Descripción de la micobiota de los tubos endotraqueales de pacientes de unidades de cuidados intensivos en Bogotá, Colombia

Introducción. La colonización por microorganismos patógenos de los dispositivos médicos usados en las unidades de cuidados intensivos es un factor de riesgo para el aumento de infecciones asociadas con la atención en salud y, por lo tanto, al de la morbilidad y la mortalidad de los pacientes intubados. En Colombia, no se ha descrito la colonización por hongos de los tubos endotraqueales, con lo cual se podrían considerar nuevas opciones terapéuticas para el beneficio de los pacientes. Objetivo. Describir los hongos que colonizan los tubos endotraqueales de los pacientes en unidades de cuidados intensivos, junto con su perfil de sensibilidad a los antifúngicos. Materiales y métodos. Se realizó un estudio observacional, descriptivo, en dos centros hospitalarios durante 12 meses. Se recolectaron tubos endotraqueales de pacientes de las unidades de cuidados intensivos. Estos fueron procesados para cultivar e identificar hongos, y para establecer su perfil de sensibilidad a los antifúngicos. Resultados. Se analizaron 121 tubos endotraqueales obtenidos de 113 pacientes. De estos, el 41,32 % se encontró colonizado por los hongos Candida albicans (64,61 %), C. no-albicans (30,77 %), Cryptococcus spp. (3,08 %) o mohos (1,54 %). Todos los hongos evaluados presentaron una gran sensibilidad a los antifúngicos, con un promedio del 91 %. Conclusión. Se encontró colonización fúngica en los tubos endotraqueales de pacientes con asistencia respiratoria mecánica. El perfil de sensibilidad en estos pacientes fue favorable. Se requiere un estudio clínico para correlacionar los microorganismos colonizadores y su capacidad de generar infección.

Introduction. Medical device colonization by pathogenic microorganisms is a risk factor for increasing infections associated with health care and, consequently, the morbidity and mortality of intubated patients. In Colombia, fungal colonization of endotracheal tubes has not been described, and this information could lead to new therapeutic options for the benefit of patients. Objective. To describe the colonizing fungi of the endotracheal tubes from patients in the intensive care unit, along with its antifungal sensitivity profile. Materials and methods. We conducted a descriptive, observational study in two health centers for 12 months. Endotracheal tubes were collected from patients in intensive care units. Samples were processed for culture, fungi identification, and antifungal sensitivity profile assessment. Results. A total of 121 endotracheal tubes, obtained from 113 patients, were analyzed: 41.32 % of the tubes were colonized by Candida albicans (64.62%), C. non-albicans (30.77%), Cryptococcus spp. (3.08%) or molds (1.54%). All fungi evaluated showed a high sensitivity to antifungals, with a mean of 91%. Conclusion. Fungal colonization was found in the endotracheal tubes of patients under invasive mechanical ventilation. The antifungal sensitivity profile in these patients was favorable. A clinical study is required to find possible correlations between the colonizing microorganisms and infectivity.

Perfil de morbidade no primeiro ano de vida entre recém-nascidos de alto risco / Morbidity profile in the first year of life among high-risk newborns

Os cuidados destinados aos recém-nascidos prematuros extremos têm propiciado importantes resultados na sobrevida dessas crianças. Objetivo: Caracterizar o perfil de morbidade no primeiro ano de vida entre recémnascidos de alto risco. Materiais e Métodos: Trata-se de uma pesquisa exploratória realizada no ambulatório de seguimento de recém-nascidos de alto risco do norte de Minas Gerais. A coleta de dados foi referente às admissões no período de março de 2014 a abril de 2015. O instrumento contemplava características: demográficas, sociais, condições de gestação e parto, intercorrências no pós-parto e condições de saúde das crianças acompanhadas ao longo do primeiro ano de vida. Realizou-se a análise estatística descritiva e o teste Qui-Quadrado, assumindo-se um nível de significância de 5% para comparação da distribuição das morbidades por faixas de peso. Resultados: Participaram deste estudo 282 recém-nascidos, sendo 53,9% do sexo masculino. Entre as mães, 58,2% era multípara e 35,8% hipertensas. Em relação ao peso de nascimento, 59,6% dos recém-nascidos acompanhados pesaram menos de 1500 gramas. As principais morbidades identificadas no primeiro ano de vida foram atraso do desenvolvimento neuro-psicomotor, infecções de vias aéreas superiores, as alterações neurológicas e as afecções respiratórias crônicas. Foram registradas diferenças estatisticamente significantes para o atraso do desenvolvimento neuro-psico-motor (p<0,001), intercorrências neurológicas (p=0,008) e episódios de diarreia (p=0,047), entre as faixas de peso de nascimento. Conclusão: A assistência ambulatorial para o recém-nascido prematuro de alto risco contribui para a identificação e a prevenção de doenças recorrentes nessa população(AU)

Introduction: Care for extremely premature newborns has provided important results in the survival of these children. Objective: To characterize the morbidity profile in the first year of life among high-risk newborns. Materials and Method: This is an exploratory research carried out at the follow-up clinic for high-risk newborns in the north of Minas Gerais. Data collection referred to admissions in the period from March 2014 to April 2015. The instrument included characteristics: demographic, social, pregnancy and delivery conditions, postpartum complications and health conditions of children monitored during the first year of life. Descriptive statistical analysis and the chisquare test were performed, assuming a significance level of 5% to compare the distribution of morbidities by weight range. Results: A total of 282 newborns participated in this study, 53.9% of whom were male. Among the mothers, 58.2% were multiparous and 35.8% were hypertensive. Regarding birth weight, 59.6% of newborns monitored weighed less than 1500 grams. The main morbidities identified in the first year of life were delayed neuro-psycho-motor development, upper airway infections, neurological disorders and chronic respiratory conditions. Statistically significant differences were recorded for delayed neuro-psycho-motor development (p<0.001), neurological complications (p=0.008) and episodes of diarrhea (p=0.047), between birth weight ranges. Conclusion: Outpatient care for high-risk premature newborns contributes to the identification and prevention of recurrent diseases in this population(AU)

