Human Papillomavirus 16 Lineage D is Associated with High Risk of Cervical Cancer in the Brazilian Northeast Region / Papillomavirus humano 16 da linhagem D associado a alto risco de câncer de colo do útero em região do nordeste brasileiro

Abstract Objective Similar to Human Papillomavirus (HPV) genotypes, different lineages of a genotype also have different carcinogenic capabilities. Studies have shown that specific genotype lineages of oncogenic HPV are associated with variable risks for the development of cervical intraepithelial neoplasia (CIN2/CIN3) and cervical cancer. The present study aimed to analyze the genetic diversity of the HPV16 genotype in women with CIN2/CIN3 and cervical cancer, from the northeast region of Brazil. Methods A cross-sectional multicenter study was conducted in the northeast region of Brazil, from 2014 to 2016. This study included 196 cases of HPV16 variants (59 and 137 cases of CIN2/CIN3 and cervical cancer, respectively). The difference of proportion test was used to compare patients with CIN2/CIN3 and cervical cancer, based on the prevalent HPV16 lineage (p < 0.05). Results According to the histopathological diagnosis, the percentage of lineage frequencies revealed a marginal difference in the prevalence of lineage A in CIN2/CIN3, compared with that in cervical cancer (p = 0.053). For lineage D, the proportion was higher in cancer cases (32.8%), than in CIN2/CIN3 cases (16.9%), with p = 0.023. Conclusion HPV16 lineage A was the most frequent lineage in both CIN2/CIN3 and cervical cancer samples, while lineage D was predominant in cervical cancer, suggesting a possible association between HPV16 lineage D and cervical cancer.

Resumo Objetivo Tanto os tipos quanto as linhagens do Papilomavírus Humano (HPV) parecem ter diferentes capacidades carcinogênicas e estão associados a riscos variados para o desenvolvimento de neoplasia intraepitelial cervical (NIC) e câncer de colo do útero. O presente estudo tem como objetivo analisar a diversidade genética do genótipo HPV 16 nos casos de NIC2/NIC3 e câncer de colo de útero em mulheres da região Nordeste do Brasil. Métodos Estudo transversal de base hospitalar realizado na região Nordeste do Brasil no período de 2014 a 2016. A amostra foi composta por 196 casos da variante HPV-16 (59 casos de NIC2/NIC3 e 137 de câncer do colo do útero). O teste de diferença de proporção foi usado para comparar os grupos NIC2/NIC3 e câncer de colo do útero por linhagem viral em relação à prevalência da linhagem HPV-16. Foi considerada significância estatística o valor de p < 0,05. Resultados As frequências de linhagem por diagnóstico histopatológico mostraram diferença limítrofe da linhagem A no grupo NIC2/NIC3 em relação ao grupo câncer de colo de útero (p = 0,053). Por outro lado, em relação à linhagem D, houve uma proporção maior nos casos de câncer (32,8%) quando comparado ao grupo NIC2/NIC3 (16,9%) e esta diferença se mostrou estatisticamente significante (p = 0,023). Conclusão A linhagem A do HPV-16 foi a mais frequente tanto nas amostras CIN2/CIN3 quanto nas amostras de câncer de colo de útero, enquanto a linhagem D predominou no câncer de colo do útero, sugerindo uma possível associação da linhagem D de HPV-16 com câncer de colo de útero.

Displasia epitelial corneal / Corneal epithelial dysplasia

Las neoplasias intraepiteliales córneo-conjuntival son lesiones premalignas, mal delimitadas, de crecimiento lento y escaso potencial de malignización. Solo el 9 por ciento progresa a carcinoma invasor de células escamosas. Posee varias formas de presentación y tiene múltiples dilataciones vasculares. La displasia epitelial corneal primaria es una forma poco frecuente de neoplasia intraepitelial córnea-epitelial. Se presenta un caso clínico confirmado por estudios anatomopatológicos. En el presente estudio se observó respuesta satisfactoria luego de un mes de tratamiento tópico con 5FU, sin efectos colaterales. El seguimiento durante tres años no ha mostrado signos de recidiva(AU)

Corneal-conjunctival intraepithelial neoplasms are premalignant, poorly demarcated, slow-growing lesions with low malignant potential. Only the 9 percent progresses to invasive squamous cell carcinoma. It appears in several forms and presents multiple vascular dilatations. Primary corneal epithelial dysplasia is a rare form of corneal-epithelial intraepithelial neoplasia. We present a clinical case, confirmed by anatomopathologic studies. In the present study we observed a satisfactory response after one month of topical treatment with 5FU, with no side effects. Follow-up for three years has shown no signs of recurrence(AU)

Cervical Intraepithelial Neoplasia: Analyzing the Disease Present Exclusively in the Endocervical Canal / Neoplasia intraepitelial cervical: Analisando a doença presente exclusivamente no canal endocervical

Abstract Objective To evaluate the role of cervical cytology (Pap smear) in the diagnosis of cervical intraepithelial neoplasia 2 or greater (CIN2+), presented exclusively in the endocervical canal, the clinical-epidemiological characteristics of this lesion, the necessary length of canal to be removed to treat, and the rate of invasive lesion hidden in the endocervical canal. Methods Cross-sectional study, by database analysis, of patients with abnormal cytology (high-grade squamous intraepithelial lesion [HSIL]), without visible colposcopy lesion, submitted to loop electrosurgical procedure (LEEP) to evaluate the association of cytology results with the histological product of the conization, to identify the epidemiological characteristics of endocervical lesion and clinical evolution, using a pvalue< 0.05 and 95% CI. Results In 444 cases, the Pap smear sensitivity for CIN2+ diagnosis was 75% (95% CI: 69.8-79.7), specificity was 40% (95% CI: 30.2-49.5), and the prevalence rate of histological lesion was 73% (95% CI: 70.1-78.7). There was a higher prevalence of CIN2+ in women over 42 years old and invasive cancer in those over 56 years old (p<0.001), and it was necessary to remove 2.6 cm in length of the canal to reduce the chance of recurrence (p<0.006). The rate of invasive cancer was 2.7%. Conclusion Cytology was related to a high prevalence to histological lesion (73%) in the diagnosis of CIN2+ in the endocervical disease; older patients presented a higher relationship with histological lesions in the canal disease, and it was necessary to remove an average of 2.6 cm in length of the endocervical canal to avoid the persistence and progression of CIN. The rate of occult neoplasia in the endocervical canal was 2.7%.

