[Development and implementation of primary nursing in the intensive care unit: evaluation in mixed-methods design.] / Entwicklung und Implementierung von Prozessverantwortlicher Pflege auf der Intensivstation.

Development and implementation of primary nursing in the intensive care unit: evaluation in mixed-methods design. Abstract:Background: In a university hospital, the development and implementation of Primary Nursing (Prozessverantwortliche Pflege, PP) in a pilot intensive care unit was initiated. To develop the roles of nurses with and without process responsibility a working group PP was founded while taking into account the skill-grade mix. Aim: The working group aimed to develop the roles of process-responsible nurses (PP) and nurses (P), as well as to plan and implement the implementation process. Methods: Development and piloting steps were taken based on the recommendations of the Medical Research Council. At three measurement points, the instrument for recording nursing systems (IzEP©) was used quantitatively and a focus group interview, as well as a ward process analysis, were used qualitatively in t0 (as-is analysis before development and piloting), t1 (6 months after implementation) and t2 (12 months after implementation). Results: PP mainly take over the care process's design and control. The IzEP© analysis showed that room care was practiced in t0 with 50.0%. The values increased towards PP from 74.0% in t1 to 83.5% in t2. Qualitatively obtained data supported these results and showed further optimization potential for practice. Conclusions: The results prove the successful implementation of PP in practice. For the development and implementation of new nursing roles, the involvement of the affected nurses is mandatory.

Deep Immune Profiling of MIS-C demonstrates marked but transient immune activation compared to adult and pediatric COVID-19

Pediatric COVID-19 following SARS-CoV-2 infection is associated with fewer hospitalizations and often milder disease than in adults. A subset of children, however, present with Multisystem Inflammatory Syndrome in Children (MIS-C) that can lead to vascular complications and shock, but rarely death. The immune features of MIS-C compared to pediatric COVID-19 or adult disease remain poorly understood. We analyzed peripheral blood immune responses in hospitalized SARS-CoV-2 infected pediatric patients (pediatric COVID-19) and patients with MIS-C. MIS-C patients had patterns of T cell-biased lymphopenia and T cell activation similar to severely ill adults, and all patients with MIS-C had SARS-CoV-2 spike-specific antibodies at admission. A distinct feature of MIS-C patients was robust activation of vascular patrolling CX3CR1+ CD8 T cells that correlated with use of vasoactive medication. Finally, whereas pediatric COVID-19 patients with acute respiratory distress syndrome (ARDS) had sustained immune activation, MIS-C patients displayed clinical improvement over time, concomitant with decreasing immune activation. Thus, non-MIS-C versus MIS-C SARS-CoV-2 associated illnesses are characterized by divergent immune signatures that are temporally distinct and implicate CD8 T cells in clinical presentation and trajectory of MIS-C. One Sentence SummaryMIS-C is defined by generalized lymphocyte activation that corrects during hospitalization, including elevated plasmablast frequencies and marked activation of vascular patrolling CX3CR1+ CD8 T cells.

Influence of cigarette smoke on enamel color stability after orthodontic debonding: an in vitro study

Objective: The aim of this study was to evaluate the color stability of dental enamel exposed to cigarette smoke after orthodontic debonding. Methods: Thirty-two bovine incisors were allocated into control (C1 and C2) and experimental groups (n=8) according to distinct bonding protocols: with adhesive (B1) and without adhesive (B2) and exposure to cigarette smoke. Samples from B1, B2 and C2 were exposed to ten cycles of smoke in a specific and hermetic chamber while the C1 remained stored in artificial saliva. Color analysis was performed with a spectrophotometer according to the L*a*b* system. Intergroup comparisons and effect of time were estimated with ANOVA/Tukey and paired Student t tests, respectively (a=0.05). Results: Statistically significant color changes have not been observed in C1 (L*: -0.69 ± 0.80; a*: 0.36 ± 0.23; b*: 0.17 ± 0.50) and without adhesive (B2) (L*: -3.74 ± 2.85; a*: 0.93 ± 0,73; b*: 1.13 ± 1.16) through the study time (p>0,05). However, the group with adhesive (B1) presented significant color changes in L*:-5.55 ± 2.28, a*: 2.33 ± 0.77 and b*: 3.30 ± 1.37, what means, darker, greener and more yellow, respectively (p<0,05) and the control group that was exposed to the cigarette smoke (C2) presented significant color changes in L*: -1.72 ± 0.28 e b*: 1.82 ± 0.22, what means, darker and more yellow, respectively. Conclusion: Enamel color stability was affected by exposure to cigarette smoke after orthodontic debonding, especially when bonding protocolcomprised the application of primer adhesive.

