Patch tests and hand eczema: retrospective study in 173 patients and literature review

Abstract Background Hand eczema (HE) is a highly prevalent, recurrent, and multifactorial disease. It encompasses a group of eczematous diseases that affect the hands, etiologically classified into irritant contact dermatitis (ICD), allergic contact dermatitis (ACD) and atopic dermatitis (AD). Few epidemiological studies in Latin America have investigated the characteristics of patients with this condition and the origin of the disease. Objectives To analyze the profile of patients diagnosed with HE submitted to patch tests aiming to determine its etiology. Methods A retrospective descriptive study was carried out on epidemiological data and patch tests of patients with HE treated at a tertiary hospital in the city of São Paulo from January 2013 to December 2020. Results A total of 173 patients were studied, whose final diagnosis was 61.8% of ICD, 23.1% of ACD and 5.2% of AD, with diagnostic overlap in 42.8% of the cases. The main positive and relevant patch tests were: Kathon CG (42%), nickel sulfate (33%), and thiuram mix (18%). Study limitations The number of treated cases and socioeconomic profile was limited to a vulnerable population group. Conclusion HE is a diagnosis in which overlapping etiologies are frequent, with the main sensitizers identified in ACD being Kathon CG, nickel sulfate and thiuram mix.

Higiene de manos, su aprendizaje mediante la utilización de medios de enseñanza

Fundamento: mejorar la higiene de las manos de manera eficaz y sostenida se consigue mediante la aplicación de múltiples medidas para abordar diferentes obstáculos, así como barreras conductuales, es por ello que se hace necesario crear medios que permitan su aprendizaje. Objetivo: diseñar medios de enseñanza que contribuyan al aprendizaje de la higiene de manos tanto en estudiantes de Lic. en Enfermería como en la comunidad. Métodos: se desarrolló una investigación cualicuantitativa, durante el período de estudio de junio 2018 a julio 2021. Los escenarios fueron el Círculo Infantil Marineritos del Sur, Escuela Primaria Guerrillero Heroico y la Universidad de Ciencias Médicas en el municipio de Cienfuegos. Se realizaron grupos de discusión en los tres escenarios, de lo cual emergieron las categorías capacitación y medios de enseñanza, que fueron creados y validados por la metodología de Barraza. Resultados: se diseñó una página web, una aplicación para móvil, juegos didácticos para los niños y trípticos. Todos fueron validados satisfactoriamente. Conclusiones: el diseño de medios de enseñanza, sustentados científicamente, se corresponde con las necesidades de los estudiantes la carrera de Licenciatura en Enfermería y de la comunidad para el logro de los conocimientos teóricos y prácticos en la adherencia a la técnica correcta de higiene de manos.

Summary: Introduction: The improvement of effective and sustained hand hygiene is achieved through the application of multiple measures to address different obstacles, as well as behavioral barriers, which is why it is necessary to create means that allow the learning of it, in such a way. In this sense, the objective is to design teaching means that contribute to the learning of hand hygiene both in Nursing students and in the community, Method; a qualitative-quantitative investigation was developed, Results the qualitative phase was evidenced when a discussion group was carried out from which the category training and teaching aids emerged, which allowed the design of a web page, a mobile application, didactic games for children and triptychs, and the quantitative phase when said teaching aids were validated by the Barraza methodology.

Application of pneumatic hand rehabilitation equipment in rehabilitation of hand function in children with spastic hemiplegia cerebral palsy / 中国康复理论与实践

ObjectiveTo apply pneumatic hand rehabilitation equipment in comprehensive rehabilitation training to improve hand function in children with spastic hemiplegic cerebral palsy. MethodsFrom Januray, 2020 to September, 2021, 58 children with spastic hemiplegia cerebral palsy in Maternity and Child Health Care Hospital of Nantong University were randomly divided into control group (n = 29) and experimental group (n = 29). Both groups accepted comprehensive rehabilitation training, while the experimental group accepted pneumatic hand rehabilitation equipment training in addition, for six months. They were assessed with Peabody Developmental Motor Scales-Fine Motor (PDMS-FM), Fine Motor Function Measurement (FMFM) and Wee-Function Independence Measure (Wee-FIM) before and after training. ResultsThe scores of PDMS-FM, FMFM and Wee-FIM improved in both groups after training (|t| > 16.310, P < 0.001), and improved more in the experimental group than in the control group (t > 2.795, P < 0.01). ConclusionApplication of pneumatic hand rehabilitation equipment in comprehensive rehabilitation training can effectively promote the recovery of hand function for children with spastic hemiplegic cerebral palsy.

Validación de la escala de autoevaluación del aprendizaje práctico cibisa en estudiantes de enfermería peruanos

Objetivo: Determinar la validez y confiabilidad de la escala CIBISA para la autoevaluación del aprendizaje práctico de estudiantes de enfermería. Material y Método: Estudio instrumental, transversal, con estudiantes de enfermería que estuvieron realizando prácticas clínicas, en el que se analizaron las propiedades psicométricas de la escala CIBISA, tales como la validación de contenido y consistencia interna a través del cálculo de V de Aiken y posteriormente Análisis factorial confirmatorio (AFC), respectivamente. Finalmente, se calculó la confiabilidad de la escala. Resultados: Se obtuvo una V de Aiken de 0,9. Asimismo, los valores de asimetría y curtosis del ítem 1 y 28 superaron el valor +/- 1,5. Los índices de bondad de ajuste del modelo original mostraron valores deficientes; por lo que, a través de la técnica de modificación de índices se eliminaron los ítems 8, 10, 18, 21, 25, 28, 13 y 26 donde los índices de bondad de ajuste mostraron que el modelo de 20 ítems era satisfactorio (χ2 = 4776,826; df= 190; p= 0,000; CFI= 0,938; TLI= 0,930; RMSEA= 0,080 y SRMR< 0,080). La confiabilidad de la escala presenta un coeficiente α de Cronbach= 0,91. Conclusión: La escala CIBISA de 20 ítems es válida y confiable para medir la autoevaluación del aprendizaje práctico del estudiante de enfermería.

