O conhecimento a respeito da Manobra de Heimlich por mães da rede social Facebook / The Knowledge about the Hemlich Manuver by mothers on the Facebook social network / El conocimiento de la Maniobra de Heimlich por parte de las madres en la red social Facebook

Objetivo: analisar o conhecimento a respeito da Manobra de Heimlich por mães da rede social Facebook, tendo como problema de pesquisa o seguinte questionamento: "Durante o pré-natal na rede pública a mãe recebeu orientações sobre a manobra de Heimlich? Que conhecimento as mães tem sobre a manobra de Heimlich." Método: Foi utilizada a abordagem qualitativa e método descritivo para este estudo, seguindo os pressupostos de Ludke e André (1986). Resultados: Foram entrevistadas 7 mulheres com idade entre 23 e 40 anos que responderam os questionamentos a respeito da Manobra de Heimlich no pré-natal e falaram sobre seus conhecimentos prévios a respeito do tema. Conclusão: As entrevistas realizadas revelam que as mulheres possuem conhecimento superficial a respeito da Manobra de Heimlich, no entanto esse conhecimento não foi obtido em seu pré-natal, mas sim por conta própria ou por necessidade.

Objective: to analyze the knowledge about the Heimlich Maneuver by mothers of the social network Facebook, having as research problem the following question: "During prenatal care in the public network the mother received guidance on the Heimlich maneuver? What knowledge do mothers have about the Heimlich maneuver." Method: The qualitative approach and descriptive method for this study were used, following the assumptions of Ludke and André (2008). Results: We interviewed 7 women aged between 23 and 40 years old who answered the questions about the Heimlich Maneuver in prenatal care and talked about their previous knowledge about the subject. Conclusion: The interviews revealed that women have superficial knowledge about the Heimlich Maneuver, however this knowledge was not obtained in their prenatal care, but rather on their own or by necessity.

Objetivo: analizar el conocimiento sobre la Maniobra de Heimlich por parte de las madres de la red social Facebook, teniendo como problema de investigación la siguiente pregunta: "¿Durante la atención prenatal en la red pública la madre recibió orientación sobre la maniobra de Heimlich? ¿Qué conocimiento tienen las madres sobre la maniobra de Heimlich?" Método: Se utilizó el enfoque cualitativo y el método descriptivo para este estudio, siguiendo los supuestos de Ludke y André (2008). Resultados: Entrevistamos a 7 mujeres de entre 23 y 40 años que respondieron a las preguntas sobre la Maniobra de Heimlich en la atención prenatal y hablaron sobre sus conocimientos previos sobre el tema. Conclusión: Las entrevistas revelaron que las mujeres tienen conocimientos superficiales sobre la Maniobra de Heimlich, sin embargo este conocimiento no se obtuvo en su atención prenatal, sino por su cuenta o por necesidad.

Low cost simulator for cardiopulmonary unobstructed and reunion procedures in infants / Simulador de baixo custo para procedimentos de desengasgo e reanimação cardiopulmonar em lactentes

INTRODUCTION: The use of realistic simulation methodology is used in several learning scenarios, allowing students to participate directly in the problematization of situations that require immediate professional action. OBJECTIVE: To develop, validate and validate a low cost simulator for cardiopulmonary resuscitation and resuscitation procedures in infants. METHODS: An experimental study carried out with undergraduate students of the 1st year of the Nursing course at a higher education institution in the State of Paraíba, developed a simulator model with dimensions similar to an infant with low cost materials and made possible the use as a prototype for Basic Life Support training. The prototype was developed with the accessories for disengagement and cardiopulmonary resuscitation maneuvers. The data collection instrument was a questionnaire based on the American Hearth Association Basic Life Support guideline to enable and validate the Basic Life Support training instrument. RESULTS: The low-cost prototype for Basic Life Support training was used as a learning object adequately and enabled the teaching-learning process as an accessible resource at low cost. Based on the questionnaire applied, we observed that there was an increase in the median number of correct answers and a reduction in the median of errors, which indicated an improvement in the acquisition of information and improvement in learning, observed through the test of Signal of Related Samples and the test of the Signs of Wilcoxon, (MA) and errors (ME), before and after training where it was found that there was an increase in MA and a reduction in ME with 5% significance (p <0.001). The frequencies of response modifications after training with the simulator were also studied by means of the two-tailed McNemar test where Q1, Q2, Q3, Q4, Q8, Q9, Q13 and Q15 questions showed significant changes (p <0, 05). CONCLUSION: A prototype was developed that simulated the training activity in Basic Life Support, which made it possible to carry out the procedures appropriately in positioning and simulation of cardiac resuscitation, mouth / nose ventilation, and tapping in the scapular region. Which allowed the validation of disengagement and resuscitation training as a low cost alternative for health education.

