Saberes, territórios e uso de drogas: modos de vida na rua e reinvenção do cuidado / Knowledge, territories, and drug use: street ways of life and reinventing care

Resumo Mediante o processo de estigmatização existente sobre a População em Situação de Rua que faz uso de drogas e a reprodução de violências nos serviços de saúde, refletiu-se neste artigo sobre esse público e o espaço da rua para além da visão de decrepitude com que costumeiramente são vistos. Nesse sentido, a pesquisa tomou contornos a partir do objetivo de conhecer práticas e saberes construídos nos processos de cuidado entre a População em Situação de Rua usuária de drogas. Para isso, delineou-se um estudo qualitativo, utilizando-se da triangulação das técnicas de observação participante, a partir da inserção de uma das pesquisadoras em um Consultório na Rua, em uma cidade no interior de Pernambuco, e duas modalidades de entrevistas individuais em profundidade: a entrevista episódica e a entrevista narrativa. A partir dos dados obtidos, delineou-se três categorias temáticas: "Sujeitos, territorialidades e contextos", "Drogas, medicalização de problemas sociais e controle" e "Redução de danos, singularidades e produção de cuidado no território". Construíram-se, assim, compreensões sobre as normativas e dicotômicas que atravessam a visão sobre a População em Situação de Rua, pretendendo contribuir para a consolidação da oferta de cuidado orientada pela perspectiva da Redução de Danos.

Abstract Through the stigmatization of drug-using People Living on the Streets (PLS) and the reproduction of violence in health services, this paper reflected on this community and the street space beyond the view of decrepitude with which they are usually seen. In this sense, the research contours were shaped from the objective of knowing practice and knowledge constructed in the care processes among the drug-using PLS. A qualitative study was designed, using the triangulation of participant observation techniques, from the inclusion of one of the researchers in a "Street Clinic" (Consultório na Rua), in an inland city of the state of Pernambuco, Brazil, and two types of in-depth individual interviews: the episodic interview and the narrative interview. Three thematic categories were outlined from the data retrieved, as follows: "subjects, territorialities and contexts", "drugs, social problem medicalization, and control", and "harm reduction, singularities and care production in the territory". Thus, understandings about the norms and dichotomies that cross the view of PLS were constructed to consolidate the care offer guided by the perspective of harm reduction.

Perfil clínico de los pacientes con cardiopatía isquémica y artritis reumatoide. Centro Cardiovascular Regional Centrooccidental / Clinical profile of patients with ischemic heart disease and rheumatoid arthritis. Central Western Regional Cardiovascular Center

La cardiopatía isquémica es la causa más frecuente de morbimortalidad a nivel mundial. La artritis reumatoide (AR) se asocia con el desarrollo prematuro de enfermedades cardiovasculares y la esperanza de vida se reduce principalmente debido a un incremento en la muerte cardiovascular. Se realizó un estudio retrospectivo de revisión de historias médicas con el objetivo de describir el perfil clínico de los pacientes con cardiopatía isquémica y AR que acudieron a la Unidad de Prevención Secundaria y Rehabilitación Cardiovascular del Centro Cardiovascular Regional Centro Occidental desde enero 2013 hasta diciembre 2018. Se incluyeron 37 pacientes con diagnóstico de AR que presentaron algún evento coronario. Ell 62% de los pacientes eran del sexo femenino con una edad media de 59 ± 11 años; el 65% tenían menos de 10 años de diagnóstico de AR. El sedentarismo representó el factor más frecuente (92%), seguido de HTA (76%), tabaquismo (73%), DM (43%), antecedentes familiares de cardiopatía isquémica (24%), obesidad (22%), dislipidemia (16%) y ERC (11%); el tipo de evento coronario más frecuente fue el IMsEST (43%). El análisis multivariado no mostró relación estadísticamente significativa entre número de factores de riesgo y tiempo de duración de la AR con la presencia de lesiones coronarias. El sedentarismo fue el factor de riesgo más frecuente en esta población especial sin embargo el comportamiento de los factores de riesgo tradicionales para cardiopatía isquémica en los pacientes con AR no difiere del de la población general...(AU)

