Ações de cuidado e diagnósticos de enfermagem ao paciente com oxigenação por membrana extracorpórea: translação do conhecimento / Acciones de cuidado y diagnósticos de enfermería para pacientes con oxigenación por membrana extracorpórea: traslación del conocimiento / Care actions and nursing diagnoses for patients with extracorporeal membrane oxygenation: knowledge translation

Resumo Objetivo mapear diagnósticos e ações de enfermagem para o cuidado ao paciente adulto com oxigenação por membrana extracorpórea, considerando um protocolo e um sistema informatizado de prescrição e a inclusão de novas ações de cuidados, em um processo de translação do conhecimento à prática clínica. Métodos estudo descritivo e exploratório, com mapeamento cruzado entre um protocolo assistencial e sistema informatizado de um hospital universitário, no período de 2014 a 2018. Foram realizados dois encontros com a chefia de enfermagem e membros do time de oxigenação por membrana extracorpórea para validar as ações. Resultados diagnósticos mais comuns utilizados nos 45 prontuários dos pacientes com oxigenação por membrana extracorpórea foram: Risco de infecção (100%); Ventilação espontânea prejudicada (93,33%); Síndrome do déficit de autocuidado (93,33%). Conclusão e implicações para a prática o mapeamento incluiu 25 novas ações associadas a 14 diagnósticos de enfermagem no sistema informatizado, visando a disseminação do conhecimento e sua aplicação em cuidados reais a pacientes com oxigenação por membrana extracorpórea.

Resumen Objetivo mapear diagnósticos y acciones de enfermería para el cuidado de pacientes adultos con oxigenación por membrana extracorpórea, considerando un protocolo y un sistema de prescripción computarizado y la inclusión de nuevas acciones de cuidado, en un proceso de traslación del conocimiento a la práctica clínica. Métodos estudio descriptivo, exploratorio, con mapeo cruzado entre un protocolo de atención y un sistema informatizado en un hospital universitario, de 2014 a 2018. Posteriormente se realizaron dos reuniones con la gerente de enfermería y miembros del equipo de oxigenación por membrana extracorpórea para validar acciones. Resultados los diagnósticos más frecuentes utilizados en los 45 prontuarios de pacientes con oxigenación por membrana extracorpórea fueron: Riesgo de infección (100%); Deterioro de la ventilación espontánea (93,33%); Síndrome de déficit de autocuidado (93,33%). Conclusión e implicaciones para la práctica el mapeo incluyó 25 nuevas acciones asociadas a 14 diagnósticos de enfermería en el sistema informatizado, con el objetivo de difundir el conocimiento y su aplicación en la atención real al paciente con oxigenación por membrana extracorpórea.

Abstract Objective to map diagnoses and nursing actions for the care of adult patients with extracorporeal oxygenation membrane, considering a protocol and a computerized prescription system and the inclusion of new care actions, in a process of translating knowledge to clinical practice. Methods descriptive and exploratory study, with cross-mapping between a care protocol and a computerized system of at a university hospital, from 2014 to 2018. Two meetings were held with the nursing manager and members of the extracorporeal oxygenation membrane team to validate the actions. Results most common diagnoses used in the 45 medical records of patients with extracorporeal membrane oxygenation were: Risk of infection (100%); Impaired spontaneous ventilation (93.33%); Self-care deficit syndrome (93.33%). Conclusion and implications for practice The mapping included 25 new actions, associated with 14 nursing diagnoses in the computerized system, aiming to disseminate knowledge and its application in real care for patients with extracorporeal oxygenation membrane.

El diálogo político sanitario para el fortalecimiento de enfermería en Uruguay / Health policy dialogue to strengthen nursing in Uruguay / Diálogo político-sanitário para o fortalecimento da enfermagem no Uruguai

RESUMEN Ese artículo presenta la experiencia del diálogo político sanitario en enfermería desarrollado en Uruguay en el 2021, con base en la teoría del cambio. Se realizaron cuatro mesas de trabajo, con participación de 725 personas. Los puntos discutidos incluyeron: que existe un déficit de enfermeros licenciados para el desarrollo de los programas y para la cobertura de las funciones en todos los niveles de la atención a salud; la falta de visibilidad del impacto asistencial de las actividades desarrolladas; los recursos financieros insuficientes para la formación de grado y posgrado y la baja integración de los enfermeros en equipos de gestión y en espacios políticos de toma de decisiones en el país. Los participantes manifestaron la necesidad de implementar el plan nacional de desarrollo de la enfermería con los objetivos de que el país: disminuya el déficit de profesionales; invierta en la creación de cargos para satisfacer la demanda de cuidados profesionales; mejore las dotaciones de personal en los servicios en todos los niveles de atención; mejore las condiciones de trabajo; genere nuevos espacios de inserción de enfermeros ampliando su rol, mediante capacitación de posgrado y mejore continuamente la calidad de la formación. Los participantes hicierón hincapié en la necesidad de aumentar la coordinación intersectorial en los ámbitos de la gobernanza, la regulación y la gestión, y de acelerar los esfuerzos para aumentar la inversión en los profesionales de salud en Uruguay.

ABSTRACT This article presents the experience of the health policy dialogue on nursing held in Uruguay in 2021, based on the theory of change. Four working groups were held, with the participation of 725 people. The points discussed included: the shortage of registered nurses to implement programs and cover functions at all levels of health care; the poor visibility of the healthcare impact of the activities carried out; insufficient financial resources for undergraduate and postgraduate training; and poor integration of nurses in management teams and policy decision-making spaces in the country. Participants expressed the need to implement the national nursing development plan so that the country can: reduce the shortage of professionals; invest in job creation to meet the demand for professional care; improve staffing of services at all levels of care; improve working conditions; create new spaces for nurses by expanding their role through postgraduate training, while continuously improving the quality of training. Participants emphasized the need to increase intersectoral coordination in the areas of governance, regulation, and management, and to step up efforts to increase investment in health professionals in Uruguay.