INTRODUÇÃO: O uso da metodologia de simulação realística é utilizado em diversos cenários de aprendizado, permitindo aos discentes a participação direta na problematização de situações que requerem ação profissional imediata. OBJETIVO: Desenvolver, viabilizar e validar um simulador de baixo custo para procedimentos de desengasgo e reanimação cardiopulmonar em lactentes. MÉTODO: Estudo experimental realizado com alunos de graduação do 1° ano do curso de Enfermagem em uma instituição de ensino superior do Estado da Paraíba, foi desenvolvido um modelo simulador com dimensões similares a um lactente com materiais de baixo custo e acessórios para manobras de desengasgo e reanimação cardiopulmonar, viabilizado o uso como protótipo para treinamento de Suporte Básico de Vida. O instrumento de coleta de dados foi o questionário baseado no guideline do Suporte Básico de Vida da American Hearth Association. RESULTADOS: O protótipo para treinamento em Suporte Básico de Vida foi utilizado como adequadamente e viabiliza o processo ensino-aprendizagem como recurso acessível de baixo custo. O questionário aplicado observamos que houve incremento na mediana de acertos e redução na mediana de erros e indicou melhora na aquisição de informações e aprendizado, através do teste de Sinal de Amostras Relacionadas e o teste dos Postos Sinalizados de Wilcoxon, as medianas de acertos (MA) e erros (ME), antes e depois do treinamento, com o aumento de MA e redução em ME com 5% de significância (p<0,001). As respostas as questões Q1, Q2, Q3, Q4, Q8, Q9, Q13 e Q15 mostraram modificações significativas (p<0,05), após o treinamento com o simulador por meio do Jteste de McNemar bicaudal ao estudar as frequências de modificações de respostas. CONCLUSÃO: O protótipo obteve sua aplicação em simulação de atividade de treinamento em Suporte Básico de Vida, viabilizou a realização dos procedimentos da forma adequada em posicionamento e simulação de reanimação cardíaca, ventilação boca/nariz e tapotagem na região escapular, permitiu validar o treinamento de desengasgo e reanimação como uma alternativa de baixo custo para educação em saúde.

Conhecimentos de funcionários de creches sobre primeiros socorros com crianças antes e após treinamento ativo / Conocimientos de los empleados de guarderías sobre primeros auxilios a niños antes y después del entrenamiento activo / Knowledge of nursery workers about first aid measures with children before and after active training

RESUMO Objetivo: identificar mudanças no conhecimento de funcionários de creches após intervenção educacional ativa em primeiros socorros com crianças no ambiente escolar. Método: estudo quase-experimental, do tipo antes e depois, com grupo único de comparação composto por 134 funcionários das seis creches públicas de um município brasileiro, mediante adesão voluntária ofertada a toda população do estudo. O treinamento em primeiros socorros contou com 16 horas/aula e utilizou métodos ativos de aprendizagem. Um questionário fechado com nove situações simuladas avaliou o conhecimento antes/após. Utilizou-se o software R Core Team 2020, nível de significância 5% e o teste não paramétrico de McNemar para efeito da intervenção. Resultados: houve um aumento estatisticamente significativo de acertos após o treinamento nos seguintes assuntos: parada cardiorrespiratória; convulsão; engasgo; choque elétrico; trauma, queda; hemorragia; e intoxicação. As principais diferenças nos acertos antes e após foram engasgo (77,6% para 98,5%), trauma (75,3% para 94,7%), intoxicação por ingestão (70,8% para 86,5%) e convulsão (87,3% para 98,5%). C onclusões: o treinamento ampliou conhecimentos acerca de todas as temáticas, com exceção de queimaduras (p=0,248). O contexto sociocultural deve ser considerado, bem como a carga horária distribuída entre teoria e práticas. Os enfermeiros podem ser os profissionais de referência para ministrar tais cursos.

Resumen Objetivo: identificar cambios en el conocimiento de empleados de guarderías tras intervención educativa activa en primeros auxilios a niños en el ambiente escolar. Método: estudio casi-experimental, del tipo antes y después, con grupo único de comparación compuesto por 134 empleados de las seis guarderías públicas de un municipio brasileño, mediante adhesión voluntaria ofrecida a toda población del estudio. El entrenamiento en primeros auxilios contó con 16 horas/clasey utilizó métodos activos de aprendizaje. Un cuestionario cerrado con nueve situaciones simuladas evaluóel conocimiento antes/después. Se utilizó el softwareR Core Team 2020, nivel de significancia 5% y la prueba no paramétrica de McNemar para efecto de la intervención. Resultados: hubo un aumento estadísticamente significativo de aciertos después del entrenamiento en los siguientes asuntos: paro cardiorrespiratorio; convulsión; atragantamiento; choque eléctrico; trauma, caída; hemorragia; e intoxicación. Las principales diferencias en los aciertos antes y después fueron atragantamiento (77,6% para 98,5%), trauma (75,3% para 94,7%), intoxicación por ingestión (70,8% para 86,5%) y convulsión (87,3% para 98,5%). Conclusiones: el entrenamiento amplió conocimientos acerca de todas las temáticas, con excepción de quemaduras (p=0,248). El contexto sociocultural debe ser considerado, así como la carga horaria distribuida entre teoría y prácticas. Los enfermeros pueden ser los profesionales de referencia para dar tales cursos.

