Manifestaciones clínicas post supresión de sedoanalgesia en pacientes adultos de una terapia intensiva / Clinical manifestations after suppression of sedoanalgesia in adult patients in intensive care

Introducción: en la unidad de cuidados intensivos (UCI), las personas asistidas con patologías relevantes se encuentran bajo sedación, una vez que estas se encuentran bajo los principios de supresión de la sedación, es importante identificar cuáles son las manifestaciones que presentan, propias de las sedaciones. Objetivo: describir las manifestaciones clínicas del síndrome de supresión de la sedoanalgesia presentes en pacientes asistidos en un Hospital Público de la Ciudad de Corrientes de enero a diciembre del 2022. Metodología: estudio cuantitativo, descriptivo, transversal y observacional. La muestra incluyó pacientes adultos de UCI. El cálculo del tamaño muestral se realizó a través del método probabilístico aleatorio simple resultando de éste una muestra de 100 historias clínicas. Para la recolección de datos se utilizó la observación y como instrumento un formulario semiestructurado, de carácter anónimo. Cada formulario contenía datos específicos donde se categorizan las variables en estudio como ser edad, sexo, comorbilidades, tiempo de sedoanalgesia, tipo de sedación, sedoanalgesia utilizada, agitación, confusión, alucinación, diaforesis, taquicardia. Resultados: en cuanto a la edad se obtuvo un promedio de 49 años, el sexo predominante fue el masculino con 52%, en cuanto a las comorbilidades más frecuentes, el 20% presentó Insuficiencia Respiratoria Aguda y el 16% Insuficiencia renal. El motivo de ingreso a UCI en mayor medida con el 33% fue por dificultad respiratoria y Post Quirúrgicos complicados 32%. Los fármacos de mayor elección fueron midazolam 94%, seguido del fentanilo 80%. En cuanto al tiempo de sedación de los pacientes, se encontró una media de 1265 horas. Las manifestaciones clínicas que se observaron en la muestra en mayor medida corresponden a taquicardia 70%, agitación 52%, un 37% confusión e hipertensión y un 24% alucinación. Conclusión: las manifestaciones que se presentaron con mayor frecuencia fueron taquicardia, agitación, confusión, hipertensión y con menor frecuencia alucinación[AU]

Introduction: in the intensive care unit (ICU), people treated with relevant pathologies are under sedation. Once they are under the principles of sedation suppression, it is important to identify the manifestations they present, typical of sedations. Objective: To describe the clinical manifestations of sedation suppression syndrome present in patients treated at a Public Hospital in the City of Corrientes from January to December 2022. Methodology: quantitative, descriptive, cross-sectional and observational study. The sample included adult ICU patients. The calculation of the sample size was carried out through the simple random probabilistic method, resulting in a sample of 100 medical records. Manifestaciones clínicas post supresión de sedoanalgesia en pacientes adultos de una terapia intensiva. Observation was used to collect data and a semi-structured, anonymous form was used as an instrument. Each form contained specific data where the variables under study were categorized, such as age, sex, comorbidities, sedation time, type of sedation, sedation used, agitation, confusion, hallucination, diaphoresis, tachycardia. Results: regarding age, an average of 49 years was obtained, the predominant sex was male with 52%, regarding the most frequent comorbidities, 20% presented Acute Respiratory Failure and 16% Renal failure. The reason for admission to the ICU to a greater extent with 33% was due to respiratory difficulty and complicated Post-Surgeries 32%. The drugs of greatest choice were midazolam 94%, followed by fentanyl 80%. Regarding the sedation time of the patients, an average of 1265 hours was found. The clinical manifestations that were observed in the sample to a greater extent correspond to tachycardia 70%, agitation 52%, confusion and hypertension 37% and hallucination 24%. Conclusion: the manifestations that occurred most frequently were tachycardia, agitation, confusion, hypertension and, less frequently, hallucination[AU]

Introdução: na unidade de terapia intensiva (UTI), as pessoas tratadas com patologias relevantes estão sob sedação. Uma vez sob os princípios da supressão da sedação, é importante identificar as manifestações que apresentam, típicas das sedações. Objetivo: Descrever as manifestações clínicas da síndrome de supressão da sedação presentes em pacientes atendidos em um Hospital Público da Cidade de Corrientes no período de janeiro a dezembro de 2022. Metodologia: estudo quantitativo, descritivo, transversal e observacional. A amostra incluiu pacientes adultos internados em UTI. O cálculo do tamanho amostral foi realizado pelo método probabilístico aleatório simples, resultando em uma amostra de 100 prontuários. A observação foi utilizada para a coleta de dados e um formulário semiestruturado e anônimo foi utilizado como instrumento. Cada formulário continha dados específicos onde foram categorizadas as variáveis em estudo, como idade, sexo, comorbidades, tempo de sedação, tipo de sedação, sedação utilizada, agitação, confusão, alucinação, sudorese, taquicardia. Resultados: em relação à idade obteve-se uma média de 49 anos, o sexo predominante foi o masculino com 52%, quanto às comorbidades mais frequentes, 20% apresentavam Insuficiência Respiratória Aguda e 16% Insuficiência Renal. O motivo de internação na UTI em maior proporção com 33% foi por dificuldade respiratória e pós-cirúrgicos complicados 32%. Os medicamentos de maior escolha foram midazolam 94%, seguido de fentanil 80%. Quanto ao tempo de sedação dos pacientes, foi encontrada uma média de 1265 horas. As manifestações clínicas mais observadas na amostra correspondem a taquicardia 70%, agitação 52%, confusão e hipertensão 37% e alucinação 24%. Conclusão: as manifestações que ocorreram com maior frequência foram taquicardia, agitação, confusão, hipertensão e, menos frequentemente, alucinação[AU]

Association between chronic kidney disease stages and changes in ambulatory blood pressure monitoring parameters / Associação entre estágios da doença renal crônica e alterações dos parâmetros da monitorização ambulatorial da pressão arterial

Abstract Introduction: Blood pressure (BP) assessment affects the management of arterial hypertension (AH) in chronic kidney disease (CKD). CKD patients have specific patterns of BP behavior during ambulatory blood pressure monitoring (ABPM). Objectives: The aim of the current study was to evaluate the associations between progressive stages of CKD and changes in ABPM. Methodology: This is a cross-sectional study with 851 patients treated in outpatient clinics of a university hospital who underwent ABPM examination from January 2004 to February 2012 in order to assess the presence and control of AH. The outcomes considered were the ABPM parameters. The variable of interest was CKD staging. Confounding factors included age, sex, body mass index, smoking, cause of CKD, and use of antihypertensive drugs. Results: Systolic BP (SBP) was associated with CKD stages 3b and 5, irrespective of confounding variables. Pulse pressure was only associated with stage 5. The SBP coefficient of variation was progressively associated with stages 3a, 4 and 5, while the diastolic blood pressure (DBP) coefficient of variation showed no association. SBP reduction was associated with stages 2, 4 and 5, and the decline in DBP with stages 4 and 5. Other ABPM parameters showed no association with CKD stages after adjustments. Conclusion: Advanced stages of CKD were associated with lower nocturnal dipping and greater variability in blood pressure.