Factors associated with recurrent wheezing in the first year of life among premature newborns from Neonatal Intensive Care Units / Fatores associados à sibilância recorrente no primeiro ano de vida entre recémnascidos prematuros provenientes de Unidades de Terapia Intensiva Neonatais

Abstract Objectives: to determine the prevalence and factors associated with recurrent wheezing in the first year of life among premature newborns from Neonatal Intensive Care Units, in the city of Montes Claros, northern Minas Gerais. Methods: cross-sectional study, with data collection from medical records of a follow-up clinic, interviews with mothers and, eventually, search in hospital records. Bivariate analyzes were carried out between sociodemographic and clinical characteristics and recurrent wheezing. Variables associated up to the level of 20% were analyzed by binary logistic regression, and associations defined by the Odds Ratio and respective 95% confidence intervals. Only variables associated with a 5% significance level were maintained in the final model of logistic regression. Results: among 277 infants studied, about one fifth (21.3%) were extremely low birth weight preterm and more than half (60.7%) had birth weight below 1500 grams. The prevalence of recurrent wheezing was 14.4% (CI95% = 10.3-18.4). Mechanical ventilation (OR = 2.12; CI95% = 1.09-4.76; p = 0.030) and oxygen therapy time ≥ 15 days (OR = 2.49; CI95%= 1.12-5.00; p = 0.010) were the risk factors for the event. Conclusions: there is a high prevalence of recurrent wheezing in the evaluated group and the associated variables reiterate the risk of prolonged oxygen therapy and mechanical ventilation for premature newborns.

Resumo Objetivos: determinar a prevalência e fatores associados à sibilância recorrente no primeiro ano de vida entre recém-nascidos prematuros egressos de Unidades de Terapia Intensiva Neonatais, na cidade de Montes Claros, norte de Minas Gerais. Métodos: estudo transversal, com coleta de dados em prontuários de ambulatório de seguimento, entrevistas com mães e, eventualmente, consultas aos prontuários hospitalares. Foram realizadas análises bivariadas entre as características sociodemográficas e clínicas e a sibilância recorrente. As variáveis associadas ao desfecho até um nível de significância de p ≤20% foram analisadas por regressão logística binária e as associações definidas pelas Odds Ratios e respectivos intervalos de confiança de 95%. Somente variáveis associadas a um nível de significância de 5% foram mantidas no modelo final de regressão logística. Resultados: entre 277 crianças estudadas, cerca de um quinto (21,3%) eram prematuros de extremo baixo peso e mais da metade (60,7%) tinha peso de nascimento abaixo de 1500 gramas. A prevalência de sibilância recorrente foi de 14,4% (IC95%=10,3-18,4). Ventilação mecânica (OR=2,12; IC95%= 1,09-4,76; p=0,030) e tempo de oxigenioterapia ≥15 dias (OR=2,49; IC95%=1,12-5,00; p=0,010) foram os fatores de risco para o evento. Conclusão: existe uma elevada prevalência de sibilância recorrente no grupo avaliado e as variáveis associadas reiteram o risco do uso prolongado de oxigenioterapia e da ventilação mecânica para recém-nascidos prematuros.

Validity of the Polar V800 heart rate monitor for assessing cardiac autonomic control in individuals with spinal cord injury

Abstract Aim: Spinal cord injury (SCI) is associated with changes in cardiac autonomic control, that can be evaluated by heart rate variability (HRV), for which the electrocardiogram (ECG) is the gold standard. However, the use of ECG is limited to laboratory environments, and new tools are needed for this purpose and that can be applied in the routine monitoring of individuals with SCI. The present study aimed to investigate the validity of the Polar V800 heart rate monitor in assessing the cardiac autonomic control of individuals with SCI. Methods: Nineteen adult men with SCI (paraplegia n = 10; 44.5 ± 8.5 years and tetraplegia n = 9; 34.4 ± 7.5 years) participated in this cross-sectional study. The participants remained in the sitting position at rest for 10 min for the acquisition of the ECG and Polar V800 signals. The last 5-min window was used to count the beat-by-beat R-R interval series and then calculate the HRV indices (linear methods in the time and frequency domains). The study subgroups were compared, and the validity of the measurements generated with a heart rate monitor was determined using the intraclass correlation coefficient (ICC2,1) and Bland-Altman graphs. Results: Agreement analyses for the R-R intervals, SDNN, rMSSD, PNN50, SD1, LF, HF, and LF: HF ratio tended to show reliability ranging from acceptable to excellent (ICC = 0.579-0.990; P = 0.043-0.001) and acceptably narrow limits of agreement within both the group with tetraplegia and the group with paraplegia. Conclusion: The Polar V800 heart rate monitor is a valid instrument for assessing HRV in individuals with paraplegia and tetraplegia.

Evaluación de un programa piloto para trabajar habilidades narrativas en niños con hipoacusia usuarios de ayudas auditivas / Evaluation of a pilot program: developing narrative skills in children with hearing aids or cochlear implant