ABSTRACT Objective: to identify changes in the knowledge of nursery workers after active educational intervention in first aid measures with children in the school environment. Method: a quasi-experimental study of the before and after type with a single comparison group composed of 134 workers from the six public nursery centers in a Brazilian municipality, through voluntary adherence offered to the entire study population. First aid training consisted of 16 hours/class and used active learning methods. A closed questionnaire with nine simulated situations assessed the knowledge before and after the intervention. The R Core Team 2020 software was used in the analysis, and a significance level of 5% and the McNemar non-parametric test were used for the purpose of the intervention. Results: there was a statistically significant increase in correct answers after training in the following subjects: cardiorespiratory arrest; convulsion; choking; electric shock; trauma, fall; bleeding, and poisoning. The main differences in terms of correct answers before and after were found for choking (77.6% to 98.5%), trauma (75.3% to 94.7%), poisoning by ingestion (70.8% to 86.5%), and convulsion (87.3% to 98.5%). Conclusions: the training expanded the knowledge about all the themes, with the exception of burns (p = 0.248). The socio-cultural context must be considered, as well as the workload distributed between theory and practices. Nurses can be the reference professionals to teach such courses.

Tecnologias para educação em saúde sobre obstrução das vias aéreas por corpo estranho: revisão integrativa / Tecnologías para la educación en salud sobre la obstrucción de la vía aérea por cuerpo extraño: una revisión integradora / Technologies for health education about foreign-body airway obstruction: an integrative review

RESUMO Objetivo Analisar as tecnologias desenvolvidas para educação em saúde sobre obstrução das vias aéreas. Método Revisão integrativa realizada mediante busca nas bases de dados Medical Literature Analysis and Retrieval System Online, Latin American and Caribbean Health Sciences Literature, Cumulative Index to Nursing and Allied Health Literature, Web of Science e Scopus. Selecionaram-se estudos originais, sem restrições de tempo e idioma. Os dados foram extraídos por dois pesquisadores independentes e organizados em quadros sinópticos. A integração dos resultados fundamentou-se no método de redução de dados. Resultados Foram incluídos oito artigos, publicados em periódicos nacionais e internacionais, com predominância de estudos metodológicos. As tecnologias evidenciadas foram dos tipos aplicativos, cursos online, animação 3D, cartilha e website. A temática foi abordada entre os conteúdos do Suporte Básico de Vida. Observou-se ausência de tecnologias que abordassem o tema com acessibilidade. Conclusão As tecnologias identificadas eram no formato digital e impresso e possuíam validade de conteúdo e efetividade para utilização na educação e saúde. Ainda assim, há lacuna de estudos que evidenciem tecnologias educacionais específicas sobre obstrução das vias aéreas.

RESUMEN Objetivo Analizar las tecnologías desarrolladas para la educación en salud sobre la obstrucción de la vía aérea. Método Revisión integradora realizada mediante búsquedas en las bases de datos Medical Literature Analysis and Retrieval System Online, Latin American and Caribbean Health Sciences Literature, Cumulative Index to Nursing and Allied Health Literature, Web of Science y Scopus. Se seleccionaron estudios originales, sin restricciones de tiempo ni de idioma. Los datos fueron extraídos por dos investigadores independientes y organizados en cuadros sinópticos. La integración de los resultados se basó en el método de reducción de datos. Resultados Se incluyeron ocho artículos publicados en revistas brasileñas e internacionales, con predominio de estudios metodológicos. Las tecnologías evidenciadas fueron de los tipos aplicaciones, cursos en línea, animación 3D, cartilla y sitio web. El tema se abordó entre los contenidos del Soporte Vital Básico. Se ha observado la carencia de tecnologías que aborden el tema con accesibilidad. Conclusión Las tecnologías identificadas estaban en formato digital e impreso y tenían validez de contenido y eficacia para su uso en educación y salud. Sin embargo, hay una carencia de estudios que evidencien tecnologías educativas específicas sobre la obstrucción de la vía aérea.

