos los más publicitados. El 33.3% (n = 20) incluían prospectos acordes según ANMAT. Un caso presentaba indicación off-label. Los folletos ex ponían el mecanismo de acción en el 31.7% (n = 19), las reacciones adversas medicamentosas 40% (n = 24), la posología en el 45% (n = 27), las contraindicaciones 38.3% (n = 23) y en 36.7% (n = 22) las precauciones necesarias. La información brindada era falaz en el 80% (n = 48) y el 53.3% (n = 32) tenían imágenes capcio sas. El 69.2% (n = 18) de los gráficos eran capciosos. En el presente trabajo, la información brindada por la publicidad médica sería insuficiente para conocer y prescribir nuevos fármacos. La falta de información en la posología, contraindicaciones, mecanismos de acción y reacciones adversas no contribuyen al uso racional de medicamentos.

Abstract Drug promotion and advertisement by pharmaceutical industry influence medical prescription and, in some cases, the information provided is incomplete or biased. The objective was to analyze the advertisements deliv ered by medical representatives and determine if the information was appropriate for rational prescribing. It is a prospective study (March to November 2018) by collecting print advertisements randomly received in neurology centers. It was evaluated if they met the ethical criteria established by the WHO, using as a reference leaflets from Administración Nacional de Medicamentos, Alimentos y Tecnología Médica (ANMAT), Food and Drugs Ad ministration (FDA) and pharmacology books. A committee of pharmacology physicians analyzed if the content of the pamphlets was misleading according to the WHO. Sixty advertisements were analyzed, being anti-epileptics and antidepressants the most advertised drugs. The 33.3% (n = 20) of them included leaflets in accordance to ANMAT. One case presented an "off-label" indication. Drug action was presented in 31.7% (n = 19) of the pam phlets, adverse reactions in 40% (n = 24), posology in 45% (n = 27), contraindications in 38.3% (n = 23) and the necessary precautions in 36.7% (n = 22) of them. The information provided was false in 80% (n = 48) and 53.3% (n = 32) contained misleading images; and 69.2% (n = 18) of the graphics were false. The information provided by medical advertisements analyzed in this study would be insufficient to know and prescribe a new drug. Lack of information in posology, contraindication, drug action and adverse reactions do not contribute to rational use of medications.

Reporte de un caso de glomerulonefritis rápidamente progresiva por anticuerpos antimembrana basal glomerular / Case report of rapidly progressive glomerulonephritis due to anti-glomerular basement membrane antibodies

RESUMEN Una vez más en medicina interna no podemos, aún, prescindir de los métodos invasivos para alcanzar un diagnóstico. Los avances diarios en el hallazgo de nuevas herramientas paraclínicas no permiten reemplazar aquellos métodos de certeza como la anatomía patológica. El caso presentado es una muestra de ello. Se trata de una mujer de 27 años de edad, con antecedente de tiroiditis de Hashimoto que consulta por presentar severo deterioro de la función renal asociado a oligoanuria. Realizamos una revisión del tratamiento de las glomerulonefritis rápidamente progresivas por anticuerpos antimembrana basal glomerular, serológicamente negativas.

ABSTRACT Once again in internal medicine we cannot do a diagnosis without invasive methods. Daily advances in the finding of new paraclinical tools do not allow the replacement of certain methods such as pathological anatomy. The case presented is a sample of this. This is a 27-year-old woman with a history of Hashimoto's thyroiditis who consults for presenting severe impairment of kidney function associated with oligoanuria. We performed a review of the treatment of the rapidly progressive glomerulonephritis for serologically negative anti-GBM antibodies.

A preliminary study of platelet hyperactivity in the chronic indeterminate phase of Chagas’ disease

@#The chronic indeterminate phase of Chagas’ disease is asymptomatic despite positive test results for antibodies specific to Trypanosoma cruzi. CD62P-APC (P-selectin) and PAC-1 FITC (GpIIb/IIIa) may improve diagnosis as biomarkers of platelet activity. Nine asymptomatic seropositive subjects, previously untreated, were selected from a blood bank within a year of Chagas’ disease detection, in addition to a control group of four. All subjects were evaluated by flow cytometry for CD62P, PAC-1 and CD41, and in a complementary study, by Tissue Doppler Echocardiography for isovolumic relaxation times (IVRT) and E/A ratios. The subjects were classified as positive or negative for CD62P and PAC-1 by a cut off obtained from their mean±2SD. For IVRT and E/A ratios, cut offs were obtained from the American Society of Echocardiography and the European Association of Cardiovascular Imaging recommendations. Fisher’s exact test was used for associated findings. Pre-test and post-test probability, sensitivity, specificity, positive and negative predictive values and likelihood ratios were calculated. Abnormalities were expressed as platelet hyperactivity and ventricular dysfunction in CD62P, PAC-1, IVRT and E/A ratios. CD62P appears to have greater sensitivity (0.75) and PAC-1, more accurate specificity (0.75), which may explain thrombotic events in Chagas’ disease. We recommend the use of CD62P and PAC-1 as biomarkers of platelet hyperactivity in patients in the chronic indeterminate phase of Chagas’ disease.