Objetivo: O objetivo deste estudo foi avaliar a estabilidade da cor do esmalte dentário exposto à fumaça de cigarro após a descolagem ortodôntica. Métodos: Trinta e dois incisivos bovinos foram alocados nos grupos controle (C1 and C2) e experimental (n = 8) de acordo com protocolos de colagem ortodôntica distintos: com adesivo (B1) e sem adesivo (B2) e expostos à fumaça de cigarro. Amostras do B1, B2 e C2 foram expostas a dez ciclos de fumaça em uma câmara específica e hermética, enquanto o C1 permaneceu armazenado em saliva artificial. A análise da estabilidade de cor foi realizada com um espectrofotômetro de acordo com osistema L* a* b*. As comparações intergrupos e o efeito do tempo foram verificados com ANOVA / Tukey e testes t de Student, respectivamente (a=0,05). Resultados: Não foram observadas alterações de cor estatisticamente significativas no C1 (L*: -0,69 ± 0,80; a*: 0,36 ± 0,23; b*: 0,17 ± 0.50) e sem adesivo (B2) (L*: -3,74 ± 2,85; a*: 0,93 ± 0,73; b *: 1,13 ± 1,16) durante o tempo de estudo (p>0,05). No entanto, o grupo com adesivo (B1) apresentou alterações significativas de cor em L*: - 5,55 ± 2,28, a*: 2,33 ± 0,77 eb*: 3,30 ± 1,37, o que significa, mais escuro, mais verde e mais amarelo, respectivamente (p<0,05) e o grupo controle exposto à fumaça de cigarro (C2) apresentou alterações significativas de cor em L*: -1,72 ± 0,28 e b*: 1, 82 ± 0,22, o que significa, mais escuro e mais amarelo, respectivamente. Conclusão: A estabilidade da cor do esmalte foi afetada pela exposição à fumaça de cigarro após a descolagem ortodôntica, principalmente quando o protocolo de colagem incluía a aplicação de adesivo.

Aryl thiosemicarbazones: In vitro and immunomodulatory activities against L. amazonensis.

Leishmaniasis is an infection caused by different species of Leishmania genus. Currently, there is no vaccine available for Leishmania infections in humans and conventional treatments are limited due to side effects. Therefore, the development of new antileishmanial drugs is an urgent need. In present study, we evaluated the cytotoxicity in host cells, leishmanicidal activity and immunomodulatory potential of seven aryl thiosemicarbazones. Host cell cytotoxicity was determined in peritoneal macrophages of BALB/c mouse, antiparasitic activity was determined against promastigotes and amastigotes of WHOM/00LTB 0016 strain of L. amazonensis. Nitric oxide (NO) production, interleukin (IL)-12, IL-10 and TNF-alpha secretion were measured in the supernatant of uninfected and infected macrophage cultures. It was observed that aryl thiosemicarbazones presented in vitro antiparasitic activity against both extracellular and intracellular forms of L. amazonensis. However, unlike Amphotericin B, these compounds displayed low cytotoxicity towards host cells. In addition to observed antiparasitic activity, compounds exhibited modulatory properties in the secretion of cytokines and nitrite content from uninfected stimulated and L. amazonensis-infected macrophages. In conclusion, we demonstrated the in vitro antiparasitic activity against L. amazonensis for aryl thiosemicarbazones, which is possible achieved by Th1 cytokine profile modulation. These findings are potential useful for drug development against cutaneous leishmaniasis.