ABSTRACT Objective To analyze technologies developed for health education about airway obstruction. Method Integrative review through search in the databases Medical Literature Analysis and Retrieval System Online, Latin American and Caribbean Health Sciences Literature, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Scopus. Original studies, with no time and language restrictions, were selected. The data were extracted by two independent researchers and organized into synoptic tables. Result integration was based on the data reduction method. Results The eight included articles were published in Brazilian and international journals and were predominantly methodological. The identified technologies were applications, online courses, 3D animations, booklet, and website. The theme was approached among the contents of Basic Life Support. An absence of technologies approaching the theme with accessibility was observed. Conclusion The identified technologies were digital and printed, presenting content validity and effectivity for use in education and health. Even so, there is gap in studies highlighting specific educational technologies on airway obstruction.

Baby led weaning: an integrative review of scientific evidence from 2011 to 2019 / Baby-led weaning: uma revisão integrativa das evidências científicas de 2011 a 2019

INTRODUCTION: Baby-led weaning (BLW) is an alternative approach to introducing food to infants that has become popular. OBJECTIVE: To investigate the scientific evidence regarding the BLW method and its modified version, Baby-Led Introduction to Solids (BLISS). METHODS: The research was carried out between June 2018 and June 2019, through the databases US National Library of Medicine National Institutes of Health (PubMed) using the following keywords: 'BLW', 'Baby-led weaning', 'BLISS', and 'Baby-Led Introduction to Solids'. All original articles from in English published between 2011 and 2019 have been included. RESULTS: Twenty-five studies were included in the analysis. Research on BLW/BLISS focused mainly on the themes: characteristics, behaviors and attitudes of mothers and children, knowledge of mothers and health professionals about feeding methods, weight and body mass index evaluation of children, evaluation of energetic and nutrient intake of children and evaluation of episodes of choking and gag reflex. CONCLUSION: Most research deals with BLW-related experiences and there is still little evidence on the method in terms of adequacy of energy and nutrient intake and growth in childhood. Positive points to child can be observed such as prolonged breastfeeding, greater independence when feeding and better response to satiety. The methods of food introduction do not differ in relation to the occurrence of episodes of choking.

INTRODUÇÃO: O Baby-led weaning (BLW) é uma abordagem alternativa para a introdução alimentar aos lactentes que tem se tornado popular. OBJETIVO: Investigar as evidências científicas a respeito do método BLW e sua versão modificada Baby-Led Introduction to Solids (BLISS). MÉTODOS: A pesquisa de artigos foi realizada entre junho de 2018 e junho de 2019, por meio da base de dados US National Library of Medicine National Institutes of Health (PubMed) utilizando as seguintes palavras-chaves: 'BLW', 'Baby-led weaning', 'BLISS', e 'Baby-Led Introduction to Solids'. Foram incluídos todos os artigos originais encontrados no idioma inglês, publicados entre 2011 e 2019. RESULTADO: Vinte e cinco estudos foram incluídos na análise. As pesquisas sobre BLW/BLISS focaram principalmente nos temas: características, comportamentos e atitudes de mães e crianças, conhecimento de mães e profissionais de saúde sobre os métodos de introdução alimentar, avaliação de peso e de índice de massa corporal, avaliação da ingestão energética e de nutrientes e avaliação de episódios de engasgo e reflexo de gag das crianças. CONCLUSÃO: A maioria das pesquisas aborda experiências relacionadas ao BLW/BLISS e ainda existem poucas evidências sobre o método em termos de adequação de ingestão de energia e nutrientes e de crescimento na infância. Pontos positivos para a criança podem ser observados como aleitamento materno prolongado, maior independência ao se alimentar e melhor resposta à saciedade. Os métodos de introdução alimentar não diferem entre si em relação à ocorrência de episódios de engasgos.

Intervención del enfermero intensivista ante un paciente con atelectasia. Reporte de un caso / The intervention of the intensive care nurse in front of a patient with atelectasis. A case report

RESUMEN En la aspiración por cuerpo extraño en vías respiratoria, los síntomas van desde el paro cardiorrespiratorio, tos de intensidad y características variables como obstrucción bronquial difusa o localizada. Como complicación puede aparecer la neumonía y atelectasias. La atelectasia es el colapso de una parte periférica del pulmón o de todo el pulmón, debido a la obstrucción de la vía aérea en bronquios o bronquiolos. El objetivo de este trabajo es presentar un caso clínico y la importancia de la intervención de Enfermería en una Transicional, de 1 año y 9 meses de edad, sexo femenino. Ingresó en la Unidad de Terapia Intensiva del Hospital Pediátrico Provincial de Matanzas, con diagnóstico de aspiración de cuerpo extraño en vías aéreas. El desarrollo de las habilidades prácticas del enfermero intensivista fomenta el razonamiento crítico en aras de brindar cuidados con calidad y enfoque científico que repercuten en la mejoría de los pacientes (AU).