Genoma de Candida albicans y resistencia a las drogas / Genome of Candida albicans and drug resistance

Resumen Candida albicans es un importante patógeno fúngico en los humanos tanto por su importancia clínica como por su uso como un modelo experimental para la investigación científica. La comprensión de la biología de este patógeno es un requisito importante para la identificación de nuevas dianas de medicamentos para la terapia antifúngica. En esta revisión nos proponemos profundizar en las características del genoma de Candida albicans, su relación con la virulencia y cómo influye en la resistencia a las drogas antifúngicas, que nos permita comprender los mecanismos por los cuales ejerce su acción patógena y desarrollar otros enfoques en la búsqueda de nuevos antifúngicos. La revisión se realizó a través de los buscadores y plataformas HINARI, SciELO y MEDLINE. Se revisaron 40 revistas de impacto de la Web of Science relacionadas con el tema. Los descriptores empleados fueron: "genome of Candida albicans", "drug resistance genes", "dimorphism", "virulence" y la combinación entre ellos y sus equivalentes en español. El análisis de los genomas fúngicos hace posible predecir el rol de genes con potencial terapéutico, con la secuenciación del genoma de Candida albicans ha aumentado la información sobre la función de los genes, entre los que destacan los posibles objetivos farmacológicos. El estudio del genoma de Candida albicans resulta imprescindible para diseñar en el futuro protocolos diagnósticos seguros, así como hallar nuevas dianas antifúngicas que permitan formular terapias más efectivas.

Abstract Candida albicans is an important fungal pathogen in humans both for its clinical importance and its use as an experimental model for scientific research. Understanding the biology of this pathogen is an important requirement for the identification of new drug targets for antifungal therapy. In this review, we propose to delve into the characteristics of the genome of Candida albicans, its relation to virulence and how it influences resistance to antifungal drugs, allowing us to understand the mechanisms by which it exerts its pathogenic action and to develop other approaches in the Search for new antifungals. The review was carried out through the HINARI, SciELO and MEDLINE search engines and platforms. We reviewed 40 Web of Science impact journals related to the topic. The descriptors employed were: "genome of Candida albicans", "drug resistance genes", "dimorphism", "virulence" and the combination between them and their equivalents in Spanish. Analysis of fungal genomes makes it possible to predict the role of genes with therapeutic potential, with sequencing of the genome of Candida albicans has increased information on the function of genes, among which stand out possible pharmacological targets-specific virulence. The study of the genome of Candida albicans is essential for the future design of safe diagnostic protocols, as well as finding new antifungal targets to formulate more effective therapies.

Aumento inusual de casos de mielitis en un hospital pediátrico en Argentina / Unusual increase of cases of myelitis in a pediatric hospital in Argentina

Introducción: La asociación entre enterovirus D68 y cuadros de mielitis aguda fláccida ha sido descrita en Estados Unidos, en 2014. Desde ese año, se han reportado casos esporádicamente en Canadá y Europa. Se describe, en este estudio, una serie de casos con mielitis aguda fláccida en el Hospital de Pediatría "Prof. Dr. Juan P. Garrahan" en Buenos Aires, Argentina, en 2016. Métodos: Estudio descriptivo, retrospectivo. Se incluyeron todos los pacientes internados desde el 1/04/2016 al 1/07/2016 con mielitis fláccida aguda con lesiones en la médula espinal que comprometieran la sustancia gris en la resonancia magnética nuclear. Se procesaron, para la búsqueda etiológica, muestras de secreciones nasofaríngeas, hisopados de materia fecal y líquido cefalorraquídeo. Resultados: Se incluyeron 10 pacientes. La mediana de edad fue 4 años (rango de 3 meses a 5 años). Ocho pacientes tuvieron una enfermedad febril autolimitada antes del inicio de los síntomas neurológicos. Los hallazgos neurológicos fueron debilidad fláccida de, al menos, un miembro, cervicoplejia (n= 2) y parálisis facial (n= 2). Todos los pacientes presentaron lesiones longitudinales en la médula espinal, con compromiso de sustancia gris, predominantemente, en el asta anterior. En todos los casos, se realizó una punción lumbar. En 7 pacientes, se observó pleocitosis. En cuatro niños, se identificó enterovirus D68 en secreciones nasofaríngeas y, en uno, se identificó el enterovirusD68 en el líquido cefalorraquídeo. Todos los pacientes persistieron con déficits neurológicos al momento del alta. Conclusiones: Se reporta el primer brote de mielitis aguda fláccida asociada a enterovirusD68 en Argentina. La vigilancia epidemiológica activa permitirá conocer la verdadera incidencia, epidemiología y etiología de esta enfermedad.