Objective: To determine the validity and reliability of the CIBISA scale for the self-assessment of practical learning of nursing students. Material and Method: Instrumental, cross-sectional study, with nursing students who were doing clinical practices, in which the psychometric properties of the CIBISA scale were analyzed, such as the validation of content and internal consistency through the calculation of Aiken's V and subsequently confirmatory factor analysis (CFA), respectively. Finally, the reliability of the scale was calculated. Results: Aiken's V of 0.9 was obtained. Likewise, the values of asymmetry and kurtosis of item 1 and 28 exceeded the value +/- 1.5. The goodness of fit indices of the original model showed deficient values; Therefore, through the index modification technique, items 8, 10, 18, 21, 25, 28, 13 and 26 were eliminated, where the goodness-of-fit indices showed that the 20-item model was satisfactory (χ2= 4776.826; df= 190; p= 0.000; CFI= 0.938; TLI= 0.930; RMSEA= 0.080 and SRMR< 0.080). The reliability of the scale presents a Cronbach's α coefficient=0.91. Conclusion: The 20-item CIBISA scale is valid and reliable to measure the self-assessment of practical learning of nursing students.

Objetivo: Determinar a validade e confiabilidade da escala CIBISA para a autoavaliação da aprendizagem prática de estudantes de enfermagem. Material e Método: Estudo instrumental, transversal, com estudantes de enfermagem que realizavam práticas clínicas, no qual foram analisadas as propriedades psicométricas da escala CIBISA, como a validação de conteúdo e consistência interna através do cálculo do V de Aiken e posteriormente confirmatório análise fatorial (CFA), respectivamente. Por fim, calculou-se a confiabilidade da escala. Resultados: Obteve-se V de Aiken de 0,9. Da mesma forma, os valores de assimetria e curtose dos itens 1 e 28 ultrapassaram o valor +/- 1,5. Os índices de qualidade de ajuste do modelo original apresentaram valores deficientes; portanto, através da técnica de modificação do índice, os itens 8, 10, 18, 21, 25, 28, 13 e 26 foram eliminados, onde os índices de qualidade de ajuste mostraram que o modelo de 20 itens foi satisfatório (χ2= 4776,826; df= 190; p= 0,000; CFI= 0,938; TLI= 0,930; RMSEA= 0,080 e SRMR< 0,080). A confiabilidade da escala apresenta coeficiente α de Cronbach= 0,91. Conclusão: A escala CIBISA de 20 itens é válida e confiável para medir a autoavaliação da aprendizagem prática de estudantes de enfermagem.

Avaliação da qualidade físico-química de formulações de álcoois em gel comercializadas na cidade de Irecê-Ba / Evaluation of the physicochemical quality of alcohol gel formulations selled in the city of Irecê-Ba / Evaluación de la calidad fisicoquímica de formulaciones de alcohol gel comercializadas en la ciudad de Irecê-Ba

Já é sabido que a higiene das mãos é a principal arma na prevenção de doenças infecciosas dentro e fora dos hospitais. No caso do vírus SARSCoV-2, a higienização das mãos é essencial, tendo em vista a possibilidade de contaminação pelo contato direto com as gotículas respiratórias ou pelo contato indireto. Existem no mercado diversas opções de produtos antissépticos disponíveis para uso pela população. No entanto, nenhum é 100% eficaz em todas as situações. Dentre esses diversos produtos disponíveis, o etanol 70% é o mais utilizado para a aplicação nas mãos, sendo veiculado na forma farmacêutica gel para facilitar a aplicação. As formas farmacêuticas gel contendo etanol 70% podem ser industrializadas ou manipuladas. Quando essas formulações são manipuladas, elas são isentas de registro na Agência de Vigilância Sanitária (ANVISA), não sendo exigidos nem mesmo os testes de segurança e eficácia que são exigidos para o registro de produtos industrializados. Para os manipulados, são realizados apenas os testes de descrição, aspecto, características organolépticas (cor e odor) pH e peso. Desta forma, a realização deste trabalho teve como objetivo avaliar a qualidade, incluindo características físico-químicas de amostras de álcool em gel manipuladas na cidade de Irecê-Ba, e compará-las com um produto industrializado de marca conhecida. Foram analisados os aspectos e características organolépticas, determinação do potencial de hidrogênio (pH), densidade, espalhabilidade, viscosidade, estabilidade (resistência a centrifugação) e teor alcoólico de 4 amostras (2 amostras industrializadas, denominadas A e B adquiridas em diferentes farmácias de manipulação da cidade, e 2 amostras magistrais, denominadas de amostra C e D. Sendo assim, observou-se que nenhuma das amostras se enquadraram nos parâmetros estabelecidos, como o pH mais ácido, densidade e viscosidade fora do padrão, diferentes comportamentos de espalhabilidade e teor alcoólico abaixo do ideal, apontando inconformidades que afetam a qualidade e ação do produto. Os resultados encontrados nesse estudo possibilitam concluir que as amostras de álcool gel de origem magistral apresentaram-se muito semelhante em termos de qualidade aos produtos industrializados. Portanto, entende-se que, apenas uma elaboração de leis não seja suficiente para garantir a qualidade e segurança do produto, se faz necessário uma fiscalização mais rigorosa e elaboração de leis mais qualificadas.