RESUMO Este artigo apresenta a experiência do diálogo político-sanitário sobre enfermagem realizado no Uruguai em 2021 com base na teoria da mudança. Foram organizados quatro grupos de trabalho, dos quais participaram 725 pessoas. Entre os pontos discutidos, destacam-se: a falta de profissionais graduados em enfermagem para desenvolver programas e cobrir funções em todos os níveis de atenção à saúde; a falta de visibilidade do impacto assistencial das atividades desenvolvidas; a insuficiência de recursos financeiros para programas de graduação e pós-graduação; e a pouca integração desses profissionais às equipes de gestão e aos espaços de tomada de decisão política no país. Os participantes indicaram a necessidade de implementar o plano nacional de desenvolvimento da enfermagem para que o país reduza o déficit de profissionais; invista na criação de cargos para atender à demanda por cuidados profissionais; melhore a dotação de pessoal nos serviços em todos os níveis de atenção; melhore as condições de trabalho; crie novas oportunidades de inserção para profissionais de enfermagem, ampliando suas funções por meio da pós-graduação; e aprimore continuamente a qualidade da formação. Os participantes enfatizaram a necessidade de aumentar a coordenação intersetorial nos aspectos de governança, regulação e gestão, bem como de acelerar os esforços no sentido de aumentar o investimento em profissionais de saúde no Uruguai.

Personalidade, ansiedade social e adaptação às medidas de distanciamento durante a pandemia / Personality, social anxiety and adaptation to distancing measures during the pandemic / Personalidad, ansiedad social y adaptación a medidas de distanciamiento durante la pandemia

O impacto da pandemia de COVID-19 está mudando drasticamente a vida das pessoas. O distanciamento social representa evitar o contato durante o surto de uma doença para minimizar a exposição. Essa condição também pode contribuir para o agravamento de determinados transtornos mentais. O presente estudo teve como objetivo avaliar em que medida características de personalidade e ansiedade social podem contribuir para uma maior dificuldade em lidar com o distanciamento social. Foram avaliados 1.120 indivíduos por meio da Escala de Ansiedade Social de Liebowitz (LSAS), marcadores da personalidade. A análise de regressão logística mostrou que neuroticismo, ansiedade social e as horas adicionais em casa revelaram-se preditores significativos de uma maior dificuldade. Conclui-se que o transtorno de ansiedade social apresenta especificidades em sua manifestação durante a pandemia. (AU)

The impact of the COVID-19 pandemic has drastically changed people's lives. Social distancing means avoiding close contact with others during a contagious disease outbreak to minimize exposure. Such constraints may also contribute to the worsening of certain mental health disorders. The present study aimed to evaluate the extent to which personality features and social anxiety may contribute to greater difficulties in coping with social distancing practices. A total of 1120 individuals were assessed using the Liebowitz Social Anxiety Scale (LSAS) and personality mini-markers to assess personality traits. Logistic regression analysis revealed that neuroticism, social anxiety, and the number of additional hours one spends at home represent significant predictors of greater difficulty. Thus, results showed that social anxiety disorder had specific presentations during the course of the COVID-19 pandemic. (AU)

El impacto de la pandemia de COVID-19 está cambiando drásticamente la vida de las personas. El distanciamiento social significa evitar el contacto cercano con otras personas durante el brote de una enfermedad contagiosa para minimizar la exposición. Esta condición también puede contribuir al empeoramiento de algunos trastornos mentales. Este estudio tuvo como objetivo evaluar en qué medida las características de personalidad y la ansiedad social pueden contribuir a una mayor dificultad para soportar el distanciamiento social. Se evaluó un total de 1120 individuos mediante la Escala de Ansiedad Social de Liebowitz (LSAS) y marcadores reducidos para evaluar la personalidad. El análisis de regresión logística mostró que el neuroticismo, la ansiedad social y el número de horas adicionales en el hogar fueron predictores significativos de mayor dificultad. Se concluye que el trastorno de ansiedad social presenta manifestaciones específicas durante la pandemia. (AU)

Influência da Pandemia da COVID-19 no desenvolvimento adolescente: uma revisão integrativa / Influence of Pandemic COVID-19 on adolescent development: an integrative review

A adolescência é um período do desenvolvimento influenciado por diferentes variáveis, tais como, o contexto social, cultural, econômico, familiar, escolar e as relações em que neles se estabelecem. Nesse sentido, as medidas de distanciamento implementadas na sociedade a partir do ano de 2020, com a finalidade de conter a disseminação da pandemia da COVID-19, provocaram mudanças no estilo de vida dos adolescentes, que por sua vez, podem influenciar no processo de desenvolvimento desse público. A partir disso, o presente estudo tem o objetivo de compreender a influência da pandemia da COVID-19 no desenvolvimento do adolescente. Para isso, foi realizada uma revisão integrativa da literatura nacional e internacional, por meio da busca de artigos no portal de periódicos eletrônicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES). Foram analisados 27 artigos que foram incluídos na amostra final a partir dos critérios de inclusão e exclusão com foco nas influências da pandemia para o desenvolvimento do adolescente. Os artigos indicaram diminuição das notificações de violência contra o adolescente, o aumento das desigualdades sociais, a diminuição do acesso à educação e políticas públicas, e um maior registro de sintomatologia psiquiátrica. Infere-se, portanto, a necessidade de maiores pesquisas sobre a temática, principalmente empíricas, dada a escassez de artigos empíricos encontrados devido à restrição de tempo entre o fenômeno e a presente pesquisa.