Ischemic heart disease is the most frequent cause of morbidity and mortality worldwide. Rheumatoid arthritis (RA) is associated with premature development of cardiovascular disease and life expectancy is mainly reduced due to an increase in cardiovascular death. A descriptive and retrospective review of medical charts was conducted with the objective of describing the clinical profile of patients with ischemic heart disease and RA who attended the Unidad de Prevención Secundaria y Rehabilitación Cardiovascular del Centro Cardiovascular Regional Centro Occidental from January 2013 to December 2018. 37 patients with RA diagnosis who presented a coronary event were included. The results show that 62% of patients were female with a mean age of 59 ± 11 years; 65% had less than 10 years of diagnosis of RA. Sedentary lifestyle represented the most frequent factor (92%), followed by HTA (76%), smoking (73%), DM (43%), family history of ischemic heart disease (24%), obesity (22%), dyslipidemia (16%) and finally CKD (11%); the most frequent type of coronary event was the IMsEST (43%). The multivariate analysis showed no statistically significant relationship between the number of risk factors and the duration of RA with the presence of coronary lesions. Sedentary lifestyle was the most frequent risk factor in this population however the behavior of traditional risk factors for ischemic heart disease in patients with RA does not differ from the general population...(AU)

Sensibilidad y Especificidad de los Índices SNAP II Y SNAPPE II como predictores de Mortalidad Neonatal en pacientes ingresados en una Unidad de Cuidados Intensivos Neonatales / Sensitivity and Specificity of the SNAP II and SNAPPE II Scoresas Predictors of Neonatal Mortality in Patients Admitted to the Neonatal Intensive Care Unit

Introducción: Los sistemas de puntuación fisiológica neonatal SNAP-II y SNAPPE-II (puntaje extendido) desempeñan un papel importante en la predicción de mortalidad. El objetivo del presente estudio fue contrastar estas escalas en pacientes ingresados a una Unidad de Cuidados Intensivos Neonatales (UCIN) y realizar un test diagnóstico para predicción de mortalidad. Métodos: Este estudio observacional analítico fue realizado en la UCIN del Hospital GinecoObstétrico Isidro Ayora, Quito-Ecuador en diciembre 2014 a noviembre 2015. Se incluyeron todos los posibles casos analizables. Las variables edad gestacional, sexo, variables clínicas del puntaje SNAP II, SNAPPE-II y mortalidad. El Grupo 1 (G1): Neonatos con fallecimiento, Grupo 2 (G2): Neonatos vivos. Se calculó Sensibilidad (S), Especificidad (E), Valor Predictivo Positivo (VPP), Valor Predictivo Negativo (VPN) de cada Puntaje. Resultados: 200 casos fueron incluidos. Componentes del Puntaje SNAP II: Tensión arterial media, temperatura Corporal y PaO2/FiO2 no tuvieron diferencias entre grupos. El pH en G1: n=48 fue de 7.25 ±0.16 en G2: n=152 fue de 7.32 ±0.13 (P=0.005). Flujo Urinario en G1: 1 ±1.27 en G2: 2.7 ±2.2 (P<0.001). En SNAPPE II, el APGAR al 5to minuto, y pequeño para edad gestacional , sin diferencias estadísticas. Puntaje SNAP II: S:79.2%, E:60.5%, VPP:38.8%, VPN:90.2%. Puntaje SNAPPE-II: S:93.8%, E:45.4%, VPP:35.2%, VPN:95.8%. Conclusión: El puntaje SNAPPE-II es el mejor predictor de mortalidad, y se recomienda su uso al ingreso de los pacientes en las UCIN

Introduction: The SNAP-II and SNAPPE-II (extended scoring) neonatal physiological scoring systems play an important role in the prediction of mortality. The objective of the present study was to contrast these scales in patients admitted to a Neonatal Intensive Care Unit (NICU) and to carry out a diagnostic test to predict mortality. Methods: This analytical observational study was carried out in the NICU of the Isidro Ayora Gyneco-Obstetric Hospital, Quito-Ecuador from December 2014 to November 2015. All possible analysable cases were included. The variables gestational age, sex, clinical variables of the SNAP II, SNAPPE-II score and mortality. Group 1 (G1): Neonates with death, Group 2 (G2): Neonates alive. Sensitivity (S), Specificity (E), Positive Predictive Value (PPV), Negative Predictive Value (NPV) of each Score were calculated. Results: 200 cases were included. Components of the SNAP II Score: Mean arterial pressure, Body temperature and PaO2 / FiO2 did not differ between groups. The pH in G1: n = 48 was 7.25 ± 0.16 in G2: n = 152 it was 7.32 ± 0.13 (P = 0.005). Urinary flow in G1: 1 ± 1.27 in G2: 2.7 ± 2.2 statistical differences. SNAP II score: S: 79.2%, E: 60.5%, PPV: 38.8%, NPV: 90.2%. SNAPPE-II score: S: 93.8%, E: 45.4%, PPV: 35.2%, NPV: 95.8%. Conclusion: The SNAPPE-II score is the best predictor of mortality, and its use is recommended when patients are admitted to the NICU