It is already known that hand hygiene is the main weapon in the prevention of infectious diseases inside and outside hospitals. In the case of the SARSCoV-2, hand hygiene is essential, in view of the possibility of contamination through direct contact with respiratory droplets or through indirect contact. There are several options of antiseptic products available on the market for use by the population. However, none are 100% effective in all situations. Among these different products available, 70% ethanol is the most used for application in the hands, being conveyed in the pharmaceutical form of a gel to facilitate the application. The pharmaceutical gel forms containing 70% ethanol can be industrialized or manipulated. When these formulations are manipulated, they are exempt from registration with the Health Surveillance Agency (ANVISA), not even requiring the safety and efficacy tests that are required for the registration of industrialized products. For manipulated products, only tests of description, appearance, organoleptic characteristics (color and odor), pH and weight are carried out. Thus, this work aimed to evaluate the quality, including physicochemical characteristics of alcohol gel samples handled in the city of Irecê-Ba, and compare them with an industrialized product of a known brand. The organoleptic aspects and characteristics, determination of the hydrogen potential (pH), density, spreadability, viscosity, stability (resistance to centrifugation) and alcohol content of 4 samples (2 industrialized samples, called A and B acquired in different compounding pharmacies) were analyzed of the city, and 2 magisterial samples, called sample C and D. Therefore, it was observed that none of the samples fit the established parameters, such as more acidic pH, non-standard density and viscosity, different spreadability behaviors and content alcohol below ideal, pointing out nonconformities that affect the quality and action of the product. The results found in this study make it possible to conclude that the samples of magistral alcohol gel were very similar in terms of quality to the industrialized products. Therefore, it is understood that just drafting laws is not enough to guarantee the quality and safety nce of the product, more rigorous inspection and the elaboration of more qualified laws are necessary.

Ya se sabe que la higiene de las manos es la principal arma en la prevención de enfermedades infecciosas dentro y fuera de los hospitales. En el caso del SARSCoV- 2, la higiene de las manos es esencial, ante la posibilidad de contaminación por contacto directo con gotitas respiratorias o por contacto indirecto. Existen varias opciones de productos antisépticos disponibles en el mercado para uso de la población. Sin embargo, ninguno es eficaz al 100% en todas las situaciones. Entre estos diferentes productos disponibles, el etanol al 70% es el más utilizado para aplicación en las manos, siendo vehiculado en la forma farmacéutica de gel para facilitar la aplicación. Las formas farmacéuticas en gel que contienen 70% de etanol pueden ser industrializadas o manipuladas. Cuando estas formulaciones son manipuladas, están exentas de registro en la Agencia de Vigilancia Sanitaria (ANVISA), no exigiendo ni siquiera las pruebas de seguridad y eficacia que se exigen para el registro de productos industrializados. Para los productos manipulados, sólo se realizan pruebas de descripción, apariencia, características organolépticas (color y olor), pH y peso. Así, este trabajo tuvo como objetivo evaluar la calidad, incluyendo las características fisicoquímicas de muestras de alcohol gel manipuladas en la ciudad de Irecê-Ba, y compararlas con un producto industrializado de marca conocida. Se analizaron los aspectos y características organolépticas, determinación del potencial de hidrógeno (pH), densidad, untabilidad, viscosidad, estabilidad (resistencia a la centrifugación) y grado alcohólico de 4 muestras (2 muestras industrializadas, denominadas A y B adquiridas en diferentes farmacias de composición) de la ciudad, y 2 muestras magistrales, denominadas muestra C y D. Así, se observó que ninguna de las muestras se ajustaba a los parámetros establecidos, tales como pH más ácido, densidad y viscosidad no estándar, diferentes comportamientos de untabilidad y contenido alcohólico por debajo del ideal, señalando no conformidades que afectan a la calidad y acción del producto. Los resultados encontrados en este estudio permiten concluir que las muestras de alcohol magistral en gel fueron muy similares en términos de calidad a los productos industrializados. Por lo tanto, se entiende que la mera elaboración de leyes no es suficiente para garantizar la calidad y seguridad nce del producto, siendo necesaria una inspección más rigurosa y la elaboración de leyes más cualificadas.

Síndrome antisintetasa: reporte de un caso / Antisynthetase syndrome: a case repor

El síndrome antisintetasa es una miopatía inflamatoria idiopática (MII) de origen autoinmune, poco frecuente, que se caracteriza por la presencia de autoanticuerpos antisintetasa ARNt (generalmente anti-Jo1), asociado frecuentemente a miositis, enfermedad pulmonar intersticial, poliartritis, manos de mecánico y fenómeno de Raynaud. Se reporta el caso de una mujer de 45 años de edad que presenta este síndrome con características fenotípicas de dermatomiositis y responde de forma favorable luego de la administración del tratamiento con glucocorticoides asociado a metotrexato.

Anti-synthetase syndrome is a rare autoimmune inflammatory myopathy characterized by autoantibodies against tRNA synthetases (most commonly anti-Jo1) with clinical features that include myositis, interstitial lung disease, polyarthritis, mechanic's hands and Raynaud's phenomenon. We report a 45-year-old woman who presented with dermatomyositis phenotypical features and a significant improvement with corticosteroids and metotrexate treatment.

Síndrome antisintetasa: reporte de un caso / Antisynthetase syndrome: a case report

El síndrome antisintetasa es una miopatía inflamatoria idiopática (MII) de origen autoinmune, poco frecuente, que se caracteriza por la presencia de autoanticuerpos antisintetasa ARNt (generalmente anti-Jo1), asociado frecuentemente a miositis, enfermedad pulmonar intersticial, poliartritis, manos de mecánico y fenómeno de Raynaud. Se reporta el caso de una mujer de 45 años de edad que presenta este síndrome con características fenotípicas de dermatomiositis y responde de forma favorable luego de la administración del tratamiento con glucocorticoides asociado a metotrexato.

Anti-synthetase syndrome is a rare autoimmune inflammatory myopathy characterized by autoantibodies against tRNA synthetases (most commonly anti-Jo1) with clinical features that include myositis, interstitial lung disease, polyarthritis, mechanic's hands and Raynaud's phenomenon. We report a 45-year-old woman who presented with dermatomyositis phenotypical features and a significant improvement with corticosteroids and metotrexate treatment.