Introduction: The association between enterovirus D68 and acute flaccid myelitis was first described in the United States in 2014. Since then, sporadic cases have been reported in Canada and Europe. This study describes a series of cases of acute flaccid myelitis at Hospital de Pediatría "Prof. Dr. Juan P. Garrahan," in Buenos Aires, Argentina, during 2016. Methods: Descriptive, retrospective study. All patients with acute flaccid myelitis and lesions in the spinal cord involving the gray matter, as observed in the magnetic resonance imaging (MRI) scan, hospitalized from 04/01/2016 to 07/01/2016, were included in the study. Samples of nasopharyngeal secretions, fecal swabs and cerebrospinal fluid were collected and processed to look for the causative agent. Results: Ten patients were included. The median age was 4 years old (range from 3 months to 5 years old). Eight patients had a self-limiting febrile condition before the onset of neurological symptoms. Neurological findings were flaccid weakness in, at least, one limb, cervical paralysis (n= 2) and facial paralysis (n= 2). All patients had longitudinal lesions in the spinal cord, with gray matter involvement, mainly in the anterior horn. In all cases, a lumbar puncture (spinal tap) was performed. Pleocytosis was observed in 7 patients. In four children, enterovirus D68 was identified in nasopharyngeal secretions, and in one, it was detected in the cerebrospinal fluid. Neurological deficit persisted in all patients at the time of discharge. Conclusions: The first outbreak of acute flaccid myelitis associated to enterovirus D68 is reported in Argentina. Active epidemiological surveillance will help to determine the true incidence, epidemiology and etiology of this disease.

Parálisis ácida aguda "polio-like" (Brote de 10 casos presentados en Buenos Aires - Argentina en 2016) / Acute acid paralysis "polio-like" (Outbreak of 10 cases presented in Buenos Aires - Argentina in 2016)

Resumen Objetivo Reportar un brote de 10 casos de mielopatías ácida aguda asimétrica por compromiso de la motoneurona espinal. Material y métodos: Relación V/M: 6/4 media de edad de 3 años, todos con parálisis ácida aguda, analizamos sus aspectos clínicos, etiológicos, neurorradiológicos, terapéuticos y evolutivos. Resultados: 8 presentaron parálisis áccida de miembros superiores asimétrica, 1 monoplejía de miembro inferior izquierdo, 1 hemiparesia, 5 sumaron compromiso de pares craneanos y 4 requirieron asistencia respiratoria mecánica. Todos coincidieron con catarro de vía aérea superior y/o ebre. La resonancia magnética medular fue anormal en todos, identi cando dos patrones de imágenes: uno lineal relacionado al compromiso del asta anterior y otro más heterogéneo con médula espinal engrosada, sin refuerzo con contraste, 5/10 presentaron además compromiso bulbo-protuberancial. Ninguno presento lesiones supratentoriales. En 4/10 identi camos enterovirus humano subtipo D68 HEV-D68) en secreciones de vía aérea y en 1/10 de ellos también en LCR. En el resto se detectaron otros enterovirus A, B y C, en uno rinovirus y otro In uenza. Nueve pacientes recibieron como tratamiento gammaglobulina y corticoides y 4 además recambio plasmático terapéutico sin mejoría clínica. Conclusiones: Ante una parálisis ácida aguda es importante descartar el HEV-D68. Consideramos los casos no detectados como "falsos negativos" dado que las muestras fueron tomadas tardíamente. Los otros virus identi cados no se han relacionado a mielopatías. Si bien la siopatología no es clara la ausencia de respuesta a tratamiento antin amatorio e inmunomodulador orienta a un mecanismo de agresión directa del virus. Se trata del primer reporte por HEV-D68 en Latinoamérica.

Abstract Objective: To report an outbreak of 10 cases of acute asymmetric accid myelopathy due to spinal motor neuron injury. Material and methods: Ten children, six male, with a mean age of 3 years presented with acute accid myelitis. We analyzed clinical features, etiology, neuroradiological images, treatment, and outcome. Results: Eight children had bilateral and asymmetric accid myelitis of the upper limbs, 1 had upper limb monoplegia, and 1 presented with hemiparesis. The cranial nerves were involved in 5 patients and 4 required mechanical ventilation. In all cases acute accid myelitis co-occurred with upper airway infection and/or fever. Spinal cord magnetic resonance imaging was abnormal in all, showing 2 di erent patterns: A linear pattern involving the anterior horns and another that was more heterogeneous showing spinal cord expansion. The lesions were non-enhancing in all. In 5/10 patients involvement of the medulla oblongata and pons was also observed. None of the patients presented with supratentorial lesions. In 4/10 children, the human enterovirus subtype D68 (HEV-D68) was identi ed in the airway and in 1/10 in the cerebrospinal uid as well. In the remaining patients di erent enterovirus species A, B, and C variants were detected, as well as rhinovirus in 1 and in uenza in another. Nine children received treatment with intravenous immunoglobulin and steroids and 4 of these children also underwent plasma exchange. Treatment did not lead to clinical improvement. Conclusions: In a patient with acute accid myelitis, HEV-D68 infection should be ruled out. Cases in which the virus was not detected were considered as "false negatives" as samples were collected late in course of the disease. The lack of response to anti-in ammatory and immunomodulatory treatment suggests a direct viral mechanism. This study is to our knowledge the rst on an HEV-D68-infection-related report in Latin America.