Adolescence is a period of development influenced by different variables, such as, the social, cultural, economic, family, school context and the relationships in which they are established. In this sense, the distancing measures implemented in society from the year 2020, in order to contain the spread of the pandemic of COVID-19, have caused changes in the lifestyle of adolescents, which, in turn, may influence the development process of this public. From this, the present study aims to understand the influence of the COVID-19 pandemic on adolescent development. To this end, an integrative review of national and international literature was conducted by searching for articles in the electronic journals portal of the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES). Were analyzed and included in the final sample 27 articles, based on the inclusion and exclusion criteria, focusing on the influences of the pandemic on adolescent development. The articles pointed a decrease in notifications of violence against adolescents, an increase in social inequalities, a decrease in the access to education and public policies, and a bigger record of psychiatric symptoms. It is inferred, therefore, the need for further research on the subject, especially empirical, given the scarcity of empirical articles found, due to the time restriction between the phenomenon and the present research.

Negative affect moderates the link between body image dissatisfaction and disordered eating among psychiatric outpatients in a multi-ethnic Asian setting

INTRODUCTION@#Few studies have investigated the factors that affect the relationship between body image dissatisfaction and disordered eating locally. Our study aimed to investigate the moderating effects of depression and anxiety levels on the body dissatisfaction-disordered eating link in Singapore.@*METHODS@#A total of 329 participants completed a set of questionnaires that included various scales pertaining to eating behaviours, body image, psychological distress and quality of life.@*RESULTS@#Participants were diagnosed with schizophrenia (47.4%), depression (46.8%) and substance use disorders (5.8%). Moderation analyses revealed that depression (F [9, 251] = 18.50, p < 0.001, R@*CONCLUSION@#Greater effort should be dedicated to the screening of disordered eating behaviours in psychiatric outpatients presenting with greater psychological distress.

In-hospital mortality in the emergency department: clinical and etiological differences between early and late deaths among patients awaiting admission

Objective@#Given that there are no studies on diseases that occur by waiting for hospitalization, we aimed to evaluate the main causes of death in the emergency room (ER) and their relationship with overcrowding. @*Methods@#Patients who died in the ER in the past 2 years (pediatrics and trauma victims excluded) were divided into two groups: patients who died within 6 hours of arrival (emergency department [ED] group) and patients who died later (LD group). We compared the causes of death, total vital signs, diagnostic tests performed, and therapy between the groups. We assessed for possible correlation between the number of monthly deaths per group and four variables of overcrowding: number of patients treated per month, waiting time before medical visit (W-Time), mean intervention time (I-Time), and number of patients admitted to the ward per month (NPA). @*Results@#During the two years, 175 patients had died in our ER (52% in ED group and 48% in LD group). The total time spent in the ER was, respectively, 2.9±0.2 hours for ED group and 17.9± 1.5 hours for LD group. The more frequent cause of death was cardiovascular syndrome (30%) in ED group and sepsis (27%) and acute respiratory failure (27%) in LD group. Positive correlations between number of monthly deaths and W-Time (R2 0.51, P<0.001), I-Time (R2 0.73, P< 0.0001), and NPA (R2 0.37, P<0.01) were found only in LD group. @*Conclusion@#Patients with sepsis and acute respiratory failure die after a long stay in the ER, and the risk increases with overcrowding. A fast-track pathway should be considered for hospital admission of critical patients.

Prevalencia de disfunción diastólica de acuerdo con las guías diagnósticas de 2009 y 2016. Relación con la valoración hemodinámica no invasiva / Prevalence of diastolic dysfunction (DD) according to the diagnostic guidelines of 2009 and 2016. Relationship with non-invasive hemodynamic assessment

Resumen Objetivos: Evaluar la prevalencia de DD de acuerdo con los criterios de las guías del 2009 y 2016, y su relación con la distensibilidad arterial sistémica (DAS) y la resistencia vascular periférica (RVP). Material y métodos: Se analizó a 306 pacientes ≥ 40 años de edad, con fracción de expulsión ≥ 50%. Se calcularon en todos DAS y RVP. Resultados: La prevalencia de DD fue de 32.7% y 22.9% según las guías de 2009 y 2016, respectivamente (p = < 0.0001). De acuerdo con las guías del 2009, los pacientes con DD presentaron una media de DAS menor que aquéllos con función normal (p = 0.0001), de modo similar a las guías del 2016 (p = 0.0007). La DD, según las guías de 2009 y 2016, mostró valores más altos de RVP que los normales (p = 0.005 y p = 0.018, respectivamente). Asimismo, la DD fue predictora, en el análisis univariado, de DAS < 0.60 ml.mm Hg-1 y RVP > 1,400 mmHg.min.l-1 según ambas guías. En el análisis multivariado, la DD, de acuerdo con las guías del 2009, persistió como predictor independiente de RVP > 1,400 mmHg.min.l-1. Conclusión: Las guías del 2016 reducen la prevalencia de DD. Ésta, tanto en las guías del 2009 como en las del 2106, fue predictor univariado de DAS < 0.60 ml.mmHg-1 y RVP > 1,400 mmHg.min.l-1. La DD, de acuerdo con las guías de 2009, resultó predictora independiente de RVP > 1,400 mmHg.min.l-1.