El Discurso Narrativo (DN) es una unidad lingüística compleja utilizada en ciertos contextos y que refleja la organización del pensamiento. La evidencia científica muestra que la población sorda, usuaria de ayudas auditivas, presenta dificultades en los diferentes niveles del lenguaje, tanto expresivos como comprensivos, incluida la habilidad para narrar. Además, existe evidencia de que la intervención terapéutica ayudaría a mejorar su rendimiento. Sin embargo, los datos disponibles sobre las características y abordaje del DN en esta población son escasos. El objetivo del estudio es evaluar un programa piloto para trabajar habilidades narrativas en niños chilenos usuarios de ayudas auditivas. Se estudiaron 22 niños con un promedio de edad de 6,5 años, adaptados con audífonos y/o implante coclear. Se aplicó a este grupo de niños una evaluación inicial del DN utilizando el instrumento Evaluación del Discurso Narrativo (EDNA), obteniéndose la Etapa y Desempeño narrativo de cada niño. Luego, se creó y aplicó individualmente un programa de estimulación del discurso narrativo de 12 sesiones una vez por semana. Finalmente, se repitió la evaluación al final del programa. Se encontraron diferencias significativas entre los resultados obtenidos previo y posterior a la implementación del programa de estimulación. En relación con la Etapa del DN, antes de la intervención el 45,5% de los niños no estructuraba, lo cual se redujo a un 9.1% en la evaluación final. En cuanto al Desempeño, previo a la intervención el 72,7% de los niños presentaba un "déficit narrativo", lo cual se redujo a un 18,2% posterior a la aplicación del programa.

Narrative discourse is considered a linguistic unit that is used in a specific communicative context, being an indicator of thinking organization. Previous evidence shows how hearing aid users, have difficulties with different language skills, both expressive and comprehensive, including the ability to narrate. Additionally, there is evidence showing how therapeutic intervention would help to improve their narrative performance. However, the information available about the discursive skilland the effect ofstimulation programs on it in hearing impaired children is scarce. Accordingly, the present study aims to explore narrative performance in hearing impaired children users of hearing aids/cochlear implants, before and after a narrative speech stimulation program. Twenty-two children diagnosed with bilateral hearing loss users of hearing aids/cochlear implants with a mean age of 6.5 years were included. An initial assessment of the narrative skills was performed using Narrative Discourse Assessment (EDNA), which provided a narrative Stage and a Total score. A twelve-session stimulation program was developed and individually administered to children once a week. Finally, an assessment was performed after the program ended. In the initial assessment, 45.5% of children did not have a structured narrative speech, a percentage that was reduced to a 9.1% in the final evaluation. Statistically significant differences were observed on the EDNA scores when comparing initial and final assessments. The results obtained in the present investigation show how children who use hearing aids/cochlear implants improved significantly their narrative abilities after participating in a pilot narrative speech stimulation program.

Perfil de seleção e consumo de medicamentos em uma instituição de ensino superior: diagnóstico situacional para promoção da saúde / Profile of drug selection and consumption in a higher education institution: situational diagnosis for health promotion

Resumo A seleção de medicamentos é um processo interdisciplinar baseado no perfil epidemiológico, econômico e técnico local. Os medicamentos selecionados devem apresentar eficácia e segurança, de acordo com a Política Nacional de Medicamentos. Este trabalho teve como objetivo identificar o perfil de seleção e consumo de medicamentos dispensados em uma instituição de ensino superior. A partir de pesquisa descritiva com característica quantitativa e qualitativa, foram utilizados os mapas de dispensação de medicamentos para a enfermagem da Divisão de Saúde de 2018 e 2019. Em 2018, 21% dos medicamentos padronizados não foram consumidos. Por esta razão, em 2019 houve nova seleção e 17,2% dos medicamentos foram excluídos. De acordo com o perfil de consumo de medicamentos, observou-se que o consumo de analgésicos foi superior ao consumo de fármacos com propósito anti-inflamatório, de acordo com a classificação Anatomical Therapeutic Chemical (ATC). Conclui-se que o perfil abordado neste estudo possibilita um diagnóstico situacional de seleção e consumo, tendo como necessidade a implantação do seguimento farmacoterapêutico com o intuito de minimizar as possíveis reações adversas produzidas por medicamentos, como estratégia de prevenção e promoção da saúde.

Abstract Drug selection is an interdisciplinary process based on the local epidemiological, economic and technical profile. The selected drugs must be effective and safe, in accordance with the National Drug Policy. This study aimed to identify the profile of selection and consumption of drugs dispensed in a higher education institution. From descriptive research with quantitative and qualitative characteristics, drug dispensing maps for the Nursing Division of the Health Division of 2018 and 2019 were used. In 2018, 21% of standardized medicines were not consumed. For this reason, in 2019 there was a new selection and 17.2% of medicines were excluded. According to the medication consumption profile, the consumption of analgesics was higher than the consumption of drugs with anti-inflammatory purposes, according to the Anatomical Therapeutic Chemical (ATC) classification. It is concluded that the profile addressed in this study allows a situational diagnosis of selection and consumption, with the need to implement pharmacotherapeutic follow-up in order to minimize the possible adverse reactions produced by drugs, as a health promotion strategy.

Sialolipoma of the sublingual salivary gland in a dog ­ first report / Sialolipoma na glândula salivar sublingual em cão ­ primeiro relato

This report describes a 14-year-old Pit Bull dog presenting with a soft tissue swelling of 3-month progression in the right sublingual region. Histopathological analysis of the surgically resected specimen revealed large numbers of mature adipocytes and islets consisting of mucin-containing atrophic acini and dilated ducts surrounded by a thin fibrous capsule. Findings were consistent with sialolipoma of the sublingual salivary gland. To the authors' knowledge, this is the first case of sialolipoma affecting the sublingual salivary gland in dogs.(AU)

O presente relato descreve um cão Pit Bull, de 14 anos, com aumento de volume de consistência macia em região sublingual direita com evolução de 3 meses. Após excisão cirúrgica, a análise histopatológica revelou grande número de adipócitos maduros, tecido glandular composto por ductos dilatados e ácinos atróficos contendo mucina, circundados por fina cápsula fibrosa, achados compatíveis com sialolipoma da glândula salivar sublingual. Pelo conhecimento dos autores, este é o primeiro relato de sialolipoma acometendo glândula salivar sublingual em cão.(AU)