Enfermedad de Chagas en México / Chagas disease in Mexico

Resumen México es un país endémico para la enfermedad de Chagas, donde dos terceras partes del territorio pueden ser consideradas en riesgo de transmisión vectorial, es decir que 1'100,000 individuos podrían estar infectados con Trypanosoma cruzi y 29'500,000 en riesgo de contraer la infección. En la morbimortalidad del padecimiento son importantes las características de la vivienda, condiciones biológicas, ambientales y factores socioculturales. El tamizaje en bancos de sangre, a la fecha, es de observancia obligatoria con una cobertura mayor al 92%. El diagnóstico no se establece frecuentemente debido al desconocimiento de la enfermedad por parte del personal de salud y de la población. La fase aguda generalmente pasa desapercibida y en la crónica, la patología se presenta principalmente en el corazón, con evolución lenta. La patogénesis de la miocardiopatía crónica es muy compleja y se presentan lesiones con mayor frecuencia en el sistema nervioso autónomo y miocardio, lo que genera trastornos en la conductibilidad y contractilidad del órgano. Se describen los principales mecanismos patogénicos implicados en el desarrollo de la enfermedad.

Abstract Mexico is a country endemic for Chagas disease in which two thirds of the territory can be considered at risk of vector-borne infection. This means that 1.1 million people could be infected with Trypanosoma cruzi and 29.5 million at risk of infection. Dwelling characteristics of poverty in these rural areas linked with biological conditions, lifestyle, environmental and sociocultural factors are important in the morbidity and mortality of the disease. Nowadays, the screening for the parasite is mandatory and at least 92% of blood banks are covered. The inadequate knowledge of the disease by the health personnel and the population limits the possibility of the diagnosis. The acute phase of the disease courses undetected. The main affected organ in Chagas disease is the heart, with a slow evolution; the pathogenesis of chronic cardiomyopathy is complex and lesions occur mainly in the autonomic nervous system and myocardium leading to disturbances in the conductivity and contractility of the organ. The main pathogenic mechanisms involved in the development of the disease are described.

Um panorama das pesquisas e publicações sobre mudança organizacional no Brasil / An overview of Brazilian research and publications about organizational change / Un panorama de las investigaciones y publicaciones sobre el cambio organizacional en el Brasil

Este trabalho analisa pesquisas brasileiras sobre mudança organizacional divulgadas em periódicos científicos de administração, sociologia, ciências da saúde e psicologia entre os anos 2000 e 2010,avaliados com classificação A ou B no Qualis/CAPES. Os artigos selecionados, por meio de título e resumos,foram classificados por juízes, que os liam e faziam registros sobre eles, com base em um sistema padronizado, previamente desenvolvido, de análise e categorização de investigações empíricas. A maioria dos textos apresenta um objeto de estudo relacionado à mudança organizacional e aborda processos de mudança contínua e seu conteúdo.É possível concluir que o objeto de estudo mudança organizacional foi classificado em termos de escopo e intensidade maiores, mas com caráter de continuidade no tempo. Quanto à abordagem metodológica, os resultados mostram estudos que adotam prioritariamente a abordagem metodológica de estudos de caso qualitativos, que utilizam a análise de conteúdo como único método de análise de dados. Assim, conclui-se que há uma tendência a valorizar a abordagem metodológica qualitativa e a escassez de fundamentação teórica. A partir das lacunas encontradas, o artigo sugere diversificar as abordagens metodológicas e apurar a fundamentação teórica dos estudos sobre o tema.

This paper analyzes Brazilian research on organizational change published in scientific journals on administration, sociology, psychology and health sciences, between 2000 and 2010, evaluated with a rating of A or B in the Qualis/CAPES. The articles selected, by means of title and abstracts, were classified by judges, who read them and created records on them, based on a previously developed standardized system of analysis and categorization of empirical investigations. Most of the texts present an object of study related to organizational change and address ongoing change processes and their content. It was concluded that the study subject, organizational change, was classified in terms of a broader scope and intensity, but with a character of continuity over time. Regarding the methodological approach, the results show studies that primarily adopt the methodological approach of qualitative case studies, using content analysis as the sole method of data analysis.Thus, it is concluded that there is a tendency to value the qualitative methodological approach and toward the lack of a theoretical basis. From the gaps found, the article suggests diversifying the methodological approaches and determining the theoretical basis of studies on the subject.

