Intervenções não farmacológicas no controle da dor em recém-nascidos pré-termo: conhecimento da equipe de enfermagem / Non-pharmacological interventions in the control of pain in newborns pre-term: knowledge of nursing staff

Objetivo: Investigar o conhecimento da equipe de enfermagem sobre o manejo não farmacológico da dor e descrever os principais métodos não farmacológicos para o manejo da dor em recém-nascidos pré-termo sob cuidados intensivos. Método: Estudo exploratório-descritivo, com abordagem qualitativa, realizado em Unidade de Terapia Intensiva, de Fortaleza-CE, Brasil, cuja coleta de dados foi realizada de julho a agosto de 2018, por meio de entrevista e observação dos cuidados de enfermagem aos neonatos. Participaram duas enfermeiras e seis técnicas de enfermagem e observaram-se quatro recém-nascidos quanto às respostas fisiológicas e comportamentais aos procedimentos invasivos durante o tratamento intensivo. Resultados: Os métodos mais utilizados pela equipe de enfermagem na Unidade pesquisada foram: soro glicosado a 25%, sucção não nutritiva, contenção facilitada, leite materno e Método Canguru. Conclusão: Algumas participantes demonstraram não conhecer os métodos para manejo não farmacológico da dor em recém-nascidos pré-termo, constatando-se necessidade de mais pesquisas relacionadas à temática investigada.(AU)

Objective: To investigate the knowledge of the nursing staff on non-pharmacological pain management and describe the main non-pharmacological methods for pain management in preterm newborns under intensive care. Method: Exploratory-descriptive study, with a qualitative approach, carried out in an Intensive Care Unit, in Fortaleza-CE, Brazil, whose data collection was carried out from July to August 2018, through interviews and observation of nursing care to neonates. Two nurses and six nursing technicians participated and four newborns were observed for physiological and behavioral responses to invasive procedures during intensive care. Results: The methods most used by the nursing team in the researched unit were: 25% glucose serum, non-nutritive suction, facilitated containment, breast milk and Kangaroo Method. Conclusion: Some participants demonstrated that they do not know the methods for non-pharmacological management of pain in preterm newborns, confirming the need for more research related to the theme investigated. (AU)

Objetivo: Investigar los conocimientos del equipo de enfermería sobre manejo no farmacológico del dolor y describir los principales métodos no farmacológicos para manejo del dolor en recién nacidos prematuros en cuidados intensivos. Método: Estudio exploratorio descriptivo, cualitativo, realizado en Unidad de Cuidados Intensivos, en Fortaleza-CE, Brasil, cuya recolección de datos se realizó de julio a agosto de 2018, a través de entrevistas y observación de cuidados de enfermería a neonatos. Participaron dos enfermeras y seis técnicos de enfermería y se observaron a cuatro recién nacidos para determinar las respuestas fisiológicas y conductuales a los procedimientos invasivos durante los cuidados intensivos. Resultados: Los métodos más utilizados por el equipo de enfermería en la unidad investigada fueron: suero de glucosa al 25%, succión no nutritiva, contención facilitada, leche materna y método canguro. Conclusión: Algunos participantes señalaron no conocen los métodos para manejo no farmacológico del dolor en recién nacidos prematuros, por lo que se necesitan más investigaciones relacionadas al tema investigado.(AU)

Mistaking a Tumour for an Infection - Acrometastasis of the Finger from Endocervical Adenosquamous Carcinoma: A Case Report

@#Acrometastasis is rare with a very low incidence of all bone metastasis. It can present with swelling, pain and warmth with erythema that may mimic an infection especially in the distal phalanx. Due to its rarity and subtle clinical presentation, it can be misdiagnosed as an infection causing the treatment to be delayed. We report a 42-year-old female with an acrometastasis to the distal phalanx of the left middle finger which we mistook as an infection thus delaying her treatment. It was a terminal presentation of her endocervical adenosquamous carcinoma. We would like to highlight that acrometastasis has an indistinct presentation and in cases where the lesion does not respond to treatment, acrometastasis should be included as one of the differential diagnoses. Thus, physicians need to have a high level of suspicion in patients with a primary malignant tumour.