Intra-articular triamcinolone hexacetonide injections in hands osteoarthritis - A double-blinded randomized controlled trial with a one year follow-up

Abstract Objective: to evaluate the effectiveness of triamcinolone Hexacetonide (TH) Intra-Articular Injection (IAI) in hand Interphalangeal Joints (IP) of Osteoarthritis (OA) patients to improve pain and joint swelling; improve function, goniometry, and grasping force, and assess IAI influence on radiographic evolution over 1-year. Methods: A randomized, double-blind study. 60 patients who underwent IAI at the most symptomatic IP joint were randomly assigned to receive TH+Lidocaine (LD) (TH/LD group) or just LD (LD group). Patients were assessed blindly for 1-year, at baseline and 1, 4, 8, 12, and 48 weeks. The following variables were assessed: articular pain and swelling, AUSCAN and COCHIN functional questionnaires, grip and pinch strength, goniometry, perception of improvement, acetaminophen consumption, and simple radiography. Repeated-measures ANOVA test was used to analyze the intervention response. Results: Sixty patients completed the follow-up. There were nine missed assessments. 97% were women; mean age of 61-years (SD = 8.2), and approximately 5-years of disease (SD = 3.6). Half of the patients present radiographic classification Kellgren and Lawrence (KL) grades I and II, and the other half grades III and IV. The two groups evolved similarly at 48-weeks. TH/LD group had a better evaluation in joint swelling and acetaminophen consumption (p = 0.04 and p < 0.001, respectively) at 48-weeks. Radiographically there was no statistical difference between groups (KL, p = 0.564; erosive OA, p = 0.999; worsening, p = 0.573). Conclusion: The IAI IP hands OA is effective for the improvement of joint swelling and decrease of analgesic consumption and does not influence the radiographic evolution of the injected joint.

Reflexão acerca dos critérios que podem contribuir para a disseminação da COVID-19 em comunidades quilombolas rurais do estado de Goiás, Brasil / Reflection on criteria that may contribute to the dissemination of COVID-19 in rural quilombolas communities in the state of Goiás, Brazil

RESUMO O SARS-CoV-2 é facilmente disseminado por aerossóis e contato direto com pessoas contaminadas. Logo, as condições adversas em áreas rurais podem influenciar a propagação do vírus. Desta forma, estabeleceu-se uma reflexão acerca da disseminação da COVID-19 em função do hábito de lavar as mãos, das condições de saneamento, dos aspectos socioeconômicos e das condições habitacionais em 26 comunidades quilombolas rurais do estado de Goiás. Para isso foram levantadas informações in loco em 533 domicílios e aplicou-se a Analytic Hierarchy Process, utilizando-se critérios selecionados com base na literatura. As comunidades apresentaram uma priorização para a disseminação da COVID-19 variando de 14,9 x 10-3 (pior condição) a 64,3 x 10-3 (melhor condição), na qual a Comunidade José Coleto ocupou a posição mais desfavorável. Buracão mostrou um resultado mais satisfatório, sendo esta menos susceptível à disseminação da COVID-19. A melhoria nas condições de saneamento pode aumentar o hábito da higiene com as mãos, o que reduziria a disseminação da COVID-19 e de outras doenças infecciosas. Assim, a partir dos resultados obtidos, é perceptível a importância do empoderamento quanto aos hábitos de higiene, acesso à informação, saneamento básico e à saúde. Os gestores devem ter uma maior disposição para implantar infraestrutura e melhorar as condições dos critérios apresentados e discutidos neste trabalho.

ABSTRACT SARS-CoV-2 is easily spread by aerosols and direct contact with contaminated people. Therefore, adverse conditions in rural areas can influence the spread of the virus. Thus, a reflection was established about the dissemination of COVID-19 due to the habits of wash hands, sanitation conditions, socioeconomic aspects, and habitability conditions in 26 rural quilombola communities in the state of Goiás. For this, informations were collected in 533 locals households and it was applied the Analytic Hierarchy Process using criteria selected based on the literature. The communities presented a priority for the dissemination of COVID-19 ranging from 14.9 x 10-3 (worst condition) to 64.3 x 10-3 (best condition), and the Community José Coleto has occupied the most unfavorable position. Community Buracão showed a more satisfactory result, being less susceptible to the spread of COVID-19. Improving sanitation conditions can increase hand hygiene habits, which would reduce the spread of COVID-19 and other infectious diseases. Thus, from the results obtained, it is noticeable the importance of empowerment regarding hygiene habits, access to information, basic sanitation and health. The managers should give greater attention to implement infrastructures and improve the conditions of the criteria presented and discussed in this paper.

Hands Free 3.c Technique - Step by Step Maximizes the Duration of Sublingual Microcirculatory Image - A Prognosis to Monitor Microcirculation in Patients with Covid-19 and Sepsis

ABSTRACT: The sublingual area is the most used site to assess microcirculation in critically ill patients at bedside. The prerequisite for microcirculation evaluation, using HVM imaging (Handheld Vital Microscopy), is to ensure measurements free of image artifacts, confirming an adequate analysis of blood flow. However, this would only be possible with standardizati on in the process of image capture. Currently, with the Hands On technique, the recommended capture time is 4 to 20 seconds, which is already considered laborious. In this study, the Hands Free 3.C technique proposes an alternative that maximizes the image period of sublingual microcirculation (as suggested by the Second Consensus) for more than 12 minutes, and thus opening the way for future research aiming at therapeutic maneuvers in critically ill patients such as COVID -19 and sepsis.

