Infectious endarteritis in aortic coarctation: two spectra of an infrequent disease / Endarterite infecciosa na coarctação da aorta: dois espectros de uma doença pouco frequente

ABSTRACT Objective: To describe two different degrees of clinical commitment and results in the evolution of infectious endarteritis in patients without a previous diagnosis of aortic coarctation. Case description: Two male patients aged 13 and 9 years old were admitted. The first due to a fever for 2 months, which started after dental cleaning, and the second due to high blood pressure, both patients with asthenia and weight loss. In the first case, the transthoracic echocardiogram showed aortic coarctation, and the transesophageal echocardiogram showed the presence of vegetations in the post-coarctation area, without pseudoaneurysms, with blood culture positive for Streptococcus mitis. This patient was treated for six weeks with crystalline penicillin, resolving the infection without complications. The second case was assessed for high blood pressure with a history of fever, and was treated with antibiotics. When performing a transthoracic echocardiogram, aortic coarctation was observed with a saccular image classified as a pseudoaneurysm by angiography and tomography. Blood culture was negative, and the patient developed an episode of hematemesis whose initial etiology could not be determined. Before surgical repair, he had a second episode of copious hematemesis with hypovolemic shock and death. Comments: We need to have a high index of clinical suspicion to establish the diagnosis of aortic coarctation complicated by endarteritis and start the appropriate antibiotic treatment, always maintaining surveillance for the early detection of pseudoaneurysms.

RESUMO Objetivo: Descrever dois diferentes graus de comprometimento clínico e resultados na evolução de endarterite infecciosa em pacientes sem diagnóstico prévio de coarctação da aorta. Descrição do caso: Dois pacientes do sexo masculino com idades entre 13 e nove anos foram internados. O primeiro por febre durante dois meses, iniciada após limpeza dentária. O segundo por hipertensão arterial. Ambos com astenia e perda de peso. No primeiro caso, o ecocardiograma transtorácico mostrou coarctação da aorta e o ecocardiograma transesofágico revelou vegetações na área pós-coarctação, sem pseudoaneurismas. A hemocultura foi positiva para de Streptococcus mitis. Este paciente foi tratado por seis semanas com penicilina cristalina, resolvendo a infecção sem complicações. O segundo caso foi avaliado pela presença de hipertensão arterial, com história de febre tratada com antibióticos. Ao realizar o ecocardiograma transtorácico, observou-se coarctação da aorta com imagem sacular classificada como pseudoaneurisma pela angiografia e tomografia. A hemocultura foi negativa. O paciente desenvolveu um episódio de hematêmese, cuja etiologia inicial não pôde ser determinada. Antes da correção cirúrgica, apresentou um segundo episódio de hematêmese profusa, com choque hipovolêmico e óbito. Comentários: Devemos ter um alto índice de suspeição clínica para poder estabelecer o diagnóstico de coarctação da aorta complicada com endarterite e iniciar o tratamento antibiótico adequado. É preciso manter a vigilância para a detecção precoce de pseudoaneurismas.

Traslado no programado de pacientes pediátricos desde una sala de internación general a una unidad de cuidados intensivos / Unplanned transfer of pediatric patients from the general ward to the intensive care unit

Introducción. Durante la internación, los pacientes pueden presentar un deterioro clínico significativo y requerir el ingreso no programado a la unidad de cuidados intensivos pediátricos (UCIP). Esto puede conllevar un aumento de la morbilidad y la mortalidad. Frecuentemente, estos eventos están precedidos por una fase de deterioro que podría pasar desapercibida. Objetivo. Determinar la frecuencia, analizar las causas, describir las características clínicas y los resultados de los traslados no programados en pacientes pediátricos hospitalizados, desde el área de internación general pediátrica (IGP) a la UCIP, y analizar las diferencias entre traslados urgentes y emergentes. Población y métodos. Estudio descriptivo prospectivo; se analizaron todos los traslados no programados desde IGP a la UCIP ocurridos entre el 1 de enero de 2014 y el 31 de diciembre 2019. Resultados. Se constataron 212 traslados no programados (21 traslados cada 1000 ingresos). El 76 % de los pacientes trasladados presentaban una comorbilidad asociada ­la más frecuente fue la patología oncológica (36 %)­ y llevaban más de 24 horas internados en IGP. Las causas más frecuentes de traslado fueron dificultad respiratoria (43 %), sepsis (20 %) y complicaciones neurológicas/neuroquirúrgicas (20 %). La tasa de mortalidad global fue del 8,96 % (19 pacientes). Conclusiones. El análisis de los traslados no programados es un elemento esencial en la evaluación de la calidad de atención y seguridad del paciente de un área, y debe constituir un indicador integrado al tablero de control. La interpretación de los traslados no programados como un evento prevenible constituye un cambio de paradigma clave.