Abstract Objectives: To assess the prevalence of developmental disabilities (DD) according to the criteria of the 2009 and 2016 guidelines, and its association with systemic arterial compliance (DAS) and peripheral vascular resistance (RVP). Material and methods: 306 patients aged ≥ 40 years, with ejection fraction ≥ 50% were analyzed. It was estimated in all DAS and RVP. Results: The prevalence of DD was 32.7% and 22.9% according to the 2009 and 2016 guidelines, respectively (p ≤ 0.0001). Patients with DD according to the 2009 guideline had a lower average of DAS than those with normal function (p = 0.0001). Similar with the 2016 guide (p = 0.0007). The presence of DD according to the 2009 and 2016 guideline showed higher RVP values than normal values (p = 0.005 and p = 0.018, respectively). The DD according to both guidelines was a predictor, in the univariate analysis, of DAS < 0.60 ml.mmHg−1 and RVP > 1400 mmHg.min.l−1. The DD according to the 2009 guideline persisted as an independent predictor, in the multivariate analysis, of RVP > 1400 mmHg.min.l−1. Conclusion: The 2016 guide decreases the prevalence of DD. The DD, both from the 2009 and 2106 guidelines, were univariate predictors of DAS <0.60 ml.mmHg−1 and RVP > 1400 mmHg.min.l−1. The DD according to the 2009 guide, was an independent predictor of RVP > 1400 mmHg.min.l−1.

Added value of dynamic magnetic resonance images in pelvic floor dysfunction / Valor agregado das imagens de ressonância magnética dinâmica na disfunção do assoalho pélvico

ABSTRACT Purpose Pelvic floor dysfunction has a high prevalence in the adult population. The Dynamic and Multiplanar Evaluation of the Pelvic Floor (DMRIPF) represents an ideal tool for multidisciplinary management. The purpose of this analysis is to evaluate the added value of the Dynamic and Multiplanar Evaluation of the Pelvic Floor in patients with suspected pelvic floor disorders. Methods Retrospective analysis of a consecutive series of patients who underwent a DMRIPF due to suspected pelvic floor disorders between April 2005 and July 2019. Results 359 patients were included. The average number of diagnoses achieved by physical examination was 1.2 vs. 2.5 by the Dynamic and Multiplanar Evaluation of the Pelvic Floor (p < 0.001). Physical examination found a single pathology in 80.8 % of cases. Anterior rectocele (AR) was the most frequent isolated diagnosis on physical examination (68 %). On the Dynamic and Multiplanar Evaluation of the Pelvic Floor, anterior rectocele was diagnosed as an isolated condition in 10.9 %. In 231 cases, anterior rectocele was associated with up to 5 other pelvic floor disorders. The number of individuals with associated pathologies of the posterior and anterior compartments tripled. It modified physical examination findings in 17 % of individuals and, in 63.5 %, allowed the identification of additional pelvic floor pathologies that were missed by physical examination. The Dynamic and Multiplanar Evaluation of the Pelvic Floor had greater added value in patients with anterior rectocele (59.6 % vs. 20.9 %; p < 0.001). Female gender was also associated with a greater diagnostic yield (p < 0.001). Conclusion The Dynamic and Multiplanar Evaluation of the Pelvic Floor allows the detection of multi-compartment defects that could otherwise go undetected, or even alter the initial clinical diagnosis, representing an ideal tool for multidisciplinary approach of pelvic floor dislocations, allowing a comprehensive therapeutic planning.

RESUMO Objetivo A disfunção do assoalho pélvico tem alta prevalência na população adulta. A avaliação dinâmica e multiplanar do assoalho pélvico (DMRIPF) representa uma ferramenta ideal para o gerenciamento multidisciplinar. O objetivo desta análise é avaliar o valor agregado da avaliação dinâmica e multiplanar do assoalho pélvico em pacientes com suspeita de distúrbios do assoalho pélvico. Métodos Análise retrospectiva de uma série consecutiva de pacientes submetidos à avaliação dinâmica e multiplanar do assoalho pélvico por suspeita de distúrbios do assoalho pélvico entre Abril de 2005 e Julho de 2019. Resultados 359 pacientes foram incluídos. O número médio de diagnósticos alcançados pelo exame físico foi de 1,2vs. 2,5 pela avaliação dinâmica e multiplanar do assoalho pélvico p < 0,001. O exame físico encontrou uma única patologia em 80.8 % dos casos. A retocele anterior (RA) foi o diagnóstico isolado mais frequente no exame físico (68 %). Na avaliação dinâmica e multiplanar do assoalho pélvico, a retocele anterior foi diagnosticada como uma condição isolada em 10.9 %. Em 231 casos, a retocele anterior foi associada a até 5 outros distúrbios do assoalho pélvico. O número de indivíduos com patologias associadas dos compartimentos posterior e anterior triplicou. Modificou os achados do exame físico em 17 % dos indivíduos e em 63.5 %; permitiu a identificação de outras patologias do assoalho pélvico que foram esquecidas pelo exame físico. A avaliação dinâmica e multiplanar do assoalho pélvico teve maior valor agregado em pacientes com retocele anterior (59.6 % vs.20.9 %; p < 0,001. O sexo feminino também foi associado a um maior rendimento diagnóstico p < 0,001. Conclusão A avaliação dinâmica e multiplanar do assoalho pélvico permite a detecção de defeitos multicompartimentários que, de outra forma, poderiam não ser detectados, ou mesmo alterar o diagnóstico clínico inicial, representando uma ferramenta ideal para a abordagem multidisciplinar das luxações do assoalho pélvico, permitindo um planejamento terapêutico abrangente.

