Successful Reconstructive Surgery for Facial Deformity Caused by Paederus fuscipes: An Illustrative Case Report

@#Full thickness skin graft is a simple and reliable method for closure of small facial wound defect. A thorough understanding of how a skin graft heals and how to perform the procedure is essential for successful outcome. We report the use of full thickness skin graft in a wound closure of a facial skin defect caused by Paederus fuscipes, locally known as charlie. An 8-year old boy developed blister and painful swelling over his right cheek following skin contact with charlie. This lesion gradually became extensive, eventually leading to tissue loss and facial wound defect. A full thickness skin grafting was performed with satisfactory functional and excellent aesthetic result.

Potential of microbial inoculum from buffalo feces in activating lignite coal bed methane

Aim: This research aimed to study the ability of microbial consortium from buffalo feces to produce coal bed methane (CBM) in lignite coal through in-vitro technique.Methodology: This study was carried out in 2 stages: In first stage, microbes activated using in-vitro technique, and at second stage volatile fatty acids (VFA) and coal bed methane production were estimated. The nutrition source for inoculum activation was of three types: 100% concentrate: 70% concentrate: 30% grass and 30% concentrate: 70% grass. Biogas digester in laboratory-scale utilized 100 ml serum bottle filled with 70 ml, 98-5 media and 7 g coal. Microbial inoculum was inoculated on digester using a 10 ml syringe and incubated at 39oC. Parameters observed to measure the quality of inoculum were total number of anaerobic microbes, kinetics, and biogas production during fermentation. Complete Randomized Design with two factorial consisted of incubation period as factor A and inoculum dosages as factor B. Results: The activation process of inoculum from buffalo feces was required to produce coal bed methane in anaerobic digestion. During activation process, the microbes from buffalo feces in a mixture of 70% concentrate and 30% grass at 48 hr observation could produce total gas approximately 22.5 ml at 48 hr observation. Addition of activated buffalo feces anaerobic inoculum on the anaerobic digestion as much as 6% produced the highest number of anaerobic bacteria, and VFA accounted for 31 x 1010 CFU ml-1 and 171.7 mM, respectively. Meanwhile, the highest methane production reached 128.61 ml on adding 6% inoculum

Endovascular Management of Hepatic Artery Pseudoaneurysm

@#Hepatic artery pseudoaneurysms (HAP) is a result of injury to the hepatic artery and must be treated due to its high risk of rupture. Endovascular treatment of pseudoaneurysm is effective and minimally invasive. We describe four cases of HAPs that presented with gastrointestinal (GI) bleed. The HAPs developed as a consequence of surgery for carcinoma, infection, trauma due to motor-vehicle accident and biliary instrumentation. Diagnoses were made using CT and conventional angiography. Embolisations were done either to the pseudoaneurysm or the parent artery using glue, Onyx or coils via microcatheter systems. Postembolisation runs showed no opacification of the pseudoaneurysms and the GI bleed resolved with no recurrence. The final outcome differs according to each patient’s underlying illness. We highlight our experience in the endovascular management of HAP using various embolic agents and in particular, Onyx. To the best of our knowledge, this is the first reported case of Onyx embolization of HAP.

Assesing the diagnostic potential of monoclonal antibodies against 20 kDa M. tuberculosis protein as candidate diagnostic method for M. tuberculosis through sputum

Background: Diagnosis of Mycobacterium tuberculosis infection is still a problem in Indonesia. Bacterial culture as the gold standard takes time while acid fast staining has a low sensitivity

Objectives: To develop and assess the diagnostic potential of an ELISA-based test using monoclonal antibodies specific for 20 kDa protein of M. tuberculosis as an alternative for rapid diagnosis of tuberculosis through sputum

Materials and Methods: One hundred sputum samples were collected from suspected pulmonary TB cases using clinical and radiological findings. All specimens were examined with Lowenstein Jensen culture, acid fast staining and polymerase chain reaction. To determine the positive cut-off point for ELISA, samples from 20 tuberculosis patients and 20 healthy controls were used. Diagnostic value was determined on the sensitivity, specificity, positive and negative predictive value using bacterial culture as the gold standard

