Laparoscopic pyeloplasty proficiency during a residency program after adoption of a standardized simulation training program is maintained during the COVID pandemic despite reduced surgery volume

ABSTRACT Purpose: To evaluate the effect of the standardized laparoscopic simulation training program in pyeloplasty, following its implementation and during the COVID-19 pandemic. Material and Methods: A retrospective chart review was performed at Hospital de Clínicas de Porto Alegre, a tertiary referral center in south Brazil, in which 151 patients underwent laparoscopic pyeloplasty performed by residents between 2006-2021. They were divided into three groups: before and after adoption of a standardized laparoscopic simulation training program and during the COVID-19 pandemic. The main outcome was a combined negative outcome of conversion to open surgery, major postoperative complications (Clavien-Dindo III or higher) or unsuccessful procedure, defined as need for redo pyeloplasty. Results: There was a significant reduction in the combined negative outcome (21.1% vs 6.3%), surgical time (mean 200.0 min vs 177.4 min) and length of stay (median 5 days vs 3 days) after the adoption of simulation training program. These results were maintained during the COVID-19 pandemic (combined negative outcome of 6.3%, mean surgical time of 160.1 min and median length of stay of 3 days) despite a reduction in 55.4% of the surgical volume. Conclusion: A structured laparoscopic simulation program can improve outcomes of laparoscopic pyeloplasty during the learning curve.

Atividade física e comportamento sedentário em idosos de grupos sociais: existe diferença em razão do risco de sarcopenia? / Physical activity and sedentary behavior in elderly in social groups: is there a difference because of the risk of sarcopenia?

Este estudo teve o objetivo de analisar se a frequência e duração da prática de atividade física e o comportamento sedentário interferem no risco de sarcopenia em idosos frequentadores de grupos sociais. Estudo transversal, em que foram avaliados 207 idosos frequentadores de grupos sociais do município de Sarandi, estado do Paraná. Foi utilizado o Questionário Internacional de Atividade Física (IPAQ) e o SARC-F. Os dados foram analisados por meio da estatística inferencial (p<0,05). Notou-se a prevalência de idosos com nível ativo de atividade física (93,2%) e que não apresentaram risco de sarcopenia (75,8%). Os idosos com risco de sarcopenia ficam mais tempo sentados em dias de semana do que os idosos com ausência de risco de sarcopenia (p=0,043). A duração e frequência da prática de atividade física não interferem no risco de sarcopenia. No entanto, o risco de sarcopenia está associado ao comportamento sedentário do idoso.

This study aimed to analyze whether the frequency and duration of physical activity and sedentary behavior interfere with the risk of sarcopenia in elderly attending social groups. Cross-sectional study to evaluate 207 elderly people attending social groups in the municipality of Sarandi, state of Paraná. The International Physical Activity Questionnaire (IPAQ) and the SARC-F were used. Data were analyzed using inferential statistics (p<0.05). The prevalence of elderly people with active level of physical activity (93.2%) and no risk of sarcopenia (75.8%) was observed. Elderly people at risk of sarcopenia spend more time sitting on weekdays than elderly people with no risk of sarcopenia (p=0.043). Duration and frequency of physical activity do not affect the risk of sarcopenia. However, the risk of sarcopenia is associated with sedentary behavior of the elderly.

Dispensação de medicamentos na atenção primária do Sistema Único de Saúde / The dispensation of drugs in the primary health care of the Single Health System