Desing and synthesis of potent anti-Trypanosoma cruzi agents new thiazoles derivatives which induce apoptotic parasite death.

Chagas disease, caused by the kinetoplastid protozoan parasite Trypanosoma cruzi, remains a relevant cause of illness and premature death and it is estimated that 6 million to 7 million people are infected worldwide. Although chemotherapy options are limited presenting serious problems, such as low efficacy and high toxicity. T. cruzi is susceptible to thiazoles, making this class of compounds appealing for drug development. Previously, thiazoles resulted in an increase in anti-T. cruzi activity in comparison to thiosemicarbazones. Here, we report the structural planning, synthesis and anti-T. cruzi evaluation of new thiazoles derivatives (3a-m and 4a-m), designed from molecular hybridization associated with non-classical bioisosterism. By varying substituents attached to the phenyl and thiazole rings, substituents were observed to retain, enhance or greatly increase their anti-T. cruzi activity, in comparison to the corresponding thiosemicarbazones. In most cases, electron-withdrawing substituents, such as bromine, 3,4-dichloro and nitro groups, greatly increased antiparasitic activity. Specifically, new thiazoles were identified that inhibit the epimastigote proliferation and were toxic for trypomastigotes without affecting macrophages viability. These compounds were also evaluated against cruzain. However, inhibition of this enzyme was not observed, suggesting that the compounds work through another mechanism. In addition, examination of T. cruzi cell death showed that these molecules induce apoptosis. In conclusion, except for compounds 3h and 3k, all thiazoles derivatives evaluated exhibited higher cytotoxic activity against the trypomastigote forms than the reference medicament benznidazole, without affecting macrophages viability. Compounds 4d and 4k were highlights, CC50 = 1.2 e 1.6 µM, respectively. Mechanistically, these compounds do not inhibit the cruzain, but induce T. cruzi cell death by an apoptotic process, being considered a good starting point for the development of new anti-Chagas drug candidates.

New 1,3-thiazole derivatives and their biological and ultrastructural effects on Trypanosoma cruzi.

In previous studies, the compound 3-(bromopropiophenone) thiosemicarbazone was described as a potent anti-Trypanosoma cruzi and cruzain inhibitor. In view to optimize this activity, 1,3-thiazole core was used as building-block strategy to access new lead generation of anti T. cruzi agents. In this way a series of thiazole derivatives were synthesized and most of these derivatives exhibited antiparasitic activity similar to benznidazole (Bzd). Among them, compounds (1c) and (1g) presented better selective index (SI) than Bzd. In addition, compounds showed inhibitory activity against the cruzain protease. As observed by electron microscopy, compound (1c) treatment caused irreversible and specific morphological changes on ultrastructure organization of T. cruzi, demonstrating that this class of compounds is killing parasites.

Smoking and Female Sex: Independent Predictors of Human Vascular Smooth Muscle Cells Stiffening.

