Guía de Práctica Clínica de cuerpo extraño gastrointestinal en niños / Clinical practice guideline of gastrointestinal foreign bodies in children

La ingestión de un cuerpo extraño es un tipo de lesión no intencionada muy frecuente en la infancia, particularmente en lactantes mayores de 6 meses y preescolares. El propósito deseado con la publicación de esta guía es contar con herramientas actualizadas en el diagnóstico y tratamiento de esta afección que permitan sistematizar la conducta y mejorar la calidad de la asistencia médica. Dentro de los cuerpos extraños más frecuentes tenemos: monedas, imanes, baterías, juguetes pequeños, plásticos, joyas, botones, huesos e impactaciones alimentarias en los niños mayores. La sintomatología varía según la naturaleza del cuerpo extraño, el lugar donde se impacte, que casi siempre es en las estrecheces anatómicas o adquiridas del tubo digestivo o por la presencia de complicaciones. Para confirmar el diagnóstico son necesarios diferentes estudios imagenológicos y endoscópicos, estos últimos con un valor terapéutico. El tratamiento depende de factores como la edad, el tiempo de ingerido, la localización, la presencia de complicaciones, la naturaleza del cuerpo extraño, su número y el potencial lacerante, tóxico o corrosivo. En la mayoría de los casos los cuerpos extraños son expulsados de forma espontánea y tienen un pronóstico favorable, pero queda un grupo de pacientes donde es necesario un tratamiento quirúrgico. Después de realizar una búsqueda de revisiones sistemáticas de calidad y tomando en cuenta la experiencia del Servicio de Cirugía Pediátrica de Matanzas en el tratamiento de estos pacientes se elaboró esta guía que fue discutida y aprobada en el IV Simposio Nacional de Cirugía Pediátrica. La publicación de esta guía permitiría a los servicios de Cirugía Pediátrica emplearla como referencia y aplicarla en sus propias instituciones con el consecuente beneficio para los pacientes(AU)

Ingestion of a foreign body is a very common type of unintentional injury in childhood, particularly in infants older than 6 months and preschoolers. The desired purpose with the publication of this guideline is to have up-to-date tools in the diagnosis and treatment of this condition that allow to systematize the behavior and improve the quality of medical care. Within the most frequent foreign bodies we have: coins, magnets, batteries, small toys, plastics, jewelry, buttons, bones and food impactations in older children. Symptomatology varies depending on the nature of the foreign body, the place where it impacted, which is almost always in anatomical or acquired narrowness of the digestive tract, or by the presence of complications. To confirm the diagnosis, different imaging and endoscopic studies are necessary, the latter with a therapeutic value. Treatment depends on factors such as age, ingestion time, location, presence of complications, the nature of the foreign body, the amount and the lacerating, toxic or corrosive potential. In most cases foreign bodies are expelled spontaneously and have a favorable prognosis, but there is a group of patients left for whom surgical treatment is necessary. After conducting a search for quality systematic reviews and taking into account the experience of Matanzas province's Pediatric Surgery Service in the treatment of these patients, this guideline was created and it was discussed and approved at the IV National Symposium of Pediatric Surgery. The publication of this guideline would allow Pediatric Surgery services to use it as a reference and apply it in their own institutions with the consequent benefit for patients(AU)

Review on applications of electric ehicles in the countryside / Revisão de aplicações de veículos elétricos no meio rural

ABSTRACT: This paper presents the main applications of electric vehicles in rural areas, pointing out the trends and challenges for the future. Technological conditions and difficulties faced by the industry for a wide dissemination of this technology are discussed. The paper described the main researches with proposals to overcome the problems of implementing electric tractors, as supply and electricity storage. Technical and economic comparisons between conventional internal combustion tractors and electric tractors are also presented and discussed. The paper showed the existence of barriers to the implementation of electric vehicles in rural areas, as well as the need for batteries technological evolution, which have high costs and for that reason they are very heavy for these purposes, but there are already systems that can be applied to minimize dependence of fossil fuels in this sector and increase the use of sustainable energy.

RESUMO: Este artigo apresenta as principais aplicações de veículos elétricos no meio rural, apontanto as tendências e mudanças futuras. O trabalho discute também as condições tecnológicas e dificuldades enfrentadas pelo setor industrial para a inserção do veículo elétrico no mercado. São apresentados os principais pesquisadores da área com propostas para superar os problemas da implementação dos tratores elétricos, tais como abastecimento e armazenamento de energia elétrica. As comparações técnicas e econômicas entre tratores convencionais, a combustão interna, e tratores elétricos são apresentadas e discutidas. A revisão mostra a existência de barreiras para a implantação dos veículos elétricos no meio rural, como a necessidade de evolução tecnológica das baterias, que apresentam alto custo e ainda são pesadas para este propósito, mas mostra também que já existem sistemas que podem minimizar a dependência de compubstíveis fóceis do setor e aumentar o uso de energia sustentável.

