Evaluation of the protection against norovirus afforded by E. coli monitoring of shellfish production areas under EU regulations.

EC Regulation 854/2004 requires the classification of bivalve mollusc harvesting areas according to the faecal pollution status of sites. It has been reported that determination of Escherichia coli in bivalve shellfish is a poor predictor of norovirus (NoV) contamination in individual samples. We explore the correlation of shellfish E. coli data with norovirus presence using data from studies across 88 UK sites (1,184 paired samples). We investigate whether current E. coli legislative standards could be refined to reduce NoV infection risk. A significant relationship between E. coli and NoV was found in the winter months (October to February) using data from sites with at least 10 data pairs (51 sites). We found that the ratio of arithmetic means (log10 E. coli to log10 NoV) at these sites ranged from 0.6 to 1.4. The lower ratios (towards 0.6) might typically indicate situations where the contribution from UV disinfected sewage discharges was more significant. Conversely, higher ratios (towards 1.4) might indicate a prevalence of animal sources of pollution; however, this relationship did not always hold true and so further work is required to fully elucidate the factors of relevance. Reducing the current class B maximum (allowed in 10% of samples) from 46,000 E. coli per 100 g (corresponding NoV value of 75750 ± 103) to 18,000 E. coli per 100 g (corresponding NoV value of 29365 ± 69) reduces maximum levels of NoV by a factor of 2.6 to 1; reducing the upper class B limit to 100% compliance with 4,600 E. coli per 100 g (corresponding NoV value of 7403 ± 39) reduces maximum levels of NoV by a factor of 10.2 to 1. We found using the UK filtered winter dataset that a maximum of 200 NoV corresponded to a maximum of 128 ± 7 E. coli per 100 g. A maximum of 1,000 NoV corresponded to a maximum of 631 ± 14 E. coli per 100 g.

Metals and pesticides in commercial bivalve mollusc production areas in the North and South Bays, Santa Catarina (Brazil).

Concentrations of heavy metals were quantified in mussels Perna perna and Pacific oysters Crassostrea gigas in 28 cultivation sites in the North and South Bays, SC (Brazil). Concentrations of pesticides were also quantified in these bivalve, water and sediment samples collected in 14 cultivation sites on four occasions in the period October 2012-October 2013. Pesticides were not detected in any of the mussel, oyster, water or sediment samples. The South Bay was found to be generally more contaminated with As while the North Bay showed higher concentrations of Ni. Concentrations of Pb and Cd were below the limit of detection of the method (0.5mg/kg) in all samples. Mussels accumulated more As and Ni than oysters, while the opposite was observed for Cu. Metal concentrations were below the maximum levels for foodstuffs specified in the Brazilian legislation.

Security requirements for a lifelong electronic health record system: an opinion.

This article discusses the authors' views on the security requirements of a central, unique electronic health record. The requirements are based on the well-known principles of confidentiality and integrity and the less discussed principles of control and legal value. The article does not discuss any technical or legal solutions to the requirements proposed herein.

[Eletroencephalographic ambulatory monitoring in refractory epilepsies in childhood]. / Monitorização eletroencefalográfica ambulatorial na epilepsia de difícil controle da infância.

The objective of our study was, by means of continuous prolonged ambulatory electroencephalographic monitoring, to analyze the temporal distribution of paroxysmal discharges during sleep and awake in children and adolescents with refractory epilepsies. Twenty-one patients in the 4-to-17 year age bracket with refractory epilepsies, with 52.3% (n=11) male and 47.6% (n=10) female from the Discipline of Neurology of the Universidade Federal de São Paulo (Federal University of São Paulo). Cerebral Holter was carried out with Bioware EEG-2008 of prolonged ambulatory electroencephalographic monitoring equipment. We observed greater frequency of isolated and grouped epileptic discharges in day and in night sleep in relation to awake; day and night sleep led to activation of epileptic discharges, both isolated and grouped. The cerebral Holter was more effective in detecting epileptiform discharges than the routine EEG in 33.33% of the patients. The cerebral Holter proved a useful and precise method in detecting epileptic discharges, as an aid in the assessment of the fluctuations in frequency of paroxysmal activity in children with refractory epilepsies, both in relation to activities in daily life, and to the relation to the biological cycle of sleep and awake.

Effect of lateralized epileptic discharges on the thought flow.