Consideraciones diagnósticas y terapéuticas de la tuberculosis intestinal / Diagnostic and Therapeutic Considerations about Abdominal Tuberculosis

Introducción: La tuberculosis es una enfermedad reemergente, importante como causa mayor de incapacidad y muerte en muchas zonas del mundo. La tuberculosis intestinal representa 11 por ciento de todas las formas extrapulmonares; 0,5 por ciento de todos los casos nuevos de y el 10 al 15 por ciento en los no infectados por el VIH. En el municipio Tunas se notificó el caso de un adolescente de 17 años, masculino, al que se le diagnostica esta enfermedad luego de haber presentado síntomas de dolor abdominal recurrente durante de varios meses antes del diagnóstico. Objetivo: Actualizar la información sobre el diagnóstico y tratamiento de la tuberculosis intestinal. Métodos: Se realizó una revisión bibliográfica sobre tuberculosis intestinal con la literatura encontrada en bases de datos disponibles en la red Infomed: PubMed, Hinari, The Cochrane Library, SciELO, MEDLINE y MedicLatina; con un enfoque histórico-lógico y de análisis-síntesis. Conclusiones: El diagnóstico precoz de la tuberculosis intestinal sin tuberculosis pulmonar activa continúa siendo un problema de salud, ya que los parámetros clínicos, bioquímicos, imagenológicos y endoscópicos aún carecen de especificidad, y en algunos casos se ha mostrado resistencia al tratamiento habitual(AU)

Introduction: Tuberculosis is a reemerging disease, also important as a major cause of disability and death in many regions of the world. Abdominal tuberculosis represents 11 percent of all extrapulmonary forms; 0.5 percent of all new cases of HIV infection and 10-15 percent of those not infected with HIV. In Las Tunas Municipality, the case of a 17-year-old male adolescent who was diagnosed with this disease was reported after the patient presented symptoms of recurrent abdominal pain for several months before diagnosis. Objective: To update information on the diagnosis and treatment of abdominal tuberculosis. Methods: A literature review on intestinal tuberculosis was carried out with the literature found in databases available on the Infomed network, such as PubMed, Hinari, The Cochrane Library, SciELO, MEDLINE, and MedicLatina, with a historical-logical and analysis-synthesis approach. Conclusions: The early diagnosis of intestinal tuberculosis without active pulmonary tuberculosis continues to be a health concern, since clinical, biochemical, imaging, and endoscopic parameters still lack specificity, and, in some cases, resistance to usual treatment has been shown(AU)

Suplementos termogênicos reduzem o peso ou prejudicam a saúde? / Thermogenic supplements reduce weight or harmful health?

Introdução: os recursos ergogênicos nutricionais (RENs) são substâncias utilizadas por praticantes de exercício físico e atletas para melhora do desempenho. Dentre os diversos tipos destes Ren´s, os suplementos termogênicos e emagrecedores vêm sendo amplamente utilizados devido aos seus efeitos no aumento da oxidação de metabolismo de lipídios que impactam na redução da composição corporal, entretanto contêm substancias que agem no sistema nervoso central e podem causar efeitos colaterais e estão sendo amplamente utilizadas de forma indiscriminada e sem orientação. Objetivo: descrever em síntese os principais efeitos dos recursos ergogênicos emagrecedores identificando suas principais consequências à saúde humana. Metodologia: foi realizado revisão narrativa de literatura acessando artigos científicos encontrados nas bases de dados Scielo, Google Acadêmico e Pubmed, pesquisando pelos seguintes descritores: suplementação, emagrecimento, efeitos ergogênicos, efeitos colaterais. Desenvolvimento: Os suplementos termogênicos emagrecedores que agem no sistema nervoso central; efedrina, 1,3-dimetilamilamina promovem muitos efeitos colaterais e risco cardíaco. A cafeína quando bem administrada apresenta efeitos desejáveis, entretanto tem variações individuais e L-Carnitina, demonstrou efeitos metabólicos na oxidação de lipídios, entretanto não estão totalmente esclarecidos. Conclusão: Sugere-se não consumir estes suplementos termogênicos e emagrecedores com ação no sistema nervoso, pois podem causar morte. Por outro lado, a adoção de estilo de vida saudável pode contribuir para o emagrecimento.