Results: Positive cut-off value was determined at optical density 0.233. Out of 100 samples tested, 72 were positive by culture. The ELISA method using monoclonal antibodies against the 20 kDa protein had a kappa value, sensitivity and specificity of 54.4%, 81% and 79%, respectively. Kappa for ELISA was better compared to acid-fast staining [51.3%] but poorer than polymerase chain reaction [64.5%]. Sensitivity was higher compared to acid-fast staining [65%] but lower than the polymerase chain reaction [92%] and specificity was better than polymerase chain reaction [71%]. Acid-fast staining had the highest specificity [100%]

Conclusion: ELISA based monoclonal antibodies against 20 kDa protein had the potential for being used as a diagnostic method for M. tuberculosis in sputum sample

Eticidad del pensamiento de Florence Nightingale / Ethics in Florence Nightingale's thought

Introducción: es un gran reto incursionar en la personalidad de Florence Nightingale, mujer que tuvo un papel brillante en su época y que aún hoy está vigente su enfoque sobre enfermería y su aplicación de ciencias como la administración, la estadística y otras, al arte de brindar cuidados. Ella desempeñó múltiples funciones: enfermera, administradora, higienista y docente. Se creció en la Guerra de Crimea y a su regreso creó la primera Escuela de Enfermería. Objetivo: analizar la eticidad del pensamiento de Florence Nightingale. Material y métodos: análisis documental en el estudio de su obra Notas sobre Enfermería. Qué es y Qué no es y bibliografía de otros autores que escribieron sobre ella, su teoría del entorno e informaciones obtenidas por Internet. Sistematización que permitió la organización de la información. Resultados: florence Nightingale añadió a los principios tradicionales de la ética médica los principios de fidelidad y veracidad. Su Juramento refleja sus concepciones y la eticidad y cientificidad de la profesión. Tanto el modelo elaborado como otras contribuciones a la dirección y a la formación de enfermería tienen vigencia actual. Conclusiones: la eticidad de su pensamiento da sentido a los conocimientos, los cuales eran su deseo que formaran parte de la profesión de enfermería. Prevalecen sus actitudes llenas de razón y se aprecian virtudes del carácter e inteligencia. En la actualidad se reconoce un grupo de virtudes, en las que, salvando la distancia en el tiempo, Florence Nightingale se ve reflejada en ellas. Su escuela implica iniciativa, control, responsabilidad, lucha, tratamiento científico de la enfermería y comprensión del método científico.

Introduction: to approach the personality of Florence Nightingale is a challenge. She played an outstanding role in her times and even today her view of Nursing and the application of administration, statistics and other disciplines are still relevant. She was a nurse, a manager, a hygienist and a trainer. She became stronger in the Crimea War, and upon return she founded the first Nursing School. Objective: analyze the ethics in Florence Nightingale's thought. Material and Methods: literature review in the study of her work Notes of Nursing. What is it and what is not and of other papers about her, theory of the environment and also information downloaded from Interne were organized and systematized. Results: florence Nightingale added the principles of fidelity and veracity to the traditional ones of medical ethics. Her pledge expresses the ethics and scientific grounds of Nursing. Both the model she designed and other contributions in management and training are still relevant nowadays. Conclusions: the ethics of her thought makes knowledge meaningful, as she wanted it to be part of nursing. Attitudes that prevail are full of reason and virtues of character and intelligence. Some virtues recognized at present reflect Florence Nightingale _considering the time elapsed. Her school implies initiative, control, responsibility, struggle, a scientific approach to nursing and understanding of the scientific method.

Martina Guevara Molina. Primera enfermera docente en Cuba / Martina Guevara Molina. First educational nurse in Cuba

Se realizó una revisión bibliográfica de fuentes documentales en la Biblioteca Rubén Martínez Villena de la Universidad de La Habana y el archivo del Museo de Historia de las Ciencias Carlos J. Finlay sobre la enfermera Martina Guevara Molina. Se hizo hincapié en las efemérides relacionadas con la enfermería y la síntesis biográfica de esta personalidad, realizada por las profesoras María del Carmen Amaro Cano y Eduarda Ancheta Niebla, con el objetivo de motivar a las nuevas generaciones de enfermeras a buscar información para ampliar y profundizar los conocimientos acerca de esta profesora, quien contribuyó a reforzar la identidad y la vocación profesional de las enfermeras cubanas. Se concluyó el trabajo con destaque a la gran participación de esta ilustre enfermera en la Asociación Nacional de Enfermeras de Cuba y sus esfuerzos por la identidad profesional, al ser la primera enfermera cubana que recibió formación teórico práctica como docente.