AIMS: Recent evidence shows the rigidity of vascular smooth muscle cells (VSMC) contributes to vascular mechanics. Arterial rigidity is an independent cardiovascular risk factor whose associated modifications in VSMC viscoelasticity have never been investigated. This study's objective was to evaluate if the arterial rigidity risk factors aging, African ancestry, female sex, smoking and diabetes mellitus are associated with VMSC stiffening in an experimental model using a human derived vascular smooth muscle primary cell line repository. METHODS: Eighty patients subjected to coronary artery bypass surgery were enrolled. VSMCs were extracted from internal thoracic artery fragments and mechanically evaluated using Optical Magnetic Twisting Cytometry assay. The obtained mechanical variables were correlated with the clinical variables: age, gender, African ancestry, smoking and diabetes mellitus. RESULTS: The mechanical variables Gr, G'r and G"r had a normal distribution, demonstrating an inter-individual variability of VSMC viscoelasticity, which has never been reported before. Female sex and smoking were independently associated with VSMC stiffening: Gr (apparent cell stiffness) p = 0.022 and p = 0.018, R2 0.164; G'r (elastic modulus) p = 0.019 and p = 0.009, R2 0.184 and G"r (dissipative modulus) p = 0.011 and p = 0.66, R2 0.141. CONCLUSION: Female sex and smoking are independent predictors of VSMC stiffening. This pro-rigidity effect represents an important element for understanding the vascular rigidity observed in post-menopausal females and smokers, as well as a potential therapeutic target to be explored in the future. There is a significant inter-individual variation of VSMC viscoelasticity, which is slightly modulated by clinical variables and probably relies on molecular factors.

An analysis of the quality indicators of the organ donation process in São Paulo, Brazil.

BACKGROUND: Few studies have investigated whether quality initiatives in the process of organ donation yield better results of the organ donation process. OBJECTIVE: To analyze whether the indicators of the organ donation process in Brazilian hospitals meet the standards established by the Organ Donation European Quality System (ODEQUS). DESIGN: We evaluated the quality of the organ donation in a selected group of Brazilian hospitals served by the Nucleus of Organ Procurement (NOP) using standards of the ODEQUS. RESULTS: Structural and process indicators had 100% conformity. Indicators of results showed a family consent rate of 61% (29% lower than ODEQUS goal); a conversion rate of potential donors to effective donors of 47% (28% below the goal); and a 12% rate of sudden cardiac arrest (higher than the quality limit). CONCLUSIONS: Our findings highlight the importance for the development of quality initiatives in identifying gaps and weaknesses in the process that should be corrected or even restructured, therefore maximizing the number of donors and organs transplanted. Hospitals that participate in the NOP process met 61% of the quality indicators proposed by ODEQUS. Identification of potential donors, family consent, conversion, and sudden cardiac arrest rates are areas that did not conform to ODEQUS standard and revealed a great opportunity for improvement.

Conquistas e desafios dos Grupos de Pesquisa da Fundação Hospitalar do Estado de Minas Gerais / Achievements and challenges of the Hospital Foundation of Minas Gerais research groups

Introdução: A reunião de pesquisadores em torno de projetos tende a originar Grupos de Pesquisa liderados por um pesquisador mais experimentado. A área de pesquisa na Fundação Hospitalar do Estado de Minas Gerais (FHEMIG) tem caminhado em busca de maior qualidade em seus produtos e na formação de recursos humanos para a pesquisa.Objetivo: Descrever os Grupos de Pesquisa credenciados pela FHEMIG com ênfase na descrição do perfil dos líderes dos grupos. Métodos: Os dados sobre os Grupos de Pesquisa e seus líderes foram coletados no site do Conselho Nacional de Desenvolvimento Científico eTecnológico (CNPq), nos bancos de dados do Núcleo de Apoio ao Pesquisador da FHEMIG e nos relatórios da Comissão Interna do Programa de Bolsas de Iniciação Científica e Tecnológica (PIBIC). Resultados: A instituição possui 74 linhas de pesquisa em 29 Grupos de Pesquisa constituídos por 375 pessoas, dentre as quais 42 são líderes de grupos. Os Grupos de Pesquisa e os bolsistas do PIBIC concentram-se nos Hospitais de Ensino da Rede FHEMIG, porém os médicos residentes ainda não aderiram a esses grupos conforme o esperado. Metade dos grupos tinha o cadastro atualizado no sítio do CNPq. Conclusões: Desde a implantação dos Grupos de Pesquisa, houve crescimento e consolidação da atividade de pesquisa na Fundação, mas de maneira geral, ainda é necessário o desenvolvimento de estratégias de estímulo à atividade de pesquisa assim como de melhor estruturação dos grupos e de maior compromisso em manter as informações atualizadas.