O sentido do trabalho para bombeiros pós-evento crítico: o caso da Boate Kiss / The meaning of work for post-event firefighters: the case of Nightclub Kiss

Atuando em eventos inesperados e tendo como missão a preservação da vida, a profissão de bombeiro merece destaque em estudos acadêmicos pelo envolvimento emocional e físico que a atividade exige. Este estudo qualitativo analisou o sentido do trabalho para 40 bombeiros envolvidos no evento crítico ocorrido na Boate Kiss (Santa Maria). Constatou-se que, para os entrevistados, o evento refletiu negativamente nas dimensões organizacional e social, alterando o sentido atribuído ao trabalho, especialmente, frente à precariedade da relação de trabalho, falta de aceitação moral e de reconhecimento social.

Acting in unexpected events and having the mission of preserving life, a firefighter's profession deserves emphasis in academic studies due to the emotional and physical involvement that the activity requires. This qualitative study analyzed the meaning of work for 40 firefighters involved in the critical event occurred at the Nightclub Kiss (Santa Maria). It was found that for the interviewees the event reflected negatively on the organizational and social dimensions, changing the meaning attributed to work, especially, when facing its precarious relationship, lack of moral acceptance and social recognition.

Multifocal hepatic abscesses in immunocompetent patient due to Bartonella henselae: Case report with review of literature

To the best of our knowledge, this is the first case of multifocal hepatic abscesses in a young immunocompetent adult from India, which was successfully treated with hepatectomy and short course of oral antibiotic regimen. Publishing further such case reports will provide more clarity regarding the clinical significance of the disease, including associated risk factors and appropriate treatment.

Genetics of nonalcoholic fatty liver disease in Asian populations

Nonalcoholic fatty liver disease (NAFLD) is characterized by the accumulation of fat in the liver without any history of chronic alcohol consumption. It encompasses a wide spectrum of diseases that range from simple steatosis to nonalcoholicsteatohepatitis. NAFLD is strongly associated with obesity, insulin resistance / type-2 diabetes mellitus and the metabolic syndrome. NAFLD is a complex disorder; environmental and genetic factors interact with NAFLD manifestation and determine its progression. In this review, an attempt was made to provide current information on the genetic variants of NAFLD in Asian populations. Literature search was performed by using PubMed, Medline and Google Scholar database. Candidate gene, validation and genomewide association studies (GWASs) were included in this review. A total of 41 studies fulfilled inclusion criteria of which 12 candidate gene studies exclusively focussed on the PNPLA3 gene and 17 other studies on other important candidate genes such as NCANCILP2, PPARG,AGTR1, FABP1, APOC3 etc. reported significant association with NAFLD. Eight validation studies identified associations of variants on PNPLA3, LYPLAL1, TM6SF2, ADIPOR2, STAT3, GCKR, SAMM50 etc. with NAFLD. Thus, so far, four GWASs have been conducted in Asian population that reported PNPLA3, SAMM50, PARVB and GATAD2A genes which were significantly associated with NAFLD. Findings indicate that PNPLA3, APOC3, PPARG, NCAN and GCKR genes emerge out to be the important biological markers associated with NAFLD.

Ipsilateral proximal and distal radius fractures with unstable elbow joint: Which should we address first? / 中华创伤杂志(英文版)

Simultaneous ipsilateral fractures involving radial head and distal end of radius are uncommon. We present our thoughts on which fracture should be addressed first. A 68-year-old lady sustained an ipsilateral fracture of the right radial head and distal end of radius following a fall. Clinically her right elbow was posteriorly dislocated and right wrist was deformed. Plain radiographs showed an intraarticular fracture of the distal end of radius and a comminution radial head fracture with a proximally migrated radius. Magnetic resonance imaging (MRI) showed no significant ligament injuries. We addressed her distal radius first with an anatomical locking plate followed by her radial head with a radial head replacement. Our rationale to treat the distal end radius: first was to obtain a correct alignment of Lister's tubercle and correct the distal radius height. Lister's tubercle was used to guide for the correct rotation of the radial head prosthesis. Correcting the distal end fracture radial height helped us with length selection of the radial head prosthesis and address the proximally migrated radial shaft and neck. Postoperative radiographs showed an acceptable reduction. The Cooney score was 75 at 3 months postoperatively, which was equivalent to a fair functional outcome.