A bibliographical revision was carried out of documental sources in the Library Rubén Martínez Villena of the University of Havana and in the files of the Museum of History of Sciences Carlos J. Finlay on the nurse Martina Guevara Molina. Stress was made in the anniversaries related with the infirmary and in the biographical synthesis of the personality in question, carried out by the teachers María del Carmen Amaro Cano and Eduarda Ancheta Fog, with the objective of motivating to the new generations of nurses to look for information to enlarge and to deepen the knowledge about this teacher that contributed to reinforce the identity and the professional vocation of the Cuban nurses. We concluded the work with highlights to this illustrious nurse's great participation in the National Association of Nurses from Cuba and to their efforts for the professional identity, being the first Cuban nurse that received formation in theoretical practice as educational.

La inclusión de la Bioética como asignatura curricular en Enfermería

La Enfermería es una profesión que tiene como base la atención de la persona como unidad socio biológica y como encargo social, su responsabilidad, su razón de ser, su fin último es cuidar. La atención de salud tiene dos vertientes: la científico - técnica y la humana, esta última muy importante dada la tendencia a la deshumanización como consecuencia de la aplicación impersonal de la tecnología. Esta situación provocó la investigación pedagógica por el Centro de Estudios Humanísticos, proponiendo la investigadora la inclusión del Programa de Bioética y Ética en Enfermería que contribuye a que el futuro egresado sea capaz de identificar que en su misión social está obligado a respetar la dignidad de la persona, su profesión, su compromiso con su pueblo y la solidaridad internacional.

El secreto profesional y su relación con enfermería / The professional secret and its relationship with Nursing

La importancia que reviste en estos tiempos el Secreto Profesional y su adecuación al campo de la enfermería determinó el tratamiento del tema. El secreto profesional mirado a la luz del diccionario Larousse es aquello que se mantiene oculto a los demás y surge del ejercicio de la profesión. La legislación adoptó diversas posiciones que van desde una protección absoluta hasta la querella del ofendido, pero en nuestros días se llega a una confidencialidad compartida. Este trabajo tiene como objetivo analizar el secreto profesional y su relación con enfermería. Es importante que la mirada que se ha prodigado haya sido de entereza moral, respetando a la autonomía. Para el análisis se realizó revisión bibliográfica sobre el tema en cuestión enfatizando en: confidencialidad, interdisciplinariedad, en un enlace del tratar y el cuidar en situaciones especiales que garanticen el bienestar de las personas. Lo experimentado se tradujo en que enfermería cumple sus obligaciones éticas a través de la aplicación de su Método Científico, asumiendo para sí el principio de no dañar y hacer el bien, así como la incorporación de los principios nightingaleanos de fidelidad y veracidad. Las condiciones actuales de desarrollo científico técnico han afectado la confidencialidad. Mantener el secreto se ha hecho cada vez más difícil, pero no imposible(AU)

At present time, significance of Professional Secret and its fitting to Nursing field, determined address ot topic. Professional secret view in the light of Larrousse Dictionary is that is maintained hidden to others, and is from practice of profession. Legislation adopted different positions going from an absolute protection up to dispute of offended, but nowadays , there exist a shared confidentiality. Aim of this paper is to analyze professional secret and its relationship with Nursing. It is very important the respect to this moral integrity, especially to the autonomy. For analysis it was necessary a blibliographic review on the matter in question, enphasizing on: confidentiality, interdisciplinary feature, on a link between to treat and to care in special situations protecting person wellbeing. Experience obtanind was translated in fulfilment of its ethical duties by Nursing by means of application of its Scientific Method, with self-acceptation of principle dont harm and to do good, as well as the addition of Nightingale principles of loyalty and truthfulness. Present conditions of scientific-technic development have affected confidentiality. To maintain the secret has become mor difficult, but not impossible(AU)

Detection of tdh and trh genes in Vibrio parahaemolyticus isolated from Corbicula moltkiana prime in West Sumatera, Indonesia.