Resumo Objetivo Avaliar o papel da citologia oncótica (CO) no diagnóstico da neoplasia intraepitelial cervical 2 ou maior (NIC2+) presente exclusivamente no canal endocervical, as características clínico-epidemiológicas deste tipo de lesão, o comprimento necessário de canal a ser retirado na conização, e a taxa de lesão invasora oculta no canal endocervical. Métodos Estudo transversal, por análise de base de dados, de pacientes comcitologia alterada, sem lesão colposcópica visível, submetidas a conização por cirurgia de alta frequência (CAF), para avaliar a associação dos resultados citológicos com o produto histológico da conização, as características epidemiológicas da lesão endocervical, e evolução clínica, utilizando o valor de p<0.05 e intervalo de confiança (IC) de 95%. Resultados Nos 444 casos analisados, a sensibilidade da CO para o diagnóstico de NIC 2+ foi de 75% (IC 95%: 69.8-79.7), a especificidade foi de 40% (IC 95%: 30.2-49.5), e a taxa de prevalência de lesão histológica foi de 73% (IC 95%: 70.1-78.7). Houve maior prevalência de NIC2+ em pacientes com mais de 42 anos de idade e de neoplasia invasora naquelas commais de 56 anos (p<0.001), e foi necessário a retirada de 2.6 cm de comprimento de canal para diminuir a taxa de recidiva (p<0.006). Foi identificada uma taxa de 2.7% de neoplasia invasora. Conclusão A citologia esteve relacionada a uma alta prevalência de lesão (73%) no diagnóstico das NIC2+ na doença endocervical; quanto maior a idade, maior foi a relação da histologia com a citologia de canal, e se fez necessário retirar uma média de 2.6 cmde comprimento de canal para evitar a persistência e a progressão da NIC. A taxa de neoplasia oculta no canal endocervical foi 2.7%.

Proficiency testing for determination of photometric method of bacterial endotoxin / 中国药理学通报

Aim To design and implement the bacteri¬al endotoxin test proficiency testing plan to evaluate the laboratory's ability and level to determine bacterial en¬dotoxin. Methods According to the Chinese Pharma-copoeia (2015 edition, Vol IV) -1143 Bacterial Endo¬toxin Test-Photometric Method ( Method 2 ) , each la¬boratory used any of these methods to determine the endotoxin content of the sample to be tested. The stati- stical software JMP13 was used for statistical analysis of the feedback results of the participating laboratories. The consensus value of the participants, namely the ro¬bust average value of the effective test results of all the participating laboratories, was used as the assigned value X of the endotoxin content of the samples to be tested in the proficiency testing of the round. The re¬sults of participating laboratories were evaluated ac¬cording to the following criteria: (1) the laboratory test results were within 50% to 200% of the assigned value of the sample, which was evaluated satisfactory; ( 2 ) the laboratory test results were not within the 50 -200% range of the assigned value of the sample, which was evaluated dissatisfactory. Results A total of laboratories participated in this capacity verification plan, with 45 in the laboratory with satisfactory re¬sults, with a satisfaction of 91. 8% ; There were 4 la¬boratories that received "dissatisfaction" results, all of which were not within the range of 50% -200% of the assigned value of samples, and the dissatisfaction of 8. 2% . Conclusions Most of the participating labora¬tories can accurately detect the bacterial endotoxin con¬tent in the sample to be tested, indicating that the level of bacterial endotoxin detection in our country is gener¬ally good at present.

Analysis of midwives' situation and the need to measure their workloads / Análise da situação das parteiras e a necessidade de medir suas cargas de trabalho / Análisis de la situación de las matronas y necesidad de medir sus cargas de trabajo

ABSTRACT Objective: to analyze midwives' employment situation of midwives and detect their workload measurement needs. Methods: a mixed methodology (quantitative and qualitative), observational, descriptive and cross-sectional study. Two phases were carried out. The first methodological phase consisted of conducting semi-structured individual interviews. The second methodological phase analyzed the Nursing Intervention Classification (NIC) interventions that midwives perform in the labor room during daily practice. Results: 90.3% of midwives have work overload, since for 80.6% the midwife-pregnant mother ratio is not well established, since the mean execution time of a Nursing Intervention Classification (NIC) intervention is 20 minutes. For this reason, 100% of the sample considers the development of workload measurement tools to be highly useful. Conclusions: the need to generate an instrument that considers the diversity of Nursing Intervention Classification (NIC) interventions that develop within the labor room is ratified.

RESUMO Objetivo: analisar a situação laboral das parteiras e detectar suas necessidades de mensuração da carga de trabalho. Métodos: estudo de metodologia mista (quantitativa e qualitativa), observacional, descritivo e transversal. Duas fases foram realizadas. A primeira fase metodológica consistiu na realização de entrevistas individuais semiestruturadas. A segunda fase metodológica analisou as intervenções da Classificação de Intervenção de Enfermagem (NIC) que as parteiras realizam na sala de parto durante o dia de atendimento. Resultados: 90,3% das parteiras apresentam sobrecarga de trabalho, pois, para 80,6%, a relação obstetriz-gestante não está bem estabelecida, pois o tempo médio de execução de uma intervenção Classificação de Intervenção de Enfermagem (NIC) é de 20 minutos. Por esse motivo, 100% da amostra considera muito útil o desenvolvimento de ferramentas de medição de carga de trabalho. Conclusões: ratifica-se a necessidade de gerar um instrumento que considere a diversidade de intervenções Classificação de Intervenção de Enfermagem (NIC) que se desenvolvem na sala de parto.

RESUMEN Objetivo: Analizar la situación laboral de las matronas y detectar sus necesidades de medición de cargas de trabajo. Métodos: Estudio de metodología mixta (cuantitativo y cualitativo), observacional, descriptivo y transversal. Se realizaron dos fases: La primera fase metodológica, consistió en la realización de entrevistas individuales semiestructuradas. Y en la segunda fase metodológica, se analizaron las intervenciones de enfermería (NIC) que las matronas efectúan en paritorio durante su jornada asistencial. Resultados: El 90,3% de las matronas presentan sobrecarga en el trabajo, pues para el 80,6% el ratio matrona- gestante no se encuentra bien establecido; pues tiempo medio de ejecución de una intervención de enfermería (NIC), es de 20 minutos. Por ello, el 100% de la muestra considera de máxima utilidad el desarrollo de herramientas de medición de cargas de trabajo. Conclusiones: Se ratifica la necesidad de generar un instrumento que considere la diversidad de intervenciones de enfermería (NIC) que desarrollan dentro del paritorio.

