Grape seed oil in the diet of primiparous Jersey cows before and after parturition: effects on performance, health, rumen environment, and milk quality.

The objective of the study was to determine whether adding grape seed oil (GSO) to the diet of primiparous Jersey breeds during the transition period would improve animal health by measuring effects on the rumen environment, serum biochemistry, oxidative response, and the composition and quality of milk. We used 14 Jersey heifers, weighing an average of 430 kg and 240 days of gestation. The animals were divided into two groups and offered a basal diet, including GSO in the concentrate for the GSO group (dose of 25 mL per animal day) and the same dose of soybean oil (SO) for the control group. The animals were allocated and maintained in a compost barn system, receiving an anionic diet (pre-partum) and a diet for postpartum lactating animals. Dry matter intake (DMI), milk production, serum biochemistry, serum and milk oxidative stability, ruminal fluid and milk fatty acid profile, milk qualitative aspects, and ruminal parameters such as pH, bacterial activity, and protozoan count were evaluated. The addition of GSO had a positive effect on the health of the cows, especially on the oxidative stability of the cows, by increasing total thiols (P = 0.03), higher plasma ferric reducing capacity (FRAP) (P = 0.01), and total antioxidant capacity (TAC) (P = 0.01). In the oxidative stability of the milk produced by the treated animals, there was also an increase in TAC (P = 0.05) and FRAP (P = 0.03). Discreet changes were observed in the ruminal environment with a decreasing trend in pH (P = 0.04) but an increase in bacterial activity (P = 0.05) and protozoa counts (P = 0.07) in cows that consumed the additive. GSO consumption affected the fatty acid profile in milk, increasing saturated fatty acids (SFA) (P = 0.05) and reducing unsaturated fatty acids (UFA) (P = 0.03). The oil did not affect milk production or efficiency in the postpartum period. Based on this information, it is concluded that the addition of GSO positively affects the cow's antioxidant system.

Medicinal Plants, Phytochemicals and Regulation of the NLRP3 Inflammasome in Inflammatory Bowel Diseases: A Comprehensive Review.

Ongoing research explores the underlying causes of ulcerative colitis and Crohn's disease. Many experts suggest that dysbiosis in the gut microbiota and genetic, immunological, and environmental factors play significant roles. The term "microbiota" pertains to the collective community of microorganisms, including bacteria, viruses, and fungi, that reside within the gastrointestinal tract, with a particular emphasis on the colon. When there is an imbalance or disruption in the composition of the gut microbiota, it is referred to as dysbiosis. Dysbiosis can trigger inflammation in the intestinal cells and disrupt the innate immune system, leading to oxidative stress, redox signaling, electrophilic stress, and inflammation. The Nod-like Receptor (NLR) Family Pyrin Domain Containing 3 (NLRP3) inflammasome, a key regulator found in immunological and epithelial cells, is crucial in inducing inflammatory diseases, promoting immune responses to the gut microbiota, and regulating the integrity of the intestinal epithelium. Its downstream effectors include caspase-1 and interleukin (IL)-1ß. The present study investigated the therapeutic potential of 13 medicinal plants, such as Litsea cubeba, Artemisia anomala, Piper nigrum, Morus macroura, and Agrimonia pilosa, and 29 phytocompounds such as artemisitene, morroniside, protopine, ferulic acid, quercetin, picroside II, and hydroxytyrosol on in vitro and in vivo models of inflammatory bowel diseases (IBD), with a focus on their effects on the NLRP3 inflammasome. The observed effects of these treatments included reductions in IL-1ß, tumor necrosis factor-alpha, IL-6, interferon-gamma, and caspase levels, and increased expression of antioxidant enzymes, IL-4, and IL-10, as well as regulation of gut microbiota. These effects could potentially provide substantial advantages in treating IBD with few or no adverse effects as caused by synthetic anti-inflammatory and immunomodulated drugs. However, additional research is necessary to validate these findings clinically and to develop effective treatments that can benefit individuals who suffer from these diseases.

Effects of Medicinal Plants and Phytochemicals in Nrf2 Pathways during Inflammatory Bowel Diseases and Related Colorectal Cancer: A Comprehensive Review.