The occurrence of Vibrio parahaemolyticus in raw Corbicula moltkiana Prime from Lake Singkarak and Pasar Raya Padang market and in cooked samples in West Sumatera, Indonesia, was studied. Thirteen raw and seven cooked bivalve samples were positive using CHROMAgar Vibrio medium. All 47 V parahaemolyticus isolates were positive for toxR gene but negative for trh. However, 36% (17/47) of V parahaemolyticus strains were positive for tdh gene. Antibiotic profiling showed that 76% and 38% of isolates from raw and cooked bivalves respectively were resistant to ampicillin. Using RAPD-PCR analysis, most of the strains were clustered according to their source of isolation but some of the strains from raw and cooked samples were clustered together. These results indicate that pathogenic V parahaemolyticus isolates are present in Corbicula moltkiana Prime in West Sumatera, Indonesia, suggesting that V parahaemolyticus may also be present in seafood in other regions of Indonesia.

Relación de la ética del cuidar y los modelos de enfermería con la persona y su dignidad / Relation of the ethics of care and the nursing models to the person and his dignity

El reconocimiento de los profesionales de enfermería acerca del derecho de las personas a ser respetadas o de respetar la dignidad de las persona, reviste gran importancia, fundamentalmente en la atención diaria del paciente. Este trabajo tiene el propósito de reflexionar y analizar los conceptos de persona y dignidad y relacionarlos con la ética del cuidado y los modelos de enfermería para puntualizar la interrelación que existe entre ellos. La persona es un todo que posee aspectos físicos, psicológicos, interpersonales y sociales en busca del equilibrio y la armonía, y es, al propio tiempo, un ser único, capaz de desarrollar y satisfacer su necesidad de ayuda. La dignidad del paciente y el derecho a su vida privada deben ser respetadas durante la atención de enfermería al igual que su cultura y sus valores. La ética del cuidar se sustenta en respetar el sufrimiento del paciente y ser sensible a su dolor. Un modelo conceptual para la práctica de enfermería identifica los elementos esenciales de la práctica, la teoría y los valores de enfermería. La Enfermería se realiza con la persona, en una plena interacción dialéctica; el contenido de los modelos de enfermería refleja la atención que merece la persona, su salud, la influencia del entorno y su bienestar, a partir del pleno respeto a su decoro. El principio ético de respeto a la dignidad del paciente es legal y constituye un imperativo moral para las enfermeras y enfermeros cubanos(AU)

The recognition of the infirmary professionals about the right of people to be respected or of respecting the person's dignity, you had great importance, fundamentally in the patient's daily attention. This work has the purpose of to meditate and to analyze person's concepts and dignity and to relate them with the ethics of the care and the infirmary models to remark the interrelation that exists among them. The person is an everything that possesses physical, psychological, interpersonal and social aspects in search of the balance and the harmony, and you/he/she is, at the own time, an unique being, able to develop and to satisfy her necessity of help. The patient's dignity and the right to their private life should be respected during the infirmary attention the same as their culture and their values. The ethics of taking care sustains in respecting the patient's suffering and sensitive being to its pain. A conceptual model for the infirmary practice identifies the essential elements of the practice, the theory and the infirmary values. The Infirmary is carried out with the person, in a full dialectical interaction; the content of the models of reflective infirmary the attention that the person, her health, the influence of the environment and her well-being, deserves starting from the full respect to her decency. The ethical principle of respect to the patient's dignity is legal and it constitutes a moral imperative for the nurses and Cuban male nurses(AU)

O diagnostico de pneumonia bacteriana em criancas / The diagnosis of pneumonia bacterial in childreens