Efectividad del cono LEEP en pacientes con lesiones intraepiteliales de alto grado en la Unidad de colposcopia del Servicio de Ginecología del Hospital de la Mujer / Effectiveness of the LEEP cone in patients with high-grade intraepithelial injuries in the colposcopy Unit of the Gynecology Service of La Mujer Hospital

OBJETIVO. Determinar la efectividad del CONO LEEP en pacientes con lesión intraepitelial de Alto Grado (LIE AG). MATERIAL Y MÉTODO. Estudio de tipo descriptivo, retrospectivo y transversal que incluyo a 68 pacientes quienes fueron sometidas a CONO LEEP por lesiones intraepiteliales de alto grado en el año 2014 en la unidad de colposcopia del Hospital de la Mujer. Se analizó la efectividad a través de la persistencia y/o recidiva de los controles posteriores en el año 2015. RESULTADOS. 33 pacientes realizaron control PAP posterior al CONO LEEP siendo el resultado citológico negativo para lesión intraepitelial más frecuente llegando a un porcentaje de 91% (30 pacientes). Se identificó que el 9% (3 pacientes) presento persistencia al tratamiento con CONO LEEP. CONCLUSIONES. El estudio determino la efectividad del procedimiento en las pacientes que acudieron a control citológico, se estimó en 91 %, lo cual demuestra que la conización es un método de ALTA EFECTIVIDAD con un 9% de persistencia encontrándose en los rangos esperados de persistencia de la NIC que es entre el 5 y el 17% de acuerdo a protocolos de Brasil, México y España.

OBJETIVE. To determine the effectiveness of the LEEP CONE in patients with High Grade Intraepithelial Lesion (HLL). MATERIAL AND METHOD. A descriptive, retrospective and crosssectional study that included 68 patients who underwent LEEP CONE for high-grade intraepithelial lesions in 2014 in the colposcopy unit of La Mujer Hospital. The effectiveness was analyzed through the persistence and / or recurrence of subsequent controls in 2015. RESULTS. 33 patients underwent PAP control after the LEEP CONE, the cytological result being negative for the most frequent intraepithelial lesion, reaching a percentage of 91% (30 patients). It was identified that 9% (3 patients) presented persistence to treatment with LEEP CONE. CONCLUSIONS. The study determined the effectiveness of the procedure in patients who attended cytological control, it was estimated at 91%, which shows that conization is a HIGH EFFECTIVENESS method with a 9% persistence, being in the expected ranges of persistence of the NIC which is between 5 and 17% according to the protocols of Brazil, Mexico and Spain.

Diagnósticos de enfermagem em recuperação pós-anestésica: intervenções e resultados segundo linguagens padronizadas / Nursing diagnoses in post-anesthetic recovery: outcomes and interventions according to standardized languages

Introdução: os sistemas de classificação com linguagens padronizadas se estabelecem em um conjunto de conhecimentos estruturados, conceitos fundados de forma lógica e coerente, com base em suas similaridades. Nesse sentido, identificar um perfil junto a populações pode cooperar para uma melhor definição e compreensão situacional para aquela unidade e/ou pacientes. Objetivos: realizar mapeamento cruzado entre os diagnósticos de enfermagem da NANDA-I com os registros manuais de enfermagem em sala de recuperação pós-anestésica; e propor intervenções e resultados, segundo linguagens padronizadas. Método: estudo exploratório, retrospectivo com análise estatística descritiva de registros de enfermagem de 187 pacientes que estiveram hospitalizados no período de junho a julho de 2018, em sala de recuperação pós-anestésica de um hospital oncológico. O mapeamento cruzado foi realizado em três etapas: identificação dos indicadores dos diagnósticos; proposição de intervenções e atividades; e indicadores de resultados. Os dados foram analisados e descritos em frequências absoluta e relativa. Resultados: dos 13 domínios da NANDA-I, cinco foram representados; identificaram-se cinco diagnósticos de risco e 11 com foco no problema; observou-se 100% de frequência para os diagnósticos de: Risco de aspiração; Risco de infecção; Risco de queda; Capacidade de transferência prejudicada; Mobilidade no leito prejudicada; Integridade da pele/tissular prejudicada e Conforto prejudicado. Conclusões: para os 16 diagnósticos de enfermagem mapeados, foram selecionadas 22 intervenções e 58 atividades; 23 resultados e 48 indicadores de resultados.

Introduction: the classification systems with standardized languages are established in a set of structured knowledge, concepts founded in a logical and coherent way, based on their similarities. In this sense, identifying a profile with the populations can cooperate for a better definition and situational understanding for that unit and/or patients. Objectives: to perform cross-mapping between the nursing diagnoses of NANDA-I with the manual nursing records in the post-anesthetic recovery room; and, to propose interventions and outcomes, according to standardized language. Method: exploratory, descriptive and retrospective analysis of the nursing records of 187 patients hospitalized from June to July 2018, in the post-anesthetic recovery room of an oncology hospital. Cross-mapping was carried out in three stages: identification of diagnostic indicators; proposition of interventions and activities; and outcomes indicators. The data were analyzed and described in absolute and relative frequencies. Results: of the 13 NANDA-I domains, five were highlighted; were identified five risk diagnoses and 11 focused on the problem; 100% frequency was observed for the diagnoses of: Aspiration, infection and falling risk; Impaired transfer capacity; Impaired bed mobility; Impaired skin/tissue integrity and impaired comfort. Conclusions: from the 16 nursing diagnoses mapped, were selected 22 interventions and 58 activities; 23 results and 48 outcomes indicators.