Introduction: The reunion of investigators around specific projects tends to originate study groups led by a more experienced researcher. The Teaching and Research Department of the Hospital Foundation of Minas Gerais (FHEMIG) has developed in search of higher quality of its products and the training of human resources for research. Objective: Describe the research groups accredited by FHEMIG, with emphasis on the characterization of the profile of group leaders. Methods: Data on Research Groups and their leaders were collected at the National Council for Scientific and Technological Development (CNPq) website, in the databases of the FHEMIG's Teaching and Research Department, and in reports of the Internal Committee of the Fellowship Program for Scientific and Technological Initiation (PIBIC). Results: FHEMIG has 74 lines of research in 29 research groups, consisting of 375 investigators, with 42 group leaders. Research Groups and PIBIC fellows concentrated in theteaching hospitals, but medical residents have not yet acceded to these groups as expected. Currently, only half of the groups had its records updated on the CNPq website. Conclusions: Since the implementation of Research Groups, research activity at FHEMIG grew and consolidated, but there is a need for strategies to stimulate research activity, as well as to better structure the groups and assure greater commitment keeping its registries updated.

Custos da internação por dependência à cocaína/crack: estudo comparativo entre hospital psiquiátrico e hospital geral / Costs of admissions for cocaine/crack abuse: comparing general hospital and psychiatric hospital settings

INTRODUÇÃO: O modelo nacional vigente de atenção ao dependente químico não distingue o atendimento em hospital psiquiátrico e em hospital geral. Não há informações sobre os custos diferenciais dessas duas modalidades de internação. OBJETIVO: Comparar os custos estimados da internação por dependência à cocaína/crack em hospital psiquiátrico com os da internação em hospital geral, no contexto da saúde pública do Estado de Minas Gerais. MÉTODOS: estimativas dos custos diretos médios diários e totais da internação por dependência à cocaína/crack, pelo método de custeio por absorção, em hospital psiquiátrico e hospital geral públicos de Minas Gerais. RESULTADOS: O custo médio diário da internação em hospital psiquiátrico foi estimado em R$ 368,65 e, no hospital geral, em R$ 484,52, correspondendo a uma diferença de 31,4%. Esta diferença foi primordialmente relativa a custos com pessoal e serviços. CONCLUSÃO: Os custos da internação por dependência a cocaína/crack são mais elevados no hospital geral que no psiquiátrico, no contexto da saúde pública de Minas Gerais.

The current Brazilian model for the assistance of drug dependents does not differentiate admissions in psychiatric or general hospitals. There is no information on the distinct costs of those two modes of hospitalization. Aim: To compare the estimated costs of hospitalization for cocaine/crack dependence in a psychiatric hospital and in a general hospital, in the context of public healthcare in the state of Minas Gerais, Brazil. Methods: Estimates of the daily average total direct costs of admissions for cocaine/crack dependence, using the method of activity based costs, in a public psychiatric hospital and in a public general hospital, in Minas Gerais, Brazil. Results: The average daily cost of hospitalization in a psychiatric hospital was estimated at R$ 368.65, and in a general hospital, at R$ 484.52, a difference of 31.4%. This difference was primarily due to staffing and services related costs. Conclusion: The costs of hospitalization for cocaine/crack dependence are higher in the general hospital than in the psychiatric hospital, in the context of public healthcare in Minas Gerais, Brazil.

Conformational restriction of aryl thiosemicarbazones produces potent and selective anti-Trypanosoma cruzi compounds which induce apoptotic parasite death.