O diagnostico etiologico de pneumonias bacterianas pode auxiliar a tomada de decisao do pediatra para instituicao de antibioticoterapia especifica. Os exames imunologicos como a contra-imunoeletroforese (CIE) e as reacoes de aglutinacao como o latex (LTX) tem sugerido uma alternativa mais rapida a tecnica tradicional de cultura de sangue, derrames ou secrecoes. O presente estudo testa a confiabilidade de alguns destes exames e discute sua aplicacao na pratica medica. Foram estudadas 116 criancas de idade entre 0 a 14 anos que tiveram diagnostico clinico de pneumonia bacteriana realizado em pronto socorros de 3diferentes hospitais pediatricos de Sao Paulo (H. Universitario, H. Candido Fontoura e H. Darcy Vargas). Alem de exame clinico e anamnese, para cada crianca realizou-se: 1. Hemograma e hemocultura; 2. CIE e LTX em sangue e urina antes do inicio de antibioticoterapia, na 48.a hora e no 7.o dia de tratamento; 3. Cultura de liquido pleural, quando aplicavel. Em quase 40% dos pacientes os exames de cultura, fossem de sangue ou liquido pleural, permitiram a identificacao de bacterias. Os indices de positividade dos exames imunologicos foram de forma geral mais altos, destacando-se o LTX de urina realizado antes do inicio do tratamento. Aplicando-se o teste de Kendall para medir-se a concordancia entre todos os exames realizados, encontrou-se que a possibilidade de discordancia entre eles e praticamente nula, o que sugere que de forma geral haja uma equivalencia entre eles.Com os pacientes com culturas positivas aplicou-se testes estatisticos para medir-se a sensibilidade, especificidade e valores preditivos dos exames imunologicos para identificacao de Streptococo pneumoniae (pneumococo) e Hemophilus influenzae. Concluiu-se que a sensibilidade dos exames tende a decrescer com o tempo decoleta de material, enquanto que a especificidade pode registrar alguma melhora.Os exames realizados com urina tem a melhor sensibilidade, sendo superior a 80% tanto para CIE como para LTX, embora este ultimo apresente ainda uma melhor performance. Encontrou-se que os valores preditivos de exames negativos sao muito proximos a 100%, o que sugere que tanto a CIE quanto o LTX podem ser usados com seguranca para excluir a presenca de quaisquer das duas bacterias, principalmente no caso do H. influenzae. Os valores preditivos dos exames positivos sao maiores(em torno de 60%) para o caso de pneumococo e podem ser tao baixos quanto 40% nocaso de H. influenzae. Como conclusao

Pneumonias agudas bacterianas na infância: estudo de 123 casos / Acute bacterial pneumonias in infancy: study of 123 cases

Os objetivos desta pesquisa foram: 1§- Determinar a etiologia bacteriana das pneumonias agudas nas crianças; 2§- Relacionar bactérias isoladas com dados clínicos, radiológicos e laboratoriais; 3§- Verificar a eficácia de um esquema padronizado de classificaçäo clínico-radiológico e de esquemas terapêuticos padronizados. As conclusöes mais importantes foram: 1§- A grande maioria das pneumonias foram benignas; 2§- As bactérias isoladas em maior número de casos (metade dos quais com derrame pleural) foi o S. pneumonae: 3§- Internaçöes anteriores (por qualquer motivo) e/ou outras pneumonias surgiram como antecedentes em número expressivo de casos; 4§- A febre, tosse e dispnéia, associados, ocorreram em 56% dos casos; 5§- Em mais da metade dos casos a leucometria foi superior a 13.000 leucócitos por m**3; 6§- A penicilina benzatina, em dose única de 600 mil unidades curou 83% dos casos em que foi utilizada

Objetivos educacionales aplicados a la enfermería / Educational objectives applied to nursing

Se realiza un análisis de los objetivos educacionales en relación con el proceso docente educativo de nuestros alumnos de enfermería, y los lineamientos emanados del I Congreso del PCC, así como los enfoques de los pedagogos de ideas más avanzadas en el campo socialista. Con todos estos elementos, plasmamos el enfoque que debe prevalecer para la formación multilateral de los alumnos de enfermería, si tenemos en cuenta su educación intelectual, científico-técnica, física, espiritual, estética, ideo-política, moral, patriótico-militar y politécnica laboral, cumplimentando así lo planteado por nuestro Comandante en Jefe: "El trabajo es el mejor pedagogo de nuestra juventud"

Importância das infecçöes respiratórias agudas (IRA) em crianças no município de Säo Pualo / Importance of acute respiratory infections in children in the municipality of Säo Paulo

Através do estudo da demanda anual por IRA, da letalidade global e específica por pneumonias agudas, realizado no Departamento de Pediatria da Faculdade de Ciências Médicas da Santa Casa de Säo Paulo e dos dados estatísticos oficiais sobre mortalidade por doenças respiratórias, procura-se evidenciar a importância destas doenças como problema de saúde pública na cidade de Säo Paulo. Os resultados obtidos permitem concluir pela altíssima incidência das IRA na infância e pela pequena proporçäo de casos graves. A demanda, letalidade e a mortalidade alcançaram níveis muito elevados, principalmente no primeiro ano de vida. Säo necessários estudos populacionais multicêntricos bem com pesquisas sobre características das doenças graves, a fim de aumentar nossos conhecimentos sobre a epidemiologia destas enfermidades em diferentes áreas. Paralelamente, é importante elaborar e viabilizar programas para o controle deste grupo de doenças