Este trabajo analiza investigaciones brasileñas acerca del cambio organizacional con base en los artículos publicados en revistas científicas de administración, sociología, ciencias de la salud y psicología cuya evaluación ha sido de A o B de acuerdo a la clasificación Qualis/ CAPES. El período inestigado fue del 2000 al 2010. Los artículos, seleccionados por su título y resúmenes, fueron clasificados por jueces, que leían los artículos y hacían anotaciones sobre ellos, con base en un sistema estandarizado, desarrollado previamente,de análisis y categorización de las investigaciones empíricas. La mayoría de los textos presenta que el objeto de estudio se centró en el cambio organizacional, que las investigaciones abordan los procesos continuos de cambio continuo y que ellas describen los contenidos del cambio. En cuanto al enfoque metodológico, los resultados muestran que los estudios adoptan principalmente el enfoque metodológico de estudios de caso, cualitativos, utilizando el análisis de contenido como el único método de análisis de datos. Se concluye que existe una tendencia a valorar el enfoque metodológico cualitativo y que los estudios no muestran un marco teórico consistente. A partir de las carencias que se encuentran en las publicaciones, el artículo sugiere diversificar los enfoques metodológicos y construir la base teórica de los estudios sobre el tema.

Configurações de poder, suporte organizacional e bem-estar pessoal em uma organização pública / Power configurations, organizational support and personal well-being in a public organization

A literatura sobre bem-estar no trabalho tem demandado investigações dos fatores preditores desse fenômeno. Assim sendo, o presente estudo teve como objetivos: 1) descrever as configurações de poder, a percepção de suporte organizacional e o bem-estar de uma organização pública; 2) avaliar a influência de variáveis demográficas e funcionais sobre o bem-estar do empregado nas organizações; e 3) avaliar o efeito das características organizacionais de poder e suporte sobre o bem-estar pessoal dos empregados. Foram utilizadas as escalas de configuração de poder organizacional, suporte organizacional percebido e bem-estar pessoal nas organizações. As escalas foram aplicadas individualmente à amostra aleatória, estratificada por área e composta por 321 funcionários de uma empresa pública. O estilo de gestão, suporte material, sobrecarga de trabalho, ascensão profissional, suporte social e a configuração missionária foram preditores de bem-estar.

The literature on well-being at work has demanded investigations on the predictors of this phenomenon. Therefore, the present study aimed at: 1) describing the configuration of an organization's power, the perception of organizational support and the well-being in a public organizational context; 2) evaluating the influence of demographic and functional variables on the employee's well-being in organizations; and 3) evaluating the effect of organizational characteristics of power and support on the personal well-being of employees. The study used the organizational power configuration scale, perceived organizational support scale and personal well-being in organizations scale. The three scales were applied individually to the random sample, stratified by area and composed of 321 employees of a public company. The missionary configuration, the work overload, the management style, the social support, the material support and the possibility of career advancement were predictors of well-being.

O Poder discriminante da escala de configuração do poder organizacional na perspectiva macro organizacional e sua utilização como instrumento de caracterização do perfil cultural das organizações / The discriminating capacity of the organizational power configuration scale in the macro organizational perspective and its use as a tool for characterizing the cultural profile of organizations

Este estudo teve como objetivo avaliar o poder discriminante da escala de Configurações de Poder organizacional para identificar as diferentes formas de manifestação de cada uma das configurações de poder em diferentes organizações, numa perspectiva macro organizacional/ cultural. Participaram do estudo 20 organizações de diferentes tamanhos, públicas, privadas, de economia mista e de direito público/privado. O instrumento de configurações de poder contendo as seis configurações propostas teoricamente e confirmadas empiricamente foi aplicado coletivamente e respondido individualmente. As amostras foram constituídas por acessibilidade, mas sendo assegurada a representatividade de cada organização no seu todo por meio da reprodução de características originais da população em termos de distribuição por áreas. 3589 participantes responderam ao instrumento. Os testes multivariados da MANOVA demonstraram que a organização tem efeito sobre as configurações de poder. Os resultados evidenciam empiricamente as diferenças entre as configurações de poder e a manifestação delas como fenômeno de nível organizacional, de forma que as configurações de poder podem ser investigadas no nível macro da organização e numa perspectiva cultural. A análise discriminante mostrou que todas as configurações contribuem para os efeitos multivariados identificados na MANOVA, sendo possível concluir que as configurações de poder caracterizam as organizações estudadas e produzem efeitos diferenciados em relação a elas, o que também remete ao construto no nível organizacional...

This study's objective is to evaluate the discriminating capacity of the organizational power configuration scale to identify the different ways each of the power configurations is manifested in different organizations, in a macro organizational and cultural perspective. Twenty-two (22) organizations of different sizes, public, private, public/private investment and legal entities participated in the study. The power configurations instrument, which contains the six theoretically proposed and empirically confirmed configurations, was applied collectively and answered individually. The samples were selected by convenience, but the representativeness of each organization as a whole was guaranteed by reproducing the original characteristics of the population in terms of distribution by area. A total of 3,589 participants responded to the instrument. The MANOVA multivariate tests showed that the organization has effect over the configurations of power. The results empirically show the differences between the power configurations and their manifestation as a phenomenon at the organizational level, thus the power configurations can be investigated on a macro organizational level and in a cultural perspective. Discriminant analysis showed that all the configurations contribute to the multivariate effects identified in the MANOVA, suggesting that the power configurations characterize the organizations studied and produce distinct effects in relation to these organizations, which is also related to the construct at the organizational level...