Chagas disease, caused by Trypanosoma cruzi, is a life-threatening infection leading to approximately 12,000 deaths per year. T. cruzi is susceptible to thiosemicarbazones, making this class of compounds appealing for drug development. Previously, the homologation of aryl thiosemicarbazones resulted in an increase in anti-T. cruzi activity in comparison to aryl thiosemicarbazones without a spacer group. Here, we report the structural planning, synthesis and anti-T. cruzi evaluation of new aryl thiosemicarbazones (9a-x), designed as more conformationally restricted compounds. By varying substituents attached to the phenyl ring, substituents were observed to retain, enhance or greatly increase the anti-T. cruzi activity, in comparison to the nonsubstituted derivative. In most cases, hydrophobic and bulky substituents, such as bromo, biphenyl and phenoxyl groups, greatly increased antiparasitic activity. Specifically, thiosemicarbazones were identified that inhibit the epimastigote proliferation and were toxic for trypomastigotes without affecting mouse splenocytes viability. The most potent anti-T. cruzi thiosemicarbazones were evaluated against cruzain. However, inhibition of this enzyme was not observed, suggesting that the compounds work through another mechanism. In addition, examination of T. cruzi cell death showed that these thiosemicarbazones induce apoptosis. In conclusion, the structural design executed within the series of aryl thiosemicarbazones (9a-x) led to the identification of new potent anti-T. cruzi agents, such as compounds (9h) and (9r), which greatly inhibited epimastigote proliferation, and demonstrated a toxicity for trypomastigotes, but not for splenocytes. Mechanistically, these compounds do not inhibit the cruzain, but induce T. cruzi cell death by an apoptotic process.

Evaluation of the anti-Schistosoma mansoni activity of thiosemicarbazones and thiazoles.

Schistosomiasis is a chronic and debilitating disease caused by a trematode of the genus Schistosoma and affects over 207 million people. Chemotherapy is the only immediate recourse for minimizing the prevalence of this disease and involves predominately the administration of a single drug, praziquantel (PZQ). Although PZQ has proven efficacy, there is a recognized need to develop new drugs as schistosomicides since studies have shown that repeated use of this drug in areas of endemicity may cause a temporary reduction in susceptibility in isolates of Schistosoma mansoni. Hydrazones, thiosemicarbazones, phthalimides, and thiazoles are thus regarded as privileged structures used for a broad spectrum of activities and are potential candidates for sources of new drug prototypes. The present study determined the in vitro schistosomicidal activity of 10 molecules containing these structures. During the assays, parameters such motility and mortality, oviposition, morphological changes in the tegument, cytotoxicity, and immunomodulatory activity caused by these compounds were evaluated. The results showed that compounds formed of thiazole and phthalimide led to higher mortality of worms, with a significant decline in motility, inhibition of pairing and oviposition, and a mortality rate of 100% starting from 144 h of exposure. These compounds also stimulated the production of nitric oxide and tumor necrosis factor alpha (TNF-α), thereby demonstrating the presence of immunomodulatory activity. The phthalyl thiazole LpQM-45 caused significant ultrastructural alterations, with destruction of the tegument in both male and female worms. According to the present study, phthalyl thiazole compounds possess antischistosomal activities and should form the basis for future experimental and clinical trials.

Structural design, synthesis and structure-activity relationships of thiazolidinones with enhanced anti-Trypanosoma cruzi activity.

Pharmacological treatment of Chagas disease is based on benznidazole, which displays poor efficacy when administered during the chronic phase of infection. Therefore, the development of new therapeutic options is needed. This study reports on the structural design and synthesis of a new class of anti-Trypanosoma cruzi thiazolidinones (4 a-p). (2-[2-Phenoxy-1-(4-bromophenyl)ethylidene)hydrazono]-5-ethylthiazolidin-4-one (4 h) and (2-[2-phenoxy-1-(4-phenylphenyl)ethylidene)hydrazono]-5-ethylthiazolidin-4-one (4 l) were the most potent compounds, resulting in reduced epimastigote proliferation and were toxic for trypomastigotes at concentrations below 10 µM, while they did not display host cell toxicity up to 200 µM. Thiazolidinone 4 h was able to reduce the in vitro parasite burden and the blood parasitemia in mice with similar potency to benznidazole. More importantly, T. cruzi infection reduction was achieved without exhibiting mouse toxicity. Regarding the molecular mechanism of action, these thiazolidinones did not inhibit cruzain activity, which is the major trypanosomal protease. However, investigating the cellular mechanism of action, thiazolidinones altered Golgi complex and endoplasmic reticulum (ER) morphology, produced atypical cytosolic vacuoles, as well as induced necrotic parasite death. This structural design employed for the new anti-T. cruzi thiazolidinones (4 a-p) led to the identification of compounds with enhanced potency and selectivity compared to first-generation thiazolidinones. These compounds did not inhibit cruzain activity, but exhibited strong antiparasitic activity by acting as parasiticidal agents and inducing a necrotic parasite cell death.