Resumo Introdução: A avaliação da pressão arterial (PA) tem impacto no manejo da hipertensão arterial (HA) na doença renal crônica (DRC). O portador de DRC apresenta padrão específico de comportamento da PA ao longo da monitorização ambulatorial da pressão arterial (MAPA). Objetivos: O objetivo do corrente estudo é avaliar as associações entre os estágios progressivos da DRC e alterações da MAPA. Metodologia: Trata-se de um estudo transversal com 851 pacientes atendidos nos ambulatórios de um hospital universitário que foram submetidos ao exame de MAPA no período de janeiro de 2004 a fevereiro de 2012 para avaliar a presença e o controle da HA. Os desfechos considerados foram os parâmetros de MAPA. A variável de interesse foi o estadiamento da DRC. Foram considerados como fatores de confusão idade, sexo, índice de massa corporal, tabagismo, causa da DRC e uso de anti-hipertensivos. Resultados: A PA sistólica (PAS) se associou aos estágios 3b e 5 da DRC, independentemente das variáveis de confusão. Pressão de pulso se associou apenas ao estágio 5. O coeficiente de variação da PAS se associou progressivamente aos estágios 3a, 4 e 5, enquanto o coeficiente de variação da pressão arterial diastólica (PAD) não demonstrou associação. O descenso da PAS obteve associação com estágios 2, 4 e 5, e o descenso da PAD, com os 4 e 5. Demais parâmetros da MAPA não obtiveram associação com os estágios da DRC após os ajustes. Conclusão: Estágios mais avançados da DRC associaram-se a menor descenso noturno e a maior variabilidade da pressão arterial.

Utilidad de la tomografía de impedancia eléctrica para la programación del ventilador mecánico en paciente crítico pediátrico, una alternativa dinámica y no invasiva: revisión de dos casos clínicos / Utility of electrical impedance tomography for mechanical ventilator programming in pediatric critical patients, a dynamic and non-invasive alternative: a review of two clinical cases

La tomografía por impedancia eléctrica (TIE) es una modalidad de monitorización funcional respiratoria por imagen, no invasiva y libre de radiación, que permite visualizar en tiempo real la ventilación pulmonar regional y global en pacientes adultos y pediátricos conectados a Ventilación Mecánica (VM). OBJETIVO: Se describe la utilidad de la TIE en dos pacientes críticos pediátricos, en quienes no fue factible realizar medición de mecánica pulmonar, como herramienta para el ajuste de parámetros ventilatorios. CASOS CLÍNICOS: Se presentan dos pacientes pediátricos de 27 y 11 meses con condiciones clínicas diferentes, conectados a VM, en quienes se utilizó la TIE como método de monitoreo de la distribución pulmonar y titulación de la presión positiva al final de la espiración (PEEP) óptima, con el objetivo de obtener una ventilación pulmonar más homogénea. Se presentan mediciones funcionales con diferentes niveles de PEEP y valores de distribución en las distintas regiones de interés (ROI), además de un flujograma de situaciones en las que la TIE podría resultar útil para el ajuste ventilatorio. CONCLUSIÓN: La información funcional proporcionada por la TIE, permitió monitorizar de forma dinámica la VM y optimizar los parámetros ventilatorios, facilitando la implementación de estrategias de protección pulmonar en ambos pacientes, imposibilitados de realizar una medición estática de la mecánica respiratoria.

The Electrical Impedance Tomography (EIT) is a non-invasive and radiation-free respiratory functional imaging monitoring modality that allows real-time visualization of regional and global lung ventilation in adult and pediatric patients connected to mechanical ventilation (MV). OBJECTIVE: This paper describes the utility of EIT in two critical pediatric patients for whom measuring pulmonary mechanics was not feasible. EIT is used as a tool for adjusting ventilatory parameters. CLINICAL CASES: Two pediatric patients aged 27 and 11 months, with different clinical conditions, connected to MV are presented. EIT was used to monitor lung distribution and titrate the optimal Positive End-Expiratory Pressure (PEEP), to achieve more homogeneous lung ventilation. Functional measurements are presented with different PEEP levels and distribution values in different regions of interest (ROI), along with a flowchart illustrating situations where EIT could be useful for ventilatory adjustment. CONCLUSION: The functional information provided by EIT, allowed dynamic monitoring of MV, optimizing ventilatory parameters and facilitating the implementation of lung protective strategies in both patients, unable to undergo static respiratory mechanics measurements.

Pausas inspiratórias de 0.5 e 2.0 segundos durante avaliação de mecânica respiratória não produzem alterações hemodinâmicas em pacientes sob ventilação mecânica: estudo transversal / Inspiratory pauses of 0.5 and 2.0 seconds during respiratory mechanics assessment do not produce hemodynamic changes in mechanically ventilated patients: cross-sectional study