Analysis of Plantar Pressure before and after Occurrence of Neurogenic Intermittent Claudication in Patients with Central Lumbar Spinal Stenosis / 医用生物力学

Objective To investigate the changes of plantar pressure distributions and risk of falling before and after the occurrence of neurogenic intermittent claudication (NIC) in patients with central lumbar spinal stenosis (LSS), so as to provide theoretical and data references for the application of plantar pressure analysis in judgment of walking abilities for LSS patients. Methods Twelve patients with LSS at the L4-5 segment were selected as the LSS group, while twelve healthy adults at the same age were selected as the control group. Footscansystem was used to measure plantar pressure of these subjects during walking. Contact area percentage of the total foot contact area (CA%), pressure-time integral (PTI), foot progression angle (FPA), contact time percentage of the stance time (CT%) and total stance time (CT) in both LSS group and control group were compared to evaluate changes of plantar pressures during walking．Results Before the occurrence of NIC, compared with the control group, the LSS group had lower CT% during the forefoot push-off phase (FFPOP) and higher CT% during the initial contact phase (ICP), the total CT and FPA also increased, and the PTI of the 1st-3rd metatarsals and the CA% of the 2nd and 3rd metatarsals were higher. After the NIC occurred, for LSS group, CT% during ICP and forefoot contact phase (FFCP) decreased, CT% during the foot flat phase (FFP) and FFPOP as well as total CT and FPA increased, the PTI and CA% increased in 1st-4th metatarsals. Moreover, the CA% also increased in toe zone, both the PTI and CA% decreased in heel zone. Conclusions In patients with central LSS during walking, the distribution of plantar pressure shifts forward, with abnormal phase of the stance time occurring. Such abnormality will be further aggravated by NIC, indicating a higher risk of falling.

Uso de lenguaje estandarizado en prácticas formativas de enfermería. Pereira 2011-2015 / Use of standardized language on nursing apprenticeships. Pereira 2011-2015 / Uso da linguaje padronizada em práticas formativas de enfermagem (Pereira 2011-2015)

Objetivo: Caracterizar el uso del lenguaje estandarizado en el registro del Proceso de Enfermería a la población atendida durante las prácticas formativas en una Institución Universitaria de Pereira Colombia, durante los años 2011 a 2015. Materiales y Métodos: Estudio descriptivo retrospectivo autorizado por el comité de Ética Institucional. Se ordenaron según frecuencia 30.020 diagnósticos enfermeros, registrados durante los años 2011 a 2015 en el sistema de información de prácticas formativas de enfermería. Se seleccionaron los diagnósticos más frecuentes, sus resultados esperados e intervenciones hasta completar el tamaño de muestra con un NC=95% y error de precisión=1%. La muestra correspondió a 7276 registros que incluyeron 15 diagnósticos presentes en 4731 personas atendidas. Variables: Características de la población atendida, tipo de práctica formativa y Proceso de Atención de Enfermería (PAE) con taxonomía NANDA-I, NOC y NIC. Resultados: Predomina la atención a la población femenina (57,4%), principalmente adultos (72%), régimen subsidiado (68%). Las prácticas se realizan principalmente en áreas clínicas (84%) de instituciones hospitalarias estatales (68%). Se priorizaron diagnósticos 'reales´ (69,3%) relacionados con los dominios: 'Seguridad/Protección´ (22,8%), 'Eliminación/Intercambio´ (21,0%) y 'Actividad/ Reposo´ (21,0%). NOC más frecuentes en dominios ´Salud fisiológica (63,0%) y 'Salud funcional '(16,8%). NIC relevantes en campos de 'Seguridad '(27,4%), ´Fisiológico complejo '(26,8%) y 'Fisiológico básico '(24,5%). Conclusiones: Coherencia en la aplicación de las fases del PAE. Los diagnósticos más frecuentes correspondieron a problemas de salud clínicos, fisiológicos y funcionales. Se requiere fortalecer la formulación y registro de diagnósticos de 'Percepción/cognición´ y resultados del dominio 'Psicosocial´ que orienten intervenciones educativas en familias y comunidades.

Objective: Characterize the use of standardized language in the nursing records of an attended population during internships in a University of Pereira, Colombia. Materials and Methods: Retrospective descriptive study authorized by the Institutional Ethics Committee. According to frequency, 30,020 nursing diagnoses registered in the information system of nursing internships from 2011 to 2015 were organized. The most frequent diagnoses, their expected results and interventions were selected until completing a sample size of NC=95% and an error precision=1%. The sample corresponded to 7276 records that included 15 diagnoses present in 4731 of the people attended. Variables: characteristics of the attended population, type of internship and Nursing Process with NANDA-I, NOC and NIC taxonomy. Results: Care predominates on female population (57.4%), mainly adults (72%), of subsidized regime (68%). The practices were mainly performed on clinical areas (84%) of State healthcare institutions (68%). 'Real' diagnoses were prioritized (69.3%) relating to the domains: 'Security/Protection' (22.8%), 'Elimination/Exchange' (21.0%), 'Activity/Rest' (21.0%). The most frequent NOC domains 'Physiological health' (63.0%) and 'functional health' (16.8%). Relevant NIC domains on areas of 'security' (27.4%), 'complex physiological' (26.8%) and 'basic physiological' (24.5%). Conclusions: Coherence in the application of the Nursing Process phases. The most frequent diagnoses corresponded to clinical physiological and functional health problems. It is required to strengthen the formulation and diagnoses records of 'Perception/Cognition' and the results of the 'Psychosocial' domain to orientate educative interventions on families and communities.

Objetivo: Caracterizar o uso da linguagem padronizada no registro do Processo de Enfermagem à população atendida durante as práticas formativas numa Instituição Universitária de Pereira na Colômbia, durante os anos 2011 a 2015. Materiais e Métodos: Estudo descritivo retrospectivo autorizado pelo comité de Ética Institucional. Ordenaram-se segundo frequência 30.020 diagnósticos de enfermagem, registrados durante os anos 2011 a 2015 no sistema de informação de práticas formativas de enfermagem. Selecionaram-se os diagnósticos mais frequentes, seus resultados esperados e intervenções até completar o tamanho de amostra com um NC=95% e erro de precisão=1%. A amostra correspondeu a 7.276 registros que incluíram 15 diagnósticos presentes em 4.731 pessoas atendidas. Variáveis: Características da população atendida, tipo de prática formativa e Processo de Atendimento de Enfermagem (PAE) com taxonomia NANDA-I, NOC e NIC. Resultados: Predomina o atendimento à população feminina (57,4%), principalmente adultos (72%), regímen subsidiado (68%). As práticas se realizam principalmente em áreas clínicas (84%) de instituições hospitalares estaduais (68%). Priorizaram-se diagnósticos 'reais´ (69,3%) relacionados com os domínios: "Seguridade/Proteção" (22,8%), 'Eliminação/Trocas" ´(21,0%) e "Atividade/ Repouso" (21,0%). NOC mais frequentes em domínios "Saúde fisiológica" (63,0%) e "Saúde funcional" (16,8%). NIC relevantes em campos de "Segurança" (27,4%), "Fisiológico complexo" (26,8%) e "Fisiológico básico" (24,5%). Conclusões: Coerência na aplicação das fases do PAE. Os diagnósticos mais frequentes corresponderam a problemas de saúde clínicos, fisiológicos e funcionais. Reque-se fortalecer a formulação e registro de diagnósticos de "Percepção/cognição" e resultados do domínio "Psicossocial" que orientem intervenções educativas em famílias e comunidades.