Una revisión narrativa de las escalas de evaluación usadas para el diagnóstico del trastorno por déficit de atención e hiperactividad en niños y adolescentes / Narrative review of scales assessing attention-deficit/hyperactivity disorder in children and adolescents

Contexto: el trastorno por déficit de atención e hiperactividad es un trastorno neuroconductual frecuente en la población escolar y representa uno de los principales motivos de consulta en servicios de salud mental. Su diagnóstico es complicado por la dificultad que representa la evaluación objetiva de aspectos subjetivos como la desatención o la impulsividad. Objetivo: describir de manera resumida las escalas de valoración más utilizadas como herramientas para el diagnóstico del trastorno por déficit de atención e hiperactividad, los subtipos y comorbilidades, fundada en una revisión de la información disponible en las bases de datos MEDLINE, Medic Latina, Academic Search Complete y Mendeley. Análisis: este trastorno es poco comprendido en el entorno familiar y escolar, lo que dificulta su detección y tratamiento oportuno. Las escalas de evaluación presentan ventajas y desventajas, pero sin duda son importantes para un primer acercamiento a las manifestaciones clínicas del trastorno por déficit de atención e hiperactividad. Conclusión: se observa la necesidad de buscar mejores herramientas diagnósticas o escalas que tomen en cuenta la etapa del neurodesarrollo, las demás etapas evolutivas, las diferencias por género, aspectos socioculturales y los criterios diagnósticos del Manual Diagnóstico y Estadístico de Trastornos Mentales, quinta edición.

Context. Attention-deficit/hyperactivity disorder is a common neurobehavioral disorder in school-age population and is a major driver of mental health consultation. Diagnosis is hindered by the difficulty of objectively assessing subjective aspects such as inattention or impulsivity. Purpose. To briefly describe the most widely used rating scales as tools for the diagnosis of attention-deficit/hyperactivity disorder, subtypes and comorbidities, based on a review of information available in MEDLINE, Medic America, Academic Search Complete and Mendeley databases. Analysis. This disorder is poorly understood in the family and school environment, which hampers detection and timely treatment. Rating scales have advantages and disadvantages, but they are undoubtedly important for an initial approach to the clinical manifestations of attention-deficit/hyperactivity disorder. Conclusion. There is a need for better diagnostic tools or scales that take into account the stage of neurodevelopment, other developmental stages, gender differences, sociocultural aspects and diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition.

Troca valvar aórtica minimamente invasiva: uma alternativa à técnica convencional / Minimally invasive aortic valve replacement: an alternative to the conventional technique

OBJETIVO: Demonstrar o uso da cirurgia minimamente invasiva para tratamento da valva aórtica e comparar seus resultados com o método tradicional. MÉTODOS: Entre 2006 e 2011, 60 pacientes foram submetidos à cirurgia na valva aórtica, após consentimento escrito, destes 40 pela técnica minimamente invasiva com acesso por minitoracotomia ântero-lateral direita (Grupo 1/G1)e 20 por esternotomia mediana (Grupo 2/G2). Comparamos os tempos operatórios e a evolução pós-operatória intra-hospitalar. RESULTADOS: Os tempos médios de circulação extracorpórea (CEC) e pinçamento aórtico no G1 foram, respectivamente, 142,7 ± 59,5 min e 88,6 ± 31,5 min e, no G2, 98,1 ± 39,1 min e 67,7 ± 26,2 min (P<0,05), uma diferença nas medianas de 39 minutos no tempo de CEC e 23 minutos no pinçamento aórtico foram observados a favor da técnica convencional. A perda sanguínea pelos drenos torácicos foi significativamente menor no grupo minimamente invasivo: 605,1 ± 679,5 ml (G1) versus 1617 ± 1390 ml (G2) (P<0,05). Os tempos médios de internamento em UTI e hospitalar foram menores em G1: 2,3 ± 1,8 dias e 5,5 ± 5,4 dias versus 5,1 ± 3,6 dias e 10 ± 5,1 dias em G2 (P<0,05), respectivamente. O uso de drogas vasoativas no pós-operatório também foi menor no grupo minimamente invasivo 12,8% em G1 versus 45% em G2. CONCLUSÃO: Troca valvar aórtica com o uso de técnicas minimamente invasivas, apesar de demonstrar maiores tempos intraoperatórios, não afeta os resultados pósoperatórios, que nesta casuística mostraram-se melhores quando comparado ao método tradicional.