A case series of button batteries as nasal foreign bodies among children.

Foreign bodies are a common occurrence in children that may be either accidental or self-induced as a matter of habit. Various materials have been reported as foreign bodies like metal, plastic toy parts, food matters, etc. Button batteries have been reported as foreign bodies in the nose and are especially relevant, due to their early chemical disintegration in contact with mucosal surface; hence, need emergency surgical intervention to avoid complications like septal necrosis and perforation. Here, we report four cases of button batteries in the nose at various stages of presentation with their sequelae along with a review of literature.

Performance analysis of ten brands of batteries for hearing aids

Comparison of the performance of hearing instrument batteries from various manufacturers can enable otologists, audiologists, or final consumers to select the best products, maximizing the use of these materials. AIM: To analyze the performance of ten brands of batteries for hearing aids available in the Brazilian marketplace. METHODS: Hearing aid batteries in four sizes were acquired from ten manufacturers and subjected to the same test conditions in an acoustic laboratory. RESULTS: The results obtained in the laboratory contrasted with the values reported by manufacturers highlighted significant discrepancies, besides the fact that certain brands in certain sizes perform better on some tests, but does not indicate which brand is the best in all sizes. CONCLUSIONS: It was possible to investigate the performance of ten brands of hearing aid batteries and describe the procedures to be followed for leakage, accidental intake, and disposal...

Batería cilíndrica en vía digestiva en el Instituto Nacional de Salud del Niño, Lima, Perú / Clindrical Battery in the Stomach in the Instituto Nacional de Salud del Niño, Lima, Peru

La ingesta de cuerpos extraños (CE) es un problema comúnmente atendido por pediatras y médicos de emergencia. La ingesta casi siempre es accidental y los objetos más comunes son monedas, piezas de juguetes, joyas o baterías. Las baterías de tipo botón son las más frecuentes, en cuyo caso son importantes el diagnóstico y extracción precoces. La ingesta de baterías cilíndricas es muy infrecuente, son típicamente alcalinas de manganeso o de níquel-cadmio (recargables) y cuando se ingieren son capaces de provocar daño tóxico y corrosivo. Tal daño podría ocurrir como resultado del efecto ácido sostenido del contenido gástrico durante un período de días o semanas. Se presenta el caso de un paciente que ingirió accidentalmente una batería cilíndrica, la cual se retiró vía endoscópica del estómago sin complicaciones.

The ingestion of foreign bodies (EC) is a problem commonly seen by pediatricians and emergency physicians. The intake is almost always accidental and most common objects are coins, pieces of toys, jewelry or batteries. The button batteries are the most common, in which case is important early diagnosis and removal. The cylindrical battery ingestion is very rare, are typically alkaline manganese or nickel-cadmium (rechargeable) and when ingested they can cause toxic and corrosive damage. Such damage may occur as a result of the effect of acid gastric contents sustained over a period of days or weeks. We report the case of a patient who accidentally ingested a cylindrical battery, which was removed from the stomach endoscopically without complications.

Legal Advice on Cognitive Dysfunction / The Japanese Journal of Rehabilitation Medicine

To provide legal advice on cognitive dysfunction, we should evaluate each plaintiff with brain injury from a neutral viewpoint. In the neuropsychological test batteries, not only the total score such as IQs of the WAIS-III or memory quotients of the WMS-R but also the scores of the subtests need to be surveyed to find out the precise nature of the cognitive dysfunction. Expert opinions are also required concerning the relationship between the cognitive dysfunction and the lesion site(s) in the brain as well as the activities of daily living and the instrumental activities of daily living. We, as experts in rehabilitation medicine, should prepare ourselves to provide excellent legal advice to ensure that judges reach a proper decision.

Hábitos relacionados ao descarte pós-consumo de aparelhos e baterias de telefones celulares em uma comunidade acadêmica / Habits related to the post-consumption discard of mobile phones and their batteries within an academic community

Cada vez mais a sociedade contemporânea incorpora em seu cotidiano equipamentos elétricos e eletrônicos, muitos deles contendo substâncias perigosas, que representam ameaças ao meio ambiente e riscos à saúde humana. Este artigo apresenta os resultados de uma pesquisa exploratória com o objetivo de relacionar comportamento de descarte pós-consumo de aparelhos e baterias de celulares, em um grupo de consumidores de telefonia móvel, que tem proximidade em seu cotidiano de trabalho e de estudo com informações sobre saúde pública e ambiental. Os resultados da pesquisa indicam que informação pode aproximar as pessoas do problema, porém não levam por si só à produção de alterações significativas sobre o que e como fazer com o descarte pós-consumo. Os participantes do estudo possibilitaram identificar, que além da informação e acesso a coletores específicos, outros aspectos e critérios pessoais ou coletivos interferem no procedimento de descarte: percepção sobre risco, valor econômico disponibilizado na compra do aparelho e vínculos afetivos, entre outros. Esses fatores podem produzir diferentes respostas dos usuários sobre como lidar com as inovações tecnológicas de uso pessoal.