Introduction: ergogenic nutritional resources (REN's) are substances used by physical exercise practitioners and athletes to improve performance. Among the various types of Ren's, thermogenic and weight loss supplements have been widely used due to their effects on the increase of oxidation of lipid metabolism that impact on the reduction of body composition, but it contains substances that act on the central nervous system and can cause effects collaterals and are being widely used indiscriminately and without guidance. Objective: to describe in brief the main effects of the ergogenic resources, identifying the main consequences in human health. Methodology: a literature review was carried out by accessing scientific articles found in the Scielo, Google Academic and Pubmed databases, the following descriptors were used: supplementation, weight loss, ergogenic effects, side effects. Development: Thermogenic weight loss supplements that act on the central nervous system; ephedrine, 1,3-dimethylamylamine promote many side effects and heart risk. While well-administered caffeine has desirable effects, however, it has individual variations and L-Carnitine has demonstrated metabolic effects on lipid oxidation, but they are not fully understood. Conclusion: However, it is suggested not to consume these thermogenic and weight loss supplements with action in the nervous system because they are at risk of death. On the other hand, adopting a healthy lifestyle can contribute to weight loss.

Factores protectores familiares para la prevención del uso de sustancias psicoactivas (SPA) en estudiantes de quinto de primaria de la Institución Educativa San Luis Gonzaga del corregimiento de Chicoral (El Espinal, Tolima) / Family protective factors for the prevention of the use of psychoactive substances in fifth grade students of educational institution San Luis Gonzaga the village Chicoral (El Espinal, Tolima)

Resumen Objetivo: Determinar los factores protectores familiares que previenen el uso de sustancias psicoactivas en los estudiantes del grado quinto de primaria de la Institución Educativa San Luis Gonzaga de Chicoral, corregimiento de El Espinal (Tolima). Materiales y métodos: La metodología utilizada fue de tipo cuantitativo, descriptivo y transversal. El análisis y procesamiento de la información se llevó a cabo mediante la utilización del paquete estadístico Statistical Package for the Social Sciences (SPSS) versión 18. La recolección de la información se realizó a través de la aplicación de una encuesta, una escala tipo Lickert autoaplicable. La muestra estuvo constituida por un total de 130 estudiantes de quinto de primaria de la institución educativa pertenecientes al estrato 1 y 2 de acuerdo con el régimen subsidiado Sisbén. Resultados: Para la realización del análisis se empleó la estadística descriptiva con tablas de frecuencias, figuras de barras y cruces de variables. Conclusiones: El estudio permitió reconocer la importancia que tienen los factores protectores para el desarrollo integral y saludable de los adolescentes. La comunicación es un posibilitador de los factores protectores familiares. El fenómeno de consumo de SPA no tiene características diferenciales para el contexto urbano y el contexto rural.

Abstract Objetive: To determine the family protective factors that prevent the use of psychoactive substances in fifth grade students of the San Luis Gonzaga Educational Institution of Chicoral, El Espinal (Tolima). Materials and methods: The methodology used was quantitative, descriptive and cross-sectional. Data analysis and processing was carried out using the statistical package Statistical Package for the Social Sciences (SPSS), version 18. The information was collected through the application of a survey, a type scale Self-applying Lickert. The sample consisted of a total of 130 fifth grade students from the educational institution belonging to stratum 1 and 2 according to the subsidized Sisbén regime. Results: Descriptive statistics were used for the analysis, with tables of frequencies, bar figures and crosses of variables. Conclusions: The study made it possible to recognize the importance of protective factors for the integral and healthy development of adolescents. Communication is an enabler of family protective factors. The phenomenon of SPA consumption does not have differential characteristics for the urban context and the rural context.