OBJECTIVES: To demonstrate the use of minimally invasive surgery for aortic valve replacement and compare your results with the traditional method. METHODS: Between 2006 and 2011 sixty patients underwent surgery on aortic valve, after written consent, these 40 by minimally invasive technique with right anterior minithoracotomy access (Group 1/G1) and 20 by median sternotomy (Group 2/G2). Compare the operating times and postoperative evolution intra-hospital. RESULTS: The average times of bypass and aortic crossclamp in G1 were, respectively, 142.7 ± 59.5 min and 88.6 ± 31.5 min and, in G2, 98.1 ± 39.1 min and 67.7 ± 26.2 min (P < 0.05), a difference in medians of 39 minutes in bypass time and 23 minutes in aortic cross-clamp were observed in favour of conventional technique. The blood loss by the thoracic drains was significantly lower in the Group: minimally invasive 605.1 ± 679.5 ml (G1) versus 1617 ± 1390 ml (G2) (P < 0.05).The average time of ICU and hospital stay were shorter in G1: 2.3 ± 1.8 and 5.5 ± 5.4 days versus 5.1 ± 3.6 and 10 ± 5.1 in G2 (P < 0.05), respectively. Vasoactive drug use was also less post-operative at 12.8% in minimally invasive group G1 versus 45% in G2. CONCLUSION: Aortic valve replacement through minimally invasive techniques, although intraoperative times larger, not demonstrate affect postoperative results that this case proved best when compared to the traditional approach.

Cirurgia cardíaca videoassistida: 6 anos de experiência / Video-assisted cardiac surgery: 6 years of experience

INTRODUÇÃO: A cirurgia cardíaca minimamente invasiva e videoassistida (CCVA) tem aumentado em popularidade nos últimos 15 anos. As pequenas incisões têm sido associadas a um bom efeito estético e menor trauma cirúrgico, consequentemente, menor dor e rápida recuperação pós-operatória. OBJETIVOS: Apresentar nossa casuística com CCVA, após 6 anos de uso do método. MÉTODOS: Cento e trinta e seis pacientes foram submetidos à CCVA, após consentimento escrito, entre setembro de 2005 e outubro de 2011, sendo 50% do sexo masculino, com idade de 47,8 ± 15,4 anos, divididos em dois grupos: com circulação extracorpórea (CEC) (GcCEC=105 pacientes): valvopatia mitral (47/105), valvopatia aórtica (39/105) e cardiopatia congênita (19/105) e sem CEC (GsCEC=31 pacientes): ressincronização cardíaca (18/31), tumor cardíaco (4/31) e revascularização miocárdica minimamente invasiva (6/31). No GcCEC, foi realizada minitoracotomia direita (3 a 5 cm) e acesso femoral para canulação periférica. RESULTADOS: No GcCEC, a média de dias em UTI (DUTI) e de internação hospitalar (DH) foi, respectivamente, 2,4 ± 4,5 dias e 5,0 ± 6,8 dias. Doze pacientes apresentaram complicações no pós-operatório e cinco (4,8%) foram a óbito. Noventa e três (88,6%) pacientes evoluíram sem intercorrências, foram extubados no centro cirúrgico, permanecendo 1,8 ± 0,9 DUTI e 3,6 ± 1,3 DH. No GsCEC, foram 1,3 ± 0,7 DUTI e 2,9 ± 1,4 DH, sem intercorrências ou óbitos. CONCLUSÃO: Os resultados encontrados nesta casuística são comparáveis aos da literatura mundial e confirmam o método como opção à técnica convencional.

INTRODUCTION: Minimally invasive and video-assisted cardiac surgery (VACS) has increased in popularity over the past 15 years. The small incisions have been associated with a good aesthetic effect and less surgical trauma, therefore less postoperative pain and rapid recovery. OBJECTIVES: To present our series with VACS, after 6 years of use of the method. METHODS: 136 patients underwent VACS, after written consent, between September 2005 and October 2011, 50% for men and age of 47.8 ± 15, 4anos, divided into two groups: with cardiopulmonary (CEC) (GcCEC=105 patients): mitral valve disease (47/105), aortic disease (39/105), congenital heart disease (19/105) and without extracorporeal circulation (CEC) (GsCEC=31 patients): cardiac resynchronization (18/ 31), cardiac tumor (4/31) and minimally invasive coronary artery bypass grafting (6/31). GcCEC was held in right minithoracotomy (3 to 5 cm) and femoral access to perform cannulation. RESULTS: In GcCEC, mean length of ICU stay and hospital stay were respectively 2.4 ± 4.5 days and 5.0 ± 6.8 days. Twelve patients presented complications in post-operative and five (4.8%) death. Ninety-three (88.6%) patients evolved uneventful, were extubated in operating room, and remained a mean of 1.8 ± 0.9 days in ICU and 3.6±1.3 days in the hospital. In GsCEC, were mean 1.3 ± 0.7 days in ICU and 2.9 ± 1.4 days in hospital and without complications or deaths. CONCLUSION: The results found in this series are comparable to those of world literature and confirm the method as an option the conventional technique.