Inflammatory bowel diseases (IBDs) are related to nuclear factor erythroid 2-related factor 2 (Nrf2) dysregulation. In vitro and in vivo studies using phytocompounds as modulators of the Nrf2 signaling in IBD have already been published. However, no existing review emphasizes the whole scenario for the potential of plants and phytocompounds as regulators of Nrf2 in IBD models and colitis-associated colorectal carcinogenesis. For these reasons, this study aimed to build a review that could fill this void. The PubMed, EMBASE, COCHRANE, and Google Scholar databases were searched. The literature review showed that medicinal plants and phytochemicals regulated the Nrf2 on IBD and IBD-associated colorectal cancer by amplifying the expression of the Nrf2-mediated phase II detoxifying enzymes and diminishing NF-κB-related inflammation. These effects improve the bowel environment, mucosal barrier, colon, and crypt disruption, reduce ulceration and microbial translocation, and consequently, reduce the disease activity index (DAI). Moreover, the modulation of Nrf2 can regulate various genes involved in cellular redox, protein degradation, DNA repair, xenobiotic metabolism, and apoptosis, contributing to the prevention of colorectal cancer.

Clinical profile of a cohort of neonates with seizures: Association between semiology, etiology, and electroencephalographic findings.

BACKGROUND: Seizures are the most common sign of neurologic dysfunction, reflecting a wide variety of central nervous system disorders. METHODS: A retrospective cross-sectional study of neonates with a clinical diagnosis of seizures was conducted in order to verify relationships between clinical aspects and EEG findings. Patients were divided into 3 groups according to the EEG recording available as: 1) with confirmatory ictal EEG; 2) with altered but non-ictal EEG; and 3) without any EEG recording. Variables related to pregnancy and birth history, neonatal complications, and seizure semiology (by video or clinical description) were compared to EEG findings. RESULTS: 97 neonates were included (39.1% preterm, 54.6% male), 71 with available EEG data (56.3% with ictal EEG). The group without EEG presented clinical characteristics significantly different from the others such as extreme prematurity, low birth weight, and higher neonatal mortality (P = 0.002, 0.001, and 0.003, respectively). The most common etiology was hypoxic-ischemic encephalopathy (HIE) (46.4%) followed by vascular disorders, which predominated in extremely preterm neonates (P = 0.006). Sequential seizure was the most common type (44.6%) and was more frequently identified in term neonates (46%). In 51.2% of the ictal recordings the main finding was electrographic seizure without clinical manifestation. Discharge using antiseizure medication was higher among those with ictal or altered non-ictal EEG (P < 0.001). CONCLUSIONS: HIE is still a frequently etiology for neonatal seizures. Even if the patients in the sample were not under continuous EEG, the substantial proportion of electrographic seizures without clinical manifestations detected suggests the importance of continuous EEG monitoring in neonates at increased risk of seizures.

Translation, cross-cultural adaptation, and validation of the heart disease fact questionnaire among the Brazilian population.

OBJECTIVE: This study aimed to translate, cross-culturally adapt, and validate the Heart Disease Fact Questionnaire into Brazilian Portuguese. METHODS: The Brazilian version of the Heart Disease Fact Questionnaire was developed through the processes of translation, back-translation, review committee, and pre-test. Test-retest reliability was measured using the intraclass correlation coefficient and the kappa coefficient. Internal consistency was measured using Cronbach's alpha. For construct validity, the total Heart Disease Fact Questionnaire score was correlated with the Diabetes Knowledge Scale and the Diabetes Attitudes Questionnaire. Ceiling and floor effects were also evaluated in this study. RESULTS: For construct validity and floor and ceiling effect measurements, a total of 100 participants were selected. Reliability was measured using a sub-sample of 30 participants from the total sample. We identified adequate values of reliability (kappa between 0.22 and 1.00 and ICC=0.75) and internal consistency (Cronbach's alpha=0.79). We observed adequate correlations of the Heart Disease Fact Questionnaire score with Diabetes Knowledge Scale (r=0.348) and Diabetes Attitudes Questionnaire (r=0.136). No ceiling or floor effects found. CONCLUSION: Brazilian Portuguese version of the Heart Disease Fact Questionnaire has adequate psychometric properties according to the best scientific recommendations.