Sentidos do trabalho na percepção de pessoas que exercem trabalho comum / Meaning of work in the perception of people who carry out common work

O trabalho comum é entendido como algo repetitivo, maçante, muitas vezes perigoso, penoso, sujo e fisicamente esgotante. Diante dessas características, ele passa despercebido pela sociedade frente à invisibilidade pública e ao desprestígio social que lhe é atrelado. Para tanto, este estudo busca analisar os sentidos do trabalho para aqueles que exercem esses trabalhos. Por meio de uma pesquisa qualitativa, foram realizadas 32 entrevistas com trabalhadores que exercem trabalhos comuns na região Norte do estado do Rio Grande do Sul. As entrevistas foram realizadas com base em um roteiro semiestruturado, gravadas, transcritas e analisadas por meio da técnica de análise de conteúdo, com o auxílio do software Max-Qda. O trabalho apresentou-se como central na vida dos pesquisados, estando relacionado à sobrevivência, inserção social e ao prazer em realizar as atividades que lhes são atribuídas. Para tanto, independentemente da função que ocupam e do nível de instrução que possuem, o trabalho que exercem tem uma finalidade e um valor para sociedade.

Common work is understood as repetitive, dull, often dangerous, painful, dirty, and physically grueling. In face of these characteristics, the common work goes unnoticed by the society in front of the public invisibility and the social discredit that is attached to it. Therefore, this study seeks to analyze the meaning of work for professionals who carry out common work. Through a qualitative research, 32 interviews were carried out with workers who performed common work in the northern region of the state of Rio Grande do Sul. Interviews were conducted based on a semi-structured script, recorded, transcribed and analyzed using the analysis technique with the help of Max-Qda software. The work presented as central in the life of the researched ones, being related to the survival, social insertion and pleasure in carrying out the activities that are attributed to them. For doing so, regardless of the function they occupy and the level of education they have, the work they carry out has a purpose and a value for society.

END-TO-SIDE NERVE TRANSFER IN NEUROPATHIC PAIN POST BRACHIAL PLEXUS INJURY

@#We report a case of a 59-year-old gentleman with complete left brachial plexus injury. He presented with chronic pain over the dorsum of his left hand since the injury eight years ago. Medical treatment had been optimized but the pain still persists. End-to-side nerve transfer was done involving superficial sensory radial nerve and median nerve to alleviate the pain. The surgery was considered successful as the patient claimed that the pain score had reduced a few weeks postoperatively. However, there was no sensory recovery and functionally no improvement was observed

Demographic profile, host, disease & viral predictive factors of response in patients with chronic hepatitis C virus infection at a tertiary care hospital in north India.

Background & objectives: Standard of care for chronic hepatitis C (CHC) in India is peginterferon and ribavirin (RBV). The response to treatment in real life stetting is unclear. The objectives of this study were to evaluate the demographic profile and assess the virological response and predictors of response in CHC patients. Methods: Consecutive patients with CHC were included in this study. Detailed clinical history, risk factors, and predictive factors of response were noted. Patients were treated with peginterferon α2b (1.5 μg/kg/wk) and RBV (12 mg/kg/day) for 6 to 18 months based on response. Results: A total of 211 patients were included in the analysis, mean age 40.6±12.3 yr, 144 (68%) were males and 71 (34%) had compensated cirrhosis. Commonest risk factor for acquiring CHC was previous transfusion and surgery (51%). Genotype 3 (72%) was most common followed by genotype 1 (23%). Overall sustained virologic response (SVR) was 64 per cent [95% CI 57.1%-70.4%]. The SVR was 66.5 per cent [95% CI 58.34-73.89%] for genotype 3 and 61.2 per cent [95% CI 46.23 to 74.80%] for genotype 1. Non-cirrhotics had better SVR rates compared to cirrhotics (76 vs 41%, P<0.001). On multivariate analysis, BMI ≥23 kg/m2, HOMA-IR ≥2, compliance (≤80%), and fibrosis >2 were predictors of low SVR. Interpretation & conclusions: Genotype 3 was the commonest HCV genotype. The commonest source of infection was previous transfusion and surgery. SVR rates for genotypes 3 were better than genotype 1 patients. Predictors of non-response were high BMI, insulin resistance, significant fibrosis and inadequate compliance.