Estimation of Serum Vaspin Levels in Humans as a Novel and Therapeutic Biomarker of Visceral Obesity

Background: Obesity is associated with metabolic complications and significantly increases the risk of developing insulin resistance. Visceral fat is potentially dangerous as it is the major player in the adverse metabolic consequences of obesity. In this context, one of the recently discovered and interesting adipokines that provide a new insight into the physiology, pathology, and treatment of obesity is vaspin. Vaspin is a visceral adipose tissue-derived serine protease inhibitor with insulin-sensitizing effects and its upregulation in obese individuals may be a defensive and a protective mechanism aimed to reduce insulin resistance in humans. Aims and Objectives: This study aims to determine the circulating serum vaspin levels in humans with visceral obesity to assess its association and link to obesity-related metabolic alterations. Materials and Methods: A cross-sectional study consisting of 120 obese subjects in the age group of 30–55 years having a body mass index (BMI) of ≥35 (Group I) and another 120 subjects of the same age group with a normal range BMI (Group II) was done with their measures of obesity and serum vaspin levels measured. Results: The obese subjects (Group I) showed significant differences in the BMI, measures of obesity, and the serum vaspin levels (P ˂ 0.001). Pearson’s correlation revealed that the serum vaspin levels were positively correlated with the measures of obesity. Conclusion: From this study, it can be demonstrated that vaspin may be used as a circulating biomarker for early identification of obesity-related metabolic alterations and vaspin also plays an important role in the pathogenesis of obesity and its related metabolic disorders.

Halo, Reversed Halo, or Both? Atypical Computed Tomography Manifestations of Coronavirus Disease (COVID-19) Pneumonia: The “Double Halo Sign”

The epidemic of 2019 novel coronavirus, later named as coronavirus disease (COVID-19), began in Wuhan, China in December 2019 and has spread rapidly worldwide. Early diagnosis is crucial for the management of the patients with COVID-19, but the gold standard diagnostic test for this infection, the reverse transcriptase polymerase chain reaction, has a low sensitivity and an increased turnaround time. In this scenario, chest computed tomography (CT) could play a key role for an early diagnosis of COVID-19 pneumonia. Here, we have reported a confirmed case of COVID-19 with an atypical CT presentation showing a “double halo sign,” which we believe represents the pathological spectrum of this viral pneumonia.

A cross-sectional study on morbidity status among school going adolescents in Thiruvallur district, Tamil Nadu

Background: Adolescents represent about 21.8 percent of India’s population. Various health risks with potentially life-threatening consequences become prominent in this age group. This study was undertaken with the objective to determine the morbidity profile of school going adolescents in Tamil Nadu.Methods: This descriptive, cross sectional study was planned and conducted from January 2016 to August 2017. The study population included 987 adolescent boys and girls aged between 10 to 19 years studying in high and higher secondary Government schools of Thiruvallur district of Tamil Nadu. Semi-structured questionnaire was used as data collection tool.Results: The mean age groups of this school going adolescent are 14.2 yrs. In the present study 583 (59%) of the study participants were affected by one or more morbidity condition. Among them, 395 (67.7%) were in the age group 10-14 years and 188 (32.2%) in the age group 15-19 years. 122 (21%) and 461 (79.1%) of male and female were affected respectively. In the present study, fever (21%) was the commonest reported morbidity followed by acute respiratory infection (15.7%) and acute gastrointestinal disease (13. 4%).Conclusions: This study shows that adolescents are prone to a wide range of morbidity conditions. Apart from respiratory and gastro intestinal diseases, reproductive tract infections and sexual health problems are important morbidities affecting this age group. There is strong need to sensitize health care practitioners at all levels, in both government and private sectors towards health problems in adolescent age groups.

Complicaciones infecciosas graves luego de la ligadura con banda elástica para hemorroides: reporte de un caso y revisión de la literatura / Acute infectious complications after ligation with elastic band for hemorrhoids: a case report and literature review

Introducción: La ligadura con banda elástica es un procedimiento efectivo y de bajo costo, para el manejo de hemorroides grado I-III, que no requiere internación. Sus complicaciones, cuando presentes, son habitualmente leves. Aunque poco comunes, existen complicaciones graves asociadas a este procedimiento. El objetivo de este estudio es realizar una revisión de las complicaciones infecciosas pelvi-perineales de la ligadura con banda elástica, características comunes de presentación y alternativas de tratamiento en aquellos que sufren estas complicaciones. Descripción del caso: Se expone el caso de un hombre de 71 años de edad que presentó una sepsis pelviana severa posterior a la realización de una ligadura con banda elástica. A las 48 horas del procedimiento consulta por dolor perianal, dificultad miccional y fiebre. Se realiza el drenaje quirúrgico de ambas fosas isquiorrectales, luego de lo cual intercurre con shock séptico, realizándose una laparotomía, drenaje de retroperitoneo, colostomía sigmoidea. Posteriormente, debido al desarrollo de un síndrome compartimental abdominal, el abdomen se dejó abierto y contenido con una malla. Discusión: Se han descripto complicaciones sépticas posteriores a escleroterapia y crioterapia hemorroidal, ligadura con banda elástica, hemorroidectomia convencional y con sutura mecánica. Se exponen 20 casos de sepsis pelviana post-ligadura con banda elástica. La relación hombre:mujer fue de 3:1, con un amplio rango de edad (27-82 años). Sólo 2 tenían antecedentes de inmunosupresión. La progresión o la persistencia del dolor asociado a fiebre, dificultad miccional, edema perineal y/o genital fueron signos y síntomas comunes que se manifestaron dentro de los 14 días posteriores a la ligadura. Tal como en el caso aquí referido como en otros ya publicados, la realización de imágenes ayudó al diagnóstico y a la planificación quirúrgica. Todos recibieron antibioticoterapia de amplio espectro y 13 requirieron además cirugía. El espectro de tratamientos quirúrgicos fue desde el drenaje incisional hasta la amputación rectal. Ante la progresión del cuadro séptico, la realización de una ostomía fue la conducta más usual. Cinco pacientes requirieron más de una cirugía, y 8 fallecieron. Conclusión: Es importante conocer las complicaciones infecciosas mayores y su presentación clínica, para realizar un diagnóstico y tratamiento precoz de las mismas, con el fin de disminuir su elevada morbilidad o mortalidad. (AU)