Minimally invasive surgery of the abdomen and thorax in veterinary medicine in Medellin, Colombia / Cirugía de mínima invasión de abdomen y tórax en medicina veterinaria en la ciudad de Medellín, Colombia / Cirurgia de mínima invasão de abdômen e tórax em medicina veterinária na cidade de Medellín, Colômbia

Despite decades of evolution of minimally invasive surgery on humans, only in recent years it has been included in veterinary practice. Publications on this subject have increased significantly in the last five years. However, its development in Colombia is very limited despite the advantages of this technique. The first interventions in Medellin were conducted on horses during year 2000. Veterinarians from the Center for Veterinary and Animal Science at CES University began training and conducted laparoscopic surgeries on dogs in 2006. At present, only the abovementioned veterinary hospital performs minimally invasive procedures in abdomen and thorax routinely on small animals, and only the Master´s program in Veterinary Medicine for Small Animal Species of the same university provides basic training in this field. Minimally invasive surgery techniques quickly gain spaces in veterinary practice throughout the world and constitute an alternative career development in Colombia.

A pesar de las décadas de evolución de la cirugía de mínima invasión en seres humanos, solo en años recientes se ha extendido de forma importante su uso en la práctica quirúrgica veterinaria. Las publicaciones en el tema aumentaron significativamente en los últimos 5 años, no obstante, el desarrollo en Colombia es muy limitado a pesar de las ventajas que ofrece la técnica.En el año 2000, en la ciudad de Medellín, los primeros veterinarios interesados en el área iniciaron entrenamientos y se efectuaron las primeras intervenciones en equinos. Durante el 2006, médicos veterinarios del Centro de Veterinaria y Zootecnia de la Universidad CES realizaron el adiestramiento y comenzaron a realizar cirugías laparoscópicas en caninos. Al momento de escribir el presente artículo, sólo el hospital veterinario mencionado realiza procedimientos de mínima invasión en abdomen y tórax de forma rutinaria en pequeños animales y sólo el programa de Maestría en Medicina Veterinaria de Pequeñas Especies Animales de la misma universidad, ofrece entrenamientos básicos para sus estudiantes. Las técnicas de cirugía de mínima invasión rápidamente ganan espacios en la práctica quirúrgica veterinaria en el mundo y se constituyen en una alternativa de desarrollo de la profesión en el país y una alternativa de evolución profesional en el área de cirugía veterinaria.

Ainda que a cirurgia de mínima invasão tem evolucionado muito em seres humanos desde faz muito tempo, só em anos recentes tem se estendido de forma importante seu uso na pratica cirúrgica veterinária. As publicações no tema aumentaram significativamente nos últimos cinco anos, não obstante, o desenvolvimento na Colômbia é muito limitado embora as vantagens que oferece a técnica. No ano 2000, na cidade de Medellín, os primeiros médicos veterinários interessados na área iniciaram treinamentos e foram efetuadas as primeiras intervenções em equinos. Durante o ano 2006, médicos veterinários do Centro de Veterinária e Zootecnia da Universidade CES, realizaram o adestramento e começaram a realizar cirurgias laparoscópicas em caninos. Ao momento de escrever o presente artigo, só no hospital veterinário mencionado realiza-se procedimentos de mínima invasão em abdômen e tórax de forma rotineira em pequenos animais e só no programa de mestrado em Medicina Veterinária de pequenas espécies animais da mesma universidade oferece-se treinamentos básicos aos seus estudantes. As técnicas de cirurgia de mínima invasão rapidamente ganham espaços na pratica cirúrgica veterinária no mundo e se constituem em uma alternativa de desenvolvimento da profissão no pais e uma alternativa de evolução profissional na área da cirurgia veterinária.

Factores de riesgo asociados con el diagnóstico de miocardiopatía chagásica crónica en individuos seropositivos del estado Barinas, Venezuela / Risk factors associated with the diagnosis of chronic chagasic miocardiopathy in seropositive individuals from Barinas state, Venezuela

