Uso de cánula nasal de alto flujo artesanal como oxigenoterapia en insuficiencia respiratoria por COVID-19 / Use of artisanal high flow nasal cannula as oxygen therapy in respiratory failure due to COVID-19

Los riesgos asociados a la neumonía por (SARS-CoV-2) es la generación de insuficiencia respiratoria secundaria que en algunos casos desencadenara al tan temido síndrome de distres respiratorio (SDRA); Informes sobre atención clínica, indican que tiene una incidencia (SDRA) de 3-10 % con necesidad de Asistencia Respiratoria Mecánica (ARM) en pacientes hospitalizados; por lo que dispositivos de oxigenación no invasivos siguen siendo una opción atractiva, de forma inicial. Caso clínico: mujer de 47 años con insuficiencia respiratoria secundario a neumonía por COVID-19, por la gravedad se indica su ingreso a terapia intensiva, pero por razones de falta de unidad es manejada en unidad respiratoria, con el uso de dispositivos de oxigenación de armado ARTESAL, de manera exitosa, con la utilización de CNAF-artesanal, se pretende mejorar el trabajo respiratorio, índices de oxigenación, mientras se da tratamiento a la infección por el COVID-19; el objetivo del presente caso es reportar el presente caso con evolución favorable a la literatura disponible. Discusión: El uso de terapia de oxigenación con dispositivo de Cánula Nasal de Alto Flujo, aún no ha sido normatizado en pacientes con COVID-19, pero existe evidencia clínica sobre los efectos beneficiosos en la insuficiencia respiratoria en neonatos mas no en adultos. Conclusión: El uso temprano de la CNAF-artesanal en la insuficiencia respiratoria resulta muy atractivo, más aún con dispositivo de confección artesanal, da una opción más al paciente fuera de UTI, pudiendo apoyar en evitar la intubación y su ingreso a ventilación mecánica.

The risks associated with pneumonia (SARS-CoV-2) is the generation of secondary respiratory failure that in some cases will trigger the much feared respiratory distress syndrome (ARDS); Reports on clinical care indicate that it has an incidence (ARDS) of 3-10% with the need for Mechanical Respiratory Assistance (ARM) in hospitalized patients; so non-invasive oxygenation devices remain an attractive option, initially. Clinical case: a 47-year-old woman with respiratory failure secondary to covid-19 pneumonia. Due to the severity, her admission to intensive care is indicated, but for reasons of lack of unity, she is managed in a common room, with the use of high-pressure oxygenation devices. ARTISAL assembly, successfully, with the use of CNAF-artisanal, is intended to improve the work of breathing, and oxygenation indices, while treating the infection by COVID-19; The objective of this case is to report the present case with a favorable evolution based on the available literature. Discussion: The use of oxygenation therapy with a High Flow Nasal Cannula device has not yet been standardized in patients with COVID-19, but there is clinical evidence on the beneficial effects in respiratory failure in neonates but not in adults. Conclusion: The early use of the artisan HFNC in respiratory failure is very attractive, even more so with an artisanal device, it gives the patient another option outside the ICU, being able to help avoid intubation and admission to mechanical ventilation.

Implementación artesanal del sistema VAC en pacientes con Gangrena de Fournier: serie de casos

La fascitis necrosante es una infección de los tejidos blandos profundos que provoca la destrucción progresiva de la fascia muscular y subcutánea. Una de sus presentaciones es la Gangrena de Fournier (GF) para el cual el diagnóstico debe de ser preciso y asociado a desbridamiento quirúrgico precoz y antibioticoterapia de amplio espectro. Si existe retraso del manejo, la repercusión en el pronóstico es negativa. Entre las opciones actuales para el tratamiento destaca una técnica para mejorar la limpieza y granulación del área cruenta mediante el uso del dispositivo tecnológico y el sistema de cierre asistido por vacío (VAC). Describimos el manejo y la técnica de la terapia VAC implementado artesanalmente en una serie de casos de pacientes masculinos con diagnóstico de GF, en respuesta a los escasos recursos económicos de los pacientes que generalmente son afectados en nuestro medio; proponiendo una opción más económica, segura y replicable para nuestro entorno.