INTRODUÇÃO: A interação coração-pulmão influenciada pela Ventilação Mecânica (VM), que impacta diretamente no retorno venoso e débito cardíaco através, e não somente, de ajustes da Pressão Positiva Expiratória Final (PEEP) e Pressão média nas vias aéreas (Pmed). Além disso, as pausas inspiratórias para avaliação da mecânica pulmonar interrompem o movimento torácico, pode impactar mais nesta interação. OBJETIVO: Comparar as alterações hemodinâmicas durante os tempos de 0,5 e 2,0 segundos de pausa inspiratória durante as mensurações de mecânica respiratória. MÉTODOS: Trata-se de um estudo transversal, realizado nas unidades de terapia intensivas de um hospital público de Salvador/BA. Foram incluídos pacientes em uso de VM e acima de 18 anos. Os excluídos foram aqueles que apresentassem instabilidade hemodinâmica e hipoxemia sustentada durante a avaliação. Para caracterização amostral, os pacientes foram divididos em grupos daqueles com e sem afecções pulmonares. Os principais dados coletados e analisados foram PEEP, Pmed, Pressão Arterial Sistólica (PAS), Pressão Arterial Diastólica (PAD), Pressão Arterial Média (PAM), Frequência Cardíaca (FC). Para comparação de dados foram utilizados os testes Wilcoxon-Rank e Mann-Whitney para dados pareados e não pareados, respectivamente. RESULTADOS: Foram incluídos 37 pacientes, mediana de idade 63 anos, 19 (51,4%) do sexo masculino, 30 (81,1%) com diagnóstico admissional de natureza clínica. Não foram identificadas alterações hemodinâmicas estatisticamente significantes entre os tempos de pausa inspiratória de 0,5 e 2,0 segundos nas variáveis PAS (p=0,99), PAD (p=0,11), PAM (p=0,29) e FC (p=0,25). CONCLUSÃO: Não foram identificadas variações hemodinâmicas durante as mensurações da mecânica respiratória nas pausas de 0,5 e 2,0 segundos.

INTRODUCTION: The heart-lung interaction is influenced by Mechanical Ventilation (MV), which directly impacts venous return and cardiac output through, but not limited to, adjustments in Positive End-Expiratory Pressure (PEEP) and mean airway pressure (Pmean). Additionally, inspiratory pauses for the assessment of pulmonary mechanics interrupt thoracic movement, potentially further impacting this interaction. OBJECTIVE: To compare hemodynamic changes during 0.5 and 2.0-second inspiratory pauses during respiratory mechanics measurements. METHODS: This is a cross-sectional study conducted in the intensive care units of a hospital in Salvador/BA. Patients on MV and over 18 years old were included. Exclusions were made for those with hemodynamic instability and sustained hypoxemia during the evaluation. For sample characterization, patients were divided into groups with and without pulmonary conditions. The main data collected and analyzed were PEEP, Pmean, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), and Heart Rate (HR). For data comparison, Wilcoxon-Rank and Mann-Whitney tests were used for paired and unpaired data, respectively. RESULTS: Thirty-seven patients were included, with a median age of 63 years, 19 (51.4%) males, and 30 (81.1%) with an admission diagnosis of a clinical nature. No statistically significant hemodynamic changes were identified between the 0.5 and 2.0-second inspiratory pause times in the variables SBP (p=0.99), DBP (p=0.11), MAP (p=0.29), and HR (p=0.25). CONCLUSION: No hemodynamic variations were identified during respiratory mechanics measurements at 0.5 and 2.0-second inspiratory pauses.

Preliminary study of the population and reproductive dynamics of Echinaster sepositus (Spinulosida: Echinasteridae) in Cala del Racó / Estudio preliminar de la población y dinámica reproductiva de Echinaster sepositus (Spinulosida: Echinasteridae) en Cala del Racó

Abstract Introduction: The red starfish (Echinaster sepositus) is one of the most common asteroid species in the Mediterranean Sea. However, information about their biology or their role in benthic communities is scarce. Objective: This study aims to provide new information on the ecology of this species through the temporal characterization of the population of E. sepositus in Cala del Racó (Alicante, Spain) and the in situ monitoring of its reproductive cycle. Methods: For this purpose, three study areas were established at different depths. For each of the recorded starfish, data about the size, the substrate on which it was found, the area, the depth and the sex in the case of observing the reproduction were collected. Results: A total of 19 samplings have been carried out throughout a year of study. In this way, it has been possible to observe that the density of individuals increases in the shallower zone during autumn and winter, when the temperature drops to 14.13 ºC, while it decreases in spring and summer when the temperature rises to 27.17 ºC. Those results are reversed in the deepest part of the study. The highest density of individuals (0.51 ind/m2) occurred in October. Arborescent photophilic algae and crustose coralline algae were the substrates with the highest number of E. sepositus recorded. Medium to large specimens are located preferably on crustose coralline algae or arborescent photophilic algae, while smaller individuals were mostly located on Posidonia oceanica. No specimens of E. sepositus were observed spawning. Conclusions: Data leads to assume that there is a migration of starfishes towards more superficial areas when the water is at colder temperature and towards deeper areas when the temperature increases. It is valued the possibility that there is a change in the nutritional needs of E. sepositus throughout its development. According to our observations, the future reproduction studies should be concentrated between late-summer and early-autumn.

Resumen Introducción: La estrella de mar roja (Echinaster sepositus) es una de las especies de asteroideos más comunes del mar Mediterráneo. Sin embargo, la información sobre su biología o su papel en las comunidades bentónicas es escasa. Objetivo: Este estudio pretende aportar nueva información sobre la ecología de esta especie mediante la caracterización temporal de la población de E. sepositus en la Cala del Racó (Alicante, España) y el monitoreo in situ de su ciclo reproductivo. Métodos: Con este fin se establecieron tres zonas de estudio a distintas profundidades. Para cada una de las estrellas registradas se tomaron datos de tamaño, el sustrato sobre el que se encuentra, la zona, la profundidad y el sexo en caso de observar la reproducción. Resultados: A lo largo de un año de estudio se han realizado un total de 19 muestreos. De esta forma se ha podido observar que la densidad de individuos aumenta en la zona menos profunda durante otoño e invierno, cuando la temperatura del agua baja hasta los 14.13 ºC, mientras que se reduce en primavera y verano, cuando la temperatura se eleva hasta los 27.17 ºC. Este resultado se invierte en la zona más profunda del estudio. La mayor densidad de individuos ha sido observada en octubre (0.51 ind/m2). Las algas fotófilas arborescentes y las algas coralinales costrosas han sido los sustratos con un mayor número de E. sepositus registrados. Los ejemplares de tamaños medianos a grandes se localizan preferentemente sobre algas coralinales costrosas o algas fotófilas arborescentes, mientras que los individuos de menor tamaño se sitúan mayormente sobre Posidonia oceanica. No se observaron ejemplares de E. sepositus reproduciéndose. Conclusiones: Los datos permiten presuponer que existe una migración entre las zonas más superficiales, cuando la temperatura del agua es menor, y zonas más profundas cuando la temperatura aumenta. Se valora la posibilidad de la existencia de un cambio en los requerimientos nutricionales de E. sepositus a lo largo de su desarrollo. De acuerdo con nuestras observaciones, los estudios futuros sobre la reproducción de esta especie deben concentrarse entre finales de verano y principios de otoño.