High bed occupancy rates: Are they a risk for patients and staff?

AIM: In order to produce empirical evidence on the relationship between high bed occupancy and its potential hazards, this study correlates bed occupancy rates with hospital patient safety and staff overload indicators. METHODS: Data from nine medium to large scale public hospitals, all pertaining to the Hospital Foundation of Minas Gerais, Brazil, were gathered for the period January 2007 to June 2011. Indicators were aggregated by month, resulting in 486 observations (54 months × 9 hospitals). Bivariate linear regressions were performed, aiming to estimate the effect of bed occupancy rates on each response variable (hospital infection rates, institutional mortality and sick leave incidence). In addition, to directly test the hypothesis that bed occupancy rates over 85% are unsafe, it was included in the models as a categorical instead of continuous variable, using 85% as the cut-off value. RESULTS: Bed occupancy rates showed an inverse correlation to mortality rates (b = -0.056; P < 0.001) and presented no significant correlation to the nosocomial infection rates (P = 0.512). High bed occupancy (>85%) was associated with a slight increment of short sick leaves, especially short leaves (<7 days) (+0.14%; P = 0.008). CONCLUSIONS: The increase in hospital loading was unexpectedly associated with reduced institutional mortality and was not related to nosocomial infection incidences. High bed occupancy was associated to a slight increment of short sick leaves.

Endoscopic use of cyanoacrylate glue in the treatment of urethral fistula.

PURPOSE: The aim of this video is to demonstrate an endoscopic and minimally invasive repair of an urethrocutaneous fistula with cyanoacrylate glue. MATERIALS AND METHODS: A 56 year-old-man with post-infectious urethral stricture and recurrent perineal abscess formation due to urethral fistulas. RESULTS: The operative time was 60 minutes, no major complications were observed perioperatively and postoperatively. At a follow-up time of 6 months the patient had no evidence of recurrent fistula and abscess formation. CONCLUSIONS: The endoscopic use of cyanoacrylate glue represents a safe and minimally invasive approach that might be offered as a first line option for the treatment of urinary fistulas in selected patients, especially those with narrow and long tracts.

Endoscopic use of cyanoacrylate glue in the treatment of urethral fistula

Purpose The aim of this video is to demonstrate an endoscopic and minimally invasive repair of an urethrocutaneous fistula with cyanoacrylate glue. Materials and Methods: A 56 year-old-man with post-infectious urethral stricture and recurrent perineal abscess formation due to urethral fistulas. Results The operative time was 60 minutes, no major complications were observed perioperatively and postoperatively. At a follow-up time of 6 months the patient had no evidence of recurrent fistula and abscess formation. CONCLUSIONS The endoscopic use of cyanoacrylate glue represents a safe and minimally invasive approach that might be offered as a first line option for the treatment of urinary fistulas in selected patients, especially those with narrow and long tracts. .