Resistance jump training may reverse the weakened biomechanical behavior of tendons of diabetic Wistar rats / O treinamento de salto de resistência pode reverter o comportamento biomecânico enfraquecido dos tendões de ratos Wistar diabéticos / El entrenamiento de salto de resistencia puede revertir el comportamiento biomecánico debilitado de los tendones de las ratas Wistar diabéticas

ABSTRACT Background: resistance training is widely applied in non-diabetic physical protocol showing effectiveness in improving the tendon tissue. To address this gap, we assessed the effects of resistance training on aquatic environment, on the biomechanical properties of the calcaneal tendon of diabetic Wistar rats. Methods: 59 male Wistar rats were evaluated for 60 days, they were randomly divided into the following groups: Sedentary Control Group (SCG, n=15), Sedentary Diabetic Group (SDG, n=15), Trained Control Group (TCG, n=14) and Trained Diabetic Group (TDG, n=15). After randomization the animals from the SDG and the TDG were induced to Diabetes Mellitus by intraperitoneal injection of Streptozotocin (60 mg/kg). The animals on the trained groups performed resistance exercise that consisted of jumping in an aquatic environment. After nine weeks the calcaneal tendons were collected and tractioned on a conventional mechanical testing machine. Results: the analysis of biomechanical parameters showed lower values in elastic modulus (p=0.000), maximum strength tension (p=0.000) and energy/area (p=0.008) in TDG compared to SDG in addition to an increase on the cross-sectional area (p=0.002). There was no difference for the specific deformation variable. Conclusion: the training protocol used restored some biomechanical parameters of the calcaneal tendon in rats induced to diabetes, thus, resulting in an improvement of its mechanical efficiency.

RESUMO Antecedentes: o treinamento de resistência é amplamente aplicado no protocolo físico não diabético mostrando eficiência na melhoria do tecido do tendão. Para abordar esta lacuna, avaliamos os efeitos do treinamento de resistência no ambiente aquático, nas propriedades biomecânicas do tendão calcâneo de ratos Wistar diabéticos. Métodos: 59 ratos Wistar machos foram avaliados por 60 dias, os quais foram divididos aleatoriamente nos seguintes grupos: Grupo de Controle Sedentário (GCS, n=15), Grupo Diabético Sedentário (GDS, n=15), Grupo de Controle Treinado (GCT, n=14) e Grupo Diabético Treinado (GDT, n=15). Após a randomização, os animais do GDS e do CDT foram induzidos a diabetes mellitus por injeção intraperitoneal de Streptozotocin (60mg/kg). Os animais dos grupos treinados realizaram exercícios de resistência que consistiam em saltar em um ambiente aquático. Após nove semanas, os tendões calcaneares foram coletados e tracionados em uma máquina convencional de teste mecânico. Resultados: A análise dos parâmetros biomecânicos mostrou valores mais baixos em módulo elástico (p=0,000), tensão máxima de força (p=0,000) e energia/área (p=0,008) em GDT em comparação com GDS, além de um aumento na área transversal (p=0,002). Não houve diferença para a variável de deformação específica. Conclusão: o protocolo de treinamento usado restaurou alguns parâmetros biomecânicos do tendão calcâneo em ratos induzidos a diabetes, resultando, assim, na melhoria da eficiência mecânica.

RESUMEN Antecedentes: el entrenamiento de resistencia se aplica ampliamente en el protocolo físico no diabético mostrándose la efectividad en la mejora del tejido del tendón. Para abordar esta brecha, evaluamos los efectos del entrenamiento de resistencia en el ambiente acuático, en las propiedades biomecánicas del tendón calcáneo de las ratas Wistar diabéticas. Métodos: se evaluaron 59 ratas Wistar machos durante 60 días, éstes se dividieron aleatoriamente en los siguientes grupos: Grupo de Control Sedentario (GCS, n=15), Grupo Diabético Sedentario (GDS, n=15), Grupo de Control Entrenado (GCE, n=14) y Grupo Diabético Entrenado (GDE, n=15). Después de la aleatorización, los animales del GDS y del GDE se indujeron a diabetes mellitus por inyección intraperitoneal de Streptozotocin (60mg/kg). Los animales de los grupos entrenados realizaron ejercicios de resistencia que consistían en saltar en un ambiente acuático. Después de nueve semanas, se recogieron y traccionaron los tendones calcaneales en una máquina convencional de prueba mecánica. Resultados: El análisis de los parámetros biomecánicos mostró valores más bajos en módulo elástico (p=0.000), tensión de fuerza máxima (p=0.000) y energía/área (p = 0.008) en GDE en comparación con GDS, además de un aumento en la área transversal (p=0.002). No hubo diferencia para la variable de deformación específica. Conclusión: el protocolo de entrenamiento utilizado restauró algunos parámetros biomecánicos del tendón calcáneo en ratas inducidas a la diabetes, lo que resultó en una mejora de su eficiencia mecánica.

Relación entre el cumplimiento del procedimiento de aspiración de secreciones y la presencia de complicaciones en pacientes críticos, emergencia de un hospital nacional de Lima / Relationship between the compliance procedure suctioning and the presence of complications in critically ill patients, emergence of a national hospital in Lima

Objetivo: determinar cuál es la relación entre el cumplimiento del procedimiento de aspiración de secreciones y la presencia de complicaciones en pacientes adultos en la sala de pacientes críticos del servicio de emergencia del Hospital Nacional Guillermo Almenara Irigoyen. Material y método: el estudio fue observacional de enfoque cuantitativo de alcance descriptivo. Los datos fueron recolectados en dos listas de cotejo, la primera recogió información sobre el cumplimiento de los pasos que realizó el profesional de enfermería en el procedimiento de aspiración de secreciones y la segunda recogió información sobre las complicaciones que se presentaron en el paciente durante el procedimiento: hipoxia, arritmia cardiaca, hipotensión y lesión de la mucosa traqueal. Análisis de datos: se realizó mediante estadística descriptiva (frecuencia y porcentaje) y estadística inferencial para establecer la relación entre variables (chi cuadrado). Resultados: el nivel de cumplimiento fue de medio a bajo en un 60 por ciento. Las complicaciones más frecuentes fueron lesión de la mucosa traqueal con un 65 por ciento, hipoxia con un 55 por ciento. Se encontró relación estadísticamente significativa entre el nivel de cumplimiento bajo y la presencia de lesión de la mucosa traqueal y la hipoxia (P<0.05).