RESUMEN: El área sublingual es el sitio más utilizado para evaluar la microcirculación junto a la cama en pacientes críticamente enfermos. El requisito previo para la evaluación de la microcirculación, utilizando imágenes HVM (Microscopía Vital Portátil), es asegurar mediciones libres de artefactos de imagen, confirmando un análisis adecuado del flujo sanguíneo. Sin embargo, esto solo sería posible con la estandarización en el proceso de captura de imágenes. Actualmente, con la técnica Hands On, el tiempo de captura recomendado es de 4 a 20 segundos, lo que ya se considera laborioso. En este estudio, la técnica Hands Free 3.C propone una alternativa que maximiza el período de imagen de la microcirculación sublingual (como sugiere el Segundo Consenso) durante más de 12 minutos, y abre así el camino a futuras investigaciones encaminadas a maniobras terapéuticas en pacientes con enfermedades graves como COVID -19 y sepsis.

Therapeutic approach to electric burn with platelet rich plasma, grafts and hyperbaric oxygenation / Enfoque terapéutico de quemadura eléctrica con plasma rico en plaquetas, injertos y oxigenación hiperbárica

Abstract Contact electrical burns are more severe than other forms of contact burn injury. Moreover, treatment of hand burns is an important therapeutic challenge. We present a 17 year-old female of low voltage electric hand injury, admitted 5 days after injury. The patient was treated with autologous platelet rich plasma, porcine dermis heterograft and partial autologous skin graft, all of them with hyperbaric oxygen therapy (HBOT) at 1.45 ATA ≈100% O2 like adjuvant therapy. Good evolution and acceptable aesthetic results were reported. Although more studies are required, we suggest that multi-therapeutic approach could be effective in treatment for electric burns in hands.

Resumen Las quemaduras eléctricas por contacto son más graves que otras formas de quemaduras. Además, el tratamiento de las mismas en las manos es un importante desafío terapéutico. Presentamos el caso de una mujer de 17 años de edad con lesión en la mano por quemadura por electricidad de baja tensión. Fue ingresada 5 días después de la lesión y tratada con plasma rico en plaquetas autólogo, heteroinjerto de dermis porcina e injerto de piel autólogo parcial, todo con oxigenoterapia hiperbárica (TOHB) a 1.45 ATA ≈100% O2 como terapia adyuvante. Tuvo buena evolución y resultados estéticos aceptables. Aunque se requieren más estudios, sugerimos que el enfoque multi-terapéutico podría ser eficaz en el tratamiento de las quemaduras eléctricas en las manos.

Hands Free Technique: New Tool Possibility for Image Capture of Sublingual Microcirculation with Handheld Vital Microscopy - HVM

ABSTRACT: New microcirculatory imaging techniques allowed direct observation of microcirculation at the bedside. This study presents a new device that assists the operator with the unprecedented Hands Free technique. To this end, a replica of Handheld Vital Microscopy was developed to simulate the method of capturing the image in the sublingual area, the most used site to assess microcirculation in critically ill patients. We achieved a reduction in the displacement of micros cope replica with a Hands Free method. The immediate consequence is an increase in the stability of HVM replica by 75 times, or more, over the current 4 seconds, during its contact with the sublingual tissue. The device also offers better control of th e pressure of the tip of the HVM replica over the sublingual area. The results demonstrated that the Hands Free technique, operating in the same sublingual area for 900 seconds, should allow for future research aimed at therapeutic maneuvers in patients with serious illnesses.

RESUMEN: Las nuevas técnicas de imagen microcirculatoria permitieron la observación directa de la microcirculación junto a la cama del paciente. Este estudio sin precedentes presenta un nuevo dispositivo que ayuda al operador con la técnica manos libres. Con este fin, se desarrolló una réplica de la Microscopía Vital Portátil para simular el método de captura de la imagen en el área sublingual, el sitio más utilizado para evaluar la microcirculación en pacientes críticos. Logramos una reducción en el desplazamiento de la réplica del microscopio con el método de manos libres. La consecuencia inmediata es un aumento en la estabilidad de la réplica de HVM en 75 veces, o más, durante los 4 segundos actuales, durante su contacto con el tejido sublingual. El dispositivo también ofrece un mejor control de la presión de la punta de la réplica de HVM sobre el área sublingual. Los resultados demostraron que la técnica de manos libres, que opera en la misma área sublingual durante 900 segundos, debería permitir futuras investigaciones destinadas a maniobras terapéuticas en pacientes con enfermedades graves.

Perineal Lacerations: A Retrospective Study in a Habitual-Risk Public Maternity / Lacerações perineais: um estudo retrospectivo em uma maternidade pública de risco habitual

Abstract Objective In around 85% of vaginal births, the parturients undergo perineal lacerations and/or episiotomy. The present study aimed to determine the incidence of lacerations and episiotomies among parturients in 2018 in a habitual-risk public maternity hospital in southern Brazil, and to determine the risk and protective factors for such events. Methodology A retrospective cross-sectional study. Data were obtained from medical records and analyzed using the Stata software. Univariate and multivariate logistic regressions were performed. Values of p<0.05 were considered significant. Results In 2018, there were 525 vaginal births, 27.8% of which were attended by obstetricians, 70.7% by obstetric nurses, and 1.5% evolved without assistance. Overall, 55.2% of the parturients had some degree of laceration. The professional who attended the birth was a significant variable: a greater number of first- and second-degree lacerations, as well as more severe cases, occurred in births attended by nurses (odds ratio [OR]: 2,95; 95% confidence interval [95%CI]: 1,74 to 5,03). Positions at birth that did not enable perineal protection techniques (expulsive period with the "hands-off" method), when analyzed in isolation, determined the risk; however, in the final regression model, this relationship was not confirmed. Although reported in the literature, there were no associations between the occurrence of laceration and age, skin color, or birth weight. In 24% of the births, episiotomy was performed, and doctors performed 63.5% of them. Conclusion Births attended by nurses resulted in an increased risk of perineal lacerations, of varying degrees. In turn, those assisted by physicians had a higher occurrence of episiotomy.