Objetivo:analisar a dispensação de medicamentos na atenção primária do Sistema Único de Saúde em um município do Estado de São Paulo. Metodologia:realizou-se análise documental dos boletins de movimentação de medicamentos das farmácias das 19 Unidades Básicas de Saúde do município de Araçatuba-SP, sede do Departamento Regional de Saúde II-SP, durante 12 meses. Os medicamentos foram agregados segundo o sistema de classificação Anatomical Therapeutic Chemicale ação farmacológica. Analisou-se o total de medicamentos dispensados e o saldo final dos principais tipos de fármacos. Resultados:foram dispensados 60.479.959 medicamentos, sendo 53,10% antibióticos, 15,42% anti-hipertensivos, 5,09% antidepressivos, 4,81% hipoglicemiantes, 3,16% ansiolíticos, 2,82% complexos vitamínicos e minerais, 2,17% antipsicóticos, 1,99% analgésicos, dentre outros tipos (11,45%). Permaneceram disponíveis 8.778.863medicamentos, sendo os anti-hipertensivos, antidepressivos e ansiolíticos os que representam a maior proporção entre estes. Os antibióticos apresentaram a menor proporção de unidades disponíveis, com aproximadamente 2%. Os hipoglicemiantes apresentaram maior diversidade de fármacos sem unidades disponíveis para dispensação. Conclusão:os principais tipos de medicamentos dispensados foram antibióticos, anti-hipertensivos, antidepressivos e hipoglicemiantes. A dispensação de medicamentos foi satisfatória, considerando que mesmo os medicamentos que não apresentaram saldo residual positivo foram substituídos por outros de propriedades farmacológicas similares

Objective: to analyze the dispensation of drugs in the primary health care of the Single Health System in a city in the State of São Paulo.Methodology: a document analysis was carried out in the reports of how the movement of drugs took place in the 19 Primary Health Care Units in the city of Araçatuba-SP, head office of the Regional Health Department II-SP, for 12 months. The medications were classified according with the Anatomical Therapeutic Chemical system and with their pharmacological action. The total number of drugs dispensed and the remaining amount of the main types of drugs were analyzed.Results: 60,479,959 medications were dispensed, among which 53.10% were antibiotics, 15.42% antihypertensive, 5.09% antidepressant, 4.81% hypoglycemic, 3.16% anxiolytic, 2.82% vitamin and mineral complexes, 2.17% antipsychotics, 1.99% analgesics, among others (11.45%). 8,778,863 drugs were still available, among which the most numerous were hypertensive, antidepressants, and anxiolytics. Antibiotics represented the lowest percentage of available units, with approximately 2%. Hypoglycemic drugs were the ones that showed that highest diversity of unavailable medications.Conclusion: the main types of medications dispensed were antibiotics, antihypertensives, antidepressants, and hypoglycemic drugs. Drug dispensation was satisfactory,considering that even medications that did not have a positive residual supply were replaced by drugs with similar pharmacological properties

Factors associated with risk of sarcopenia in older adults / Fatores associados com o risco de sarcopenia em idosos

This study aimed to assess the factors associated with the risk of sarcopenia in older adults who attend social groups. This is a cross-sectional conducted with 207 older adults. A sociodemographic questionnaire, the International Physical Activity Questionnaire (IPAQ) and the SARC-f ques-tionnaire were used as instruments. Data analysis was carried out by using the chi-squared test and the Binary Logistic Regression (p < 0.05). The results showed a significant association of the risk of sarcopenia with the education level (p = 0,016). There was a significant difference among the groups in self-perceived health (p = 0.001), health perception compared to older adults of the same age (p = 0.001), amount of medications used (p = 0.001), history of falls (p = 0.001) and near-falls (p = 0.001). No significant difference was found in the risk of sarcopenia with level of physical activity. When comparing the ratios of diseases reported according to the risk of sarcopenia, there was a significant difference in heart disease (p = 0.001), systemic arterial hypertension (p = 0.001), stroke (p = 0.001), diabetes (p = 0.049), osteoarthritis (p = 0.001), lung disease (p = 0.034), depression (p = 0.001) and osteoporosis (p = 0.001). The logistic regression revealed that the older adults who had no history of falls and reported no heart disease, lung disease, depression or osteoporosis were more likely to have no risk of sarcopenia. Therefore, it was concluded that the education level and health conditions reported by the older adults can be considered as factors associated with the risk of sarcopenia. The level of physical activity is not a factor associated with the indication of sarcopenia