Complete Brachial Plexus Injury - An Amputation Dilemma. A Case Report

Brachial plexus injuries with intact yet flail limb presents with problems of persistent neuropathic pain and recurrent shoulder dislocations, that render the flail limb a damn nuisance. As treating surgeons, we are faced with the dilemma of offering treatment options, bearing in mind the patient’s functional status and expectations. We present a case of a 55-year old housewife with complete brachial plexus injury begging for surgical amputation of her flail limb, 6 years post-injury. Here we discuss the outcome of transhumeral amputation and the possibility of offering early rather than delayed amputations in this group of patients.

Local versus international criteria in predicting gestational diabetes mellitus-related pregnancy outcomes / Philippine Journal of Obstetrics and Gynecology

OBJECTIVE: To evaluate the Philippine Obstetrical and Gynecological Society Clinical Practice Guidelines (POGS-CPG) and the International Association of Diabetes and Pregnancy Study Group (IADPSG) diagnostic criteria for gestational diabetes mellitus (GDM) against pregnancy outcomes.METHODS: This is a randomized controlled trial which enlisted patients attending the Out-patient clinic of our institution. All women included in the study were requested to take a 2-hour 75-gram oral glucose tolerance test (OGTT) between estimated 24th and 28th gestational weeks. In order to diagnose GDM, POGS-CPG consensus required a fasting plasma glucose of >92 mg/dl (5.1 mmol/L) or a 2-hour post-glucose load of >140 mg/dl (7.8 mmol/ml) while lADPSG criteria required 92 mg/dL (5.1 mmol/L) for fasting plasma glucose, 180 mg/dL (10 mmol/L)1-hour post-glucose load, or 153 mg/dL (8.5 mmol/L) 2-hour post-glucose load. Only 1 abnormal value on the OGTT is needed on both criteria to diagnose GDM. Women with diabetes antedating pregnancy were excluded in this study. Based on the 75-g OGTT result, the patients were divided into 4 groups and were followed through delivery. Pregnancy out-comes of the 4 groups were then compared.RESULTS: Among the 389 patients studied, POGS-CPG group had a GDM prevalence rate of 29% whereas the IADPSG group had 16%. Trends have shown that in patients diagnosed with GDM under IADSGP and POGS criteria, no significant differences in the birth-weight status (p=0.156), mode of delivery (p=1.000), indication of cesarean section (p=1.000), and other complications (p=1.000) were noted. The 75 g OGTT values of patients in both groups were not significant predictors of APGAR scores. However, the 1-hour post-glucose load value was shown to be a significantpredictor of birth weight. Yet, the regression models of FBS parameters in predicting APGAR scores and birth weight were still weak.CONCLUSION: There was no significant difference noted between the IADPSG group versus the POGS-CPG group in terms of maternal neonatal outcome.

Melorheostosis of the hand affecting the c6 sclerotome and presenting with carpal tunnel syndrome

Melorheostosis is a rare, progressive bone disease accompanied by hyperostosis and soft tissue fibrosis. While affected adults present with contracture and pain, children present with limb length discrepancy and deformity. We report the case of a 20-year-old woman with melorheostosis since childhood who presented with right hand deformity and numbness. Radiographs showed not only a combination of dense sclerosis and opacities, but also the classic 'flowing candle wax' appearance. Radiography can be used to identify melorheostosis, thus preventing unnecessary bone biopsies. Carpal tunnel release revealed the presence of a thickened flexor retinaculum and a degenerated median nerve distal to the retinaculum, but did not show hyperostosis. This case highlights the role of nerve decompression in melorheostosis and the importance of early identification of the disease to prevent unnecessary bone biopsies.