The goal was to determine what is the relationship between compliance with the procedure of aspiration of secretions and the presence of complications in adult patients in the room of critical patients from emergency service of the Guillermo Almenara Irigoyen National Hospital. Material and method: the study was observational approach to quantitative descriptive scope. The data were collected in two lists of matching, the first collected information on the implementation of the steps made by the nursing professional in the procedure of aspiration of secretions and the second collected information about the complications that arose in the patient during the procedure: hypoxia, cardiac arrhythmia, hypotension, and tracheal mucosal injury. Data analysis: was performed by descriptive statistics (frequency and percentage) and statistical inference to establish the relationship between variables (Chi-square). Results: The level of compliance was of medium to low at 60 percent. The most frequent complications were lesion of the tracheal mucosa with 65 percent, hypoxia with 55 percent. It was found statistically significant relationship between low compliance level and the presence of lesion of the tracheal mucosa and hypoxia (P < 0.05).

Estudo retrospectivo de afecções cirúrgicas em aves / Retrospective study of surgical disorders in birds

Avaliaram-se retrospectivamente as cirurgias realizadas em aves no Serviço de Cirurgia de Pequenos Animais do Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, durante período de oito anos. De um total de 90 intervenções cirúrgicas para diagnóstico e/ou tratamento de afecções, 27 foram ortopédicas e 63 de tecidos moles. Quanto ao percentual de cirurgias ortopédicas realizadas segundo as diferentes ordens, observou-se: Psittaciformes 85,19%, Piciformes 7,41%, Anseriformes 3,70% e Falconiformes 3,70%. Para as de tecidos moles os Psittaciformes representaram 92,06%, Columbiformes 3,17%, Passeriformes 3,17% e Anseriformes 1,60%. Entre os tipos de afecções ortopédicas encontradas as fraturas apresentaram a maior ocorrência (88,90%), seguidas de luxação (3,70%), avulsão traumática de extremidade (3,70%) e artrite/osteomielite (3,70%). Dentre as afecções cirúrgicas de tecidos moles as neoplasias apresentaram a maior ocorrência (30,15%), seguidas das neoformações cutâneas ou de anexos não neoplásicos (17,46%), neoformações cutâneas sem diagnóstico (7,94%), distocia (7,94%), fístula de papo (7,94%), hérnia abdominal (4,76%), sinusite (4,76%), gangrena de extremidade de membros (3,17%), perfuração de esôfago (3,17%), prolapso de cloaca (3,17%), "Necrose avascular de dígito" (1,59%), ferida na região da quilha (1,59%), perfuração de cavidade celomática (1,59%), neoformação em cavidade celomática sem diagnóstico (1,59%), corpo estranho em trato gastrointestinal (1,59%) e otite (1,59%). A distribuição das afecções cirúrgicas segundo as espécies acometidas mostrou o "grupo dos papagaios", representado em sua maioria por espécies do gênero Amazona, como prevalente. O conhecimento das afecções cirúrgicas e espécies de aves mais acometidas acrescentam informações para aqueles que já atuam nesta área e servem como indicador de estudo para futuros cirurgiões de aves.

The study assessed retrospectively avian surgeries at the Service of Small Animal Surgery, Veterinary Hospital of the Faculty of Veterinary Medicine and Animal Science, University of São Paulo, performed during eight years. A total of 90 procedures was done for diagnosis or treatment of surgical disorders. From these, 27 were orthopedic and 63 soft tissue surgeries. Considering the orthopedic surgeries performed according to orders we observed: Psittaciformes 85.19%, Piciformes 7.41%, Anseriformes 3.70%, and Falconiformes 3.70%; for soft tissues, the Psittaciformes represented 92.06%, Columbiformes 3.17%, Passeriformes 3.17%, and Anseriformes 1.60%. Fractures presented the highest incidence among orthopedic disorders (88.90%), followed by luxation (3.70%), traumatic avulsion of the end (3.70%) and arthritis/osteomyelitis (3.70%). Among the surgical disorders of soft tissue, neoplasms accounted in 30.15%, followed by cutaneous neoformation or non-neoplastic annexes (17.46%), undiagnosed cutaneous neoformations (7.94%), dystocia (7.94%), crop fistula (7.94%), abdominal hernia (4.76%), sinusitis (4.76%), gangrene of the extremities (3.17%), esophageal perforation (3.17%), cloaca prolapse (3.17%), "avascular necrosis of digit" (1.59%), wound in the region of the keel (1.59%), perforation of the coelomic cavity (1.59%), neoformation in the coelomic cavity without a diagnosis (1.59%), foreign body in the gastrointestinal tract (1.59%), and otitis (1.59%). The distribution of surgical disorders according to species affected showed that the "group of parrots", mainly represented by species of Amazonas genus, was prevalent. Knowledge of surgical and bird species most affected add information for those who work in this area and will be an indicator for future surgeons of birds.

Factores asociados a los niveles de depresión situacional en pacientes oncológicas / Factors associated with levels of situational depression in cancer patients

Objetivo: la investigación tuvo como objetivo identificar los factores asociados a la depresión en pacientes oncológicos. Material y métodos: estudio cuantitativo, descriptivo y de corte transversal realizado en el servicio de oncología del Hospital Edgardo Rebagliati Martins de Lima durante los meses de mayo a junio 2010. La muestra estuvo conformada por 44 pacientes hospitalizados que cumplieron con los criterios de inclusión. El instrumento utilizado para medir el nivel de depresión fue el inventario de depresión de Beck, para identificar los factores asociados se utilizó un cuestionario de preguntas cerradas elaborado por las investigadoras y validado a través de juicio de expertos y prueba piloto. Resultado: muestran que el factor sociocultural sentimiento ante el diagnóstico (p=0,002). con estos datos se concluye que la depresión en pacientes oncológicos se ve influenciada por factores socioculturales y propios de la enfermedad.