PURPOSE: Pauses in verbal expression of thought flow in patients with partial epilepsy was studied in order to achieve a best comprehension of brain interhemispheric influences. METHOD: We studied thirty nine patients with partial epileptic seizures and twenty four volunteers (control group). Free association of ideas was used as a method to establish the thought flow, starting with a stimulus word (subject name) that must be followed by spontaneous and consecutive word-phrase. Patients were instructed to say any thought that came to their minds without any kind of censoring. Subject responses were recorded through a PC keyboard and time intervals (pauses) between each word-phrase were processed by a software developed for this purpose. RESULTS: Time intervals reduction among associations in right lesional group were compared to left lesional, right non-lesional and control groups. An increase of associative time intervals was observed in the right non-lesional group compared to left non-lesional group. CONCLUSIONS: We suggest a possible inhibitory inter-hemispheric function of the right hemisphere modulating verbal expression of the thought flow. Considering the hypothesis of the inter-hemispheric inhibition by the right hemisphere on left hemisphere, we admit that in epileptic patients with right hemispheric lesion there is an attenuation of the inter-hemispheric inhibition and an increase in thought flow, whereas in patients without a lesion but a paroxysmal epileptic activity in right temporal lobe there is an exacerbation of this inhibitory function and consequent reduction in the thought flow.

[Caring of the mental patient in the emergency room: feelings and attitudes of the nursing team members]. / O atendimento do doente mental em pronto-socorro geral: sentimentos e ações dos membros da equipe de enfermagem.

This work is based upon a day-by-day study of the services provide by a nurse team at a mentally impaired emergency room. Our aim is to study staff's reactions toward the patients as well as service itself. We could feel the dynamic relation among thinking, feeling and performance created strong conceptions on individuals based upon a common sense. The feelings noticed are: pity, scare and rage depending upon behavior. The assistance given to the mentally impaired is, at large, based exclusively on technical data resorted to organic/biological aspects.

Incisión transuretral de la próstata: una alternativa de tratamiento de la hiperplasia prostática obstructiva / Trans-urethral incisión of the prostate: an alternative for treatment of obstructive prostatic hyperplasia

La hiperplasia prostática benigna (HPB) es un problema común en el varón senil. La HPB es el crecimiento prostático estromal-glandular en varones con un efecto testicular hormonal asociado con la edad y que produce obstrución urinaria conocida como prostatismo. 50 por ciento de varones con evidencia histológica de HPB evolucionarán a una obstrucción clínica y 25 por ciento tendrá que recibir algún tipo de tratamiento para sus síntomas. Este estudio valoró hombres con prostatismo asociado a HPB con un bajo volumen de zona transicional (ZT), y la utilidad de la incisión transuretral de próstata (ITUP), al compararse con varones en vigilancia y otros que recibieron tratamiento con bloqueadores alfa. Material y métodos. Doce hombres fueron sometidos a ITUP después de evaluación con la puntuación de la AUA, índice de calidad de vida y tasa de flujo máximo y se compararon los resultados con 10 pacientes que recibieron bloqueadores alfa y otro grupo de 10 pacientes que se vigilaron en un tiempo de 24 semanas, cada grupo con una ZT prostática de 15 cc o menor. Resultados. Los pacientes sometidos a ITUP obtuvieron los beneficios de esta modalidad incrementando la tasa de flujo máximo 4.93 ml/s, los pacientes con bloqueadores alfa incrementaron 4.36 ml/s, y los pacientes vigilados sólo incrementaron 1.8 ml/s, la puntuación de la AUA disminuyó 10.4 puntos en los pacientes sometidos a ITUP, en los pacientes con bloqueadores alfa disminuyó 3.8 puntos y en los pacientes vigilados se incrementó 1.5, el índice de calidad de vida disminuyó 2.5 puntos en los pacientes sometidos a ITUP, 1.6 en los que recibieron bloqueadores alfa y 0.2 en los pacientes vigilados. Conclusiones. La ITUP es una excelente alternativa de tratamiento de la BPB con bajo volumen de ZT (< de 15 cc), con buenos resultados a mediano plazo valorando lo anterior con la puntuación de síntomas de la AUA, índice de calidad de vida y tasa de flujo máximo

The effects of transesophageal echocardiography on hemodynamic variables in small infants undergoing cardiac surgery.