Necrotizing fasciitis is a deep soft tissue infection that causes progressive destruction of the muscle fascia and subcutaneous . One of its presentations is Fournier's Gangrene (FG) for which the diagnosis must be accurate and associated with early surgical debridement and broad-spectrum antibiotic therapy. If management is delayed, the impact on prognosis is negative. Current treatment options include a technique to improve cleaning and granulation of the cruciate area using a technological device and the vacuum assisted closure system (VAC). We describe a handmade technique of VAC therapy implemented in a series of cases of male patients diagnosed with FG, in response to the scarce economic resources of patients who are generally affected in our environment; proposing a more economical, safe and replicable option for our environment.

Effects of handmaking and social skills training on quality of life of patients with schizophrenia / 中国实用护理杂志

Objective:To explore the effect of hand making combined with social skills training on the self-care ability and quality of life of patients with schizophrenia.Methods:According to random number table method, totally 120 patients with schizophrenia admitted to the Second People ′s Hospital of Chuzhou City, Anhui Province from January to December 2019 were divided into observation and control groups, which had 60 patients in each groups, 10 cases and 7 cases fell off respectively. The control group received antipsychotic medication and routine nursing, meanwhile the general recreational activities (circles, radio exercises, etc.) and physical therapy were also carried out in the department and rehabilitation physical therapy center. The observation group was given hand making and social skills training for 12 weeks on the basis of the control group. The self-care ability and quality of life of patients in the two groups were compared before intervention, 6 and 12 weeks after intervention. Results:Before intervention, there was no statistical significance in the scores of World Health Organization Quality of Life Scale (WHOQOL-BREF) and Activities of Daily Living (ADL) in 2 groups ( P>0.05). After 6 and 12 weeks of intervention, ADL scores in the observation group were (96.40±3.79) and (98.50±2.53) points, while those in the control group were (93.96±4.31) and (94.06±4.28) points. And the difference between the two groups was statistically significant ( t values were 3.38, 6.36, P<0.05). However, after 6 weeks of intervention, there was no significant difference in WHOQOL-BREF scores between the two groups ( P>0.05); after 12 weeks of intervention, the scores of WHOQOL-BREF in the domains of G1(patients′ self-rated quality of life), G4(patients′ satisfaction with self-rated health status), physiology, psychology, social relations and environment in the observation group were (3.76±1.14), (3.86±1.03), (14.83±2.56), (15.04±3.07), (14.72±3.67) (14.55±3.22) points. The scores of the control group were (3.00±0.83), (3.34±0.90), (12.79±2.06), (12.70±2.45), (12.70±3.06) and (12.64±2.42) points. And the difference between the two groups was statistically significant ( t values were from 2.73 to 4.47, P<0.01). Conclusions:Hand making combined with social skills training can improve the self-care ability and quality of life of patients with schizophrenia, and it is an effective means of treatment to help the patients with schizophrenia to achieve recovery, out of the hospital, back to society.

Propriedades físico-químicas e nutricionais de dietas enterais artesanais produzidas a partir de vegetais de baixa carga glicêmica / Physico-chemical and nutritional properties of handmade enteral diets produced from vegetables of low glycemic load

O propósito desse estudo foi elaborar dietas enterais artesanais, para uso por pacientes em Terapia Nutricional Enteral Domiciliar estabilizados e com expectativa de uso prolongado ou permanente da via enteral, a partir de uma formulação contendo fontes vegetais de baixa carga glicêmica e teores significativos de fibra alimentar. O presente trabalho objetivou avaliar as propriedades físico-químicas e nutricionais das dietas enterais artesanais produzidas a partir de vegetais de baixa carga glicêmica, oferecendo alternativas de baixo custo para a nutrição e controle da glicemia e metabolismo glicídico para indivíduos em uso domiciliar de dietas enterais. Foram estabelecidas 18 combinações classificadas em 3 grupos, utilizando diferentes vegetais, acrescidos de maltodextrina, albumina, óleo de soja e amido de milho até que a fórmula obtivesse a proporção de 1 kcal/mL. Verificou-se a fluidez e estabilidade das dietas, além da realização de análise bromatológica de macro e micronutrientes. Todas as dietas formuladas foram caracterizadas como normocalóricas, normoprotéicas e normolipídicas. O teor médio de fibra alimentar dos 3 grupos de dietas foi de 1,83 g/100 mL, sendo 0,87 g (47%) de fibra solúvel, atingindo valores próximos às recomendações diárias. Em relação aos micronutrientes, as dietas prescritas para um dia atingiram 71% das necessidades recomendadas de ferro, 116% das de cobre, 48% das de zinco, 32% das de cálcio, 110% das de fósforo, 46% das de potássio, 50% das de magnésio, 90% das de manganês, 25% das de selênio e 39% das de sódio. A partir dos dados analisados neste trabalho, é possível concluir que as dietas formuladas possuem um perfil de macronutrientes que atendem as necessidades de um indivíduo adulto. No tocante aos minerais, essa adequação é parcial e ajustes são necessários. As características de cor, fluidez e estabilidade fazem dessas dietas uma opção importante para uso domiciliar, podendo contribuir para a diminuição de custos e aumento da aceitação desse tipo de alimentação.