Conduta pós-conização em casos de margem comprometida / Post conization conduct in cases of compromised margins

O comprometimento de margens pós-conização é uma situação que se apresenta ao médico, que aborda as neoplasias intraepiteliais do colo, com relativa frequência. Deve ser conduzida de forma individualizada, obedecendo algumas características da paciente e outras particularidades da própria doença, não se esquecendo que uma abordagem especificamente dirigida, com bom relacionamento médico-paciente, deverá ter prioridade.(AU)

The compromised margins post conization is a situation what one presents to a doctor, who approaches the neoplasias intra epiteliais of the cervix, with relative frequency; must be driven in the individualized form, obeying some characteristics of the patient and other peculiarities of the disease itself; not forgetting that an specific direct approach must be priority, with a good patient-medical relationship.(AU)

Controversia en el tratamiento de la lesión intraepitelial escamosa de alto grado (NIC II) / Controversy in the treatment of high-grade squamous intraepithelial lesion (CIN II)

Contexto: el cono LLETZ actualmente es el tratamiento de las NIC de alto grado. La resistencia al procedimiento es argumentada por los efectos del sobretratamiento (estenosis e insuficiencia cervical), sobre todo cuando se utilizan métodos ablativos destructivos en lugar de la resección quirúrgica ambulatoria (LLETZ). Objetivo: analizar el diagnóstico y tratamiento del NIC II mediante cono y legrado en pacientes que acuden al servicio de Patología del tracto genital inferior del Hospital Oncológico SOLCA-Quito Ecuador. Sujetos y métodos: en este estudio epidemiológico descriptivo observacional de corte transversal se analizaron expediente clínicos de 820 pacientes con diagnóstico histopatológico por biopsia de NIC II; mujeres entre 17 a 82 años que acudieron al servicio de patología del tracto genital inferior sujetas a control, en estas pacientes se realizó 530 legrados. El estudio fue realizado en el Hospital Oncológico SOLCA de Quito Ecuador, de los años 2004 a 2013. Resultados: la histopatología de los conos libres de neoplasia representa el 98,66% (n=809); existen 11 casos de neoplasias residuales (1,34%). El 53,7% de casos presenta una lesión igual o mayor que en biopsia, lo que justifica el cono. Conclusión: el procedimiento de cono LLETZ tiene gran utilidad diagnóstica, terapéutica y pronóstica en mujeres que presentan NIC II y otras patologías similares. (AU)

Background: the LLETZ cone is currently the treatment of high grade NICs. The resistance to the procedure is argued by the effects of overtreatment (stenosis and cervical insufficiency), especially when destructive ablative methods are used instead of ambulatory surgical resection (LLETZ). Objective: to analyze the diagnosis and treatment of CIN II by means of cone and curettage in patients attending the pathology department of the lower genital tract of the SOLCA-Quito Ecuador Oncology Hospital. Subjects and methods: in this cross-sectional descriptive epidemiological observational study, we analyzed clinical records of 820 patients with histopathological diagnosis by CIN II biopsy; women between 17 and 82 years old who visited the pathology service of the lower genital tract subject to control, in these patients 530 catheters were performed. The study was conducted at the SOLCA Oncology Hospital of Quito, Ecuador, from 2004 to 2013. Results: the histopathology of neoplasm-free cones represents 98.66% (n = 809); there are 11 cases of residual neoplasms (1.34%). 53.7% of cases present a lesion equal to or greater than in biopsy, which justifies the cone.(AU)

Application of dual-source CT dual-energy scanning fusion 3D reconstruction in gastric cancer and lymph nodes / 实用肿瘤学杂志

Objective The objective of this study was to determine the lesion range between gastric cancer lesions and normal gastric wall,improve the early diagnosis of gastric cancer rate,distinguish between me-tastatic lymph nodes and non-metastatic lymph nodes,and accurate N staging by dual-source CT double-en-ergy enhanced scan parameters.Methods The dual energy enhanced scan of patients with preoperative gastric cancer was performed by Siemens Somatom Definition Flash dual-source CT.The collected data were analyzed by Syngo.Via software and reconstructed three-dimensionally to obtain the absolute iodine of gastric cancer,nor-mal gastric wall,metastatic lymph node and non-metastatic lymph node value,standardized iodine value and vir-tual single energy spectrum curve of the slope to combine with postoperative pathological results.The use of statis-tical methods was to determine the difference between the post-and preoperation.Results The absolute iodine values(IC)were(3.329±0.812)g/L in the gastric cancer lesion and(64.006±17.450)% for the standard io-dine values(NIC).The slope of the virtual single energy spectrum curve was-2.916±1.3227,IC(1.563±0.708)g/L in the normal gastric wall.The NIC were(37.122±16.267)%and-1.621±1.4028 for the slope of the virtual single energy spectrum curve.They were significantly statistical difference(P<0.05).The IC of meta-static lymph nodes were(2.968±0.547)g/L,(63.597±14.633)% for the NIC and(-2.532±0.753)for the slope of the virtual single energy spectrum curve.The IC of non-metastatic lymph nodes were(1.465±0.408)g/L,(35.240±14.357)%for the NIC and(-1.378±0.726)for the slope of the virtual single energy spectrum curve.They also had significantly statistical difference(P<0.05).Conclusion Dual-source CT dual-energy scan combined with three-dimensional reconstruction technique can help to determine the lesion range,improve the diagnostic rate of early gastric cancer,distinguish between metastatic and non-metastatic lymph nodes,and improve the accuracy of N staging.