OBJECTIVE: To assess the effects of transesophageal echocardiography (TEE) on hemodynamic variables during cardiac surgery in small infants. DESIGN: A prospective clinical study. SETTING: A medical college-affiliated tertiary care children's hospital. PARTICIPANTS: Twenty-three infants weighing 2 to 5 kg undergoing cardiac surgery. INTERVENTIONS: Baseline heart rate, arterial pressure, and central venous pressure were recorded. A pediatric TEE probe was inserted, and the hemodynamic variables were again recorded. Postoperatively the hemodynamic measurements were measured again before and after probe removal, with the addition of left atrial pressure and pulmonary artery pressure when available. Hemodynamic parameters were carefully observed during all phases of the TEE examinations for any changes attributable to probe manipulation. MEASUREMENTS AND MAIN RESULTS: No statistically significant changes occurred in this group of patients during TEE. No clinically significant changes in any individual patient occurred during the measurement or during manipulation of the TEE probe for the complete examination. CONCLUSION: Although hemodynamic compromise can occur in small infants, this study suggests that it is infrequent. Fear of hemodynamic compromise should not prevent use of intraoperative TEE in small infants when otherwise indicated.

The effect of transesophageal echocardiography on ventilation in small infants undergoing cardiac surgery.

UNLABELLED: Transesophageal echocardiography (TEE) is frequently used during congenital cardiac surgery. Complications are infrequent, but interference with ventilation has been reported, especially in small infants. Ventilation variables were measured prospectively in 22 infants, 2-5 kg, undergoing heart surgery with TEE. Measurements were made preoperatively before and after TEE probe insertion and postoperatively before and after TEE probe removal. The variables measured included arterial blood gases, expired tidal volume, peak inspiratory pressure, positive end-expiratory pressure, minute ventilation, airway resistance, dynamic compliance, and peak inspiratory and expiratory flow rates. No significant change in any ventilatory variable at either time period was noted in the infants. IMPLICATIONS: Ventilatory compromise is infrequent in small infants undergoing transesophageal echocardiography (TEE) examination. Careful ventilatory monitoring rapidly detects changes in ventilation during TEE examination. Small infants who benefit from TEE during heart surgery should not be excluded from receiving a TEE examination because of concern of ventilatory compromise.

Comparison of NAD 6000 and servo 900C ventilators in an infant lung model.

UNLABELLED: We compared the ability of the NAD 6000 (North American Dräger, Telford, PA) and the Servo 900C (Siemens-Elema AB, Solna, Sweden) anesthesia ventilators to maintain precise delivery of small tidal volumes (V(t)) and positive end-expiratory pressure using an infant test lung model. A variety of ventilator and lung model settings were selected to test clinical conditions simulating normal and extremely compromised lung function. Differences in ventilator output were analyzed by using an independent t-test with P <0.05 considered significant. With the ventilators set to deliver a V(t) of 30 mL, the actual delivered V(t) was significantly better for the NAD 6000 (25 +/- 2 mL) compared with the Servo 900C (18 +/- 3 mL), P <0.001. When the ventilators were set to deliver 100 mL V(t), their delivered V(t) were not significantly different, NAD 6000 (66 +/- 19 mL) and Servo 900C (60 +/- 12 mL), P = 0.09. The exhaled V(t) read by the anesthesia machines was significantly closer to the delivered V(t) for the NAD 6000 (11 +/- 9 mL) compared with the Servo 900C (37 +/- 11 mL), P < 0.001. Both ventilators maintained the end expiratory pressure delivered to the test lung within 2 cm H(2)O of the set positive end-expiratory pressure on average. As the conditions changed requiring the ventilator to develop a higher peak inflating pressure, both ventilators showed a decrease in V(t) delivered, which was proportionate to the tubing compression volume loss. IMPLICATIONS: The NAD 6000 (North American Dräger, Telford, PA) and Servo 900C (Siemens-Elema AB, Solna, Sweden) are able to precisely deliver small Tidal Volumes. They both decreased in performance when tested under extreme conditions. Earlier studies of traditional anesthesia ventilators suggest that the NAD 6000 and Servo 900C are superior pediatric ventilators.

[New system of ambulatory EEG monitoring: analysis and classification of epileptic discharges in 100 patients]. / Novo sistema de monitorização EEG ambulatorial. Metodologia de análise do registro e classificação das descargas epilépticas em 100 pacientes.