Objective: The research had as an objective to identify the factors related to depression on oncological patients. Material and Methods: ItÆs a quantitative, descriptive and cross sectional study made at the Oncology Service at Edgardo Rebagliati Mastins Hospital-Lima during the months of may û june of 2010. The sample was conformed by 44 patients hospitalized who fulfilled inclusion criteria. The tool used to measure the depression level was the BeckÆs depression Inventory, and, to identify the associated factors, a closed question questionnaire was used, elaborated by investigators and validated by expertsÆ there was just an association between the patientsÆ satisfaction level about their disease and treatment (p=0.002). With these information itÆs concluded that depression on oncological patients is more influenced by sociocultural and diseaseÆs own factors, than personal factors.

Nivel de conocimientos de las enfermeras, sobre maniobras de resucitación cardiopulmonar / Level of knowledge of the nurses, on maneuvers of resucitation cardiac pulmonary

La resucitación cardiopulmonar (RCP) es un conjunto de maniobras encaminadas a sustituir y luego reinstaurar la respiración y circulación espontáneas. Es una secuencia de tareas que deben realizarse en forma sistemática, pues el éxito de estas maniobras depende del conocimiento y correcta ejecución de sus fases. Objetivo: determinar el nivel de conocimiento de las enfermeras sobre las maniobras de reanimación cardiopulmonar (RCP). Material y métodos: estudio descriptivo, transversal, realizado en la Clínica Maison de Santé de Lima, Perú. La población estuvo conformada por 39 enfermeras asistenciales de los servicios de hospitalización a quienes se les aplicó un cuestionario sobre reanimación cardiopulmonar. Para obtener los resultados se utilizó el paquete estadístico SPSS versión 12 aplicándose el análisis descriptivo. Resultados: los resultados muestran que la mayoría de enfermeras (59%) tiene un nivel de conocimiento regular sobre la RCP; y según las fases del RCP, su conocimiento también fue regular; sólo en la fase de circulación el nivel de conocimiento fue bueno (48,7%). El nivel de conocimiento fue independiente de los años de experiencia y capacitaciones recibidas. Conclusiones: el RCP no es un evento frecuente, sin embargo, del reconocimiento y actuación oportuna por parte del personal de salud dependería la calidad de vida del paciente atendido.

Cardiopulmonary resuscitation (CPR) is a set of maneuvers designed to replace and then restore spontaneous respiration and circulation. It is a sequence of phases, which should be taken sequentially and systematically as the success of these moves depends on the knowledge and proper execution of its phases. Objectives: Determine the level of knowledge of professional nursing on cardiopulmonary resuscitation maneuvers. Material and methods: Descriptive study and a cross. The population was comprised of 39 nurses in the care of the hospital clinic Maison de Santé. The instrument was a questionnaire of 21 questions about CPR. Results: The results show that most nurses (59%) had a fair knowledge level of CPR and CPR according to the phases of his knowledge, was also regularly, only at the stage of movement (48.7%) the level of knowledge was good. The level of knowledge was independent of years of experience and training received. Conclusions: PCR is not a frequent event, but the recognition and timely action by the health personnel will determine the quality of life of patients treated.

Anomalías congénitas del sistema renal: agenesia renal izquierda asociada a variante arteriovenosa renal derecha y vena cava inferior / Congenital anomalies of the renal system: left renal agenesis associated with right renal arteriovenous variant and inferior vena cava

Este trabajo describe la variante anatómica en un caso incidental de disección en la Escuela de Medicina de la Universidad de Costa Rica, el cual presenta agenesia renal izquierda con variante arteriovenosa renal derecha que consta de cinco arterias renales y dos venas renales, asociado a la variante anatómica del origen de la vena cava inferior ya que es superior a la arteria mesentérica inferior.

This work describes the anatomic variation from an incidental case of dissection founded at Costa Rica’s University School of Medicine, which presents left renal agenesia with a right arteriovenous variant which consists of five renal arteries and two renal veins, related to the anatomic variant from the inferior cava vein, this variation its superior to the inferior mesenteric arterie.

Doença de Kawasaki / Kawasaki disease

A doença de Kawasaki é vasculite sistêmica e aguda de etiologia desconhecida. Constitui a principal causa de doença cardíaca adquirida em crianças nos EUA. Ocorre mais frequentemente em meninos, 80 por cento dos casos em crianças com menos de cinco anos, sendo rara após os oito anos. Pode atingir crianças de todas as raças, tendo maior incidência entre os descendentes asiáticos. Caracteriza-se por febre, conjuntivite bilateral não exsudativa, eritema e edema de língua, lábios e mucosa oral, alterações de extremidades, linfonodomegalia cervical, exantema polimórfico. Aneurismas e estenoses de artérias coronárias são comuns em percentual que varia de 20 a 25 por cento dos pacientes não tratados, podendo posteriormente levar a infarto agudo do miocárdio e morte súbita. O tratamento com imunoglobulina intravenosa é efetivo e deve ser iniciado precocemente a fim de evitar sequelas cardíacas. O desenvolvimento de testes diagnósticos, terapêuticas mais específicas e a prevenção dessa doença potencialmente fatal em crianças dependem dos contínuos avanços na determinação de sua etiopatogenia.