Este estudo teve como objetivo avaliar os fatores associados ao risco de sarcopenia em idosos que frequentam grupos sociais. Trata-se de um estudo transversal realizado com 207 idosos. Utilizaram-se como instrumento os questionários sociodemográficos, o International Physical Activity Questionnaire (IPAQ) e o SARC-f. A análise dos dados foi realizada pelo teste do qui-quadrado e pela regressão logística binária (p < 0,05). Os resultados mostraram associação significante do risco de sarcopenia com o nível de escolaridade (p = 0,016). Houve diferença significante entre os grupos com e sem risco de sarcopenia em relação à autopercepção de saúde (p = 0,001), percepção de saúde em comparação com idosos da mesma idade (p = 0,001), quantidade de medicamentos utilizados (p = 0,001), histórico de quedas (p = 0,001) e quase quedas (p = 0,001). Não foi encontrada diferença significativa do risco de sarcopenia com nível de atividade física. Ao comparar as proporções de doenças relatadas de acordo com o risco de sarcopenia, houve diferença significante entre cardio-patia (p = 0,001), hipertensão arterial sistêmica (p = 0,001), acidente vascular cerebral (p = 0,001), diabetes ( p = 0,049), osteoartrite (p = 0,001), doença pulmonar (p = 0,034), depressão (p = 0,001) e osteoporose (p = 0,001). A regressão logística revelou que os idosos que não tinham histórico de quedas e não relataram cardiopatia, doença pulmonar, depressão ou osteoporose apresentaram maior probabilidade de não ter risco de sarcopenia. Concluiu-se que o nível de escolaridade e as condições de saúde relatadas pelos idosos podem ser considerados fatores associados ao risco de sarcopenia. O nível de atividade física não é um fator associado ao risco de sarcopenia

Socioeconomic impact of high-cost drugs in Brazilian dermatology. Legal and financial aspects, and impact on clinical practice

Abstract The technological advancement of the pharmaceutical industry, resulting from the techniques of molecular biology and expansion of the knowledge of immunopathogenesis, has modified the therapeutic arsenal used in dermatology. Scientific research and regulatory standards cause drug costs to rise, thus making their use impossible in most public policies. In order to make high-cost drugs viable in the public health network, the Specialized Pharmaceutical Assistance Component was created. However, despite the frequent incorporation of medications, the constant requirement of drugs through lawsuits leads to exorbitant costs to the state budget. The present work analyzed through a descriptive observational study, the current situation of the Specialized Component and the involvement of medicines used in dermatology, through legal reviews, financial analyses, and medical articles, aiming at future incorporations for the specialty. When assessing the legal demands for dermatological drugs in the state of São Paulo, the specialty still has a low participation and psoriasis is the main disease involved in requiring drugs through the judicial system in the state. New methods of access to raw materials must be created to reduce legal issues. Cost-effectiveness and public planning studies are mandatory for incorporating new dermatological therapies.

Terapia combinada de laser de CO2 e luz intensa pulsada no tratamento de lesões vasculares / Combined CO2 laser and intense pulsed light therapy in the treatment of vascular lesions

As lesões vasculares congênitas podem ser divididas em: tumores e malformações. Os hemangiomas são tumores vasculares benignos decorrentes da proliferação anormal de células endoteliais; já as manchas em vinho do Porto são malformações vasculares de provável herança autossômica dominante. Até o presente momento, não há estudos sobre a associação entre luz intensa pulsada e laser de CO2 como forma terapêutica destas patologias. A presente série de casos apresenta 10 casos de lesões vasculares tratadas com a combinação destas formas de irradiação. Conclui-se que esta terapia combinada pode ser efetiva na redução da espessura das lesões ou na atenuação da coloração

Congenital vascular lesions can be subdivided into tumors and malformations. Hemangiomas are benign vascular tumors resulting from the abnormal proliferation of endothelial cells, whereas port-wine stains are vascular malformations of a possible autosomal dominant inheritance. To date, there are no studies associating the use of intense pulsed light and CO2 laser as a therapeutic form for these pathologies. We present a series of 10 cases of vascular injuries treated with the combination of these forms of irradiation. This combined therapy can be effective in reducing the thickness of the lesions or in attenuating the color.