Translation, cross-cultural adaptation, and validation of the heart disease fact questionnaire among the Brazilian population

SUMMARY OBJECTIVE: This study aimed to translate, cross-culturally adapt, and validate the Heart Disease Fact Questionnaire into Brazilian Portuguese. METHODS: The Brazilian version of the Heart Disease Fact Questionnaire was developed through the processes of translation, back-translation, review committee, and pre-test. Test-retest reliability was measured using the intraclass correlation coefficient and the kappa coefficient. Internal consistency was measured using Cronbach's alpha. For construct validity, the total Heart Disease Fact Questionnaire score was correlated with the Diabetes Knowledge Scale and the Diabetes Attitudes Questionnaire. Ceiling and floor effects were also evaluated in this study. RESULTS: For construct validity and floor and ceiling effect measurements, a total of 100 participants were selected. Reliability was measured using a sub-sample of 30 participants from the total sample. We identified adequate values of reliability (kappa between 0.22 and 1.00 and ICC=0.75) and internal consistency (Cronbach's alpha=0.79). We observed adequate correlations of the Heart Disease Fact Questionnaire score with Diabetes Knowledge Scale (r=0.348) and Diabetes Attitudes Questionnaire (r=0.136). No ceiling or floor effects found. CONCLUSION: Brazilian Portuguese version of the Heart Disease Fact Questionnaire has adequate psychometric properties according to the best scientific recommendations.

The Influence of Religiosity and Spirituality on the Happiness, Optimism, and Pessimism of Brazilian Medical Students.

BACKGROUND: Mental health problems are very common among medical students, becoming a concern for health care professionals and educators. Despite the fact that there is a growing body of literature supporting the role of religiosity and spirituality (RS) on mental health and on positive psychology outcomes, little evidence is available among medical students, a population subjected to important distress. AIMS: This study aimed to investigate the role of RS on the levels of optimism, pessimism, and happiness among Brazilian medical students. METHODS: This is a cross-sectional study including medical students from the first to the eighth semester of a private medical school. The instruments used were: TOT-R for optimism and pessimism, Lyubomirsk and Lepper subjective happiness scale, and sociodemographic profile. The independent variables were Brazilian Portuguese Duke University Religiosity Scale for religiosity, Brief Spiritual Religious Coping (SRC) for negative and positive SRC; and Facit-Sp for spiritual well-being. RESULTS: A total of 353 medical students were included (response rate 97.51%). Higher levels of intrinsic religiosity and peace were associated with greater happiness and optimism. However, negative SRC was associated with lower levels of happiness and optimism and higher levels of pessimism. CONCLUSION: Medical students tend to use their RS as a resource for dealing with the challenges of medical school, influencing their happiness and optimism. In this context, it seems that religiousness acts in two different ways, not only have positive but also negative outcomes among the participants.

Evaluation of mandibular buccal shelf characteristics in the Colombian population: A cone-beam computed tomography study.

OBJECTIVE: To evaluate the mandibular buccal shelf (MBS) in terms of the angulation and bone depth and thickness according to sex, age, and sagittal and vertical skeletal patterns in a Colombian population using cone-beam computed tomography (CBCT). Accordingly, the optimal site for miniscrew insertion in this area was determined. METHODS: This descriptive, retrospective study included 64 hemi-arches of 34 patients. On CBCT images, the angulation, buccal bone depth (4 and 6 mm from the cementoenamel junction [CEJ] of MBS), and buccal bone thickness (6 and 11 mm from the CEJ of MBS) were measured at the mesial and distal roots of the mandibular first and second molars. RESULTS: There were no statistically significant differences in the angulation, depth, and thickness of MBS between male and female patients. The values for the bone around the distal root of the mandibular second molar were significantly greater than the other values. The osseous characteristics were significantly better in participants aged 16-24 years. Class III patients exhibited the best osseous characteristics, with the bone depth at 6 mm being significantly different from that in Class I and Class II patients. Although values tended to be greater in patients with low angles, the difference was not statistically significant. CONCLUSIONS: MBS provides an optimal bone surface for miniscrew insertion, with better osseous characteristics at the distal root of the mandibular second molar, 4 mm from CEJ. Adolescent patients, Class III patients, and patients with a low angle exhibit the most favorable osseous characteristics in the MBS area.

An Umbrella Review of the Effectiveness of Temporary Anchorage Devices and the Factors That Contribute to Their Success or Failure.