Sintomatología persistente en trabajadores agrícolas expuestos a plaguicidas órgano-fosforados / Persistent symptoms in agricultural workers exposed to organophosphate pesticides

Objetivo: evaluar la prevalencia de estos síntomas y analizar su relación con la exposición a plaguicidas y el nivel de colinesterasa en trabajadores agrícolas. Metodología: se realizó un estudio transversal analítico con 106 jornaleros en un campo agrícola en México. Se determinó el nivel decolinesterasa y los síntomas según la exposición. La exposición se delimitó con un índice constituido por 15 variables. Resultados: la prevalencia de síntomas fue de 52 por cada 100 trabajadores. 31% refirió de 1 a 3, 16% de 4 a 9 síntomas y el 5% presentó más de 10. Hubo asociaciónentre días de exposición y síntomas persistentes p = 0.03.También entre nivel de exposición y presencia de síntomas probables y específicos. Los más expuestos tuvieron una probabilidad 20% mayor de tener síntomas. La concentraciónde colinesterasa estuvo dentro de rangos normales. Se detectó anemia en el 28% de la población. Esta fue tresveces más frecuente en las mujeres p < 0,001. Conclusiones: en este grupo fue posible identificar el aumento de síntomas persistentes en jornaleros con niveles de colinesterasa dentro derangos habitualmente considerados normales.

Objective: to evaluate the prevalence of these symptoms and their relationship with pesticide exposure and the cholinesterase levels in agricultural workers. Methodology: an analyticalcross-sectional study conducted in Mexico. Cholinesterase concentration and symptom frequency were assessed for 106 agricultural workers. Exposure was defined with a composed index of 15 variables. Results: symptom prevalence was 52 out of 100 workers. 31% of workers had 1 to 3 of thesymptoms, 16% had 4 to 9 of them and 5% had 10 or more of the symptoms. There was an association, p = 0.03, between days of exposure and persistent symptoms. Likewise, therewas an association between exposure level and the presence of probable and specific symptoms. Patients with the highest exposure level had 20% more chances of exhibiting symptoms.Cholinesterase concentration ranges were normal. Anemia was detected in 28% of the population. It was three times as frequent in females as in males (p < 0.001). Conclusions: it was possible to identify the increase of persistent symptoms in workers with cholinesterase levels that are usually considered to be normal.

Valores y bienestar de los dietistas brasileños / Values and well-being of brazilian dieticians

Este estudio tuvo el objetivo de identificar las relaciones existentes entre las variables valores generales y del trabajo, el bienestar personal en el trabajo, así como comprobar las diferencias que existen en dichas variables con respecto a las variables demográficas (región geográfica, estado civil, sexo, edad, escolaridad, tiempo de trabajo y área de actuación). La muestra fue de 587 contestadores, todos dietistas. Los valores generales autotrascendencia y realización en el trabajo se notaron como los que más orientaban las prácticas profesionales de los dietistas que se consideraron, a menudo, en bienestar personal. Los análisis de variancia mostraron que los solteros que actuaban en el área de clínica, valoraban más la autopromoción; los solteros y más jóvenes valoraban más la apertura al cambio; los que estaban hace más de 10 años en el actual trabajo y actuaban en el área de clínica y salud colectiva se percibieron/vieron más en bienestar, que aquellos con hasta dos años en el trabajo actual y que actuaban en el área de alimentación colectiva-producción.

The study aimed to identify the hierarchy of the general values and work of brazilian dieticians, identify the level of personal wellbeing at their work, identify the relations and the differences between the cited variables and demographic variables: a) personal; b) functional. The final sample included 587 dieticians. Self-transcendence and fulfillment at work were the most important values considered. Dieticians said they often had a feeling of well-being. The results of variance analysis showed that self-transcendence was more valued by single dieticians who acted in the clinical area and self-promotion, and by single dieticians with less working hours. Open to change was more valued by the youngest and single dieticians. Social Relationship was more valued by single dieticians while the youngest dieticians with post graduation and less working hours put more value on prestige. Dieticians with over 10 years working experience and practice in areas like clinic and public health had a better feeling of well-being than dieticians with over 2 years working experience and practice in the production area.

Bem-estar pessoal nas organizações: o impacto de configurações de poder e características de personalidade / Individual well-being in organizations: the impact of power configurations and personality traits

Atualmente há um crescente interesse pelo bem-estar no trabalho, definido neste estudo como satisfação de necessidades e realização de desejos dos indivíduos ao desempenhar seu papel na organização. Como a literatura aponta a influência de características organizacionais e individuais no bem-estar ocupacional, esta pesquisa visa identificar o impacto das configurações de poder organizacional e das características de personalidade do Big Five nesta variável. A amostra possui 319 trabalhadores e suas respostas foram analisadas por meio de regressões. Os resultados apontam uma relação positiva entre as configurações sistema autônomo e missionária e bem-estar, e negativa entre instrumento e bem-estar, sendo essas duas últimas relações mediadas pela conscienciosidade. A discussão visa suscitar reflexões e estimular pesquisas futuras nesta área.

There has been growing concern for well-being at the workplace, which is defined, in this study, as the satisfaction of needs and fulfillments of desires while working at the organization. Considering that the literature points out that both organizational and individual characteristics may influence occupational well-being, this research aims to identify the impact of organizational power configurations and of the Big Five personality traits on that variable. The sample has 319 workers and their responses were analyzed by means of regressions. The results indicate a positive relation between well-being and the missionary and autonomous system configurations, and a negative relation between well-being and instrument. The last two relations have been mediated by conscientiousness. The discussion tends to provoke reflections and stimulate future research in this area.