Desconexão do ventilador mecânico de não doadoresde órgãos: percepção de médicos intensivistas / Disconnection of the mechanical breathing machine used by non-organ donors: perception of intensivist doctors

O presente estudo teve como objetivo conhecer a opinião de médicos frente à desconexão do ventilador mecânico do indivíduo comdiagnóstico de morte encefálica e não doador de órgãos. Trata-se de uma pesquisa qualitativa com análise de conteúdo de Bardin. Os discursos foramobtidos por meio de entrevistas semiestruturadas. Participaram do estudo 12 médicos que atuam na Unidade de Terapia Intensiva de um hospitalescola do município de São Paulo. Após a análise das entrevistas, foram revelados motivos para desconectar o ventilador mecânico e motivos para nãodesconectar, considerados pelos sujeitos da pesquisa. Mesmo diante das divergências de opiniões de médicos frente à desconexão da ventilação mecânicado não doador, as categorias desvelaram que esse procedimento pode proporcionar benefícios para a família e sistema de saúde. Sendo assim,acreditamos que do ponto de vista ético, legal e moral não se justifica a manutenção de suportes terapêuticos nesses indivíduos.

Prevalência de Esôfago de Barret nos doentes do Hospital do Servidor Público Municipal (HSPM) submetidos a endoscopia digestiva alta em 2001 / Prevalence of Barrett's esophagus in patients of the Hospital do Servidor Público Municipal (HSPM) who underwent endoscopy in 2001

Esôfago de Barrett é uma enfermidade secundária ao refluxo gastroesofágico e associado com adenocarcinoma de esôfago. Atualmente entre 8 e 20% dos pacientes com sintomatologia de refluxo que são submetidos a endoscopia apresentam Esôfago de Barrett, e o risco de malignização de 0 a 50%. Revisamos 2148 endoscopias digestivas altas em um espaço de tempo de 12 meses de janeiro a dezembro de 2001, sendo encontrado 18 (0,84%) casos de Esôfago de Barrett, apresentando resultado semelhantes a literatura mundial. Em vista da elevada incidência de malignização do Esôfago de Barrett, percebe-se a importância de estudos em nosso meio

Prevalência de Esôfago de Barret nos doentes do Hospital do Servidor Público Municipal (HSPM) submetidos a endoscopia digestiva alta em 2001

Esôfago de Barrett é uma enfermidade secundária ao refluxo gastroesofágico e associado com adenocarcinoma de esôfago. Atualmente entre 8 e 20% dos pacientes com sintomatologia de refluxo que são submetidos a endoscopia apresentam Esôfago de Barrett, e o risco de malignização de 0 a 50%. Revisamos 2148 endoscopias digestivas altas em um espaço de tempo de 12 meses de janeiro a dezembro de 2001, sendo encontrado 18 (0,84%) casos de Esôfago de Barrett, apresentando resultado semelhantes a literatura mundial. Em vista da elevada incidência de malignização do Esôfago de Barrett, percebe-se a importância de estudos em nosso meio

Influência materna e os fatores de risco de cárie dentária / Maternal influence and the risk factors of dental decay

Por ser multifatorial e transmissível, a cárie dentária deve ter seus métodos preventivos baseados principalmente na educação materna, uma vez que a mãe é a pessoa mais intimamente relacionada à criança. O presente trabalho foi realizado em 153 crianças, de zero a cinco anos de idade, de seis creches públicas da cidade de Diamantina/MG, abordando os fatores comportamentais de risco das mães, em ralação à transmissibilidade de cárie, dieta cariogênica noturna, higiene bucal das crianças e o nível de instrução materno em relação à doença. Para sua execução, aplicou-se um questionário às mães e, posteriormente, foi realizado o exame físico intra-bucal nas crianças, onde foi observado elevado índice ceo-d (4,83) sendo que, deste total, 84,57 por cento estavam cariados, 13,53 por cento extraídos/extração indicada e somente 1,90 por cento obturados. Algumas mães, apesar de conhecerem os métodos corretos de higiene bucal, bem como a idade correta para o seu início, não os aplicam aos filhos. Foi constatado que o número de crianças assistidas por serviço odontológico é muito baixo, refletindo assim o desinteresse ou falta de conhecimento das mães sobre a necessidade de assistência odontológica precoce, bem como a deficiência dos programas de saúde, tanto em nível preventivo quanto curativo