We present the first results of a new medical instrument for ambulatory EEG monitoring (Cerebral Holter) used in Brazil since 1994. One hundred high quality recordings from epileptic and non-epileptic patients allowed the development of a systematic analysis of EEG and ECG signals, and classification of epileptic discharges during daily life activities.

A controlled study of transesophageal echocardiography to guide central venous catheter placement in congenital heart surgery patients.

UNLABELLED: Transesophageal echocardiography (TEE) and central venous catheter (CVC) placement are often used during congenital cardiac surgery. Complications of CVC placement include cardiac perforation, inadvertent arterial placement, and erroneous hemodynamic data from unrecognized malposition. In this study, we used a prospective, randomized, controlled design to evaluate the use of TEE to guide depth of insertion and confirm superior vena cava cannulation, and to improve the percentage of correctly placed CVCs and reduce complications of CVC placement. One hundred forty-five patients were studied. Eighty patients were randomized to have subclavian vein insertion, 64 to have internal jugular insertion, and 1 to have external jugular insertion of CVC. TEE-guided CVC placement resulted in 100% correct placement when assessed by preoperative TEE, versus 86% in the control group (72 of 72 vs. 63 of 73; P = 0.01). There was no difference in correct placement between the two groups when assessed by postoperative chest radiograph (81.9% TEE versus 75.3% control; P = not significant). One significant complication, a superior vena cava perforation, occurred in the control group. Time to placement was 9.6 min in the TEE group versus 8.0 min in the control group (P = 0.015). IMPLICATIONS: Transesophageal echocardiography can be used to guide central venous catheter placement in congenital heart surgery. Central venous catheters that seem to be located high in the right atrium by chest radiograph in these patients are often actually in the superior vena cava and pose little risk of cardiac perforation.

[Laterality of musical functions in partial epilepsy]. / Lateralização das funções musicais na epilepsia parcial.

Fourteen right handed patients with partial epilepsy (Epileptic Group) and with a median age of 31 years were divided into two groups (Right and Left), according the laterality of paroxystic activity in the electroencaphalogram. Of the 14 patients, 42.8% (6/14) presented a focus at the right side while the others 57.2% (8/14) presented a focus at the left. The Control Group consisted of 31 right handed individuals with a median age of 30 years and with no previous history of neurological disease or epileptic seizures. All the individuals had no musical skills. They carried out Music Abilities Tests including Spontaneous Rhythm, Elemental Music Functions Perception (tone color, duration, pitch, intensity and rhythm) and Complex Strutures Tests (recognition and reproduction of corporal rhythmic movements). We concluded that the focus at the right and the left cerebral hemisphere affect the development of the melodic recognition functions while in cases with focus at the left cerebral hemisphere, rhythmic reproduction and organization are more impaired when compared to the Control Group.

[Patients' and relatives' opinion and knowledge about electroconvulsive therapy: implications for nursing]. / Opinião e conhecimento de pacientes e familiares sobre o uso da eletroconvulsoterapia: implicações para a enfermagem.

The aim of this report was to verify in-patients and their relative's opinion and knowledge of the use of electroconvulsive therapy. By means of a quantitative analysis, the use of this treatment was shown to be accepted despite the individuals knew little about it. It was observed that the knowledge of this treatment had influence over individual's opinion about it. Thus nurses play an important role on the instruction of these individuals regarding this treatment.

[Surgical treatment of cerebral vascular pathologies in epileptic patients]. / Tratamento cirúrgico das patologias vasculares cerebrais nos pacientes epilépticos.

Surgery of arteriovenous malformations (AVM) and of cavernous angiomas (cavernoma) in the majority of cases is indicated subsequently to episodes of bleeding. With the development of techniques for diagnosis and surgery for epilepsy of difficult control, indication for surgery of these vascular lesions has become greater. We present nine patients with cerebral vascular lesions and very frequent crises in spite of adequate clinical treatment. Ages ranged from 12 to 42 years with an average of 25 years; there was a prevalence of the male sex (2:1). Surgery consisted of exercises of the lesion in all cases and in four there was also resection of the perilesional irritative area shown by electrocorticography. The pathologic study of lesions showed five cases of cavernoma, three cases of AVM, and one case of venous angioma. As to localization, we observed three lesions in the temporal lobe, four in the frontal, and two in the parietal region. Outpatient follow-up showed a reduction in crises in all of the patients, and seven evolved seizure free following surgery.