Se determinaron los factores de riesgo asociados al diagnóstico de miocardiopatía chagásica crónica (MChC) en 115 individuos seropositivos para anticuerpos anti-Trypanosoma cruzi, en el Estado Barinas, Venezuela. La seropositividad fue determinada mediante ELISA y MABA (Multiple Antigen Blot Assay) y el diagnóstico de MChC fue establecido mediante electrocardiografía y ecocardiografía. A cada individuo se le realizó una historia clínica completa que incluyó antecedentes epidemiológicos, antecedentes patológicos personales y familiares, y hábitos psicobiológicos; además se realizó una encuesta donde se interrogó acerca de factores de riesgo socioeconómicos, psicosociales y de hábitos alimentarios. Los factores de riesgo fueron establecidos mediante una regresión logística binaria. Los resultados mostraron que 81 (70,4%; IC95% = 66,4-74,4) pacientes reunían criterios para el diagnóstico de MChC, de los cuales 74 (64,4%; IC95% = 60,2-68,6) estaban en Fase II (6,1%; IC95% = 4,0-8,2) y 7 en Fase III, mientras que 34 (29,6%; IC95% = 25,5-33,5) estaban en Fase I. En el periodo de 1 año murieron 2 individuos en Fase III. El diagnóstico de MChC estuvo asociado con la práctica de la caza de animales silvestres, el consumo de chimó, antecedentes maternos de cardiopatía, antecedentes personales de hipertensión arterial y un ápex visible, como factores de riesgo, mientras que: el consumo de alimentos preservados y enlatados constituyó un factor de protección. En conclusión, el diagnóstico de MChC tiene una alta frecuencia en individuos seropositivos del estado Barinas y la prevención del desarrollo de insuficiencia cardíaca debe basarse en la atención médica precoz y en medidas educativas para controlar los factores de riesgo.

This study evaluates the risk factors associated with the diagnosis of chronic chagasic miocardiopathy (CChM) in 115 seropositive individuals to anti-Trypanosoma cruzi antibodies, in Barinas state, Venezuela. Serology was performed with ELISA and MABA; while the CChM diagnosis was established by electrocardiography and echocardiography. A complete clinical history including epidemiological, personal/familiar antecedents and psychobiological habits, plus socioeconomic, psychosocial and alimentary habits interviews were performed for each individual. Risk factors were determined through binary logistic regression. Results showed that 81 patients (70,4%; CI95% = 66.4-74.4) had criteria for CChM, of which 74 (64.4%; IC95% = 60.2-68.6) were in phase II; while 34 (29.6%; IC95% = 25.5-33.5) were in phase I of the disease and 7 (6.1%; IC95% = 4.0-8.2) in phase III. In a one year period, two patients in phase III died of heart failure. The diagnosis of CChM was associated with hunting practice, maternal history of cardiopathies, chewing chimó, medical history of hypertension and apex beat visible; it was negatively associated with canned and preserved foods ingest. In conclusion the CChM diagnosis has high frequency in seropositive individuals in Barinas and heart failure prevention must be based on an early medical attention and educative strategies in order to control risk factors.

A fé: Bion e Kierkegaard / Faith: Bion and Kierkegaard

O artigo aborda o significado que toma o termo fé no campo da psicanálise, tal como introduzido por Bion no contexto de seu pensamento a partir do livro Transformações. Para penetrar a penumbra de significados do termo, a autora se dirige à concepção religiosa de fé, usando subsídios do pensamento de Søren Kierkegaard. O artigo procede a uma aproximação dos dois vértices numa ilustração clínica do conceito de fé.

This paper explores the meaning of faith in the field of psychoanalysis, as introduced by Bion in the context of his thoughts since 1965, in his book Tansformations. The author searches the religious concept of faith in the thoughts of Søren Kierkegaard and tries to approximate the two vertices through a clinical illustration of the concept of faith.

Compreendendo a adoção: um estudo com moradores de Aracaju (SE), Brasil / Understanding adoption: a study with residents of Aracaju (SE), Brazil

O objetivo desse estudo foi analisar os sentidos que os moradores de Aracaju associam à adoção. Para tanto, foi realizada uma pesquisa com moradores da capital sergipana na qual foram feitas perguntas sobre família, crenças sobre filhos biológicos e adotivos. Os resultados encontrados mostram que os participantes da pesquisa entendem a família como base da sociedade, ressaltando a sua importância, possuindo uma visão positiva a respeito da adoção. No entanto, apesar dessa visão positiva, a grande parte dos participantes ainda desconhece os procedimentos necessários para se adotar uma criança. De modo geral, foi possível considerar que existem avanços na maneira de se compreender a adoção e interesse sobre o assunto. Por outro lado, ainda há bastante desinformação da sociedade, o que aponta para a necessidade de divulgar melhor o tema para que tabus e preconceitos possam desaparecer, e maiores oportunidades sejam dadas às crianças e adolescentes brasileiros.