Application of dual-source CT dual-energy scanning fusion 3D reconstruction in gastric cancer and lymph nodes / 实用肿瘤学杂志

Objective The objective of this study was to determine the lesion range between gastric cancer lesions and normal gastric wall,improve the early diagnosis of gastric cancer rate,distinguish between me-tastatic lymph nodes and non-metastatic lymph nodes,and accurate N staging by dual-source CT double-en-ergy enhanced scan parameters.Methods The dual energy enhanced scan of patients with preoperative gastric cancer was performed by Siemens Somatom Definition Flash dual-source CT.The collected data were analyzed by Syngo.Via software and reconstructed three-dimensionally to obtain the absolute iodine of gastric cancer,nor-mal gastric wall,metastatic lymph node and non-metastatic lymph node value,standardized iodine value and vir-tual single energy spectrum curve of the slope to combine with postoperative pathological results.The use of statis-tical methods was to determine the difference between the post-and preoperation.Results The absolute iodine values(IC)were(3.329±0.812)g/L in the gastric cancer lesion and(64.006±17.450)% for the standard io-dine values(NIC).The slope of the virtual single energy spectrum curve was-2.916±1.3227,IC(1.563±0.708)g/L in the normal gastric wall.The NIC were(37.122±16.267)%and-1.621±1.4028 for the slope of the virtual single energy spectrum curve.They were significantly statistical difference(P<0.05).The IC of meta-static lymph nodes were(2.968±0.547)g/L,(63.597±14.633)% for the NIC and(-2.532±0.753)for the slope of the virtual single energy spectrum curve.The IC of non-metastatic lymph nodes were(1.465±0.408)g/L,(35.240±14.357)%for the NIC and(-1.378±0.726)for the slope of the virtual single energy spectrum curve.They also had significantly statistical difference(P<0.05).Conclusion Dual-source CT dual-energy scan combined with three-dimensional reconstruction technique can help to determine the lesion range,improve the diagnostic rate of early gastric cancer,distinguish between metastatic and non-metastatic lymph nodes,and improve the accuracy of N staging.

Programa de cáncer de cérvix en el Policlínico Tula Aguilera Céspedes de Camagüey, Cuba (2012-2014) / Cervical Cancer Program at Tula Aguilera Cespedes Policlinic in Camagüey (2012-2014)

Introducción: el programa cubano de diagnóstico precoz del cáncer cervicouterino plantea entre sus objetivos: Disminuir la mortalidad y conocer la morbilidad por cáncer de cuello uterino, mediante su detección en su etapa más temprana posible, lo que permite aplicar una terapéutica precoz y eficaz. Objetivo: caracterizar el comportamiento del programa de cáncer de cérvix durante los últimos tres años. Métodos: se realizó un estudio observacional descriptivo transversal, durante el período desde enero de 2012 hasta diciembre de 2014, en el policlínico Universitario Tula Aguilera Céspedes del municipio Camagüey, Cuba. El universo estuvo constituido por 8 599 tomas de citología que era el plan a realizar. Se trabajó con 8 018 tomas de citologías realizadas en el periodo, incluyendo citologías que se volvieron a realizar y casos nuevos. Los datos se obtuvieron del libro de registro de citologías del área y de las tarjetas de las féminas con resultados positivos en la citología. Se confeccionó una hoja de vaciamiento que se convirtió en el registro definitivo de la investigación. Se determinaron estadísticas descriptivas. Resultados: hubo un cumplimiento del plan por encima de 90 por ciento, la mayoría de las muestras fueron citologías que se volvieron a realizar, una minoría resultó positiva. Predominaron lesiones de alto grado NIC II, hubo calidad en la toma de las muestras y correlación entre el resultado citológico e histológico. Conclusiones: el programa y su ejecución son indispensables para el diagnóstico precoz de la afección(AU)

Introduction: The Cuban program for early diagnosis of cervical cancer poses among its objectives to reduce mortality and know morbidity from cervical cancer by detection at the earliest possible stage, allowing to apply early and effective treatment. Objective: Characterize the behavior of Cervical Cancer Program during the last three years. Methods: Adescriptive cross-sectional observational study was conducted during from January 2012 to December 2014, at Tula Aguilera Cespedes University Polyclinic in Camagüey, Cuba. The universe consisted of 8,599 cytology smears that was our plan. We worked with 8,018 smear tests performed in the period, including repeated cytology and new cases. The data were obtained from the cytology logbook of the area and from the cards with positive results in cytology. A data sheet is constructed and it became the definitive record of this investigation, and descriptive statistics were determined. Results: There was a fulfillment of the plan above 90 percent, most of the samples were cytology that were perform again, a minority was positive. High-grade lesions CIN II predominated, there was quality in making samples and correlation between cytological and histological results. Conclusions: The program and its implementation are essential for early diagnosis of this condition(AU)

Tipificación de virus de papiloma humano en lesiones preneoplásicas y neoplásicas del cérvix

Objetivo: Determinar los tipos de virus papiloma humano mediante la técnica de reacción en cadena de polimerasa en lesiones preneoplásicas (neoplasia intraepitelial cervical I, II, III) y neoplásica (cáncer in situ), en pacientes que acudieron a la consulta de patología cervical. Métodos: Estudio descriptivo transversal, no experimental y de campo, se evaluaron 102 pacientes de la consulta de patología cervical, de las cuales 42 pacientes se incluyeron en el estudio, se les practicó una entrevista y luego una toma de exfoliado cervical por la técnica de hisopado, que fueron recogidas en un tubo recolector, para ser procesados en el laboratorio clínico e inmunodiagnóstico BRIMED C. A. mediante la técnica de reacción en cadena de polimerasa. Resultados: Mediante reacción en cadena polimerasa para virus papiloma humano dieron positivo en 24 pacientes, mayormente entre las edades de 34 a 39 años con 7 pacientes, el genotipo 6 fue el más común con un total de 12 de pacientes, siendo la neoplasia intraepitelial cervical I el tipo de lesión cervical más afectada con 5 pacientes en este grupo, mientras que solo 10 pacientes dieron positivo para genotipo de riesgo alto, siendo el más común el de otro genotipo con un total de 7 pacientes, obteniéndose la cervicitis y la neoplasia intraepitelial cervical II como las lesiones cervicales más afectadas con 2 pacientes en cada grupo. Conclusiones: La técnica por reacción en cadena de polimerasa para virus papiloma humano obtuvo una sensibilidad de 57,1 % y especificidad de un 42,9 % en este estudio, siendo el genotipo 6 de bajo riesgo el más frecuente en total, el de riesgo intermedio fue habitual en solo 2 pacientes y el de riesgo alto, el más común fue el de otro genotipo con un total de 7 pacientes, mientras que el genotipo 16 fue el menos frecuente. Asimismo, la relación del virus papiloma humano con el grupo etario se ubicó frecuentemente entre las edades de 34 a 39 años, y en relación al tipo de lesión cervical la neoplasia intraepitelial cervical I fue la más común.