[Temporal lobe epilepsy. Surgical treatment]. / Epilepsia do lobo temporal. Tratamento cirúrgico.

The authors report the surgical management of 32 patients with medically intractable seizures. In all cases the epileptiform focus present in the temporal region was demonstrated by electroencephalography. Our report was made up of 14 male patients and 18 female patients. Their ages ranged from 9 to 62 years. The material was divided into two groups. The first, with eighteen patients with cerebral lesion (like gliomas, arteriovenous malformation, epidermoid tumor) demonstrated on the CT scan and MR imaging underwent to lesion resection: in some cases with adjacent irritative area (guided by electrocorticography) out of eloquent zone, the removal of this irritative area was done. The second, with fourteen patients without cerebral expansive lesion; the MR imaging showed mesial temporal sclerosis in eight cases; all the patients of this group underwent to temporal lobectomy; the histopathologic exam showed temporal sclerosis in nine cases and normal brain in five. The postoperative follow-up showed better results in the cases with expansive cerebral lesion (83.4% seizure free) than the cases without that lesion (71.4% seizure free).

Serotonina sérica e síndrome de Rett / Serum serotonin and Rett syndrome

A síndrome de Rett, uma patologia neurodegenerativa que afeta meninas, caracteriza-se por uma involuçäo neuropsicomotora do desenvolvimento. Sendo o diagnóstico desta síndrome exclusivamente clínico, o presente trabalho teve como objetivo o estudo do conteúdo de serotonina sérica em crianças normais e portadoras da síndrome de Rett. A metodologia empregada para a quantificaçäo de 5HT no soro foi a cromatografia líquida de alta eficiência acoplada a detecçao eletroquímica. Os resultados obtidos mostraram uma hiperserotonemia em 81 por cento das crianças com síndrome de Rett. Verificou-se também uma correlaçäo positiva entre níveis altos de serotonina no soro e a deambulaçäo independente, mostrando que pacientes sem marcha voluntária apresentam níveis séricos maiores deste neurotransmissor. O presente trabalho sugere que o nível sérico de serotonina pode vir a ser usado como um possível marcador biológico no diagnóstico de estadiamento da síndrome de Rett.

[Hemispheric functional specialization in motor aphasia. Neurophysiologic findings with computerized electroencephalographic brain mapping during musical and oral sound stimulation. Study of 2 cases]. / Especialização funcional hemisférica na afasia motora. Achados neurofisiológicos ao mapeamento eletrencefalográfico computadorizado sob estimulação sonora musical e verbal. Estudo de dois casos.

This study concerns about brain electrical activity during auditory stimulation in 2 aphasic patients, one with classical (left hemisphere lesion) and another with cross aphasia (right hemisphere lesion). Both cases were submitted to dichotic listening test (consonant-vowel-consonant task) and music audition (gregorian chant), during brain mapping examination. We found, in both cases, a great proportion in delta frequency and power in non-lesional hemisphere during dichotic and musical stimulation. Besides, increasing in frequency of alpha activity was observed only in the non-lesional hemisphere restricted to temporal lobe region. Such findings suggest an interesting field of research about measurements of neurophysiological correlates of auditory stimulation and brain electrical activity in aphasia.

[Sex differences of visual attention in cryptogenic partial epilepsy]. / Diferenças sexuais da atenção visual na epilepsia parcial criptogênica.

The performance in visual verbal and non-verbal attentional tests was studied in 14 male and 18 female control subjects and 33 patients with cryptogenic partial epilepsy. The epileptic group was formed of 17 men and 16 women with no evidence of brain damage in CT scan examinations. Interictal epileptiform activity was observed only unilaterally, either in the right (8 male, 8 female) or left (9 male, 8 female) temporal lobes. The performance of epileptic men in visual tests was similar to that of normal men. On the other hand, the performance of epileptic women was worse than that of normal women. These results seem in accordance with the literature that suggests that visual attention in women depends on the functional integrity of both cerebral hemispheres. In men, verbal visual attention is suggested to occur in the left cerebral hemisphere while non-verbal processes, predominantly in the right cerebral hemisphere. Further studies are necessary for the understanding of these sexual differences in cerebral hemispheric asymmetry.