Introduction. During hospitalization, patients may develop significant clinical deterioration and require unplanned admission to the pediatric intensive care unit (PICU). This may result in increased morbidity and mortality. These events are often preceded by a deterioration phase that may go unnoticed. Objective. To determine the frequency, analyze the causes, and describe the clinical characteristics and outcomes of unplanned transfers of hospitalized pediatric patients from the general pediatric ward (GPW) to the PICU, and analyze the differences between urgent and emergent transfers. Population and methods. Prospective, descriptive study; all unplanned transfers from the GPW to the PICU occurring between January 1st, 2014 and December 31st, 2019 were analyzed. Results. There were 212 unplanned transfers (21 transfers per 1000 admissions). An associated comorbidity was present in 76% of transferred patients ­being cancer the most frequent one (36%)­ and they had been hospitalized for more than 24 hours in the GPW. The most frequent causes of transfer were respiratory distress (43%), sepsis (20%), and neurological/neurosurgical complications (20%). The overall mortality rate was 8.96% (19 patients). Conclusions. The analysis of unplanned transfers is a critical component in the assessment of the quality of care and patient safety of an area, and should be an indicator integrated into the control panel. The interpretation of unplanned transfers as a preventable event is a key paradigm shift.

Función sexual y calidad de vida relacionada con la salud en mujeres climatéricas con prolapso genital en Centros de Salud Familiar de la región de Ñuble / Sexual function and health related quality of life in climacteric women with genital prolapse in Family Health Centers of the Ñuble region

RESUMEN Introducción y objetivos: Los síntomas de climaterio junto con el prolapso genital en la mujer que envejece, afectan la función sexual y la calidad de vida relacionada con la salud. El objetivo de este estudio fue describir la función sexual y la calidad de vida relacionada con la salud en mujeres climatéricas con prolapso genital según características sociodemográficas y clínicas. Métodos: Diseño descriptivo de corte transversal, sobre una muestra consecutiva de 45 mujeres climatéricas inscritas en dos Centros de Salud Familiar de la región de Ñuble, se seleccionaron a todas aquellas entre 42 y 60 años de edad, con diagnóstico clínico o ecográfico de prolapso genital, con vida sexual activa los últimos 6 meses y sin terapia hormonal de reemplazo. Para evaluar la función sexual se aplicó el Índice de Función Sexual Femenina y para la calidad de vida relacionada con la salud el Menopause Rating Scale. Se utilizó estadística descriptiva, y para analizar la diferencia entre las variables se aplicaron las pruebas estadísticas Chi-cuadrado y Test Exacto de Fisher. En todos los casos se consideró un nivel de significancia p<0,05. Los datos fueron analizados con el software estadístico SPSS v. 23. Resultados: Se observó una diferencia estadísticamente significativa entre escolaridad y función sexual (p= 0,005) y el tipo de parto y la calidad de vida relacionada con la salud (p=0,034). Conclusiones: El nivel educacional se podría considerar como factor protector de la función sexual.

SUMMARY Introduction and objectives: The climacteric symptoms together with genital prolapse in the aging woman, affects the sexual function and the health related quality of life. The objective of this study was to describe sexual function and health related quality of life in climacteric women with genital prolapse according to sociodemographic and clinical characteristics. Methods: Descriptive cross-sectional design, on a consecutive sample of 45 climacteric women enrolled in two Family Health Centers of the Ñuble region, were selected all those between 42 and 60 years of age, with a clinical or ultrasound diagnosis of genital prolapse, with active sexual life the last 6 months and without hormone replacement therapy. To evaluate sexual function the Index of Feminine Sexual Function was applied and for the health related quality of life the Menopause Rating Scale was applied. Descriptive statistics were used, and to analyze the difference between the variables, the Chi-square and Fisher's Exact test were applied. In all cases a level of significance was considered p <0.05. The data was analyzed with the statistical software SPSS v. 23. Results: A statistically significant difference was observed between schooling and sexual function (p = 0.005) and type of delivery and health related quality of life (p = 0.034). Conclusions: The educational level could be considered as a protective factor of sexual function.