Background: Rubber band ligation is an effective, low-cost procedure for grade I-III hemorrhoids, and does not require hospitalization. Its complications, when present, are usually mild. Although rare, there are serious complications associated with this procedure. The purpose of this review was to identify common presenting features and treatment alternatives in those who suffer pelviperineal infectious complications after rubber band ligation. Case Report: The present case is that of a 71-year-old man who presented severe pelvic sepsis after rubber band ligation. He complained of perianal pain, voiding difficulties and fever 48 hours after the procedure. Surgical drainage of both ischiorectal fossae was carried out. He developed septic shock. Laparotomy, retroperitoneal drainage and sigmoid loop colostomy were performed. In a subsequent operation due to abdominal compartment syndrome, the abdomen was left open and contained with a mesh. Discussion: Septic complications have been described after sclerotherapy, cryotherapy, rubber band ligation, conventional hemorrhoidectomy and stapled haemorrhoidopexy. We describe 20 cases of pelvic sepsis after rubber band ligation. The male: female ratio was 3: 1, with a wide age range (27- 82 years). Only 2 had a history of immunosuppression. The progression or persistence of pain associated with fever, voiding difficulties, perineal and / or genital edema were common signs and symptoms that appeared within 14 days after rubber band ligation. In the case here referred to as in others already published, imaging studies helped the diagnosis and surgical planning. All received broad spectrum antibiotic therapy and 13 required surgery. The spectrum of surgical treatments ranged from incisional drainage to rectal amputation. In view of the progression of the septic condition, performing an ostomy was the most usual conduct. Five patients required more than one surgery, and 8 died. Conclusion: It is important to acknowledge the major infectious complications and their clinical presentation, to help with an early diagnosis and treatment, in order to reduce their high morbidity and mortality. (AU)

Biosurfactant from endophytic Bacillus cereus: Optimization, characterization and cytotoxicity study

Aims@#The increased importance of biosurfactant in the recent past is mainly due to their applications in various industries ranging from petroleum to pharmaceuticals. Their biodegradability and environmental compatibility with low toxicity makes it even more interesting. Microbial production of biosurfactant is found to be a viable option as they are diverse, eco-friendly, facilitate large scale production, able to perform under extreme conditions etc. One class of microbes that is endophytes are known to show great potential in producing different varieties of medically and industrially significant biological compounds. The present study focuses on the screening and production of biosurfactant from endophytic bacteria. @*Methodology and results@#Of all the isolates tested, one endophyte identified as Bacillus cereus HM998898 was found to produce maximum biosurfactant. Statistical method Plackett burman was used to optimize the media for the maximum production and the ideal composition was found to be KNO3 (1 g/L), Gingley oil (2 mL), K2HPO4 (2.5 g/L), KH2PO4 (0.75 g/L), MgSO4·5H2O (0.5 g/L), FeSO4.7H2O (0.005 g/L) and NaCl (0.025 g/L). The extracted biosurfactant was characterized and was identified to be glycolipid. This was further tested for biocompatibility against Fibroblast (3T3) cells and was evaluated for their anti tumor activity against Hep2 cells. @*Conclusion, significance and impact of study@#The biosurfactant produced was found to induce toxicity to cancer cells at appreciable levels while they remained non-toxic to normal cells supporting the possible applications of biosurfactant in medical field.

Coupling dye degradation and biodiesel production by Geitlerinema sp TRV27

In this study, the dye degrading the ability of marine cyanobacteria, Geitlerinema sp TRV27 was tested against the textile dye Acid black 52. Optimum conditions like pH, temperature, dye concentration for acid black 52 dye degradation were studied and were found to be pH 7, 25±2°C. More than 50% of degradation was observed for the tested maximum dye concentration, 100 ppm. The degraded dye intermediate was found to be naphthalene by GC-MS analysis and their toxicity on seed germination was studied. The dye treated biomass was used for the production of biodiesel and the physicochemical properties of biofuel were found to be within the standard limits.

Permanent mandibular protostylid: A rare developmental anomaly and its overview

Developmental malformations of the teeth might result in alterations of their size, shape, and structure. An accessory cusp is a developmental alteration to the shape of the teeth and is more commonly found in anterior teeth, and its occurrence in permanent molars is quite rare. Accessory cusps occurring in permanent mandibular molars are termed as protostylids. Although they do not pose any significant problem with respect to the function and occlusion, it is of tremendous importance in forensic odontology. This case report presents a rare finding of protostylid on the permanent mandibular molar, and its clinical implications are illustrated.

Duration of effectiveness of Botulinum toxin type A in excessive gingival display: a systematic review and meta-analysis

Abstract Botulinum toxin type A is effective in reducing excessive gingival display caused by hyperfunctional upper lip elevator muscles; however, this effect is transient. This study aimed to determine the duration of the effectiveness of botulinum toxin type A on a gummy smile. A systematic search was conducted using Medline (PubMed), Scopus, and Web of Science electronic databases, from 1970 to March 2017 with no language restriction; the search included studies evaluating adult patients with excessive gingival display who were treated with botulinum toxin and were followed-up for at least 3 months. OpenGrey and Clinical Trial Registry were also consulted. Quality assessment was applied to determine the level of evidence and bias, and a meta-analysis was performed. Of 2181 full texts, 71 were obtained, with 3 prospective studies meeting the selection criteria. The gingival display was significantly reduced to baseline with 2, 4, and 8 weeks of treatment. The gingival display considerably reduced at the baseline-2-week comparison (-4.44 mm using raw data and-4.05 mm using the standard difference) and increased throughout the weeks of follow-up. There is scant evidence to determine the duration of the effectiveness of toxin type A on a gummy smile. The effect tends to be stable until at least 8 weeks of follow-up, and the gingival exposure may not return to baseline within 12 weeks of follow-up. Well-designed randomized clinical trials with a minimum of 6 months of follow-up are necessary to strengthen the evidence.