Resumo Objetivo Aproximadamente 85% dos partos vaginais cursam ou com lacerações perineais e/ou com episiotomia. Este estudo objetivou determinar a incidência de lacerações e episiotomias das parturientes de 2018 de uma maternidade pública de risco habitual, no sul do Brasil, bem como determinar os fatores de risco e proteção para tais eventos. Métodos Estudo transversal retrospectivo, no qual os dados foram obtidos dos prontuários e analisados no programa Stata. Realizaram-se regressões logísticas uni e multivariada. Foram considerados como significantes valores de p<0,05. Resultados Em 2018, aconteceram 525 partos vaginais, sendo 27,8% assistidos por médicos obstetras, 70,7%, por enfermeiros obstetras, e 1,5% evoluíram sem assistência. Ao todo, 55,2% das parturientes apresentaram algum grau de laceração. O profissional que assistiu ao parto foi uma variável que demonstrou significância: um maior número de lacerações de primeiro e segundo graus, bem como casos de maior gravidade, ocorreram em partos assistidos por enfermeiros (razão de probabilidades [RP]: 2,95; intervalo de confiança de 95% [IC 95%]: 1,74 a 5,03). Posições ao nascimento que não permitiam técnicas de proteção perineal (período expulsivo na técnica "sem mãos" [hands off, em inglês]), quando analisadas isoladamente, determinaram o risco; contudo, no modelo final de regressão, essa relação não se confirmou. Apesar de relatada na literatura, não houve associação entre a ocorrência de laceração e a idade, a cor da pele, ou o peso de nascimento. Em 24% dos partos, uma episiotomia foi realizada, tendo os médicos executado 63,5% delas. Conclusão Partos assistidos por enfermeiros resultaram em um maior risco de lacerações perineais, de variados graus. Por sua vez, os assistidos por médicos apresentaram maior ocorrência de episiotomia.

Recommendations for improving photo quality in close range photogrammetry, exemplified in hand bones of chimpanzees and gorillas / Recomendaciones para mejorar la calidad de las fotos en fotogrametría de corto alcance, ejemplificado en huesos de las manos de chimpancés y gorillas

SUMMARY: Photogrammetry is becoming increasingly popular in morphological research and teaching due to its portability, ability to reliably render 3D models, and quality-to-price relationship relative to some popular surface scanners. Compared to surface scanners, however, the learning process in photogrammetry can be very time consuming. Here we describe common mistakes of photo capture in close-range photogrammetry that greatly affect 3D output and tips to improve them. Problems were identified after the 3D model construction of 780 hand bones of chimpanzees and gorillas from museum collections. Their hands are composed of 27 bones which vary in length and complexity. We show how lighting, object position and orientation, camera angle, and background affect the 3D output. By taking these factors into account, time and error rates for beginners can be greatly reduced and 3D model quality can be considerably improved.

RESUMEN: La fotogrametría está siendo cada vez más popular en la investigación y enseñanza morfológica. Esto debido a su portabilidad, confiabilidad de los modelos 3D y buena relación calidadprecio. Comparada con los escáneres de superficie, sin embargo, el proceso de aprendizaje de la fotogrametría puede llevar mucho tiempo. Aquí se describen errores comunes en la toma de fotos para fotogrametería que afectan de manera importante la creación de los modelos 3D, así como consejos para superarlos. Los problemas descritos fueron identificados luego de la construcción de 780 modelos 3D de huesos de la mano de chimpancés y gorillas depositados en distintas colecciones de museos. Las manos de estas especies están compuestas por 27 huesos que varían en tamaño y complejidad. En este artículo mostramos como la luz, la posición y orientación del objeto, el ángulo de la cámara y el fondo de la imagen afectan el resultado en 3D. Considerando estos factores, personas que están aprendiendo esta técnica pueden reducir de manera importante el tiempo y la probabilidad de error, y mejorar considerablemente la calidad de los modelos 3D.

Doble mecanismo de estrangulación. A propósito de un caso / Double mechanism of strangulation. Apropos of a case

RESUMEN Las asfixias mecánicas son aquellas que resultan del impedimento mecánico a la penetración del aire en las vías respiratorias, suelen clasificarse atendiendo a la naturaleza del medio mecánico que las origina y a su modo de actuar. La estrangulación puede definirse como la constricción del cuello mediante la aplicación de una fuerza activa, ajena al peso del cuerpo, que actúa por intermedio de un lazo, las manos, el antebrazo o cualquier otra estructura rígida. En la estrangulación antebraquial, la constricción del cuello se lleva a cabo normalmente rodeando al individuo con el brazo y el antebrazo. Cuando el mecanismo de la compresión del cuello es lateral, no se afectan las vías aéreas, la compresión de las arterias carótidas hace que se produzca una isquemia cerebral y pérdida de conocimiento en 10-15 segundos. El mecanismo de muerte en estos casos será la anoxia cefálica. Si la compresión del cuello es anterior, actúa ocluyendo las vías aéreas, la presión sobre los cartílagos tiroides y cricoides puede producir fracturas y el mecanismo de muerte será la obstrucción respiratoria. El presente trabajo constituyó un caso poco común de estrangulación, donde se utilizó un mecanismo combinado que llevó al occiso al deceso final. Para la realización de la discusión del caso se tuvo en cuenta los elementos del lugar del hecho, el examen del exterior y el interior del cadáver (AU).