ABSTRACT This paper´s aim is to present a clinical case and the importance of the nursing interventions in a female transitional patient, aged 1 years and 9 months. She entered the Intensive Care Unit of the Provincial Pediatric Hospital of Matanzas, with a diagnosis of foreign body aspiration in the airways. The development of the intensive care nurses´ practical skills promotes the critical reasoning for the sake of giving qualitative care with a scientific approach striking on the improvement of the patients (AU).

Pediatric food impaction detected through point-of-care ultrasonography

A previously healthy 1-year-old boy suddenly began coughing while eating a dried sweet potato. Because he continued gagging after vomiting a piece of the dried sweet potato, his mother brought him to our emergency room. Upon arrival, despite normal pulmonary findings, he was drooling and gagging. Ultrasonography was performed because food impaction at the upper esophagus was suspected based on his medical history and physical examination, and results showed that a linear hyperechoic lesion was obstructing the posterior esophageal wall. Computed tomography was also considered for a detailed examination of the foreign body. However, the patient vomited the dried sweet potato before the test was performed. After vomiting the foreign body, the patient stopped gagging, and his ultrasonographic findings were normal. Therefore, the patient was discharged without any complications.

Dental treatment in patients with severe gag reflex using propofol-remifentanil intravenous sedation

Patients with severe gag reflex (SGR) have difficulty getting the treatment they require in local clinics, and many tend to postpone the start of their treatment. To address this problem, dentists have used behavioral techniques and/or pharmacological techniques for treatment. Among the pharmacological methods available, propofol IV sedation is preferred over general anesthesia because it is a simpler procedure. Propofol in combination with remifentanil is characterized by stable sedative effects and quick recovery, leading to a deep sedation. Remifentanil acts to reduce the pain caused by lipid-soluble propofol on injection. The synergistic effects of propofol-remifentanil include reduction in the total amount of drug required to achieve a desired sedation level and anti-emetic effects. In this case report, we outline how the use of propofol-remifentanil IV sedation enabled us to successfully complete a wide range of dental treatments in a patient with SGR.

Qualidade de vida (QV) na doença de Parkinson: o PDQ-39 contempla a avaliação de QV nos indivíduos disfágicos? / Quality of life (QOL) in Parkinson´s disease: the PDQ-39 evaluates QV in disfagic individuals?

OBJETIVO: Avaliar o impacto da disfagia na qualidade de vida (QV) de indivíduos com Doença de Parkinson (DP) através do instrumento recomendado para essa população. MÉTODOS: Participaram deste estudo pacientes com diagnóstico de DP. Todos os participantes foram submetidos à avaliação fonoaudiológica de deglutição com as consitências sólida (pão francês) e líquida (água), responderam ao PDQ-39 e tiveram o estadiamento da DP classificado pela escala de Hoehn &Yahr. RESULTADOS: Foram avaliados 31 indivíduos com DP, sendo 21 (67,7%) do gênero masculino. A média de idade foi 59,6 anos (± 11,3), variando de 38 a 79 anos e o tempo doença desde o diagnóstico foi, em média, 9,8 (±4,8) anos. A disfagia esteve presente em 74,2% dos indivíduos avaliados e na correlação entre o PDQ-39 total e a presença de disfagia houve significância apenas no domínio estigma. CONCLUSÃO: Em indivíduos com DP avaliados através do PDQ-39 não fica evidente o impacto da disfagia na percepção de QV dessa população.

OBJECTIVE: To assess the impact of dysphagia on the overall quality of life (QOL) of patients with Parkinson's disease (PD) through the tool recommended for this population. METHODS: The study included 31 patients diagnosed with PD. All participants underwent clinical assessment of swallowing the solid consistency (French bread) and liquid (water), answered to the PDQ-39 and had the staging of PD classified by Hoehn & Yahr scale. RESULTS: We evalueted 31 subjects with PD, 21 (67.7%) were male. The mean age was 59.6 years (± 11.3), ranging from 38 to 79 years and the disease time since diagnosis was on average 9.8 (± 4.8) years. Dysphagia was present in 74.2% of the individuals and the correlation between the PDQ-39 the presence of dysphagia was significant only in stigma domain. CONCLUSION: In patients with PD assessed by PDQ-39 is not evident the impact of dysphagia on the perception of overall QoL of this population.