Importância da interação entre comunidade e graduando, para uma formação humanizada: relato de experiência / Importance of interaction between community and undergraduate, for humanized training: experience report

Durante a vivência acadêmica, as universidades conectam seus futuros profissionais para assistência à comunidade, tendo em vista uma formação centrada na humanização dos pacientes. O programa de monitoria para a clínica interdisciplinar no tratamento de feridas, do Centro Universitário do Espírito Santo (UNESC), não se limita apenas ao campo teórico, abrangendo muito a prática com o corpo social e possibilita essa experiência com a comunidade de forma humanizada. Objetivo: Relatar a inter-relação com a sociedade durante o tempo de monitoria, como isso é importante para a capacitação de excelência, e também como essa humanização contribui para tratamento e evolução do paciente. Metodologia: O estudo consiste em um relato de experiência de um dos monitores da clínica de feridas durante um semestre de monitoria, apresentando caráter descritivo. Resultados e Discussão: Durante a vivência notou-se o quão importante é enxergar esse lado humano do paciente, não se preocupando apenas com suas queixas. Agindo desse modo, teve como resultado pacientes mais felizes, engajados com o tratamento e gostando de estar naquele ambiente, por mais doloroso que fosse o real motivo. Considerações finais: É vital para o graduando aprender a lapidar sua abordagem com o paciente, atuando de maneira holística. Essa interação entre universidade e corpo social é de fundamental importância para desenvolver profissionais que saiam ainda mais capacitados para o mercado de trabalho, principalmente quando se trata de profissionais da área da saúde, possibilitando mesclar assistência e atendimento, com o processo de ensino-aprendizado das práticas de saúde.(AU)

During their academic experience, universities connect their future professionals to assist the community, with a view to training centred on the humanization of patients. The monitoring program for the interdisciplinary wound care clinic at the Centro Universitário do Espírito Santo (UNESC) is not just limited to the theoretical field, but also encompasses a lot of practice with the social body and enables this experience with the community in a humanized way. Objective: To report on the interrelationship with society during the monitoring period, how important this is for the training of excellence, and also how this humanization contributes to the treatment and evolution of the patient. METHODOLOGY: The study consists of a report on the experience of one of the wound clinic monitors during a semester of monitoring, and is descriptive in nature. Results and Discussion: During the experience, we noticed how important it is to see the human side of the patient, not just worrying about their complaints. Acting in this way resulted in happier patients, engaged with the treatment and enjoying being in that environment, no matter how painful the real reason.Final considerations: It is vital for undergraduates to learn how to refine their approach to patients, acting in a holistic way. This interaction between the university and society is of fundamental importance for developing professionals who are even more qualified for the job market, especially when it comes to health professionals, making it possible to merge assistance and care with the teaching-learning process of health practices.(AU)

Durante su experiencia académica, las universidades vinculan a sus futuros profesionales con la asistencia a la comunidad, con vistas a una formación centrada en la humanización de los pacientes. El programa de acompañamiento de la clínica interdisciplinaria de cuidado de heridas del Centro Universitario do Espírito Santo (UNESC) no se limita apenas al campo teórico, sino que abarca mucha práctica con el cuerpo social y posibilita esta experiencia con la comunidad de forma humanizada. Objetivo: Informar sobre la interrelación con la sociedad durante el período de seguimiento, cuán importante es esto para la formación de excelencia, y también cómo esta humanización contribuye al tratamiento y evolución del paciente. Metodología: El estudio consiste en un informe sobre la experiencia de uno de los monitores de la clínica de heridas durante un semestre de monitorización, y es de naturaleza descriptiva. RESULTADOS Y DISCUSIÓN: Durante la experiencia, nos dimos cuenta de lo importante que es ver el lado humano del paciente, no sólo preocuparse por sus quejas. Actuar de esta manera resultó en pacientes más felices, comprometidos con el tratamiento y disfrutando de estar en ese ambiente, por más doloroso que sea el motivo real.Consideraciones finales: Es fundamental que los estudiantes universitarios aprendan a perfeccionar su abordaje con los pacientes, actuando de forma holística. Esta interacción entre la universidad y la sociedad es de fundamental importancia para el desarrollo de profesionales aún más cualificados para el mercado de trabajo, especialmente cuando se trata de profesionales de la salud, haciendo posible la fusión de la asistencia y el cuidado con el proceso de enseñanza-aprendizaje de las prácticas de salud.(AU)

Surgical site infection in patients undergoing hip and knee arthroplastie / Infección del sitio quirúrgico en pacientes sometidos a artroplastias de cadera y rodilla / Infecção de sítio cirúrgico em pacientes submetidos a artroplastias de quadril e joelho

Objective: To characterize cases of Surgical Site Infections (SSI) in patients undergoing hip and knee arthroplasties. Method: A cross-sectional, retrospective, and quantitative study conducted in a public, teaching, and high-complexity hospital in the southern region of Brazil. Data collection took place between 2020 and 2022 from records contained in 91 medical records and post-discharge forms within 90 days after surgery for prosthesis implan-tation. Data were analyzed by descriptive statistics and SSI incidence rate. Results: 49 (53.8%) knee arthroplasty records and 42 (46.2%) hip arthroplasty records were analyzed. Five cases developed infection, all detected at the post-arthroplasty knee outpatient visit, resulting in an SSI incidence rate in arthroplasties of 5.5% (n=5). Infections were characterized as deep incisional (40%; n=2), organ or cavity (40%; n=2), and superficial (20%; n=1), resul-ting in readmission in 80% of cases and a corresponding average hospitalization time of 11 days (SD=4.2). Conclusion: The significant rate of SSI in clean surgeries points to the need to intensify good surgical practices. Outpatient surveillance is emphasized as a strategy for building realistic indicators and providing support for prevention efforts. (AU)