Kawasaki disease is a systemic acute vasculitis of unknown etiology. It is the leading cause of acquired heart disease in children in the USA. It occurs more frequently in boys and eighty percent of the cases occur in children under five years of age. The disease rarely occurs after eight years and it can affect children of all races, with higher incidence among Asian descendants. Kawasaki disease is characterized by fever, bilateral non-exudative conjunctivitis, redness and swelling of the tongue, lips and oral mucosa, abnormalities in the extremities, cervical lymph node, and polymorphic exanthema. Aneurysms and stenoses of coronary arteries occur in pproximately 20 to 25 percent of untreated patients and subsequently can lead to acute myocardial infarction and sudden death. Treatment with intravenous immunoglobulin is effective and should be initiated early to prevent cardiac sequel. The development of diagnostic tests, more specific treatment approaches and prevention of this potentially fatal disease in children depends on continuous advances in the determination of its pathogenesis.

Miniavaliação nutricional na determinação do estado de saúde de idosos com ou sem a doença de alzheimer: aspectos positivos e negativos / Mini nutritional assessment in the determination of the health status of the elderly with or without Alzheimer disease: positive and negative points

A população idosa mundial vem crescendo rapidamente, o que representa um desafio para a saúde pública. A longevidade trouxe à tona doenças de natureza crônica, conseqüentes de processos degenerativos comuns ao envelhecimento. Entre estas as demências e a mais prevalente a doença de Alzheimer A DA provoca desordens cognitivas e nutricionais; a perda de apetite e de peso são sintomas que levam a implicações indesejáveis ao prognóstico da doença. Objetivou-se nesta revisão reunir estudos atuais nos quais o questionário de mini avaliação nutricional (MAN) foi utilizado na determinação do estado nutricional de idosos com ou sem a DA, considerando seus aspectos positivos e negativos. As evidências científicas ressaltam que o questionário da MAN é uma ferramenta simples e rápida na avaliação do estado nutricional de pacientes idosos em clínicas, hospitais e asilos. Estudos revisados indicam ter a MAN alta especificidade na determinação precoce do risco de desnutrição em idosos, apresentando forte correlação com resultados obtidos através de exames bioquímicos e antropométricos. Percebem-se limitações da MAN quando os idosos avaliados apresentam déficit cognitivo. As dificuldades no preenchimento da MAN devem ser reduzidas com adaptações e esclarecimentos oportunos por parte do pesquisador. Sendo assim, mais estudos devem ser realizados com a aplicação da MAN em idosos demenciados, dada a alta correlação entre estado nutricional com prognóstico da DA. Palavras chave: mini avaliação nutricional, estado nutricional, idosos, déficit cognitivo, doença de Alzheimer.

The elderly world population has been growing up quickly, which representsa public health challenge. The longevity brought up chronicdiseases, caused by degeneration problems that usually occur in elderlypeople. Dementias are beyond those diseases, especially theAlzheimer disease (AD). AD causes nutritional and cognitive disorders;low appetite and weight lost are symptoms that lead to undesirableimplications to the disease prognostic. This study objected to reviewactual studies in which the mini nutritional assessment (MNA) was appliedin the determination of the nutritional status of elderly, with orwithout AD, considering negative and positive points. Scientific evidencesshow that MNA questionnaire is a simple and quickly tool onthe nutritional assessment of elderly patients from clinics, hospitalsand nursing homes. The questionnaire permits the detection of risk ofdevelopment of malnutrition and nutrition intervention when necessary.The studies reviewed indicate a high specificity of MNA in determiningearlier the risk of malnutrition in elderly, and strong correlation betweenthe results obtained from biochemical and anthropometrics exams.Limitations are perceived in MNA when elderly assessed present cognitivedeficits. The difficulties in the filling of the MNA must be reducedwith adaptations in the questionnaire and with explanations given bythe researcher. As so, more studies should be realized with the applicationof the MNA in elderly demented, given the high correlationbetween nutritional status and AD evolution.

Aprendizaje colaborativo en el rendimiento académico y habilidades sociales en el programa de especialización en enfermería / Collaborative learning in the academic performance and social skills in the nursing's specialization program

El aprendizaje colaborativo se logra por el consenso obtenido de la colaboración de los miembros del grupo en una tarea específica. Objetivo: determinar diferencias en el rendimiento académico y habilidades sociales entre las alumnas que estudiaron con la metodología aprendizaje colaborativo y las alumnas que estudiaron con la metodología tradicional. Material y método: estudio cuasi experimental, realizado en la Facultad de Enfermería de la Universidad Peruana Cayetano Heredia de Lima, Perú. La investigación se realizó con el total de alumnas matriculadas en el curso de Enfermería II del Programa de Especialización en Cuidados Intensivos (22 alumnos), divididas en dos grupos integrados de forma aleatoria: grupo control (11) y grupo experimental (11). El estudio se realizó entre octubre de 2007 y enero 2008. Para medir el rendimiento académico se utilizó una prueba objetiva y para las habilidades sociales se utilizó la lista de chequeo de Arnold Goldstein. Los datos se analizaron utilizando estadística descriptiva en el programa SPSS v 12. Resultados: el pretes mostró que ambos grupos partían en iguales condiciones tanto en rendimiento académico como en habilidades sociales. El postest del rendimiento académico mostró que el grupo experimental mejoro su promedio en 5 puntos (de 9 a 14); mientras que el grupo control mejoró su promedio en 2 puntos (de 9 a 11) siendo esta diferencia estadísticamente significativa. Con relación a las habilidades sociales, el promedio obtenido por el grupo experimental mostró una mejora en 14 puntos frente a los 12 puntos de mejora obtenido por el grupo control; sin embargo, esta diferencia no fue significativa. Conclusiones: la metodología de aprendizaje colaborativo mejora el rendimiento académico de los alumnos y también fortalece las habilidades sociales puesto que es una metodología alternativa que permite al alumno participar activamente en la construcción de su aprendizaje y el aprendizaje de sus pares.