Bilateral scaphoid stress fracture in a platform diver presenting with unilateral symptoms

Scaphoid stress fracture is rare and occurs mainly in gymnasts. The current literature has only two reported cases: unilateral scaphoid stress fracture in a platform diver and bilateral scaphoid stress fracture in a gymnast. We herein report bilateral stress fracture of the scaphoid in a platform diver who presented with only one symptomatic side. Our patient was a 16-year-old competitive platform diver with an 18-month history of pain in the right wrist. Radiography revealed fracture of the right scaphoid at the waist. As part of our preoperative plan of measuring the scaphoid length to determine the appropriate screw, radiography of the contralateral side was performed, revealing an unexpected fracture of the left scaphoid. Due to the frequency of stress fractures in competitive sports, especially gymnastics, we recommend that bilateral scaphoid radiography be performed for athletes presenting with a unilateral scaphoid fracture, to avoid missing a fracture in the contralateral side.

Slow movement: trabalho e experimentação do tempo na vida líquido-moderna / Slow movement: work and time experimentation in the liquid-modern life

O presente artigo coloca em pauta uma reflexão cujo objetivo é discorrer sobre os modos de trabalhar e de viver na vida líquido-moderna. Para tanto, apresenta o Slow Movement como referência de análise. Divulgado como movimento mundial em prol da desaceleração, sua proposta difundiu-se e firmou-se ao acolher a sensação generalizada de esgotamento promovida pela vida líquida, conforme preconizada por Bauman (2007). Objetiva-se compreender se e como o Slow Movement possibilita uma outra experimentação do tempo, bem como se interpõe enquanto expressão da resistência aos atuais modos de trabalhar e de viver. A análise empreendida permite perceber que o Slow Movement, apesar de se apresentar como um modo de expressão da resistência frente à aceleração, mantém-se subordinado à ideologia gerencialista (Gaulejac, 2007) que caracteriza os atuais modos de trabalhar. Desse modo, o movimento contribui para apaziguar os sofrimentos psíquicos causados pela pressão do tempo, mas não para a sua revolução.

The following paper aims at describing work and life in the liquid modern life. For that matter the Slow Movement is presented as an analysis reference. Advertised as a world movement towards a slower time, its proposition has spread and been recognized as it acknowledges the feeling of hopelessness brought up by the liquid life, as described by Bauman (2007). The objective is to understand if and how the Slow Movement leads to a different experimentation of time, as well as if it is an expression of resistance to the current ways of working and living. The analysis proposes that although the Slow Movement presents itself as a resistance to the current acceleration, it is still linked to a managerial ideology (Gaulejac, 2007). Thus, the movement contributes to peace the psychological damages caused by the pressures of time, although it doesn't operate as a revolution.

Approaches to deriving Schwann cells from human bone marrow for neural tube regeneration in a clinical setting

Bone marrow derived Mesenchymal stem cells (MSCs) were evaluated as an alternative source for tissue engineering of peripheral nerves. Human MSCs were subjected to a series of treatment with a reducing agent, retinoic acid and a combination of trophic factors. This treated MSCs differentiated into Schwann cells were characterized in vitro via flow cytometry analysis and immunocytochemically. In contrast to untreated MSCs, differentiated MSCs expressed Schwann cell markers in vitro, as we confirmed by flow cytometry analysis and immunocytochemically. These results suggest that human MSCs can be induced to be a substitute for Schwann cells that may be applied for nerve regeneration since it is difficult to grow Schwann cells in vitro.

A Study on the Absence of Palmaris Longus in a MultiracialPopulation

Palmaris longus is a dispensable muscle with a long tendon which is very useful in reconstructive surgery. It is absent 2.8 to 24% of the population depending on the race/ethnicity studied. Four hundred and fifty healthy subjects (equally distributed among Malaysias 3 major ethnic groups) were clinically examined for the presence or absence of palmaris longus. This tendon was found to be absent unilaterally in 6.4% of study subjects, and bilaterally in 2.9% of study participants. Malays have a high preval