The objective of this study was to analyze the meanings associated to adoption by residents of Aracaju. In order to accomplish this goal, a and adoptive children were made. The results found show that the participants of the research understand family as the basis of society, highlighting its importance and demonstrating to have a positive point of view about adoption. However, despite this positive perspective, the majority of the participants still do not know about the necessary procedures to adopt a child. Overall, it was possible to consider that there are some advances regarding the way people comprehend adoption and their interest in this subject. On the other hand, there is still a considerable lack of information of the society, which points out the necessity to better disclose the subject so that prejudice and taboos can disappear and bigger opportunities can be given to the Brazilian children and adolescents.

Bacteremia por Acinetobacter baumannii en pacientes en estado crítico / Bacteremia caused by Acinetobacter baumannii among patients in critical care

Objetivo: Determinar la severidad y el comportamiento de las bacteremias por Acinetobacter baumannii (BAb). Métodos: Se revisaron de manera prospectiva todos los Acinetobacter baumannii aislados en una unidad de cuidados intensivos. Resultados: Se identificaron 46 pacientes con BAb y una tasa de BAb de 14 por mil ingresos. A. baumannii se adquirió en la unidad de cuidados intensivos en 85%. El periodo entre el ingreso y la BAb fue de 9±7 días. La BAb se presentó en 31 pacientes y bacteremia polimicrobiana en 15. Las manifestaciones clínicas de los 31 pacientes: choque séptico en 42%, sepsis severa en 42% y sepsis en 16%. Dos o más episodios de BAb ocurrieron en 13%. Se presentó resistencia a imipenem en 17% de los A. baumannii. La mortalidad para los pacientes con BAb fue de 45% y para bacteremia polimicrobiana de 40%. La mortalidad para los pacientes con choque séptico fue de 60%; 70% de los pacientes murió durante las primeras 72 horas seguidas a la BAb. Conclusiones: La distribución de los casos de BAb se presentó en forma continua con un patrón endémico. Sepsis severa y choque séptico fueron las principales manifestaciones de BAb. Las BAb se asocian con una tasa de mortalidad significativa.

OBJECTIVE: Determine the severity and the course of Acinetobacter baumannii blood infections (AbBI). METHODS: We carried out a prospective review of all Acinetobacter baumannii (A. baumannii) isolated from the Intensive Care Unit (ICU) of a medical facility. RESULTS: During the study period, 46 patients were identified with AbBI. The rate of AbBI was 14 per 1,000 admissions. A. baumannii was ICU acquired in 85% of cases studied. The median time frame between ICU admission and acquisition of AbBI was 9 +/- 7 days. 31 patients displayed blood infection (BI) by A. baumannii alone and 15 with polymicrobial BI. The clinical manifestation of the 31 patients with AbBI included the following symptoms: 42% presented with septic shock, 42% had severe sepsis and 16% had sepsis. Two or more episodes of AbBI were observed among 13% of patients. Of A. baumannii isolates, 17% were resistant to imipenem. Patient mortality with AbBI alone was 45% and 40% for polymicrobial BI. Patient mortality for septic shock was 60%, 70% died during the first 72 hrs after AbBI. CONCLUSIONS: AbBI displayed an endemic pattern during the study period. Severe sepsis and septic shock were the most common clinical presentations of AbBI. AbBI are associated with a significant increase in the death rate of patient in the ICU studied.

Evaluación sobre el conocimiento de técnicas y criterios de reparación de restauraciones de amalgama de plata, en la Facultad de Odontología de la Universidad de El Salvador / Evaluation of the knowledge of techniques and criteria for the repair of silver amalgam restorations, at the School of Dentistry of the University of El Salvador