Lidocaine spray on an endoscope immediately before insertion improves patient tolerance to endoscopy: A single center, clinical observational study

BACKGROUND: Topical pharyngeal anesthesia reduces discomfort during upper gastrointestinal endoscopy (UGIE) but may not increase tolerance to the procedure. This case-control study was performed to assess whether lidocaine spray on the endoscope in addition to pharyngeal anesthesia improves patient tolerance to endoscopy we performed. METHODS: Patients who underwent UGIE were assigned to either the case group where the endoscope was treated with 2 sprays of 10% lidocaine before insertion or the control group given only conventional pharyngeal anesthesia. And we compared the frequency of belching and retching during endoscopy. RESULTS: Among 497 eligible patients, 262 were assigned to the case group and 235 to the control group. There were significant differences between the two groups in belching (odds ratio [OR] = 0.15, 95% confidence interval [CI] = 0.09-0.24, P < 0.01) and retching (OR = 0.22, 95% CI = 0.15-0.34, P = 0.01) during endoscopy using multivariate analysis. Younger patients (OR = 0.96, 95% CI = 0.94-0.98, P < 0.01) and female patients (OR = 2.16, 95% CI = 1.40-3.33, P = 0.01) had belching more frequently than older patients and male patients, respectively. Retching was more frequent in sedated patients (OR = 0.39, 95% CI = 0.25-0.61, P = 0.01) and those with gastro-esophageal reflux disease (OR = 1.48, 95% CI = 1.00-2.21, P = 0.06). CONCLUSIONS: Use of lidocaine spray on the endoscope improves patient tolerance during UGIE compared to only conventional pharyngeal anesthesia.

Spontaneous Bleeding from a Short Gastric Artery after Vomiting Successfully Treated without Surgery / 대한소화기학회지

Spontaneous bleeding from a short gastric artery in the absence of pre-disposing trauma is reported very rarely. To the best of our knowledge, the published literature includes only 14 cases. Young men comprise almost all of the patients, and were induced by vomiting or gagging. The patients usually required emergent surgery. Our patient, a 32-year-old man, was diagnosed with spontaneous hemoperitoneum due to short gastric artery tearing after a few instances of vomiting. We managed him conservatively including fluid, vitamin K and antifibrinolytic agent without surgery.

Apparent life-threatening event in infancy / 소아과

An apparent life-threatening event (ALTE) is defined as the combination of clinical presentations such as apnea, marked change in skin and muscle tone, gagging, or choking. It is a frightening event, and it predominantly occurs during infancy at a mean age of 1–3 months. The causes of ALTE are categorized into problems that are: gastrointestinal (50%), neurological (30%), respiratory (20%), cardiovascular (5%), metabolic and endocrine (2%–5%), or others such as child abuse. Up to 50% of ALTEs are idiopathic, where the cause cannot be diagnosed. Infants with an ALTE are often asymptomatic at hospital and there is no standard workup protocol for ALTE. Therefore, a detailed initial history and physical examination are important to determine the extent of the medical evaluation and treatment. Regardless of the cause of an ALTE, all infants with an ALTE should require hospitalization and continuous cardiorespiratory monitoring and evaluation for at least 24 hours. The natural course of ALTEs has seemed benign, and the outcome is generally associated with the affected infants' underlying disease. In conclusion, systemic diagnostic evaluation and adequate treatment increases the survival and quality of life for most affected infants.

Influence of gag reflex on removable prosthetic restoration tolerance according to the patient section of the short form of the Gagging Problem Assessment Questionnaire

PURPOSE: To assess removable prosthetic restoration tolerance according to the patient section of the short form of the Gagging Problem Assessment Questionnaire (GPA-pa SF) and the influence of gender, education level and prosthesis type and denture-related mucosal irritation on the GPA-pa SF scores before treatment and over a period of two months after prosthesis insertion. MATERIALS AND METHODS: 130 participants who required removable prosthesis were surveyed with a standard form that included questions regarding age, gender, education level, dental attendance, and prosthetic restoration type. Participants answered the GPA-pa SF before restoration (T0) and 1 day (T1), 2 days (T2), 15 days (T3), 1 month (T4), and 2 months (T5) after prosthesis insertion. RESULTS: Of the 130 participants, 110 participants completed the prosthetic restoration procedure, but only 93 of these were able to use the prosthesis over the two-month period. The mean GPA-pa SF score obtained at T0 was higher than the scores obtained at the other periods in the total of the sample. Significant difference was present between mean scores obtained at T0-T1 and T2-T3 than scores obtained at other periods (P.05). CONCLUSION: GPA-pa SF scores were higher before the restoration procedure began, and decreased over time with the use of prosthesis. Gender and denture-related mucosal irritation affected the GPA-pa SF scores.