The contemporary society increasingly incorporates electric and electronic equipments (EEE) in its everyday life, many of them containing dangerous substances that represent threats to the environment and risks to human health. This article presents the results of an exploratory research with the objective of investigating the behavior of post-consumption discard of mobile phones and their batteries in a group of consumers of mobile phones who are in contact, in their work and study, with information about public and environmental health. The results of the research indicate that information can approximate the people to the problem; however, it does not lead, by itself, to the production of significant alterations on how to perform the post-consumption discard. The study's participants enabled to identify that besides information and access to specific collectors, other personal or collective aspects and criteria interfere in the discard procedure: risk perception, economic value available in the purchase of the mobile phone and affective bonds, among others. Those factors can produce different responses of users concerning how to deal with the technological innovations of personal use.

Cognitive deficits in multiple sclerosis: a systematic review / Déficits cognitivos na esclerose múltipla: uma revisão sistemática

OBJECTIVE: To present the results of prospective and retrospective studies on multiple sclerosis patients cognitive dysfunctions, as well as to discuss the batteries of neuropsy- chological tests used in these investigations. METHOD: A systematic review was performed involving 40 studies published from 1997 to 2009, in PubMed, Scopus, Ovid, ISI Web of Knowledge, Scientific Electronic Library on line (Scielo) and Latin-American and Caribbean Center of Health Sciences Informations database. Clear description of multiple sclerosis patients cognitive deficits evaluation, study design, sample size; inclusion-exclusion and discontinuation criteria; instruments for neuropsychological evaluation, diagnostic methods, evaluated functions and detailed statistical analysis had been the inclusion criteria. RESULTS: There is consensus on cognitive impairment of multiple sclerosis patients, especially on memory, speed processing, executive function, attention and concentration domains. One has identified use of 23 batteries and 74 neuropsychological tests, despite the recommendation of Consortium of Multiple Sclerosis Centers to the application of MACFIMS battery. CONSIDERATIONS: The absence of the uniformization for multiple sclerosis patients cognitive evaluation battery has precluded to achieve evidences to recommend its incorporation on diagnostic routine. Nevertheless this tendency is already outlined.

OBJETIVO: Apresentar os resultados de estudos prospectivos e retrospectivos sobre disfunções cognitivas em pacientes com esclerose múltipla, assim como discutir as baterias de testes neuropsicológicos empregadas em tais investigações. MÉTODO: Uma revisão sistemática foi realizada envolvendo 40 estudos publicados no período de 1997 a 2009, nas bases de dados PubMed, Scopus, Ovid, ISI Web of Knowledge, Scientific Electronic Library on line (Scielo) e Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde. Descrição clara de: avaliação de déficits cognitivos em pacientes com esclerose múltipla, desenho do estudo, tamanho amostral, critérios de inclusão, exclusão e descontinuação, instrumentos de avaliação neuropsicológica, métodos diagnósticos, funções avaliadas e detalhamento da análise estatística foram critérios de inclusão. RESULTADOS: Há consenso quanto ao comprometimento cognitivo de pacientes com esclerose múltipla, especialmente nos domínios de memória, velocidade de processamento, função executiva, atenção e concentração. Identificou-se o emprego de 23 baterias e 74 testes neuropsicológicos, apesar da recomendação do Consórcio de Centros de esclerose múltipla para emprego da bateria MACFIMS. CONSIDERAÇÕES: A falta de uniformização da bateria de avaliação cognitiva desses pacientes está impedindo que se obtenham evidências para recomendar sua incorporação como rotina diagnóstica. Mesmo assim essa tendência já se delineia.

The Effect of Carbamazepine-Controlled Release on the Congnitive Function

We evaluated the effect of carbamazepine-controlled release (CR) on the cognitive function. By using monotherapy study, we investigated the effects of carbamazepine on cognitive function in 10 epileptic patients and 17 normal controls. The evaluations were conducted before and one and six months after therapy using neuropsychological batteries(BUSCHKE SELECTIVE REMINDING TEST BSRT, REY OSTERRIETH COMPLEX FIGURE TEST ROCFT, CONCENTRATION ENDURANCE TEST d2 test, REY VISUAL DESIGN LEARNING TEST RVDLT, FINGER TAPPING TEST). In the patients treated with carbamazepine-CR monotherapy, follow up studies were made in one and six months later, respectively. It was found that the cognitive function determined in the three tests(consistent long-term retrieval : one item of BSRT, d2 test, and ROCFT : P 0.05). The mean anticonvulsant blood levels on the day of cognitive function tests were 6.48mg/ml (SD=l. 87) and 6.53mg /ml (SD=l.97) in one and six months respectively. This study showed carbamazepine-CR monotherapy had an adverse effect on the cognitive function.