Objetivo: Caracterizar los casos de Infecciones del Sitio Quirúrgico (ISQ) en pacientes sometidos a artroplastia de cadera y rodilla. Método: Investigación transversal, retrospectiva y cuantitativa realizada en un hospital público, docente y de alta complejidad en la región sur de Brasil. La reco-lección de datos se realizó entre 2020 y 2022 en registros contenidos en 91 historias clínicas y formularios posteriores al alta hospitalaria en un período de hasta 90 días después de la cirugía destinada al implante de la prótesis. Los datos fueron analizaron mediante estadística descriptiva y tasa de incidencia de ISQ. Resultados: Se analizaron 49 (53,8%) registros de artroplastia de rodilla y 42 (46,2%) de cadera. Cinco casos evolucionaron con infección, todos detectados en el seguimiento ambulatorio después de la artroplastia de rodilla, lo que resultó en una tasa de incidencia de ISQ en artroplastias del 5,5% (n=5). Las infecciones se caracterizaron como incisionales profundas (40%; n=2), de órgano o cavidad (40%; n=2) y superficiales (20%; n=1); resultando en reingreso en el 80% de los casos y el correspondiente tiempo promedio de hospitalización de 11 días (SD=4,2). Conclusión: La tasa significativa de ISQ en cirugías limpias apunta a la necesidad de intensificar las buenas prácticas quirúrgicas. Se reitera la vigilancia ambulatoria como estrategia para la construcción realista de indicadores y apoyo a la prevención. (AU)

Objetivo: Caracterizar os casos de Infecções de Sítio Cirúrgico (ISC) em pacientes submetidos a artroplastias de quadril e joelho. Método:Pesquisa transversal, retrospectiva e quantitativa realizada em um hospital público, de ensino e de alta complexidade da região sul do Brasil. A coleta de dados ocorreu entre 2020 e 2022 em registros contidos em 91 prontuários e fichas pós alta hospitalar no período de até 90 dias após a cirurgia destinada ao implante da prótese. Os dados foram analisados por estatística descritiva e taxa de incidência de ISC. Resultados: Foram analisados 49 (53,8%) regis-tros de artroplastia de joelho e 42 (46,2%) de quadril. Cinco casos evoluíram com infecção, todos detectados no retorno ambulatorial pós artroplastia de joelho, resultando em taxa de incidência de ISC em artroplastias de 5,5% (n=5). As infecções foram caracterizadas como incisional profunda (40%; n=2), de órgão ou cavidade (40%; n=2) e superficial (20%; n=1); decorrendo em reinternação em 80% dos casos e correspondente tempo médio de hospitaliza-ção de 11 dias (DP=4,2). Conclusão: O expressivo índice de ISC em cirurgias limpas direciona para a necessidade de intensificar boas práticas cirúrgicas. Reitera-se a vigilância ambulatorial como estratégia para a construção realística de indicadores e subsídio para a prevenção. (AU)

Mortalidade por COVID-19 em um município do Oeste Baiano: incidência e fatores de risco / Mortality by COVID-19 in a municipality in Western Bahia: incidence and risk factors

Objetivo: descrever e analisar os fatores de risco associados aos óbitos por COVID-19 no município de Barreiras-BA. Método: estudo de coorte em que foram analisadas as notificações de casos positivos da doença no período de março de 2020 a dezembro de 2022. As variáveis incluídas foram: sexo, idade, raça/cor, sintomas apresentados e condições de saúde. Para verificar a associação entre as variáveis, foi utilizada Regressão de Poisson, com estimativa do risco relativo. Resultados: Ocorreram 348 óbitos no período analisado, sendo estes mais frequentes em homens (60,6%), idosos (58,9%), pretos/pardos (88,1%). Os principais sintomas apresentados pelos indivíduos que vieram a óbito foram a tosse (67,8%), a dispneia (62,9%) e a febre (53,4%), e as principais comorbidades as doenças cardíacas (39,1%) e o diabetes (21,8%). Foram encontrados como fatores de risco associados à ocorrência do óbito ser do sexo masculino e idoso e ter apresentado sintomas como dispneia e febre, além de apresentar comorbidades como doenças respiratórias, cardíacas, diabetes, renais, imunossupressão, doenças cromossômicas e obesidade (p < 0,05). Ter tido sintomas como dor de garganta, dor de cabeça, coriza e distúrbios olfativos demonstraram menor risco de morte (p < 0,05). Conclusão: O número de mortes ocorridas por COVID-19 foi considerado baixo, com risco maior para homens e idosos e indivíduos com outras doenças prévias. Apresentação de sintomas mais graves, como febre e dispneia, também aumentam o risco de morte.

Objective: the objective of this study was to describe and analyze the risk factors associated with deaths from COVID-19 in the city of Barreiras-BA. Methods: a cohort study in which notifications of positive cases of the disease were analyzed from March 2020 to December 2022. The variables included were sex, age, race/color, presented symptoms, and health conditions. Poisson Regression was used to verify the association between variables with relative risk estimation. Results: There were 348 deaths in the period analyzed, these being more frequent in men (60.6%), elderly people (58.9%), black/brown people (88.1%). The main symptoms presented by the individuals who died were cough (67.8%), dyspnea (62.9%) and fever (53.4%), and the main comorbidities were heart disease (39.1%) and diabetes (21.8%). Risk factors associated with the occurrence of death were found to be male and elderly and having symptoms such as dyspnea and fever, in addition to presenting comorbidities such as respiratory, cardiac, diabetes, kidney diseases, immunosuppression, chromosomal diseases and obesity (p < 0 .05). Having had symptoms such as sore throat, headache, runny nose and olfactory disorders demonstrated a lower risk of death (p < 0.05). Conclusion: The number of deaths caused by COVID-19 was considered low, with a higher risk for men and the elderly and individuals with other previous illnesses. Presentation of more serious symptoms, such as fever and dyspnea, also increases the risk of death.