Esta investigación fue elaborada con el objetivo de indagar sobre el conocimiento y criterios de técnicas de reparación de restauraciones de amalgama de plata en los docentes odontólogos y estudiantes del área clínica de la facultad de odontología de la Universidad de El Salvador (FOUES); y conocer porque no son aplicadas. La investigación es de tipo Diagnostica porque se indagó sobre un tema que no ha sido elaborado antes en la FOUES. Se utilizó: el cuestionario; fue pasado en el ciclo II año 2006, a 53 docentes y 175 estudiantes de los ciclos VI, VIII, IX y XI. Resultados principales: aspectos que determinan que una restauración de amalgama de plata se encuentra en buen estado: adapte marginal 5% docentes y 21% estudiantes, ausencia clínica y radiográfica de caries 14% docentes y 11% estudiantes; todas las anteriores 78% docentes y 65% estudiantes. Aspectos tomados en cuenta para cambiar una restauración de amalgama: caries secundaria 66% docentes y 44% estudiantes, fractura de un segmento 24% docentes y 49% estudiantes. El 63% de docentes y el 50% de estudiantes tienen conocimiento sobre procedimientos de reparación de restauraciones de amalgama; el 65% de docentes y el 87% de estudiantes contestaron que no han utilizado técnicas de reparación de restauraciones de amalgama de plata. Las situaciones en las que se pueden reparar restauraciones de amalgama fueron: Fractura de un segmento de la restauración 36% docentes y 38% estudiantes; caries secundaria limitada 16% docentes y 17% estudiantes; y otras situaciones con menor porcentaje. El 84% de docentes y el 87% de estudiantes no realizaron técnicas de reparación de restauraciones de amalgama durante su carrera universitaria. Se concluye que: la mayoría de docentes y estudiantes dicen conocer sobre reparación de restauraciones de amalgama, pero no hay conocimiento específico sobre técnicas, por lo que se considera ésta una de las razones principales de no realizar este tratamiento en la FOUES.

This research was developed with the objective of investigating the knowledge and criteria of repair techniques for silver amalgam restorations in dental professors and students of the clinical area of ​​the Faculty of Dentistry of the University of El Salvador (FOUES); and know why they are not applied. The investigation is of a Diagnostic type because it was investigated on a subject that has not been elaborated before in the FOUES. The following were used: the questionnaire; it was passed in cycle II in 2006, to 53 teachers and 175 students of cycles VI, VIII, IX and XI. Main results: aspects that determine that a silver amalgam restoration is in good condition: marginal fit 5% teachers and 21% students, clinical and radiographic absence of caries 14% teachers and 11% students; all of the above 78% teachers and 65% students. Aspects taken into account to change an amalgam restoration: secondary caries 66% teachers and 44% students, fracture of a segment 24% teachers and 49% students. 63% of teachers and 50% of students have knowledge of amalgam restoration repair procedures; 65% of teachers and 87% of students answered that they have not used repair techniques for silver amalgam restorations. The situations in which amalgam restorations can be repaired were: Fracture of a segment of the restoration, 36% teachers and 38% students; limited secondary caries 16% teachers and 17% students; and other situations with a lower percentage. 84% of teachers and 87% of students did not perform amalgam restorations repair techniques during their university career. It is concluded that: the majority of teachers and students say they know about the repair of amalgam restorations, but there is no specific knowledge about techniques, which is why this is considered one of the main reasons for not performing this treatment at FOUES.

Asymptomatic bacteriuria and inflammatory response urinary tract infection of elderly ambulatory women in nursing homes

Background. Bacteriuria = 10 to fifth CFU/ml is evidence of urinary tract infection in the absence of associated signs or symptoms. The presence of pyuria with asymptomatic bacteriuria established the response of elderly women against microorganisms capable of causing invasiveness or tissue injury of the urinary tract. Methods. The association between bacteriuria and pyuria was determined in 178 elderly, ambulatory women without symptoms of urinary tract infection in seven nursing homes. Urine culture results were subsequently analyzed in conjunction with absolute leukocyte count in urine. In this cross-sectional study, asymptomatic bacteriuria in elderly women was classified with and without pyuria. Results. The prevalence of asymptomatic bacteriuria was found in 44 (24.7 percent) elderly women. The presence of pyuria had a sensitivity of 63.6 percent for bacteriuria and a specificity of 91 percent. The positive predictive value for the presence of pyuria predicting those with bacteriuria was 70 percent, and the negative predictive value for the absence of pyuria predicting those without bacteriuria was 88.4 percent. Escherichia coli was the most common organism isolated in 81.8 percent of the women. Conclusions. bacteriuria = 10 to fifth CFU/ml associated with pyuria was detected in 77 percent of elderly women with asymptomatic urinary tract infections bacteriuria of < 10 to fifth CFU/ml with pyuria proves less sensitive as an indicator of urinary tract infection. Elderly women with pyuria but without bacteriuria should be studied for other causes of urinary tractinflammation