ABSTRACT Mechanical asphyxias are those resulting from the mechanical obstruction of the air penetration in the airways. They are usually classified according to the nature of the mechanical mean producing it and the way it performs. Strangulation may be defined as neck constriction through the application of an active force not proper to the body weight, acting by means of a knot, hands, forearm or any stiff structure. In ante brachial strangulation, neck constriction is normally performed surrounding the individual with the arm and forearm. When the neck constriction mechanism is lateral, the airways are not affected: carotid arteries constriction produces a brain stroke and loss of consciousness in 10-15 s. The death mechanism in these cases will be cephalic anoxia. If the neck compression is anterior, it occludes the airways; the pressure on thyroidal and cricoid cartilages may produce fractures and death mechanism will be respiratory obstruction. The current work deals with an uncommon strangulation case, where a combined mechanism led the person to the final decease. For the case discussion the authors took into account the elements of the place, and the examination of the exterior and the inside of the corpse (AU).

Colonización bacteriana después de la aplicación de un programa educativo: estudio cuasi experimental / Bacterial colonization after applying an educational program: A quasi-experimental study

INTRODUCCIÓN: La intervención en poblaciones por medio de programas educativos logra aumentar el conocimiento en un determinado grupo y además, en algunos casos, se logra un cambio de conducta. OBJETIVO: Determinar si el programa educativo de lavado de manos aplicado a los estudiantes de educación secundaria reduce la colonización de bacterias infecciosas en las manos. METODOLOGÍA: Se realizó un estudio cuasi experimental no aleatorizado mediante muestreo consecutivo a los alumnos del último año de secundaria, quienes fueron divididos en dos grupos de intervención y control, analizados en dos etapas antes y después de la aplicación del programa educativo. Se tomaron las muestras de la mano dominante para el cultivo bacteriano. Además, se aplicó un cuestionario que evaluó los conocimientos sobre higiene de manos antes y después de la aplicación del programa, que estuvo dirigido a mejorar el nivel de conocimiento y de las actitudes de los estudiantes en relación a la higiene de manos. RESULTADOS: De 208 muestras obtenidas los agentes más frecuentes antes y después de la aplicación del programa educativo fueron Staphylococcus epidermidis (39% versus 23%) y Staphylococcus aureus (21%versus15%); el promedio del número de colonias fue 236 y 183 respectivamente (p = 0,35). CONCLUSIÓN: La aplicación del programa educativo logró mejorar el nivel de conocimiento sobre la higiene de manos. Sin embargo, no fue suficiente para reducir la colonización bacteriana, por lo que debería agregarse otras conductas como la supervisión directa.

INTRODUCTION: Educational interventions can raise awareness and understanding in population groups and may help to achieve changes in behavior. OBJECTIVE: To determine if the educational handwashing program applied to high-school students reduces the colonization of infectious bacteria on the hands. METHODS: A non-randomized quasi-experimental study was carried out using consecutive sampling of the students of the last year of high-school who were divided into an intervention group and a control group. Data were obtained before and after the implementation of the educational program. Samples were taken from the dominant hand for bacterial culture, and a questionnaire was applied that assessed knowledge of hand hygiene before and after the program. The program was aimed at improving the level of understanding and attitudes of students regarding hand hygiene. RESULTS: Of 208 samples obtained, the most frequent agents before and after the educational program were Staphylococcus epidermidis (39% versus 23%) and Staphylococcus aureus (21% versus 15%). The average number of colonies was 236 and 183 respectively (p = 0.35). CONCLUSION: The educational program managed to improve the level of understanding about hand hygiene; however, it was not enough to reduce bacterial colonization, so other behaviors such as direct supervision should be considered.

Relación entre el conocimiento y recomendación del baby led weaning en nutricionistas de atención primaria, en las ciudades de Coquimbo y La Serena, Chile / Relationship between knowledge and recommendations of baby-led weaning in primary care settings in the cities of Coquimbo and La Serena, Chile

Introducción: La OMS recomienda la entrega de lactancia materna exclusiva hasta los 6 meses, debiendo a esta edad introducir la alimentación complementaria mediante una papilla de carne con verduras o una nueva técnica de alimentación llamada baby led weaning (BLW). Objetivo general: relacionar el nivel de conocimiento con la recomendación de la técnica BLW en Nutricionistas de atención primaria de salud de las ciudades de Coquimbo y La Serena. Métodos: se aplicó un cuestionario presencial o vía Google forms a nutricionistas, el cual evaluó el nivel de conocimiento y la recomendación (actual y pasada) del BLW. Resultados: el 57,4% de las nutricionistas ha recomendado alguna vez el BLW y el 38,3% tiene un conocimiento suficiente de la técnica, según el análisis de regresión las y los nutricionistas de la ciudad de La Serena tienen un mayor nivel de recomendación del BLW. Conclusión: El BLW es una técnica de alimentación conocida por los y las nutricionistas, sin embargo, refieren un bajo nivel de recomendación y conocimiento, siendo la papilla tradicional la técnica más recomendada en la consulta nutricional de los 5 meses.

Introduction: The WHO recommends exclusive breast-feeding up to 6 months, at which time complementary feeding with pureed meats and vegetables or a new feeding technique called baby led weaning (BLW) begins. General objective: to relate the level of knowledge of the BLW recommendation among primary health care nutritionists in the cities of Coquimbo and La Serena, Chile. Methods: a face-to-face questionnaire or google forms, which assessed knowledge level and recommendation (current and past) of the BLW was answered by nutritionists. Results: 57.4% of the nutritionists had recommended the BLW and 38.3% had sufficient knowledge of the technique. According to regression analysis, nutritionists from the city of La Serena recommended BLW more often than those from Coquimbo. Conclusion: The BLW was a feeding technique familiar to nutritionists, however they had a low level of recommendation and knowledge, with the traditional pureed meat with vegetables the most recommended technique in the 5-month nutritional consultation.