Ansiedad, depresión y sobrecarga en cuidadores primarios de pacientes internados en un hospital general de zona en Nuevo León, México / Anxiety, depression and fatigue in primary caregivers of hospitalized patients in a general hospital in Nuevo León, México

Resumen

Introducción: los cuidadores de enfermos enfrentan vulnerabilidad y tensión física y emocional, por lo que se incrementa el riesgo de problemas de salud mental. Algunos experimentan agobio y culpabilidad, que pueden provocar incapacidad para seguir atendiendo al enfermo.

Objetivo: determinar el grado de sobrecarga y la presencia de ansiedad y depresión en los cuidadores primarios de pacientes hospitalizados en un hospital general de zona (HGZ).

Metodología: estudio descriptivo, transversal y prospectivo. Se aplicaron 480 encuestas a cuidadores de pacientes en un HGZ, seleccionándolos mediante un muestreo aleatorio por conglomerados, distribuyendo el número de sujetos proporcionalmente por servicio. Se aplicaron las escalas de Katz (incapacidad), Zarit (sobrecarga) y Goldberg (ansiedad-depresión).

Resultados: los cuidadores fueron principalmente mujeres (68%), en su mayoría amas de casa. La edad media fue 42.9 ± 9 años. Las enfermedades prevalentes en los cuidadores fueron diabetes (10%) e hipertensión (8%). En los pacientes, el promedio de internamiento fue de 12 días y la media diaria de horas de permanencia del cuidador fue de 10. Hubo una correlación positiva entre las horas de permanencia diaria del cuidador en el hospital y el grado de sobrecarga, ansiedad y depresión.

Conclusiones: Tener más hermanos puede atenuar la presencia de depresión. A mayor cantidad de horas dentro del hospital al cuidado del paciente, mayor sobrecarga, ansiedad y depresión.

Abstract

Introduction: Caregivers of sick people face vulnerability, as well as emotional and physical stress, which is why the risk of having mental health issues increases. Some of these caregivers feel overwhelmed, and experience feelings of guilt that can lead them to an inability to continue assisting their sick relative.

Objective: To establish the fatigue grade and the presence of anxiety and depression in primary caregivers of patients hospitalized in a general hospital.

Methods: Descriptive, cross-sectional and prospective study. 480 surveys were administered to caregivers of patients. These were selected through a cluster sampling and the number of subjects was distributed proportionally by service. We used Katz (inability), Zarit (fatigue) and Goldberg (anxiety-depression) scales.

Results: Primary caregivers of hospitalized patients were mainly women (68%), mostly housewives. Mean age was 42.9 ± 9 years. The most frequent illnesses in caregivers were diabetes (10%) and hypertension (8%). The average of days of patients' stay was 12 and the average hours of stay for caregivers per day was 10. There was a positive correlation between the caregiver's daily hours of stay and fatigue, anxiety and depression.

Conclusions: Having a greater number of siblings can mitigate the presence of depression. The more hours the caregiver spends inside the hospital increases the fatigue, the anxiety and the depression.

The Incidence of Transient Neonatal Tyrosinemia Within a Mexican Population

Abstract Transient neonatal tyrosinemia (TNT) is a form of hypertyrosinemia produced by the immaturity of 4-hydroxyphenylpyruvate dioxygenase (4-HPPD), a high intake of phenylalanine and tyrosine, and a relative ascorbic acid deficiency. Our objectives are to determine the incidence of TNT in Mexican newborns and to correlate it based on their sex, gestational age, and weight for gestational age to determine whether these are risk factors that predict the development of TNT. A cross-sectional descriptive study was conducted from January 2006 to August 2017. We analyzed 175 976 of newborn screening reports and found that the overall incidence of TNT was 1 (0.29%) in 342 newborns. It is more prevalent in preterm infants and in small for gestational age newborns (0.35%).The TNT incidence was determined in this Mexican population, and it was established as the most frequently occurring amino acid defect. We propose that pediatricians intentionally search for this pathology to offer patients access to adequate and timely treatment.