Monitoramento de vetores do gênero Aedes durante o inverno no município de Barbacena, Minas Gerais, Brasil ­ 2018 / Monitoring of vectors of the genus Aedes during winter in the municipality of Barbacena, Minas Gerais, Brazil ‒ 2018

Objetivo: estimar a oviposição e distribuição espacial de vetores Aedes durante a estação de inverno e correlacionar essas estimativas com dados climáticos do mesmo período. Métodos: estudo de campo conduzido no município de Barbacena-MG, em 2018. O monitoramento, a coleta de ovos e a estimativa de índices estegômicos de vetores Aedes foram obtidos por meio de ovitrampas. Os Índices de Densidade de Ovos (IDO) e de Positividade de Ovitrampas (IPO%) foram estimados conforme estações climáticas e semanas epidemiológicas. A correlação entre parâmetros meteorológicos (temperatura/pluviometria) e índices estegômicos (IDO/IPO) foi determinada pelo coeficiente de Spearman. Resultados: um total de 1.080 ovitrampas, instaladas em 39 bairros, foi analisado durante 10 semanas epidemiológicas, fornecendo um total de 970 ovos. Nas estações de outono, inverno e primavera, foram obtidos, respectivamente, 421, 470 e 70 ovos. Durante o outono, houve variação do IDO entre 14,2 e 34,2. O IPO manteve-se constante em 4,5%. Durante o inverno, houve variação do IDO entre 0,00 e 47,50 e do IPO entre 0,00% e 8,25%. Houve correlação negativa significativa tanto entre aumento da precipitação mensal e diminuição do número de ovos coletados (rho=-0.673) quanto entre aumento da precipitação mensal e diminuição do IPO (rho=-0.612). O valor geral do IDO e do IPO nas 10 semanas foi, respectivamente, 22,04 e 4,17% e, na estação de inverno, foi, respectivamente, 23,50 e 3,73%. Conclusão: os achados corroboram a presença de ovos e vetores do gênero Aedes mesmo em condições climáticas adversas para essas espécies e sustentam ações de manejo sanitário durante todo o ano.

Objective: to estimate oviposition and spatial distribution of Aedes vectors during the winter season and correlate these estimates with climate data from the same period. Methods: field study conducted in the municipality of Barbacena-MG in 2018. Monitoring, egg collection, and estimation of stegomic indices of Aedes were obtained using ovitraps. The Indices of Egg Density (EDI) and Positive Ovitrap (POI%) were estimated according to climatic seasons and epidemiological weeks. The correlation between meteorological parameters (temperature/rainfall) and stegomic indices (EDI/POI) was determined by the Spearman coefficient. Results: a total of 1,080 ovitraps installed in 39 neighborhoods were analyzed during ten (10) epidemiological weeks, providing a total of 970 eggs. In the autumn, winter, and spring seasons, 421, 470, and 70 eggs were obtained, respectively. During the autumn, there was a variation in EDI between 14.2­34.2. The POI remained constant at 4.5%. During the winter, the EDI varied between 0.00­47.50, and the POI varied between 0.00%­8.25%. There was a significant negative correlation, respectively, between an increase in monthly precipitation and a decrease in the number of eggs collected (rho=-0.673) and between an increase in monthly precipitation and a decrease in POI (rho=-0.612). The overall value of EDI and POI in the ten (10) weeks was 22.04 and 4.17%, and in the winter season, they were 23.50 and 3.73%, respectively. Conclusion: the findings corroborate the presence of eggs and vectors of the genus Aedes even in adverse climatic conditions for these species and support health management actions throughout the year.

Práticas Avançadas de Enfermagem ­ PAE / Advanced Nursing Practices ­ ANP

Trata de nota técnica sobre Práticas Avançadas de Enfermagem (PAE) no Brasil, elaborada por comissão e submetida à aprovação do plenário do Conselho Federal de Enfermagem (Cofen). O documento aborda conceitos, ações, implementação e regulação das práticas avançadas de Enfermagem, expandindo os limites do escopo da atuação do enfermeiro e reforçando a sua prática clínica. (AU)

This is a technical note on Advanced Nursing Practices (ANP) in Brazil, prepared by a committee and submitted for approval by the plenary of the Federal Nursing Council (Cofen). The document addresses concepts, actions, implementation and regulation of advanced nursing practices, expanding the limits of the scope of nurses' work and reinforcing their clinical practice. (AU)

Esta es una nota técnica sobre las Prácticas Avanzadas de Enfermería (PAE) en Brasil, elaborada por un comité y sometida a la aprobación del plenario del Consejo Federal de Enfermería (Cofen). El documento aborda los conceptos, acciones, implementación y reglamentación de las prácticas avanzadas de enfermería, ampliando los límites del ámbito de actuación de las enfermeras y reforzando su práctica clínica. (AU)

Advantages of intraventrilular intracranial pressure monitoring with modified paine point puncture in decompression of severe traumatic brain injury / 解放军医学杂志

Objective To explore the advantages of modified Paine point puncture for intraventricular intracranial pressure(ICP)monitoring probe implantation during decompressive craniectomy(DC)for severe traumatic brain injury.Methods The clinical data of 48 patients with severe traumatic brain injury admitted from April 2020 to April 2022 in Jiaxing Second Hospital were retrospectively collected.All patients underwent DC combined with ICP monitoring probe implantation.According to different ICP monitoring methods,they were divided into observation group(23 cases)and control group(25 cases).The observation group underwent the implantation of the intracerebroventricular ICP monitoring probe by puncture at the modified Paine point in the DC incision,while the control group underwent implantation of intracerebroventricular ICP monitoring probe by drilling of the skull through contralateral incision of DC at the Kocher point.The preoperative general data,operation time,postoperative mannitol dose and duration,ICP monitoring duration,postoperative rebleeding rate,intracranial infection rate and Glasgow outcome score(GOS)at 3 months after the operation were compared between the two groups.Results There was no statistical difference between the two groups in general data,mannitol dosage,mannitol duration and ICP monitoring duration(P>0.05).The operation time,postoperative rebleeding rate and intracranial infection rate in observation group were lower than those in control group(P<0.05).In the GOS score at 3 months after the operation,there was no statistical difference between the two groups(P>0.05).Conclusions Compared with the traditional implantation of intraventricular ICP monitoring probe through Kocher point through skull drilling with contralateral incision of DC,the implantation of intraventricular ICP monitoring probe through modified Paine point in the DC incision for severe traumatic brain injury can shorten the operation time and lower the postoperative rebleeding rate and intracranial infection rate.

Research progress in technologies for on-site monitoring and evaluation of fatigue during military operations / 军事医学

The accumulation of fatigue during military operations may lead to decreased operational efficiency and non-combat attrition,which can impact combat effectiveness.On-site monitoring and evaluation of fatigue during military operations,as an important means to keep track of military operations and bring about quick changes in training,underlie the combat effectiveness of military personnel.Focusing on the on-site monitoring and evaluation methods of fatigue during military operations,this paper reviews the determinants of such fatigue as well as on-site monitoring and comprehensive evaluation methods so as to provide reference for accurate and efficient evaluation of fatigue during military operations and for early warning of such fatigue.