OBJECTIVES: New methodological approaches, such as the umbrella review, constitute an important pathway for synthesizing the scientific evidence provided from studies with a high level of evidence. This study aims to summarize the results on the effectiveness of temporary anchorage devices (TADs) and the factors that contribute to their success or failure during orthodontic treatment in patients of different age groups and to identify the gaps in knowledge based on analysis of the scientific literature. METHODS: An umbrella review of systematic reviews and meta-analyses was performed. A quality evaluation and a descriptive analysis of the included studies were conducted. The study protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO: CRD42018094463). RESULTS: Seventeen systematic reviews and meta-analyses were considered (10 descriptive and 7 with meta-analysis; 12 of high quality and 5 of moderate quality). Variability was observed in the type of intervention and the type of system (TADs). Most of the studies reported high success rates (≥90%), and just one systematic review indicated a low rate of success (≤56%) for the mini-screws. All the studies discussed several factors related to the success of the TADs. These factors were classified as device-related factors, patient-related factors, procedure-related factors, and orthodontic treatment-related factors. Conceptual and methodological gaps were observed when considering the data analysis, the terminology used, and the orthodontic protocols. CONCLUSIONS: The results should be analysed cautiously because of several research gaps related to the methodological quality and the high heterogeneity of the original studies and because of the necessity to add several clinical and sociodemographic variables to enrich the data analysis.

Translation, cross-cultural adaptation and validation of the Finnish Diabetes Risk Score (FINDRISC) for use in Brazilian Portuguese: questionnaire validity study.

BACKGROUND: The Finnish Diabetes Risk Score (FINDRISC) is a questionnaire that was developed by Finnish researchers to track the risk of diabetes. OBJECTIVE: To translate, cross-culturally adapt and validate the FINDRISC for use in Brazilian Portuguese. DESIGN AND SETTING: Questionnaire validity study conducted at a private university. METHODS: The Brazilian version of the FINDRISC was developed through the processes of translation, back-translation, committee review and pre-testing. Test-retest reliability was measured using the intraclass correlation coefficient (ICC), kappa coefficient, standard error of measurement (SEM) and minimum detectable change (MDC). Internal consistency was measured using Cronbach's alpha. For construct validity, the total score of the FINDRISC was correlated with the Diabetes Knowledge Scale (DKN-A) and Diabetes Mellitus Risk Questionnaire (QRDM). Ceiling and floor effects were also evaluated in the present study. RESULTS: For construct validity and floor and ceiling effect measurements, a total sample of 107 participants was used. For reliability, a subsample of 51 participants out of the total sample was used. We identified adequate values for reliability (kappa ≥ 0.79 and ICC = 0.98) and internal consistency (Cronbach's alpha = 0.84). Regarding the error inherent in the FINDRISC, we found SEM = 8.02% and MDC = 22.44%. There were significant correlations between the FINDRISC and the QRDM (r = 0.686) and DKN-A (r = -0.216). No ceiling or floor effects were found. CONCLUSION: The Brazilian version of the FINDRISC has adequate psychometric properties that are in accordance with the best international recommendations.

Translation, cross-cultural adaptation and validation of the Finnish Diabetes Risk Score (FINDRISC) for use in Brazilian Portuguese: questionnaire validity study

ABSTRACT BACKGROUND: The Finnish Diabetes Risk Score (FINDRISC) is a questionnaire that was developed by Finnish researchers to track the risk of diabetes. OBJECTIVE: To translate, cross-culturally adapt and validate the FINDRISC for use in Brazilian Portuguese. DESIGN AND SETTING: Questionnaire validity study conducted at a private university. METHODS: The Brazilian version of the FINDRISC was developed through the processes of translation, back-translation, committee review and pre-testing. Test-retest reliability was measured using the intraclass correlation coefficient (ICC), kappa coefficient, standard error of measurement (SEM) and minimum detectable change (MDC). Internal consistency was measured using Cronbach's alpha. For construct validity, the total score of the FINDRISC was correlated with the Diabetes Knowledge Scale (DKN-A) and Diabetes Mellitus Risk Questionnaire (QRDM). Ceiling and floor effects were also evaluated in the present study. RESULTS: For construct validity and floor and ceiling effect measurements, a total sample of 107 participants was used. For reliability, a subsample of 51 participants out of the total sample was used. We identified adequate values for reliability (kappa ≥ 0.79 and ICC = 0.98) and internal consistency (Cronbach's alpha = 0.84). Regarding the error inherent in the FINDRISC, we found SEM = 8.02% and MDC = 22.44%. There were significant correlations between the FINDRISC and the QRDM (r = 0.686) and DKN-A (r = -0.216). No ceiling or floor effects were found. CONCLUSION: The Brazilian version of the FINDRISC has adequate psychometric properties that are in accordance with the best international recommendations.