Objective: To determine the type of virus human papillomavirus by the technique of polymerase chain reaction in premalignant lesions (NIC I, II, III) and neoplastic (cancer in situ) in patients who attended the consultation cervical pathology. Methods: Not experimental and field, cross-sectional study of 102 patients with cervical pathology consultation, of which 42 patients were included in the study and, she underwent an interview and then a decision by the exfoliated cervical swab technique, which were collected in a collecting tube to be processed in the clinical laboratory and immunodiagnostic BRIMED CA by polymerase chain reaction. Results: Using polymerase chain reaction were positive for human papillomavirus 24 patients, mostly between the ages of 34 to 39 with 7 patients, genotype 6 was the most common with a total of 12 patients being the NIC I the type of neck injury more affected with 5 patients in this group, while only 10 patients tested positive for high-risk genotype, the most common being that of another genotype with a total of 7 patients, obtaining cervicitis NIC II and neck injuries as most affected 2 patients in each group. Conclusions: Human papillomavirus polymerase chain reaction technique had a sensitivity of 57.1 % and specificity of 42.9 % in this study, with the low risk genotype 6 the most common in all, the intermediate risk was common in just 2 patients and high risk, the most common was that of another genotype with a total of 7 patients, while genotype 16 was the least frequent. Likewise, the ratio of the age group human papillomavirus is frequently ranked among the ages of 34-39 years and in relation to the type of cervical lesion NIC I was the most common.

Randomized controlled trial of noninvasive positive pressure ventilation technology combined with respiratory stimulant in the treatment of pulmonary encephalopathy in patients with COPD / 中国基层医药

Objective To explore the efficacy of noninvasive positive pressure ventilation technology com-bined with respiratory stimulant in the treatment of pulmonary encephalopathy in patients with COPD.Methods For-ty -eight COPD patients with early pulmonary encephalopathy were included.They were randomly divided into the treatment group and control group.The treatment group was treated by not only regular treatment and noninvasive posi-tive pressure ventilation technology,but also respiratory stimulant.The control group was only treated by regular treat-ment and noninvasive positive pressure ventilation technology.The indexes were recorded,including tracheal intubation rate,clinical recovery rate,mortality,Glasgow coma score,arterial blood gas analysis and adverse reactions.Results Compared with the control group,the arterial blood gas analysis of treatment group on the 2h,24h and 72h were statis-tically significant different(P <0.05).The GCS score on the 24h and 72h were also statistically significant different [24h,(13.4 ±1.6)vs.(11.8 ±2.1),P <0.05;72h,(14.6 ±1.5)vs.(12.4 ±2.4),P <0.05].The treatment group had lower tracheal intubation rate(12% vs.56.5%,P =0.001),shorter consciousness recovery time[(3.0 ± 0.5)h vs.(5.6 ±0.7)h,P =0.023],shorter hospitalization time in ICU[(12.6 ±1.5)d vs.(19.2 ±1.8)d,P =0.004]and better clinical recovery(22 /25 vs.10 /23,P =0.001)than the control group.But the mortality rate had no significant difference between the two groups(1 /25 vs.4 /23,P =0.129).Conclusion NIPPV combined with respiratory stimulant is an effective,safe and simple method for treatment of COPD complicated with pulmonary encephalopathy.It can significantly improve the clinical symptoms and the index of arterial blood gas analysis,and it can shorten consciousness recovery time and decrease tracheal intubation rate.But close observation must be carried out,and the invasive mechanical ventilation should be promptly executed in case of emergency or exacerbation.

Neoplasias intraepiteliais cervicais: faixa etária no momento do diagnóstico citológico / Cervical intraepithelial neoplasia: age group in the moment of the cytological diagnosis

Objetivo: Avaliar a distribuição de diagnósticos citológicos de neoplasia intraepitelial cervical (NIC), considerando a idade das mulheres incluídas. Material e Métodos: Osresultados citológicos de mulheres com NIC 1 (721), NIC 2(218) e NIC 3 (84) foram analisados em um modelo estratificado por faixa etária. Resultados e Conclusão: As prevalências encontradas foram de 70,48% (721/1023) para NIC 1, 21,31% (218/1023) para NIC 2 e 8,21% (84/1023) para NIC 3. Os diagnósticos citológicos de NIC 1 foram observados com maior frequência em mulheres com menos de 40 anos (88,35%; 637/721). Os diagnósticos citológicos de NIC 2 também foram mais frequentes emmulheres com menos de 40 anos, com uma prevalência de 43,6% (95/218), observada na faixa etária de 20-30 anos, e de 22,5% (49/218) em mulheres de 31-40 anos. Osdiagnósticos de NIC 3 foram mais frequentes em mulheres com mais de 30 anos (83,3%; 70/84). Houve uma maior prevalência de NIC 1 e NIC 2 em mulheres na faixa etária de 20 a 30 anos, enquanto que NIC 3 teve prevalência maior em mulheres com mais de 30 anos. É possível que a história natural da NIC 2 seja mais próxima a de NIC 1, quando comparadaà de NIC 3.

Objective: To evaluate the distribution of the cytological diagnosesof cervical intraepithelial neoplasia (CIN) considering the includedwomen's age group. Material and Methods: The cytological resultsof woman with CIN 1 (721), CIN 2(218) and CIN 3 (84) were analyzedin a stratified model by age group. Results and Conclusion: Thetotal prevalences founded were 70.48% (721/1023) for CIN 1, 21.31%(218/1023) for CIN 2 and 8.21% (84/1023) for CIN 3. The cytologicdiagnosis of CIN 1 were observed more frequently in women underthe age of 40 (88.35% 637/721). The cytologic diagnosis of CIN 2were also more frequent in women under 40 years of age with aprevalence of 43.6% (95/218) observed in the age group of 20-30years and 22.5% (49/218) in women of 31-40 years. The diagnosis ofCIN 3 were more frequent in women over 30 years (83.3% 70/84).There is a higher prevalence of CIN 1 and CIN 2 in women aged 20to 30 years while CIN 3 prevalence is higher in women over 30 years.It is possible that the natural history of CIN 2 is closer to CIN 1 whencompared to CIN 3.