Current research on driving fatigue induced by special vehicles / 军事医学

Fatigue-related traffic accidents and fatalities have been extensively studied by scholars globally.Specialized vehicles,due to their unique mission profiles,are more likely to cause driving-related fatigue and serious consequences.This paper reviews the current research of fatigue driving by using an inductive analysis method to summarize the mechanisms,risk factors,and monitoring methods.This paper also offers a vision of priorities and methodologies for research in the future.It is recommended that the mechanisms of driving fatigue be explored at the molecular biological level and that fatigue monitoring systems be made more feasible via the combined application of non-intrusive monitoring in order to reduce the toll on life and property taken by driving fatigue.

Analysis of Cumulative Live Birth Rate of Selective Single Embryo Transfer by Time-lapse Monitoring System and Conventional Morphological Assessment in IVF/ICSI-ET / 实用妇产科杂志

Objective:To analyse the clinical significance of selective single embryo transfer by time-lapse mo-nitoring(TLM)or conventional morphology assessment(CMA)in vitro fertilization/intracytoplasmic sperm in-jection and embryo transfer(IVF/ICSI-ET),and to initially explore the predictive value of Raman spectral analy-sis of embryo culture medium for clinical pregnancy rate.Methods:The study is a prospective randomized con-trolled clinical trial.We assigned 139 patients treated with IVF/ICSI-ET in Reproductive and Genetics Center of Suzhou Municipal Hospital from April 2019 to July 2020,which were randomly assigned to either the CMA or the TLM group.We performed selective single-embryo transfer(fresh cycle and FET)after selecting the optimal em-bryos with TLM or CMA respectively.If the patient's first embryo transfer was unsuccessful,a second one would be performed to compare the differences in the cumulative live birth rate of embryo transfer and other pregnancy outcomes between the two groups.Meanwhile,we collected 15 μl of embryo culture medium at day 3 after IVF/ISCI fertilization for Raman spectroscopy analysis.Results:There were no differences in cumulative live birth,cu-mulative clinical pregnancy,cumulative premature birth,cumulative early spontaneous abortion,cumulative ectopic pregnancy and LGA or SGA between TLM and CMA groups(P＞0.05).The Neonatal sex ratio in the TLM group was lower than that in the CMA group,but the difference was not significant(P＞0.05).Raman spectros-copy analysis of embryo culture medium predicted the clinical pregnancy rate with 67.21％accuracy.Conclu-sions:In young women with a good ovarian reserve,the advantage of using TLM to evaluate embryos is not obvi-ous,so we should remain vigilant that embryo selection based on morphokinetic parameters may affect the sex ratio.Raman spectroscopic analysis of embryo culture medium is not yet able to effectively predict the planting ability of embryos.

Effects of different frequency of blood glucose monitoring on glucose control in overweight/obese young and middle aged people with prediabetes / 中国实用护理杂志

Objective:To explore the effectiveness of blood glucose monitoring at different frequencies on the control of blood glucose in overweight/obese prediabetes population on the basis of health education, and to provide a basis for blood glucose monitoring and management in prediabetes population.Methods:A randomized controlled study was used. 90 prediabetes patients from the Physical Examination Center/Endocrine Clinic/Endocrine Ward of the First Affiliated Hospital of China Medical University from January to March 2021 were selected by continuous sampling method, and were randomly divided into the group A, B and C by lottery method, with 30 patients in each group, and the study period was 12 months. Group A, B and C received unified health education guidance at enrollment, 6-month follow-up, and 12-month follow-up. Group A underwent blood glucose monitoring every 6 months, group B underwent blood glucose monitoring every 3 months, group C underwent blood glucose monitoring every month. Recorded and compared the levels of glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), 2-hour post-load blood glucose (2 hPG), and body mass index (BMI) of three groups at the time points of enrollment, 6-month follow-up, and 12-month follow-up.Results:There were 15 males and 15 females in the group A, 14 males and 16 females in the group B, 12 males and 18 females in the group C. The ages in the group A, B and C were (48.37 ± 10.80), (49.20 ± 9.25) and (44.77 ± 12.28) years old respectively. At the time point of 12-month follow-up, the HbA1c in the group A, B and C were (6.01 ± 0.36)%, (5.82 ± 0.35)% and (5.64 ± 0.27)%, the difference was significant ( F=9.72, P<0.05); the FPG in the group A, B and C were (5.64 ± 0.88), (5.05 ± 0.53) and (4.98 ± 0.48)mmol/L, the difference was significant ( F=9.23, P<0.05); the 2 hPG in the group A, B and C were (9.38 ± 1.23), (8.23 ± 0.72) and (7.71 ± 0.86) mmol/L, the difference was significant ( F=23.89, P<0.05); the BMI in the group A, B and C were (28.52 ± 4.24), (27.02 ± 2.67) and (25.56 ± 1.34) kg/m 2, the difference was significant ( F=7.37, P<0.05). Conclusions:On the basis of health education, compared with the routine blood glucose monitoring once every six months, blood glucose monitoring once every three months and once every month can improve the blood glucose control and BMI level of overweight/obese young and middle-aged people with prediabetes, and provide a basis for seeking an effective and economic blood glucose monitoring mode in clinical practice.

The predictive value of MP hypertension monitoring system combined with PLGF and PI for preeclampsia / 天津医药

Objective To establish a clinical prediction model for preeclampsia by monitoring risk rating of MP gestation and levels of placental growth factor(PLGF)combined with uterine artery pulsatility index(PI)measured during examination of fetal nuchal translucency(NT).Methods Twenty-four patients with preeclampsia who met the inclusion criteria were selected as the case group,and 95 healthy pregnant women during the same period were randomly selected as the control group.Serum concentrations of PLGF,uterine artery PI values measured by quantitative immunofluorescence assay at 11-14 weeks of gestation,risk ratings for MP hypertension monitoring at 11-20 weeks of gestation,and other relevant data,BMI,age,gestation,mode of delivery,neonatal birth weight and Apgar score were collected in the two groups.Results Results of univariate regression analysis showed that BMI,age,high risk of PI,MP and PLGF<12 were influencing factors for adverse outcomes.Results of multivariate regression analysis showed that high PI,medium high risk in MP and PLGF<12 were independent risk factors for adverse outcomes.The prediction model of PE established was logit(P)=-15.767 + 0.020×PI + 0.072×MP risk(medium-high risk = 1,low risk = 0)+ 0.181×PLGF classification(＜12 = 1,≥12 = 0),with an AUC area of 0.883,specificity of 0.816 and sensitivity of 0.846.Conclusion The combination of PI,MP risk and PLGF to establish a clinical predictive model for preeclampsia has certain value,and its combined predictive value is higher than that of single application.