The purpose of this study was to elaborate handmade enteral diets for use by patients in stabilized enteral home therapy and with an expectation of extend or permanent use of the enteral route from a formulation containing vegetal sources of low glycemic load and significant levels of dietary fiber. The aim of this study was to evaluate the physicochemical and nutritional properties of handmade enteral diets produced from vegetables with low glycemic load, offering low-cost alternatives for nutrition and control of glycemic metabolism for people using enteral diets. Eighteen food combinations were established in 3 groups, using different vegetables associated with maltodextrin, albumin, soybean oil and cornstarch until the formula obtained the ratio of 1 kcal / mL. The fluidity and stability of the diets were verified, as well as the macromicronutrient and bromatological markers. All diets formulated were characterized as normocaloric, normoprotein and normolipidic. The average dietary fiber content of the three groups of diets was 1.83 g / 100 mL, being 0.87 g (47%) of soluble fiber, reaching values close to daily recommendations. In the case of micronutrients, caloric values prescribed for one day reached 71% of recommended iron requirements, 116% of copper, 48% of zinc, 32% of calcium, 110% of phosphorus, 46% of potassium, 50% of magnesium, 90% of manganese, 25% of selenium and 39% of sodium. From the data analyzed in this study, it is possible to conclude that the formulated diets have a macronutrient profile that meets the needs of an normal adult. Regarding minerals, this availability is partial and adjustments are required. The characteristics of color, fluidity and stability make these diets an important option for home use, which may contribute to lower costs and increase the acceptance of this type of food therapy.

Caracterização do Queijo do Marajó tipo manteiga produzido em duas estações do ano / Characterization of Marajó's butter-type cheese made in two seasons seasons of the year

A Ilha de Marajó possui o maior rebanho bubalino do Brasil, sendo a Microrregião de Arari a principal produtora de leite e queijo de búfala. O objetivo do presente estudo foi caracterizar, por meio de análises físico-químicas e microbiológicas, o Queijo do Marajó tipo manteiga e verificar se há diferenças de suas características entre as estações do ano, chuvosa e seca. A acidez, pH e a porcentagem de gordura no extrato seco foram atributos de composição centesimal que apresentaram diferença significativa (P<0,05) pelo teste Tukey, entre as duas estações do ano. Os demais componentes (umidade, gordura, proteína total, cinza, EST e sal) desse queijo não variaram em função da época do ano. Quanto às características microbiológicas, as contagens foram maiores na estação chuvosa, exceto para as de Escherichia coli, que mantiveram-se constantes e adequadas à legislação. As contagens de Staphylococcus aureus foram altas e fora dos padrões da norma vigente. A contagem de aeróbios mesófilos foi maior na época das chuvas. Não foi detectada a presença dos patógenos Listeria monocytogenes e Salmonella sp. Apesar dos queijos analisados se enquadrarem nas legislações estadual e nacional, no tocante à composição química, os resultados indicam contagem S. aureus muito elevadas, o que enfatiza a necessidade da implementação imediata de Boas Práticas de Fabricação para a inocuidade dos produtos, a fim de atingir consonância com as contagens microbiológicas da legislação vigente.