A study on assessment of knowledge, attitude and practice on handwashing among nursing students of Sree Venkateswara College of Nursing, Chittoor, Andhra Pradesh

Background: Handwashing is the act of cleaning one's hands for the purpose of removing soil, dirt & microorganisms. Through review of literature it is understood that the most nosocomial infections are thought to be transmitted by the hands of healthcare workers, handwashing is considered the single most important intervention to prevent nosocomial infections. This study was conducted to assess the knowledge, attitude and practices (KAP) on handwashing among the nursing students and to identify the areas of gap in their KAP along with the provisions for handwash.Methods: A descriptive, cross-sectional study was conducted among 192 nursing students at S.V. College of Nursing, Chittoor during October 2018 using pre-validated self-reported questionnaire. Statistical analysis was done with SPSS 20.0 software and Chi-Square test was used with “P” value<0.05 taken as statistically significant.Results: Among all respondents 85% were aware about washing their hands during all common critical times, but practicing was observed in 08% only. 50% felt that alcohol based handrub is effective than handwashing with soap and water, but facilitated 10% only. While the final year students all (100%) were well aware about all critical times of handwashing, whereas 1st and 2nd years 71% and 3rd year students 87% were aware (p=0.002).Conclusions: There is a need of orientation and arrangements for proper handwashing to be improved.

The Role of the Hand Surgeon in Microsurgery in Brazil / Atuação do médico cirurgião de mão em microcirurgia no Brasil

Abstract Objective This study evaluates the conditions for microvascular procedures found by hand surgeons in Brazilian clinical practices. Methodology A prospective, observational, and analytical primary clinical research conducted during the 37th Brazilian Congress of Hand Surgery, from March 30th to April 1st, 2017, in Belo Horizonte, in which physicians answered 12 closed, objective, multiple-choice questions regarding their geographic region, type of institution (public or private), microsurgical training, time of experience, technical conditions, the availability of a standby team for emergencies and compensation. Results The study analyzed 143 hand surgeons; among them, 65.7% participants were based at the Southeast region, 13.3% in the Northeast region, 11.9% in the South region, 6.3% in the Central-West region and 2.8% in the North region. Regarding the time of experience, 43.4% of the hand surgeons had less than 5 years, 16.8% had 5 to 10 years, 23.8% 10 to 20 years, and 23% hadmore than 20 years of practice in microvascular surgery. Seven percent of the surgeons had no training in microvascular surgery; for 63.6%, training occurred during medical residency, whereas 30.8% were trained in another institution, and 7.7% in another country. Among these surgeons, 76.9% worked at both private and public hospitals, 14.7% at private hospitals and 5.6% at public hospitals. Regarding compensation, 1.8% of the surgeons considered it adequate, and 98.2%, inadequate in public hospitals, whereas 5.0% considered it adequate, and 95.0%, inadequate in private hospitals. Conclusion This research shows that most surgeons were trained in microsurgery, had never performed reattachments, and considered that compensation is inadequate; moreover, standby teams were not available. There are few, unevenly distributed hand surgeons with microsurgical ability in emergency settings, and their compensation is low.

Resumo Objetivo Avaliar quais as condições que o cirurgião de mão no Brasil tem encontrado na prática clínica para a realização de procedimentos microvasculares. Métodos Pesquisa clínica primária prospectiva, observacional, transversal e analítica; realizada no 37° Congresso Brasileiro de Cirurgia deMão, de 30 demarço a 1 de abril de 2017, em Belo Horizonte. Por meio de aplicação de questionário a médicos do Congresso, com 12 perguntas, respostas objetivas, fechadas ou de múltipla escolha; envolveram a região geográfica, o tipo de instituição, se pública e/ou privada, seu treinamento microcirúrgico, tempo de formação, condições técnicas, presença de equipe de retaguarda para urgências e remuneração. Resultados Um total de 143 médicos foram entrevistados, 65,7% atuavam na região sudeste;13,3% na região nordeste; 11,9% na região sul; 6,3% na região centro-oeste; e 2,8% na região norte. Do total de cirurgiões, 43,4%, atuavam há < 5 anos; 16,8% de 5 a 10 anos; 23,8% de 10 a 20 anos; e 23% há > 20 anos. Do total de cirurgiões, 7,0% não tiveram treinamento em cirurgias microvasculares; 63,6% realizaram treinamento na residência médica, 30,8% em outra instituição, e 7,7%, outro país. Do total de cirurgiões, 5,6% trabalhavam em hospitais públicos, 14,7% em hospitais privados, e 76,9% em ambos. Do total de cirurgiões, 1,8% consideravam adequada a remuneração nas instituições públicas e 5,0% nas instituições privadas; 98,2% consideraram inadequadas as remunerações nas instituições públicas e 95,0% nas instituições privadas. Conclusão A maioria obteve treinamento em microcirurgia, não fazia reimplantes, considerava a remuneração inadequada, e não dispunha de equipe de sobreaviso. Há escassez e má distribuição de cirurgiões de mão com habilidade microcirúrgica nas emergências e baixo valor de reembolso.

Evaluation Of Bactericidal Activity Of An Antiseptic Gelthrough The Dilution-Neutralization Method

Objective: To evaluate the bactericidal activity of an antiseptic gel for hygiene and disinfection of the hands by rubbing. Methods: The dilution-neutralization method was used according to Colombian Technical Standard NTC, 2009, 12, 16 in Instituto Colombiano de Normas Técnicas y Certificación (ICONTEC), 5 strains, over 6 different types and with 6 replicas per time were exposed to the antiseptic gel, using Letheen Broth as a neutralizer substance. Results: A 99% of reduction was obtained with Staphylococcus aureus 6538, Enterococos hirae 10541, Pseudomonas aeruginosa 15442 and Klebsiella sp, within the first 30 s of exposure to the gel and within the first 60 s of exposure using the Escherichia coli 19538. All strains used coming from American Type Culture Collection (ATCC). Conclusion: It was confirmed that the product is effective. In presence of a neutralizer substance, the microorganisms were not inhibit, so the growing reduction occurs due to the action of the product.