Ensayo de la aplicación de los diagnósticos enfermeros de la nAnDA (nOC nIC) en los planes de cuidado de enfermería de la enfermedad de Alzheimer / essay about the application of nAnDA nursing diagnoses (nOC nIC) for the nursing health care planification for Alzheimer's disease

El presente ensayo se elaboró con fines didácticos a partir de la taxonomía diagnóstica de la NANDA, de la clasificación de intervenciones de enfermería y de la clasificación de los criterios utilizados para evaluar las intervenciones de enfermería que son aplicadas a las personas con enfermedad de Alzheimer, con el fin de identificar si este ejercicio permite orientar la práctica de enfermería en el desarrollo de planes de cuidado

This paper was elaborate for educational purposes from the diagnostic NANDA taxonomy, from the classification of nursing interventions and the classification of the used criteria to evaluate nursing interventions that are applied to people with Alzheimer's disease, in order to identify whether this exercise allows to orientate nursing practice in the development of health care plans

Proceso de Atención de Enfermería a una lactante con neumonía basado en patrones funcionales de Marjory Gordon / Nursing Care Process on an infant suffering from pneumonia based on the Marjory Gordon Functional Patterns

El Proceso de Atención de Enfermería (PAE) que se presenta tiene como objetivo: Identificarlas necesidades alteradas, corregir, mantener y rehabilitar al paciente por medio de la aplicación de conocimientos y procedimientos, con la finalidad de que este recobre en el menor tiempo posible su salud, en este caso una lactante con neumonía. Hoy en día, la neumonía es la causa principal de muerte de niños menores de 5 años en todo el mundo, su principal afectación son los alvéolos pulmonares, lo que compromete el patrón respiratorio. Esta enfermedad si no es tratada oportunamente puede tener complicaciones como: fallo respiratorio agudo, absceso pulmonar, insuficiencia cardiaca congestiva. Es entonces cuando el personal de Enfermería juega un papel importante en la ejecución de intervenciones, que ayuden a mantener la permeabilidad y la estabilidad de la vía aérea. Se identificaron las necesidades prioritarias con base en los 11 patrones funcionales de Marjory Gordon; se diseñó un plan de cuidados individualizado encaminado al mantenimiento del patrón respiratorio, para este se utilizaron las taxonomías: NANDA, NIC y NOC. Los resultados obtenidos fueron satisfactorios, se logró disminución de la dificultad respiratoria, mejoría en la permeabilidad de la vía aérea, mantenimiento de la frecuencia cardiaca y prolongación de periodos de sueño; sin embargo debido a que la paciente presentaba una desnutrición severa con evolución de 6 meses, no pudo modificarse ese patrón y aunado a la gravedad del padecimiento falleció.

The Nursing Attention Process (NAP) aims to identify altered needs, and correct, maintain and rehabilitate the patient through the use of knowledge and procedures, so that he/she can be healthy as soon as possible. In this study, the patient was an infant suffering from pneumonia. Currently, pneumonia is the world's principal cause of death in children younger than 5 years old. Indeed, consequences of not treating this illness on time include acute respiratory arrest, lung abscesses, and congestive cardiac insufficiency. Here, is when the nursing staff has a crucial role at maintaining the permeability and stability of the respiratory airways of these patients. Priority needs were identified through the 11 functional pattern of Marjory Gordon. An individualized care plan was designed and aimed to the maintenance of the child's respiratory patterns. NANDA, NIC and NOC taxonomies were used. Satisfactory results included a decrease in the respiratory difficulty, an improvement in the airway permeability, the maintenance of the cardiac rate, and the improvement of sleep time. However, due to a 6 month previous malnutrition, and the complications of this illness, unfortunately this patient died.

Proceso de atención de Enfermería a pacientes con gangrena de Fournier / Nursing attention process in a Fournier gangrene patient

La gangrena de Fournier es un complejo no muy común y potencialmente letal descrito por Baurienne en 1764, y posteriormente por A. L. Fournier en 1883, como un proceso gangrenoso de causa desconocida; ha adoptado varios nombres como: gangrena idiopàtica, erisipela gangrenosa y gangrena estreptocócica del escroto. Es una patología que ha sido descrita en hombres y mujeres, con alta morbimortalidad especialmente entre los pacientes de 40 a 70 años, que tienen factores predisponentes como (diabetes mellitus y alcoholismo crónico), su incidencia es de 1 en 7,500 casos. Se caracteriza por el inicio abrupto de una infección necrotizante de los tejidos blandos de la región genital y perirectal, progresiva, que compromete tejidos circundantes. El personal de Enfermería en el desarrollo de su función asistencial y en búsqueda de resolver las necesidades humanas de los pacientes, emplean una metodología propia como el Proceso Atención de Enfermería (PAE) y la implementación del Plan de Cuidados de Enfermería (PLACE), como método sistemàtico y organizado para brindar cuidado individualizado y holístico, este proporciona una directriz en el cual se utilizan las competencias, el conocimiento y habilidades. El objetivo fue identificar las necesidades humanas afectadas de un paciente con gangrena de Fournier a través de la valoración de los patrones funcionales, y mejorar la calidad del cuidado empleando la taxonomía NANDA, NOC , NIC.

Fournier gangrene is a complex, not common, but potentially fatal necrotizing infection which was first described by Baurienne in 1764, and later by J. A. Fournier in 1883 as a gangrenous process of unknown etiology. It has been named also as idiopathic gangrene, gangrenous erysipelas, and scrotum streptococcal gangrene. It is both a male and female pathology with a high mortality rate, especially among patients over 40 years old with predisposing factors such as diabetes mellitus and chronic alcoholism. Its incidence is 1 in 7 500 cases. It is characterized by a sudden necrotizing infection of the soft tissues of the genital and perirectal areas, which progressively compromises other surrounding tissues. The nursing staff in the development of their caring role and solve human needs of patients have a right to use a proprietary methodology as the Nursing Care Process (SAP), and the implementation of the Nursing Care Plan (PLACE by its Spanish initials), as organized, systematic approach to provide individualized, holistic care, this provides a guideline that uses the skills, knowledge and abilities. Objective: To identify human needs of a patient affected with Fournier's gangrene through the assessment of functional patterns and improve the quality of care using the taxonomy NANDA, NOC, NIC.