Marajó Island has the biggest water buffalo herd in Brazil, and the Microregion of Arari is the main water buffalo's milk and cheese producer. This study aimed to characterize physicochemical and microbiological composition of Marajó's butter-type cheese and to verify differences in its characteristics between rainy and dry seasons of the year. Acidity, pH and percentage of fat in dry matter (% FDM) were attributes that showed significant difference (P<0.05) by Tukey test between the two seasons. The remaining Marajó's butter-type cheese components (moisture, fat, total protein, ash, salt and total dry matter) did not vary along the year. Regarding to microbiological characteristics, in general, the count was higher in the rainy season, except for Escherichia Coli, wich remained constant. Values found for total coliforms were medium to low. For E. coli values meet legal requirements (less than 101CFU g-1) and, therefore, were satisfactory. Counts of Staphylococcus aureus were high, with 0% of samples within the standards of the norm in the rainy season and 9.1% in the dry season. The aerobic mesophilic count was different between the periods of the year and was higher in the rainy season. Presence of the pathogens Listeria monocytogenes and Salmonella sp. was not detected. Despite the cheeses analyzed are in accordance with national legislation regarding chemical composition, the results indicate counts of S. aureus very high, emphasizing the need for immediate implementation of Good Manufacturing Practices so the safety of products will be in agreement with actual legislation.

Condições higiênico-sanitárias e composição nuticional de salames artesanais e industrializados: uma comparação / Conditions sanitary and nutritional quality of handmade salami and industrialized: a comparaction

O salame tipo colonial é um produto de grande aceitação na região sudoeste do Paraná, especialmente, por fazer parte da tradição de origem italiana e pela cultura na produção de suínos. Tradicionalmente, o salame tipo colonial é produzido de forma artesanal, no próprio domicílio ou pequenas indústrias, sendo comercializado em feiras, supermercados e bancas de produtos coloniais em rodovias. A contaminação desses produtos pode ser proveniente da utilização de matérias-primas contaminadas ou por manipulação inadequada antecedente ao consumo. O fato de, normalmente, o produto ser consumido sem cozimento prévio, pode ser considerado um potencial risco a saúde do consumidor. Com o intuito de conhecer a qualidade dos salames coloniais e salames industrializados comercializados na região sudoeste paranaense, realizou-se análises físico-químicas e microbiológicas. Os resultados demonstraram que, enquanto os salames industrializados se encontravam de acordo com a legislação brasileira quanto aos parâmetros físico-químicos e microbiológicos, os salames artesanais apresentaram teores de umidade e de proteínas em discordância com a legislação pertinente, bem como 16,67% das amostras apresentaram-se contaminadas por Coliformes a 45°C e 22,22% por Salmonella ssp., indicando que é um problema sanitário que carece atenção em nível nacional, uma vez que em estudos anteriores, ficou comprovada a contaminação de salames artesanais de várias regiões do país por microrganismos patogênicos.

Colonial-type salami is a widely accepted product in the southwestern region of Paraná, especially as part of the Italian tradition and its culture in pig production. Traditionally, the colonial-type salami is handmade in the farmer's house or in small industries, being marketed in fairs, supermarkets and colonial product stands along the roads. The contamination of these products can happen due to the use of contaminated raw materials or by poor handling prior to consumption. The fact that the product is usually consumed without prior cooking can be considered a potential risk to consumer's health. In order to evaluate the quality of industrialized salami and colonial salami marketed in the southwestern region of Paraná, a physical-chemical and microbiological analysis was performed. The results showed that while the industrial salami was manufactured in accordance with the Brazilian law regarding the physical-chemical and microbiological parameters, the handmade salami presented moisture and protein levels in disagreement with the relevant legislation, as well as 16.67% of the samples presented contamination by coliforms at 45 °C. They also presented 22.22% of the samples contaminated by Salmonella spp., indicating that this is a health issue that needs to be addressed at a national level, since it can be seen in previous studies that handmade salami presented contamination by pathogenic microorganisms in several regions of the country.

Bioremediation of industrial waste through mushroom cultivation.

Handmade paper and cardboard industries are involved in processing of cellulosic and ligno-cellulosic substances for making paper by hand or simple machinery. In the present study, solid sludge and effluent of both cardboard and handmade paper industries was collected for developing a mushroom cultivation technique to achieve zero waste discharges. Findings of present research work reveals that when 50% paper industries waste is used by mixing with 50% (w/w) wheat straw, significant increase (96.38%) in biological efficiency over control of wheat straw was observed. Further, cultivated basidiocarps showed normal morphology of stipe and pileus. Cross section of lamellae did not show any abnormality in the attachment of basidiospores, hymenal trama and basidium. No toxicity was found when fruiting bodies were tested chemically.