The potential contribution of the natural products from Brazilian biodiversity to bioeconomy

ABSTRACT The development of our society has been based on the use of biodiversity, especially for medicines and nutrition. Brazil is the nation with the largest biodiversity in the world accounting for more than 15% of all living species. The devastation of biodiversity in Brazil is critical and may not only cause the loss of species and genes that encode enzymes involved in the complex metabolism of organisms, but also the loss of a rich chemical diversity, which is a potential source for bioeconomy based on natural products and new synthetic derivatives. Bioeconomy focus on the use of bio-based products, instead of fossil-based ones and could address some of the important challenges faced by society. Considering the chemical and biological diversity of Brazil, this review highlights the Brazilian natural products that were successfully used to develop new products and the value of secondary metabolites from Brazilian biodiversity with potential application for new products and technologies. Additionally, we would like to address the importance of new technologies and scientific programs to support preservation policies, bioeconomy and strategies for the sustainable use of biodiversity.

Webquest e blog como estratégias educativas em saúde escolar / Webquest y blog como estrategias educativas en salud escolar / Webquest and blog as educational strategies in school health

Resumo OBJETIVO Descrever ação de educação em saúde sobre alimentação saudável utilizando como estratégia o webquest e o blog com estudantes do ensino fundamental de uma escola pública. MÉTODO Relato da atividade de educação em saúde realizada em 2014 com quatorze estudantes do 8º ano de escola pública. O "Blog da Alimentação Saudável" foi desenvolvido pelos estudantes utilizando a metodologia da webquest orientados pela enfermeira durante quatro períodos da disciplina de ciências. RESULTADOS Em três grupos de trabalho os estudantes realizaram o webquest disponibilizado em site com as etapas introdução, tarefa, processos e recursos. O blog foi elaborado em site gratuito em resposta às questões do webquest. A avaliação dos estudantes destacou os aspectos positivos, as dificuldades e as recomendações para futuras atividades. CONCLUSÃO Essa tecnologia torna a busca pelo conhecimento participativa e ativa, além de ser um espaço de integração dos profissionais da saúde no ambiente escolar.

Resumen OBJETIVO Describir la acción de educación en salud en la alimentación saludable mediante una estrategia de búsqueda en la red y el blog con los estudiantes de primaria en una escuela pública. MÉTODO Actividades de educación en salud realizado en 2014 con catorce estudiantes de la escuela pública de 8º grado. La "Alimentación saludable Blog" fue desarrollado por los estudiantes utilizando la metodología de la webquest guiada por la enfermera durante cuatro períodos de la disciplina de la ciencia. RESULTADOS En los tres grupos de trabajo que los estudiantes llevan a cabo la búsqueda en la red disponible en el sitio con los pasos de introducción, tareas, procesos y recursos. El blog se preparó de sitio web gratuito en respuesta a preguntas webquest. La evaluación de los estudiantes destacó los aspectos positivos, dificultades y recomendaciones para las actividades futuras. CONCLUSIÓN Esta tecnología hace que la búsqueda del conocimiento participativa y activa, además de ser uno de los espacios de integración profesionales de la salud en el entorno escolar.

Abstract OBJECTIVE To describe health education strategy on healthy eating using WebQuest and blog with elementary school students from a public school. METHOD To report the health education activity carried out in 2014 with fourteen students from the 8th year of public school. The "Healthy Food Blog" was developed by the students using the WebQuest methodology guided by the nurse during four periods of the science discipline. RESULTS In three work groups, the students performed the WebQuest made available on the website with the introduction, task, process and resource stages. The blog was written in a free website in response to WebQuest questions. The students' evaluation highlighted the positives, difficulties and recommendations for future activities. CONCLUSION This technology makes the search for knowledge participatory and active, besides being a space for integration of health professionals in the school environment.

Influence of elastic modulus of intraradicular posts on the fracture load of roots restored with full crowns / Influência do modulo de elasticidade de retentores intrarradiculares na carga para fratura de raízes restauradas com coroas totais

Objective: This study aimed to evaluate the fracture load and displacement of roots restored with posts of different elastic modulus. Material and method: Thirty-six replicas of epoxy resin mixed with glass microfibers were made from an endodontically-treated human premolar root prepared to a length of 12 mm with a custom drill, leaving the apical 4 mm unprepared. Replicas were randomly restored with (n = 12): FP-LM (fiber post with low elastic modulus- 50 GPa), FP-HM (fiber post with high elastic modulus - 67 GPa) and MP (metallic post - 208 GPa), using self-curing adhesive and dual resin cement. Cores were built up with composite resin and metallic crowns were cemented in all the roots with self-adhesive resin cement with self-curing mode. Specimens were subjected to a fracture load test (45° inclination/0.5 mm/min) and displacement was registered at 100 N. Result: One-way ANOVA showed that elastic modulus of the post did not affect the fracture load means (p = 0.203) (FP-LM: 237.4 ± 65.11 N; FP-HM: 236.7 ± 92.85 N; MP: 295.8 ± 108.7 N) but was statistically significant for the displacement (p < 0.00): Tukey's test showed that FP-LM displacement mean (0.81 ± 0.15 mm) was significantly higher than those for FP-HM (0.46 ± 0.26 mm; p = 0.00) and MP (0.62 ± 0.07 mm; p = 0.04). Conclusion: Posts with different elastic modulus exhibit similar fracture loads, but a lower displacement is achieved when fiber posts with a high elastic modulus and metallic posts are used.