Bedside echocardiography to predict mortality of COVID-19 patients beyond clinical data: Data from the PROVAR-COVID study

Abstract INTRODUCTION: Cardiac involvement seems to impact prognosis of COVID-19, being more frequent in critically ill patients. We aimed to assess the prognostic value of right ventricular (RV) and left ventricular (LV) dysfunction, evaluated by bedside echocardiography (echo), in patients hospitalized with COVID-19. METHODS: Patients admitted in 2 reference hospitals in Brazil from Jul to Sept/2020 with confirmed COVID-19 and moderate/severe presentations underwent clinical and laboratory evaluation, and focused bedside echo (GE Vivid-IQ), at the earliest convenience, with remote interpretation. The association between demographics, clinical comorbidities and echo variables with all-cause hospital mortality was assessed, and factors significant at p<0.10 were put into multivariable models. RESULTS: Total 163 patients were enrolled, 59% were men, mean age 64±16 years, and 107 (66%) were admitted to intensive care. Comorbidities were present in 144 (88%) patients: hypertension 115 (71%), diabetes 61 (37%) and heart failure 22 (14%). In-hospital mortality was 34% (N=56). In univariate analysis, echo variables significantly associated with death were: LV ejection fraction (LVEF, OR=0.94), RV fractional area change (OR=0.96), tricuspid annular plane systolic excursion (TAPSE, OR=0.83) and RV dysfunction (OR=5.3). In multivariate analysis, after adjustment for clinical and demographic variables, independent predictors of mortality were age≥63 years (OR=5.53, 95%CI 1.52-20.17), LVEF<64% (OR=7.37, 95%CI 2.10-25.94) and TAPSE<18.5 mm (OR=9.43, 95% CI 2.57-35.03), and the final model had good discrimination, with C-statistic=0.83 (95%CI 0.75-0.91). CONCLUSION: Markers of RV and LV dysfunction assessed by bedside echo are independent predictors of mortality in hospitalized COVID-19 patients, after adjustment for clinical variables.

Efeito da polimerização adicional com micro-ondas na rugosidade superficial de duas resinas compostas / Effect of additional microwave polymerization on the surface rugosity of two compound resins

Introdução: a resina composta é um dos materiais restauradores mais pesquisados na Odontologia, visando melhorias nas suas propriedades e aperfeiçoamento da técnica. Este trabalho tem o objetivo de avaliar a rugosidade superficial de duas resinas compostas, micro-híbrida e nanoparticulada, após a polimerização adicional com micro-ondas. Materiais e métodos: para cada resina composta, foram confeccionados 24 corpos de prova, medindo 0,8 cm de diâmetro interno por 0,2 cm de espessura, dos quais, 12 receberam polimerização adicional com micro-ondas e 12, apenas a polimerização com luz azul visível. Foram estabelecidos quatro grupos: G1 - resina micro-híbrida submetida à polimerização convencional; G2 - resina nanoparticulada submetida à polimerização convencional; G3 - resina micro-híbrida exposta à polimerização adicional em forno de micro-ondas caseiro; e G4 - nanoparticulada exposta à polimerização adicional em forno de micro-ondas caseiro. Os corpos de prova foram lixados em politriz, com o intuito de uniformizar as superfícies, seguindo com leitura no rugosímetro digital Mitutoyo SJ 301. O teste não paramétrico Exato de Mann-Whitney (significância de 5%) foi realizado utilizando a média aritmética (Ra, µm). Conclusão: não houve significância estatística entre os tipos de polimerização e nem entre as diferentes resinas compostas estudadas.(AU)