Calidad sanitaria en queso artesanal tipo “telita”. Upata, estado Bolívar, Venezuela / Sanitary conditions of hand-made “telita” type cheese in Upata, Bolivar State, Venezuela

En este trabajo se investigaron microorganismos indicadores de calidad sanitaria en queso artesanal tipo “telita” de Upata, municipio Piar, estado Bolívar. Se analizaron 60 muestras y se investigaron estafilococos coagulasa positivos (Staphylococcus aureus) según Norma Venezolana COVENIN 1292-89 como indicador de manipulación; bacterias coliformes según Norma Venezolana        COVENIN 1104-96 y presencia de Escherichia coli como indicador de contaminación fecal. Todos los crecimientos bacterianos correspondieron a estafilococos coagulasa negativos con recuentos de hasta 10(4) diluciones decimales. Coliformes totales mostraron recuentos de hasta ≤10(5) NMP/g y coliformes fecales en concentración ≤10(4) NMP/g. Escherichia coli estuvo presente en 43,3% de los quesos. Se concluyó que el queso artesanal tipo “telita” que se expende en los alrededores de Upata, estado Bolívar, evidencia fallas en la manipulación e higiene posterior a su elaboración; y por no cumplir con los criterios que establece el Reglamento Centroamericano de Criterios Microbiológicos de los Alimentos Procesados, se considera un producto que podría representar un alto riesgo microbiológico para el consumidor.

This study investigated microorganisms indicators of sanitary conditions in hand-made “telita” type cheese in Upata, Piar Municipality, Bolivar State. Sixty cheese samples were analyzed, and coagulase-positive staphylococci (Staphylococcus aureus) were investigated according to Venezuelan COVENIN Regulation 1292-89 as indicator of manipulation, coliform bacteria according to the Venezuelan COVENIN Regulation 1104-96 and presence of Escherichia coli as fecal contamination indicator. All bacteria growths corresponded to coagulase-negative staphylococci with counts up to 10(4) decimal dilutions. Total coliforms showed counts of up to ≤10(5) NMP/g, and fecal coliforms in concentrations of ≤10(4) NMP/g. Escherichia coli, appeared in 43.3% of samples. It was concluded that the hand-made “telita” type cheese that is sold in the surroundings of Upata, Bolivar State, shows evidences of faulty manipulation and hygienic conditions after its production , and that it does not fulfill the criteria established by the Central American Regulation of Microbiological Criteria For Processed Foods, and is considered as a product which could represent a high microbiological risk for consumers.

Avaliação de resíduos de painéis de madeira gerados por indústrias moveleiras para aproveitamento na confecção de pequenos objetos: estudo de caso / Evaluation of residues of wood boards generated by furniture industries for their utilization in the production of small objects: study of case

A indústria moveleira produz uma quantidade de resíduos que, normalmente, é descartada no meio ambiente ou utilizada como combustível em caldeiras e similares, ou apenas queimada. Alternativas para utilização desses resíduos têm sido alvo de pesquisas, destacando-se a confecção de pequenos objetos, na forma de artesanato. Neste trabalho, objetivou-se avaliar os resíduos de indústrias do pólo moveleiro de Ubá/MG. No levantamento quantitativo, constatou-se que as empresas geraram resíduos dos mesmos tipos de painéis de madeira. Os resíduos mais comuns foram de aglomerado e MDF (Medium Density Fiber). Observou-se grande variabilidade das dimensões desses resíduos, principalmente em sua largura. Concluiu-se que alguns resíduos não apresentaram dimensões adequadas para a confecção de determinados objetos e que se torna necessária uma seleção prévia desses resíduos para direcioná-los a trabalhos mais minuciosos, de forma a viabilizar a sua utilização.

The furniture industry generates an amount of residues, which, normally, is discarded in the environment or destined to steam production in boilers. The handmade production of small wood board objects is an outstanding alternative to take advantage of these residues. The general aim of this study was to evaluate residues in furniture industries located at the pole of Ubá/MG. Through the survey and the analysis of the data, one established that the industries generate residues from the same kind of wood board. The most common residues were of particleboard and MDF (Medium Density Fiber). One observed a great diversity of residue dimensions, mainly in width. One concluded that some residues did not present adequate dimensions for the manufacturing of some objects and that there is a necessity of previous residues selection, in order to destine them to more detailed works and make possible their use.