Objetivo: Este trabalho avaliou a carga para fratura e deslocamento de raízes restauradas com pinos de diferentes módulos de elasticidade. Material e método: Trinta e seis réplicas de microfibras de vidro embutidas em resina epóxi foram fabricadas a partir de uma raiz de um pré-molar tratado endodonticamente preparado em 12 mm de comprimento com brocas customizadas, deixando 4 mm apicais sem preparo. As raízes foram randomicamente restauradas com (n = 12): FP-LM (pino de fibra com um baixo módulo de elasticidade - 50 GPa), FP-HM (pino de fibra com um alto módulo de elasticidade - 67 GPa) e MP (pinos metálicos - 208 GPa), usando adesivo autopolimerizável e cimento resinoso dual. Núcleos foram confeccionados com resina composta e coroas metálicas foram cimentadas em todas as raízes com cimento resinoso autoadesivo com modo de polimerização químico. Os espécimes foram submetidos ao teste de fratura em 45° (inclinação de 45° / 0,5 mm/min) e o deslocamento foi registrado aos 100 N. Resultado: Anova 1 fator mostrou que o módulo de elasticidade dos retentores não afetou as médias de fratura (p = 0,203) (FP-LM: 237,4 ± 65,11 N; FP-HM: 236,7 ± 92,85 N; MP: 295,8 ± 108,7 N) mas foi estatisticamente significante para o deslocamento (p < 0,00): o teste de Tukey mostrou que a média de deslocamento do grupo FP-LM (0,81 ± 0,15 mm) foi significativamente maior do que o grupo FP-HM (0,46 ± 0,26 mm; p = 0,00) e MP (0,62 ± 0,07 mm; p = 0,47). Conclusão: Pinos com diferentes módulos de elasticidade mostram resistência similar, porém um menor deslocamento é obtido quando pinos de fibra com alto módulo de elasticidade (FP-HM/MP) são usados.

Epidemiological profile and findings found intra operatively of glioblastoma at the neurosurgery service of Santa Casa of Ribeirão Preto Hospital - SP - Brazil / Perfil epidemiológico y hallazgos intraoperatorios de los glioblastomas en el servicio de neurocirurgia del Hospital Santa Casa de Ribeirão Preto - SP - Brasil

Introducción: El Glioblastoma (GB) o Astrocitoma grado IV (OMS), representan 15-20 por ciento de los tumores del SNC y aproximadamente 50 por ciento de los gliomas en adultos. Objetivo: Revelar el perfil epidemiológico del HSCMRP, correlacionar los hallazgos macroscópicos y microscópicos durante la cirugía de enero de 2011 a noviembre de 2015. Método: Estudio epimedeológico observacional, descriptivo, retrospectivo, 429 casos de tumores intracraneales a partir de los datos obtenidos de los archivos de La institución y los registros patológicos de los pacientes tratados quirúrgicamente. Resultados: Tumores encontrados 429 y 96 (22,37 por ciento) GB, edad media de 59 años, predominante séptima década 33 por ciento. Una relación entre mujeres y hombres fue de 1:1.12, respectivamente. Las quejas más frecuentes: dolor de cabeza (58 por ciento), confusión (41 por ciento), hemiparesia 37 por ciento. Comorbilidades frecuentes: hipertensión (64 por ciento), diabetes (22 por ciento) y fumadores (24 por ciento). La topografía más común fue la frente izquierdo. El tiempo medio de inicio de los síntomas a la cirugía fue de 39 días. Resección completa en 76 por ciento de los casos. La duración media de la recurrencia fue de 96 días, en 68% de los pacientes se observó una exuberancia de los vasos trombosados durante la cirugía Hallazgos patológicos: necrosis 98 por ciento, mitosis atípica 96 por ciento, proliferación microvascular 73 por ciento y polimorfismo nuclear 57 por ciento. Discusión: GB estado del arte. Conclusión: Nuestros resultados son similares con la literatura. Observación intraoperatoria de vasos trombosados y agresividad tumoral en pacientes con peor pronóstico y menor tiempo de recaída sugiere que es real, sin embargo. El pequeño número de casos, necesita más investigación, incluyendo otros hallazgos y resultados inmunohistoquímicos.

Introduction: Glioblastoma (GB) or Astrocytoma grade IV (WHO), represent 15-20 percent of CNS tumors and approximately 50 percent of gliomas in adults. Objective: Reveal the epidemiological profile of HSCMRP, correlate macroscopic and microscopic findings during surgery treated from January 2011 to November 2015. Method: Observational epidemiological study, descriptive, retrospective, of medical records of 429 cases of intracranial tumors from data obtained from the files of the institution and pathological records of patients treated surgically. Results: Total tumors found 429 and 96 (22.37 percent) GB with a mean age of 59 years, predominant seventh decade of life 33 percent. A relationship between women and men was with little difference 1:1.12, respectively. The most common complaints were headache (58 percent), confusion (41 percent), hemiparesis 37 percent. Most prevalent comorbidities: hypertension (64 percent) and diabetes (22 percent) and smokers (24 percent). Most common topography were followed by left front lesions. The average time of onset of symptoms to surgery was 39 days. Complete resection in 76 percent of cases. The mean length of postoperative recurrence was 96 days, in 68 percent patients were noticed an exuberance of thrombosed vessels during surgery. Pathological findings: necrosis 98%, atypical mitosis 96%, microvascular proliferation 73 percent and nuclear polymorphism 57 percent. Discussion: GB state of art. Conclusion: Our results are very slightly with the literature. The association of intraoperative observation thrombosed vessels, and tumor aggressiveness in patients with worse prognosis and shorter time to relapse, suggests that it is real, however, the small number of cases, needs further investigation, including other findings and immunohistochemical results.