Introduction: composite resin is one of the most researched restorative materials in dentistry, aiming to improve its properties and improve the technique. This work aims to evaluate the superficial rugosity of two composite resins, microhybrid and nanoparticulate, after additional polymerization with microwaves. Materials and methods: for each composite resin, 24 specimens were made, measuring 0.8cm internal diameter by 0.2cm thick, of which 12 received additional microwave polymerization and 12 visible-blue-light polymerization only. Four groups were established: G1 - microhybrid resin subjected to conventional polymerization; G2 - nanoparticulate resin subjected to conventional polymerization; G3 - microhybrid resin exposed to additional polymerization in a home microwave oven; and G4 - nanoparticulate exposed to additional polymerization in a home microwave oven. The specimens were sanded in a polishing machine in order to standardize the surfaces, followed by reading on the Mitutoyo SJ 301 digital roughness meter. The Mann-Whitney Exact nonparametric test (5% significance) was performed using the arithmetic mean (Ra, µm). Conclusion: there was no statistical significance between the polymerization types and neither among the different composite resins studied.(AU)

Paciente com lesões hipercrômicas e pruriginosas na região posterior do tórax / Patient with hyperchromic and pruritic lesions in the posterior region of the thorax / Paciente con lesiones hipercrómicas y pruriginosas en la región posterior del tórax

Qual seu diagnóstico? Paciente feminina atendida no posto de saúde com queixas de lesões hipercrômicas e pruriginosas no dorso. Também relatou dor em coluna toracolombar e lombossacra de longa data. Realizou ressonancia que evidenciou compressão de raízes nervosas em alguns pontos, mas sem sinais de compressão medular. Analisando anamnese, exame fisico e exame de imagem a paciente foi diagnosticada com notalgia parestética.(AU)

Judicialização, o médico regulador do sus e os desafios bioéticos na tomada de decisão nas internações hospitalares

Este artigo trata dos aspectos bioéticos da tomada de decisão do médico regulador perante uma ordem judicial que requer a internação ou a transferência hospitalar do usuário do Sistema Único de Saúde (SUS). As leis e normas regulamentadoras do SUS respaldam políticas públicas que evidenciam o papel do médico como autoridade sanitária no âmbito do complexo regulador do acesso às ações e serviços públicos de saúde. O objetivo deste estudo é o de compreender o trabalho do médico regulador na central de regulação de internações ou transferências hospitalares no Sistema Único de Saúde de Minas Gerais, buscando identificar os limites e dificuldades, e as possíveis razões aplicadas à regulação por esta autoridade-sanitária-chave diante de uma determinação judicial. Trata-se de uma pesquisa de doutorado em andamento onde se busca discutir articular três temáticas: judicialização da saúde, o trabalho médico e a regulação do acesso à assistência. A hipótese do estudo é que a ordem judicial para internação está presente no cotidiano do médico regulador e considerando a especificidade desta demanda no âmbito da saúde pública e a existência de um complexo regulador, com normas administrativas próprias relativas ao acesso, se faz necessário refletir os aspectos particulares do processo de tomada de decisão desta autoridade sanitária, identificando argumentos, e os valores sociais, morais e técnicos que envolvem a deliberação

Pediatric minor head trauma: do cranial CT scans change the therapeutic approach?