Apparent life-threatening events in neonatal period: clinical manifestations and diagnostic challenges in a pediatric referral center

Apparent Life-Threatening Events [ALTEs] is an episode that is frightening to the observer and is characterized by some combination of apnea, color change, altered muscle tone, choking, and gagging. This study was designed to evaluate and follow up neonates who presented with clinical manifestation of an ALTE in a year. In this prospective observational study, all of the neonates with episode of ALTE who were admitted to the Children's Medical Center [CMC] in Tehran, from June 15[th] 2010 to May 14[th] 2011 were enrolled in the study. Data from patients consisting of history, physical examinations, and paraclinical findings were recorded in a checklist and all followed up 3 to 6 months after discharge. During the study period 18 neonates were admitted due to ALTE episode[s] with mean age of 15 +/- 13 days. Nine [50%] neonates had previous attacks of ALTE. The most frequent complaint was cyanosis in 12 [67%] and apnea in 8 [44%] patients. In 10 [56%] the event lasted less than one minute, 13 [72%] were awake, 17 [95%] in supine position and 13 [72%] on their parent's lap. Primary antagonistic impression on admission was sepsis in 11 [61%] and concomitant seizure in 5 [28%]. The most common final diagnosis according to repeated physical examinations, result of paraclinical investigations and follow up was sepsis 4 [22%] and aspiration 9 [50%]. ALTE recurred in none of the neonates during follow up. The rate of ALTE seems to be higher than in this study owing to high incidence of recurrent ALTE. Although most of these attacks regress spontaneously, more attention should be paid for the underlying diseases

Palateless custom bar supported overdenture: A treatment modality to treat patient with severe gag reflex.

Objective: To suggest a custom bar supported overdenture treatment modality for prosthodontic management of patients with severe gag reflex. Background: Some patients have a severe gag reflex and cannot tolerate conventional maxillary complete dentures with maximum palatal coverage and extensions of all borders. The condition further gets complicated in patients suffering from respiratory problems along with severe gag reflex. Severe gagging acts as a barrier to treat such patients with accepted clinical procedures and prevent patients from wearing the prosthesis. By saving some of the remaining natural teeth and fabricating, a horse shoe shape palateless simple tooth or bar supported overdenture can be successfully used for treating such patients. Materials and Methods: The remaining maxillary right and left canines were prepared with the tapered round end diamond bur to receive copings of custom bar after intentional root canal treatment of same teeth. Impression was made with light body and putty of the polyvinyl siloxane elastomer with double step putty wash technique. Impression was poured with die stone. Wax pattern of copings with bar was fabricated with inlay wax which was invested and casted. After retrieving the bar, it was finished and its fit was evaluated. The coping-bar assembly was finally cemented with the glass ionomer cement. Palateless overdenture was fabricated by conventional technique used for the fabrication of complete denture. Conclusion: Palateless custom bar supported overdenture procedure can be successfully used for the management of patients with severe gag reflex with improved denture retention, stability, chewing efficiency and comfort of the patient.

Náuseas, vómitos, diarrea, estreñimiento e hiporexia en la alimentación del niño con cáncer / Nausea, vomiting, diarrhea, constipation and decreased appetite in feeding the child with cancer

Entre las manifestaciones digestivas que se presentan en el tratamiento del niño con cáncer, bien sea por la quimioterapia, la radioterapia, los medicamentos subyacentes a estas terapias o a la misma enfermedad per sé, se encuentran las náuseas, los vómitos, la diarrea, el estreñimiento y la disminución del apetito. Todos ellos, junto con la pérdida de la actividad física y los cambios en los hábitos alimentarios, pueden conllevar a malnutrición. Es necesario así entonces realizar algunas sugerencias preventivas nutricionales y de puericultura, para evitar la morbilidad secundaria a ello.

Among the digestive symptoms that occur in the treatment of children with cancer, either gy chemotherapy, radiotherapy, drug therapy or underlying these the same disease per se, include nausea, vomiting, diarrea, constipation and the decline and loss of appetite. They, along with the loss of physycal activit and changes in eating habits, can lead to malnutrition. Need and then make some suggestions preventive nutrition and childcare, to avoid the morbidity secondary to it.

[Effect of Elaeagnus angustifolia lozenge on gag reflex in dental patients]

Gag reflex is one of the most common problems in dental treatment. All researches performed to reduce or eliminate this reflex were not effective or were time-consuming. The aim of this study was to evaluate the use of Elaeagnus angustifolia lozenge in controlling gag reflex during dental treatment. This study was a randomized double blind controlled trial with convenient sampling on 84 patients that were candidates for radiographic procedures in the School of Dentistry, Isfahan University of Medical Sciences. The cases were randomly divided into two groups of case and control. The case group used Elaeagnus angustifolia L extracts and the control group used placebo. Fruit extract was formed into lozenge. Before and after intervention, the gag reflex was evaluated by stimulation of the soft palate and pharyngeal tonsils. Data analysis and comparison was performed with SPSS 11 software and Chi-square, McNamara and t tests. The gag reflex significantly decreased in the soft palate region [p<0.001] and pharyngeal tonsils [p<0.001] in the intervention group. In the placebo group, decrease of gag reflex was not significant in any of these locations [p=0.9]. The decrease in gag reflex in the soft palate and the pharyngeal tonsils in the case and control groups before and after the intervention showed statistically significant differences [P<0.01]. Elaeagnus angustifolia L. extracts seem to be an effective method to control gag reflex during dental treatment. It may be a confident method to use on dental procedures, especially radiographic procedures