Collaborative learning is obtained by consensus from collaboration of members of working group in a specific topic. Objectives: To determine differences in academic performance and social skills among the students who studied with the methodology and collaborative learning with students who studied the traditional methodology. Material and methods: Quasi-experimental study, conducted at the school of Nursing at the UPCH Lima- Perú. The research was performed with Students enrolled to the nursing from course II Specialization Program in Intensive Care (22 pupils) and divided into control group (11) and experimental group (11). The groups were formed at random. The study was conducted between October - 2007 and January 2008. To measure academic achievement were studied for objective evidence for social skills are using the check list by Arnold Goldstein. The data were analyzed using descriptive statistics in the SPSS v12. Results: The pre-test showed that both groups started on the same terms both in academic performance as in social skills. The post-test of academic performance showed that both groups improved their average, but the improvement was greater by the experimental group and this difference was statistically significant. In relation to social skills had also improved in both groups, but is not statistically significant difference between groups. Conclusions: The methodology for collaborative learning improves the academic performance of students and also strengthens the social skills to be good alternative methodology that allows the student to participate actively in the construction of learning and learning from their peers.

Molecular genetics of papillary thyroid carcinoma: great expectations...

Papillary thyroid carcinoma (PTC) is the most prevalent type of endocrine cancer and, in recent epidemiological surveys, one of the types of human cancer whose incidence is growing. Despite the favourable outcome and long survival rates of most patients, some tumours display an aggressive behaviour and may progress to the highly aggressive and lethal, anaplastic thyroid carcinoma. In recent years, several progresses have been made on the molecular characterization of PTC, in general, and in the genetic alterations underlying the histotype diversity of this type of cancer, in particular. This holds true regarding alterations on nuclear DNA as well as mitochondrial DNA. In this review we have summarized the most recent findings in the genetic characterization of PTC, giving a particular emphasis to the genotype-phenotype associations, the prognosis implications, and the diagnostic and therapeutic value of the newly identified genetic markers.

O carcinoma papilífero de tireóide (CPT) é o tipo mais prevalente de câncer endócrino e, em pesquisas epidemiológicas recentes, um dos tipos de câncer humano cuja incidência vêm crescendo. A despeito do prognóstico favorável e da longa taxa de sobrevivência da maioria dos pacientes, alguns tumores mostram um comportamento agressivo e podem progredir para o altamente agressivo e letal carcinoma anaplásico de tireóide. Recentemente, vários progressos foram feitos quanto à caracterização molecular do CPT, em general, e às alterações genéticas subjacentes à diversidade histológica desse tipo de câncer, em particular, particularmente com respeito às alterações dos DNAs nuclear e mitocondrial. Nesta revisão, nós sumarizamos os achados mais recentes da caracterização genética do CPT, dando ênfase particular às associações genótipo-fenótipo, às implicações prognósticas e ao valor diagnóstico e terapêutico dos marcadores genéticos recentemente identificados.

Broncodilatadores en la crisis asmática: ¿Aerosol o nebulización? / Bronchodilators in acute asthma: metered dose inhalers or wet nebulizations?

El número de consultas por asma aguda en el Hospital María Ferrer ha aumentado de 3300 consultas anuales en 1980 a 15364 en 2002. Los broncodilatadores de acción corta (salbutamol-ipratropio) en nebulizaciones, procedimiento que consume tiempo y recursos humanos, eran el tratamiento inicial en 2002. Para tratar de mejorar el cumplimiento del tratamiento frente al aumento de la demanda, se reemplazaron las nebulizaciones por aerosoles dosificadores. El objetivo de este estudio es evaluar el impacto de este cambio. Comparamos 90 pacientes con crisis asmática tratados con aerosoles en diciembre del 2003 con igual número tratados con nebulizaciones en diciembre del 2002 pareados por sexo, edad, altura, VEF1 teórico y de ingreso. Con aerosoles se observó una reducción significativa del tiempo de permanencia en el Departamento de Emergencia (mediana 3 h (2-4.75) versus 4 h (1-6) p=0.01) y un número mayor de altas en las primeras 2 horas (48% vs. 31% p=0.03). Los pacientes tratados con aerosol recibieron el 87% de las dosis prescriptas, mientras que el otro grupo recibió sólo el 38%. El VEF1 mostró una tendencia a ser mayor al egreso en el grupo que recibió aerosoles, pero la diferencia no fue estadísticamente significativa (78% ± 17% vs. 73% ± 17% p=0.09). El porcentaje de alta final fue similar en los dos grupos (96% vs. 93%). El tratamiento con aerosoles produjo una mejoría más rápida y mejor cumplimiento de las normas de tratamiento indicadas

The number of patients attending our Emergency Department (ED) with acute asthma has increased from 3300 patient/year in 1980 to 15364 in 2003. Short acting bronchodilators (albuterol/ipratropium) administered in wet nebulizations, a resource consuming procedure, were our main initial treatment in 2002. To improve treatment goals, we switched the method of bronchodilator delivery to metered dose inhalers (MDI) in 2003. The purpose of this study is to evaluate the impact of this change in the bronchodilator delivery system. We compared 90 patients with acute asthma treated with MDIs in December 2003 with a similar number treated with wet nebulizers in December 2002 matched for sex, age, height, and FEV1 on admission. Treated with MDIs resulted in significant reduction of length of stay in the ED (median 3 vs 4 hs – quartiles 2-4.75 vs 1-6 hs, p=0.01) and an increase in the number of discharges in the first 2 hours of treatment (48 vs 31% p = 0.03). Overall, patients in the MDI´s group received 87% of the scheduled bronchodilator doses, while patients in the wet nebulizer´s group received only 37% of the prescribed doses. Although there was a trend towards better FEV1 at discharge in the MDI´s group, the difference was not statistically significant (78% ± 17% vs 73% + 17% p=0.09). Percentage of patients finally discharged from the ED was similar in both groups (96 vs 94%). Patients treated with bronchodilators delivered by MDI improved faster and had better fulfillment of treatment standards