OBJECTIVES: 1) To verify clinical signs correlated with appropriate cranial computed tomography scan indications and changes in the therapeutic approach in pediatric minor head trauma scenarios. 2) To estimate the radiation exposure of computed tomography scans with low dose protocols in the context of trauma and the additional associated risk. METHODS: Investigators reviewed the medical records of all children with minor head trauma, which was defined as a Glasgow coma scale ≥13 at the time of admission to the emergency room, who underwent computed tomography scans during the years of 2013 and 2014. A change in the therapeutic approach was defined as a neurosurgical intervention performed within 30 days, hospitalization, >12 hours of observation, or neuro-specialist evaluation. RESULTS: Of the 1006 children evaluated, 101 showed some abnormality on head computed tomography scans, including 49 who were hospitalized, 16 who remained under observation and 36 who were dismissed. No patient underwent neurosurgery. No statistically significant relationship was observed between patient age, time between trauma and admission, or signs/symptoms related to trauma and abnormal imaging results. A statistically significant relationship between abnormal image results and a fall higher than 1.0 meter was observed (p=0.044). The mean effective dose was 2.0 mSv (0.1 to 6.8 mSv), corresponding to an estimated additional cancer risk of 0.05%. CONCLUSION: A computed tomography scan after minor head injury in pediatric patients did not show clinically relevant abnormalities that could lead to neurosurgical indications. Patients who fell more than 1.0 m were more likely to have changes in imaging tests, although these changes did not require neurosurgical intervention; therefore, the use of computed tomography scans may be questioned in this group. The results support the trend of more careful indications for cranial computed tomography scans for children with minor head trauma.

Quality of continuous chest compressions performed for one or two minutes

OBJECTIVES: This study was designed to assess cardiopulmonary resuscitation quality and rescuer fatigue when rescuers perform one or two minutes of continuous chest compressions. METHODS: This prospective crossover study included 148 lay rescuers who were continuously trained in a cardiopulmonary resuscitation course. The subjects underwent a 120-min training program comprising continuous chest compressions. After the course, half of the volunteers performed one minute of continuous chest compressions, and the others performed two minutes, both on a manikin model. After 30 minutes, the volunteers who had previously performed one minute now performed two minutes on the same manikin and vice versa. RESULTS: A comparison of continuous chest compressions performed for one and two minutes, respectively, showed that there were significant differences in the average rate of compressions per minute (121 vs. 124), the percentage of compressions of appropriate depth (76% vs. 54%), the average depth (53 vs. 47 mm), and the number of compressions with no errors (62 vs. 47%). No parameters were significantly different when comparing participants who performed regular physical activity with those who did not and participants who had a normal body mass index with overweight/obese participants. CONCLUSION: The quality of continuous chest compressions by lay rescuers is superior when it is performed for one minute rather than for two minutes, independent of the body mass index or regular physical activity, even if they are continuously trained in cardiopulmonary resuscitation. It is beneficial to rotate rescuers every minute when performing continuous chest compressions to provide higher quality and to achieve greater success in assisting a victim of cardiac arrest. .

Prevalence of Microorganisms and Immunoglobulins in Children with Tonsillar Hypertrophy and Adenoiditis

Introduction: Benign idiopathic tonsillar hypertrophy (HBI) may affect a child's quality of life and sleep. Several studies have sought to relate the clinical features of HBI with the infectious and/or immunologic changes that occur. Objective: To increase the knowledge of the etiology of HBI. Data Synthesis: From 2012 to 2013 we conducted a retrospective observational study of 101 children with HBI who underwent tonsillectomies at Ambulatory ENT General Hospital of the East Zone of São Paulo City, a region with a poor socioeconomic population. Preoperative serologic results were available to confirm mononucleosis, cytomegalovirus, anti-streptolysin O (ASLO) and immunoglobulins. The mean patient age was 5.8 years (55% male, 45% female). Using the Mann-Whitney U test, we identified significant gender differences in the parameters of immunoglobulins (Ig) M (IgM), IgA, and IgE. Forty-seven percent of the patients had increased ASLO levels, and 37% had increased IgE levels. Conclusion: An evaluation of a patient's serologic parameters and laboratory results may be relevant to the etiology and prevention of HBI. Based on the results obtained from the study sample, the identification of etiologic agents and causative factors remain a public health challenge that affects the quality of life of children...