Study on neurological monitoring with cortical electrodes in thyroidectomy / 西安交通大学学报(医学版)

Objective To compare the synergies between the transcutaneous needle electrodes and the ETT surface electrodes used for neurological surveillance in thyroidology,and explore how to identify and protect recurrent laryngeal nerve and vagus nerve when the patient is not suitable for oral plug or surface electrodes are failure.Methods To collect and analyze the clinical data of 32 patients undergoing surgical treatment for thyroid disease,a total of 40 neurons of the recurrent laryngeal nerves and vagus nerves were monitored,and the amplitude and latency were recorded using ETT surface electrodes and transcutaneous needle electrodes for nerve monitoring,respectively.SPSS 26.0 software was used for statistical analysis,paired t-tests were used to analyze and compare the latency periods,and the rank sum test was used to analyze whether there is a difference in the amplitude obtained from stimulation of transcutaneous needle electrodes and ETT surface electrodes.Results When the transcutaneous needle electrodes were used in thyroid surgery,we identified all the nerves,obtained two-phase electrical signals similar to the latency and amplitude of the ETT surface electrodes,and could effectively identify the recurrent laryngeal nerve and vagus nerve[(3.22±0.50)ms vs.(3.85±1.00)ms,P＜0.05]through the incapacity period,with no obvious difference in the monitoring effect from the ETT surface electrodes[(3.04±0.58)ms vs.(3.89±1.07)ms,P＜0.05].At the same time,the visualization and safety of transcutaneous needle electrodes were higher,with great advantages.Conclusion Transcutaneous needle electrodes can effectively assist in identifying and protecting the recurrent laryngeal nerve and vagus nerve,and thus are an important supplement to ETT surface electrodes.

Analysis of hot topics and frontiers on blood pressure monitoring in research of chronic kidney disease at home and abroad,2011-2022 / 现代临床护理

Objective To analyse the hot topics(CKD)frontiers,and of blood pressure monitoring in research of chronic kidney disease(CKD)at home and abroad,and provide references for future research in this field.Methods Articles on blood pressure monitoring in published in Web of Science,China Knowledge Network Infrastructure(CNKI),Wanfang(Wanfang Data)and China Science and Technology Journal Database(VIP)from 2011 to 2022 were searched,and CiteSpace 5.8.R3 visual analysis software was employed to analyse the number of articles involved,country,institution,keyword co-occurrence.The analysis was performed on the number of published papers,countries,institutions,keyword co-occurrence atlas,high frequency subject terms,keyword emergence and emergence of literatures.Results ① A total of 504 articles in English and 72 articles in Chinese were extracted from the literature search.Annual distribution of the number of articles generally showed a continuous upward trend,in which 2 peaks of articles were formed in 2016 and 2018;the main country of issuance was the United States,and the main institution of issuance was the Aristotle University of Thessaloniki,Greece;② In the analysis of keyword co-occurrence,8 high-frequency keywords with a word frequency greater than or equal to 30 were identified.It indicated that the research hotspots mainly focused on the classification of hypertension,the characteristics of blood pressure circadian rhythm,the management of cardiovascular disease and the prediction of death and prognosis in the blood pressure monitoring of CKD;③ Further testing of the emergent terms and emergent literatures yielded 23 strongest emergent terms and 11 emergent literatures,which went through three stages of development,namely,early,intermediate and latest.It was found that the research gradually shifted from the application of blood pressure monitoring in the assessment and diagnosis of kidney disease to the treatment,management and prognostic assessment of hypertension in CKD Conclusion The importance of blood pressure monitoring in the management of hypertension in CKD has received increasing attention from researchers,and future researches should focus on using different blood pressure monitoring schemes to enhance the assessment of cardiovascular risks and the individualised management of hypertension.

Exploration of the application of hospital quality monitoring system in medical quality management / 现代医院

Objective To explore and analyze the application effect of hospital quality monitoring system in medical quality management.Methods 800 patients from March 2021 to March 2022 were selected as the control group and routine medical quality management was adopted;and 800 patients from April 2022 to April 2023 were selected as the experimental group and the hospital quality monitoring system was adopted for medical quality management.Results The complication rate and re-admission rate after implementation were significantly lower than before implementation,with statistical significance(P＜0.05).The satisfaction of patients after implementation was significantly higher than before implementation,and the difference was statis-tically significant(P＜0.05).The score of medical service quality after implementation was significantly higher than before im-plementation,and the difference was statistically significant(P＜0.05).Conclusion The application effect of hospital quality monitoring system in medical quality management is remarkable,and it is worthy of promotion.

Design and implementation of multi-point trigger system for infectious disease warning / 现代医院

Objective With the focus on emerging infectious diseases and diseases of unknown cause,the study aims to realize multi-point trigger monitoring of infectious diseases through key monitoring sites and key populations.Methods Using ar-tificial intelligence,deep learning,big data and other information technologies to build an intelligent information center for infec-tious diseases with patients'disease files as the core,construct a core capacity of infectious disease surveillance,early warning and situation prediction,and predict and evaluate the importance of infectious disease warning signals.Results The system cov-ered 1 425 primary-level medical institutions,18 hospitals,2 580+schools,4 134 pharmacies,4 laboratories and civil affairs departments,detected 55 kinds of infectious diseases and 6 kinds of syndrome monitoring signals.Since its launch,121 000 ac-tive notification cards have been issued,more than 54 000 new notification cards have been added,35.256 million times of multi-source monitoring and 14.4 million disease files have been recorded.Conclusion By expanding monitoring content and chan-nels,we realized early monitoring,auxiliary investigation and multi-mode visual early warning of infectious diseases,built a multi-point trigger mechanism,and moved forward the infectious disease surveillance.