Crescimento e produção de antúrio submetido a diferentes intensidades de desfolha / Growth and production of anthurium submitted to different defoliation intensities

O objetivo do presente trabalho foi avaliar o crescimento e a produção de Anthurium andraeanum 'Apalai' submetido a diferentes intensidades de desfolha no Vale do Ribeira, SP. Foram utilizadas mudas micropropagadas dessa espécie, as quais foram plantadas em canteiros construídos sob telado coberto com tela de náilon preta, com malha que proporciona 70 por cento de sombreamento, no espaçamento 0,40x0,40m. O experimento foi conduzido em delineamento de blocos casualizados em parcelas subdivididas, com dezesseis repetições. O efeito da desfolha foi avaliado na parcela e o efeito do tempo após a desfolha na subparcela. As diferentes intensidades de desfolha consistiram em plantas com três, quatro e cinco folhas e plantas sem desfolha, e o tempo após a desfolha, as avaliações realizadas em 2006 e 2007. Ocorreu um aumento na área das folhas individuais em plantas mantidas com quatro e cinco folhas, proporcional à intensidade de desfolha, que pode ser relacionado a uma tentativa de compensação da área foliar perdida. A desfolha com a manutenção de três, quatro ou cinco folhas em plantas de antúrio 'Apalai' é prejudicial para o seu crescimento e produção.

The aim of this research was to evaluate the growth and yield of Anthurium andraeanum 'Apalai' submitted to different defoliation intensities in Vale do Ribeira, SP. In order to develop this research, micropropagated seedlings of this species were used, planted in beds built under a roof covered with a black nylon screen, with a mesh that provides 70 percent shading, spaced 0.40x0.40m apart. The experiment was conducted in a randomized block design in split splot with sixteen replicates.The defoliation effect was evaluated in the whole plots and the effect of time after defoliation was evaluated in the split-plots. The different defoliation intensities consisted of plants with three, four and five leaves and plants without defoliation, and the time after defoliation. Assessments were conducted in 2006 and 2007. There was an increase in the area of individual leaves in plants maintained with four and five leaves, proportional to the defoliation intensity, which may be related to an attempt to offset the lost leaf area. Defoliation caused by the maintenance of three, four or five leaves in anthurium 'Apalai' plants is detrimental to their growth and production.

Crescimento e produção de antúrio cultivado sob diferentes malhas de sombreamento / Growth and yield of anthurium under different shading screens

O uso de malhas ou filmes plásticos de diferente naturezas ou cores pode alterar a qualidade espectral da radiação e, como consequência, o crescimento e a produção de uma cultura vegetal. O objetivo do presente trabalho foi avaliar aspectos do crescimento e da produção de Anthurium andraeanum 'Apalai' sob diferentes malhas de sombreamento. Para tal, mudas micropropagadas foram plantadas em canteiros sob quatro malhas com 70% de sombreamento (azul, vermelha, preta e termo-refletora). O delineamento experimental foi inteiramente casualizado, com quatro tratamentos e quatro repetições de quatro plantas úteis por parcela. As avaliações foram realizadas durante 12 meses, sendo iniciadas após a produção de hastes florais comercializáveis. A malha preta se sobressaiu em relação às demais, proporcionando a melhor condição para crescimento e produção do antúrio, bem como as maiores dimensões da haste floral, que são consideradas atributos de qualidade para flor de corte.

The use of screen or plastic films of different nature or color can change the quality of spectral radiation, and as consequence the growth and production of a crop. The objective of the present research was to evaluate the growth and yield of Anthurium andraeanum 'Apalai' under different shading screens. For developing such research, micropopageted seedlings were planted in beds under four screens with 70% shading (blue, red, black and thermo-reflective). The experimental design was completely randomized, with four treatments and four repetitions. The assessments were conducted for 12 months, started after the production of flower stalks marketable. The black screen gave the best results, providing the best conditions for growth and production of anthurium, and the larger dimensions flowers stem, that are considered attributes of quality to cut flower.