I diretriz de ressuscitação cardiopulmonar e cuidados cardiovasculares de emergência da Sociedade Brasileira de Cardiologia: resumo executivo / I guideline for cardiopulmonary resuscitation and emergency cardiovascular care - Brazilian Society of Cardiology: executive summary

Apesar de avanços nos últimos anos relacionados à prevenção e a tratamento, muitas são as vidas perdidas anualmente no Brasil relacionado à parada cardíaca e a eventos cardiovasculares em geral. O Suporte Básico de Vida envolve o atendimento às emergências cardiovasculares principalmente em ambiente pré-hospitalar, enfatizando reconhecimento e realização precoces das manobras de ressuscitação cardiopulmonar com foco na realização de compressões torácicas de boa qualidade, assim como na rápida desfibrilação, por meio da implementação dos programas de acesso público à desfibrilação. Esses aspectos são de fundamental importância e podem fazer diferença no desfecho dos casos como sobrevida hospitalar sem sequelas neurológicas. O início precoce do Suporte Avançado de Vida em Cardiologia também possui papel essencial, mantendo, durante todo o atendimento, a qualidade das compressões torácicas, adequado manejo da via aérea, tratamento específico dos diferentes ritmos de parada, desfibrilação, avaliação e tratamento das possíveis causas. Mais recentemente dá-se ênfase a cuidados pós-ressuscitação, visando reduzir a mortalidade por meio do reconhecimento precoce e tratamento da síndrome pós-parada cardíaca. A hipotermia terapêutica tem demonstrado melhora significativa da lesão neurológica e deve ser realizada em indivíduos comatosos pós-parada cardíaca. Para os médicos que trabalham na emergência ou unidade de terapia intensiva é de grande importância o aperfeiçoamento no tratamento desses pacientes por meio de treinamentos específicos, possibilitando maiores chances de sucesso e maior sobrevida.

Despite advances related to the prevention and treatment in the past few years, many lives are lost to cardiac arrest and cardiovascular events in general in Brazil every year. Basic Life Support involves cardiovascular emergency treatment mainly in the pre-hospital environment, with emphasis on the early recognition and delivery of cardiopulmonary resuscitation maneuvers focused on high-quality thoracic compressions and rapid defibrillation by means of the implementation of public access-to-defibrillation programs. These aspects are of the utmost importance and may make the difference on the patient's outcomes, such as on hospital survival with no permanent neurological damage. Early initiation of the Advanced Cardiology Life Support also plays an essential role by keeping the quality of thoracic compressions; adequate airway management; specific treatment for the different arrest rhythms; defibrillation; and assessment and treatment of the possible causes during all the assistance. More recently, emphasis has been given to post-resuscitation care, with the purpose of reducing mortality by means of early recognition and treatment of the post-cardiac arrest syndrome. Therapeutic hypothermia has provided significant improvement of neurological damage and should be performed in comatose individuals post-cardiac arrest. For physicians working in the emergency department or intensive care unit, it is extremely important to improve the treatment given to these patients by means of specific training, thus giving them the chance of higher success and of better survival rates.

Diagnóstico das boas práticas de fabricação em unidades produtoras de cachaça de alambique do Brejo Paraibano / Diagnosis of good manufacturing practices in producing units of the alembic cachaça in the Brejo Paraibano

O objetivo deste trabalho foi avaliar as Boas Práticas de Fabricação em três unidades produtoras de cachaça de alambique do Brejo Paraibano. Foi utilizado o checklist, recomendado no Anexo II da Resolução RDC n. 275/2002, da ANVISA, e adaptado para o processamento de cachaça. As três empresas avaliadas foram classificadas como regular em relação aos cuidados higiênicos. O bloco de quesito “Tipo e manutenção dos equipamentos e dos utensílios” apresentou a maior percentagem de não conformidades, seguido do bloco “Controle do processo produtivo e garantia da qualidade”. Foi observada a necessidade das empresas implantarem as Boas Práticas de Fabricação para garantir a qualidade da cachaça e a segurança do consumidor.