Oropharyngeal examination as a predictor of obstructive sleep apnea: pilot study of gag reflex and palatal reflex / Avaliação orofaríngea como preditor da apneia obstrutiva do sono: estudo piloto dos reflexos nauseoso e palatal

Obstructive sleep apnea (OSA) has high prevalence and may cause serious comorbities. The aim of this trial was to show if simple noninvasive methods such as gag reflex and palatal reflex are prospective multivariate assessments of predictor variables for OSA. METHOD: We evaluate gag reflex and palatal reflex, of fifty-five adult patients, and their subsequent overnight polysomnography. RESULTS: Forty-one participants presented obstructive sleep apnea. The most relevant findings in our study were: [1] absence of gag reflex on patients with severe obstructive apnea (p=0.001); [2] absence of palatal reflex on moderate obstructive apnea patients (p=0.02). CONCLUSION: Gag reflex and palatal reflex, a simple noninvasive test regularly performed in a systematic neurological examination can disclose the impact of the local neurogenic injury associated to snoring and/or obstructive sleep apnea syndrome.

A síndrome da apneia obstrutiva do sono (SAOS) possui alta prevalência e pode causar sérias comorbidades. O objetivo deste estudo foi mostrar se métodos não invasivos como os reflexos nauseoso e palatal podem ser avaliações prospectivas multivariadas preditoras para SAOS. MÉTODO: Avaliamos os reflexos palatal e nauseoso em 55 pacientes adultos, com exame polissonográfico subsequente. RESULTADOS: 41 pacientes apresentaram SAOS. Os achados mais relevantes em nosso estudo foram: [1] ausência do reflexo nauseoso em pacientes com SAOS grave (p=0,001); [2] ausência do reflexo palatal em pacientes com SAOS moderada (p=0,02). CONCLUSÃO: Os reflexos nauseoso e palatal, um simples exame não invasivo, aplicado em uma avaliação neurológica rotineira, pode revelar o impacto de lesões neurogênicas locais associadas ao ronco e/ou a SAOS.

Hernias internas luego de bypass gástrico en Y de roux por laparoscopia / Internal hernias following laparoscopic roux en Y gastric bypass

Presentamos nuestra experiencia en el diagnóstico y tratamiento de los pacientes con hernias luego de bypass gástrico en Y de Roux por laparoscopia (BGYRL) debido a obesidad mórbida. Se revisaron las historias de una serie`prospectiva de pacientes sometidos a BGYRL, incluyéndose para el análisis a aquellos casos con diagnóstico de hernia interna posoperatoria. Se determinó el tiempo de presentación, síntomas hallazgos radiológicos, abordaje quirúrgico, tipo de hernía, técnica quirúrgica, y morbilidad. Desde enero de 2004 a diciembre de 2009 intervenimos 512 pacientes con obesidad mórbida mediante BGYRL, utilizando una posición antecólica del asa alimentaria, sin cerrar los defectos mesentéricos. Se reoperaron 30 pacientes (5.8%) debido a hernia interna, de los cuales 27 (90%) se pudieron resolver mediante un abordaje laparoscópico. El tiempo promedo de presentación fue de 20 meses, y el principal síntoma dolor abdominal postprandial. La radiología simple de abdomen fue positiva sólo en 8 casos (26.6%). Una`paciente falleció debido a infarto intestinal masivo y sepsis intraabdominal para una mortalidad de 3.3%. Se concluye que las hernias internas constituyen la complicación tardia con mayor potencial de letalidad luego de BGYRL, por lo que es necesario un alto índice de sospecha clínico para un diagnóstico y tratamiento tempranos.

We present our experience in the diagnosis and treatment of patients with internal hernias following laparoscopic Roux en Y gastric bypass (LRYGB) for morbid obesity. The records of a prospective series of patients submitted to LRYGB were reviewed, including for the analysis those with diagnosis of postoperative internal hernia. Time of onset, symptoms, radiologic findines, surgical approach, type of hernia, surgical technique, and morbidity were determined. From January 2004 to December 2009, 512 morbidity obese patients were submitted to LRYGB, using an antecolic alimentary limb, without closing the mesentetic defects. Thirty patients (5.8%) were reoerated because an internal hernia, 27 of them (90%) solved by laparoscopic approach. Mean time of onset was 20 months, and postprandial abdominal pain was the main symptom. Plain abdominal x-ray was positive only in 8 cases (26.6%) One patient died because intestinal infarction and abdominal sepsis for a 3.3% mortality rate. We concluded that internal hernias are the late complication with most lethality potential after a LRYGB, a high index of clinical suspición is necessary for an early diagnosis and treatment.