Influência do substrato e do tipo de fertilizante na aclimatação de mudas de bananeira 'Prata-Anã' / Influence of substrate and fertilizer type on the acclimatization of 'Prata-Anã' banana plantlets

Objetivando-se avaliar a influência do substrato e tipo de fertilizante na aclimatação de mudas de bananeira ‘Prata-Anã’, provenientes de micropropagação, foi instalado um experimento em blocos casualizados, no esquema fatorial 5 x 3, com quatro repetições. Os substratos utilizados foram: S1 - Terra de subsolo + casca de arroz carbonizada + substrato comercial Rendimax Floreira®; S2 - Terra de subsolo + casca de arroz carbonizada + composto orgânico Organifol®; S3 - Terra de subsolo + casca de arroz carbonizada + composto orgânico Organifol® 9% SiO; S4 - substrato comercial Technes Vivatto®; S5 - Areia grossa + casca de arroz carbonizada + Rendimax Floreira®, todos na proporção 1:1:1 (v/v/v). Os fertilizantes utilizados foram: SF - sem fertilizante; FLL - fertilizante de liberação lenta, 14-14-14 (5,0 kg m-3) misturado ao substrato; e FLN - fertilizante de liberação normal, 14-14-14 (5,0 kg m-3) aplicado em cobertura, 30 dias após o plantio. As mudas foram plantadas em sacos de polietileno quando apresentavam quatro a cinco folhas, sendo mantidas em viveiro com 50% de sombreamento. Foram feitas medidas de altura, diâmetro do colo e número de folhas, e determinada a massa seca das mudas. As diferenças químicas das misturas utilizadas como substrato, juntamente com o tipo de fertilizante utilizado, proporcionaram crescimento diferenciado das mudas. O substrato S4 pode ser utilizado sem fertilização. Ossubstratos S2 e S3 devem ser utilizados com fertilizante de liberação normal ou lenta de nutrientes, e S1 e S5, sendo pobres em nutrientes, com fertilizante de liberação lenta.

With the aim of evaluating the influence of the substrate and fertilizer type on the acclimatization of plantlets of ‘Prata-An㒠banana obtained from micropropagation, a complete randomized block design was installed, in a 5 x 3 factorial structure, with fourreplications. The substrates used were: S1 - subsoil dirt + carbonized rice hull + Rendimax Floreira® commercial substrate; S2 - subsoil dirt + carbonized rice hull + Organifol® organic mixture; S3 - subsoil dirt + carbonized rice hull + Organifol® 9% SiO organic mixture;S4 - Technes Vivatto® commercial substrate; S5 - thick sand + carbonized rice hull + Rendimax Floreira® commercial substrate, all in proportion 1:1:1 (v:v:v). The fertilizers used were: WF- without fertilizer; FSR - slow- release fertilizer, 14-14-14 (5.0 kg m-3) mixed to the substrate; and FNR - normal-release fertilizer, 14-14-14 (5.0 kg m-3) applied as top dressing 30 days after the planting. The seedlings were planted in polyethylene bags when they presented four to five leaves, being kept at a nursery with 50% shading. Height, stem base diameter, and number of leaves were measured and the dry mass of the plantlets was determined. The chemical differences of the mixtures used as substrate, together with the fertilizer type used, resulted in differentiated growth of the plantlets.The S4 substrate may be used without fertilization. The substrate S2 and S3 may be used with fertilizer of normal or slow release of nutrients, and S1 and S5, being poor in nutrients, with fertilizer of slow release.

Assistência prestada na Unidade de Terapia Intensiva Adulto: visão dos clientes / Assistance offering at adult ITU: clients view

O presente estudo tem como objetivo verificar a percepção dos pacientes sobre o atendimento recebido na UTI adulto e elaborar uma proposta de atendimento visando a qualidade do serviço prestado. A metodologia adotada foi à pesquisa quantitativa descritiva. Os dados foram coletados através de um questionário contendo 12 questões, sendo 11 fechadas e 1 aberta. Os dados apontaram que a maioria dos pacientes gostou do atendimento oferecido, mas apesar disto a unidade foi reformada à partir das colocações dos clientes na tentativa de melhorar a qualidade da assistência prestada pela equipe multiprofissional.