Deficiencia selectiva de inmunoglobulina A: manifestaciones clínicas, hallazgos de laboratorio y diagnóstico preciso / Selective Immunoglobulin A deficiency: clinical manifestations, laboratory findings and accurate diagnosis

Resumen La inmunoglobulina A (IgA) es el isotipo de anticuerpo más abundante en los humanos y fundamentalmente participa en la defensa contra las infecciones y el desarrollo de la tolerancia inmune en las mucosas. La deficiencia de IgA es la inmunodeficiencia más frecuente en humanos, pero comúnmente es asintomática y transitoria. Para diagnosticarla, se cuantifica la concentración de IgA en sangre y se evalúa la magnitud de su disminución. De acuerdo con esta evaluación se clasifica en deficiencia parcial (DPIgA) o deficiencia total (DTIgA). Adicionalmente, si solo se afectan los niveles de IgA sin alteraciones de otras inmunoglobulinas séricas como IgM e IgG o subclases de inmunoglobulina G, entonces se denomina como deficiencia selectiva de IgA (DSIgA). La deficiencia selectiva de IgA es de mayor relevancia clínica y considerada un error innato de la inmunidad, aunque su etiología aún es desconocida y clínicamente se asocia a infecciones de los tractos respiratorio y gastrointestinal, alergias y manifestaciones autoinmunes. Se realizó una búsqueda de artículos científicos en PubMed, Scopus, SciELO y Redalyc sobre la deficiencia selectiva de inmunoglobulina A, con el objetivo de realizar una revisión temática sobre las manifestaciones clínicas, el diagnóstico y el adecuado manejo clínico de los pacientes con esta inmunodeficiencia. Se propone un nuevo algoritmo clínico con el objetivo de mejorar el diagnóstico y brindar un adecuado manejo clínico de los pacientes con esta inmunodeficiencia. Un paciente con deficiencia selectiva de IgA se caracteriza por infecciones recurrentes de los tractos gastrointestinal y respiratorio, en asociación con manifestaciones alérgicas y autoinmunes en individuos mayores de cuatro años, con niveles de IgA sérica menores de 7 mg/dL y con niveles normales de IgG e IgM, y en quienes se hayan descartado defectos relacionados con los linfocitos T u otras causas de hipogammaglobulinemia. Con respecto al manejo clínico, se deben ajustar los esquemas de vacunación e implementar profilaxis antibiótica en las infecciones graves y recurrentes. Para mejorar el pronóstico se debe realizar una atención del paciente por un equipo médico interdisciplinario y un seguimiento continuo por un prolongado periodo de tiempo.

Abstract Immunoglobulin A (IgA) is the most abundant antibody isotype in humans and participates in protection against infections and the development of immune tolerance in mucous membranes. IgA deficiency is the most common immunodeficiency in humans, but it is commonly asymptomatic and transient. To diagnose it, the concentration of IgA in blood is quantified and the magnitude of its decrease is evaluated. According to this evaluation, it is classified as partial deficiency (DPIgA) or total deficiency (DTIgA). Additionally, if only IgA levels are affected without alterations in other serum immunoglobulins such as IgM and IgG or subclasses of IgG, then it is referred to as selective IgA deficiency (DSIgA). Selective IgA deficiency is of greater clinical relevance and considered an innate immunity error, although its etiology is still unknown. This immunodeficiency is clinically associated with respiratory and gas- trointestinal tract infections, allergies and autoimmune manifestations. A search of scientific articles was conducted in bibliographic databases PubMed, Scopus, SciELO and Redalyc on selective immunoglobulin A deficiency. Our objective was to perform a review on clinical manifestations, diagnosis, and appropriate clinical management of patients with this immunodeficiency. A new clinical algorithm is proposed in order to improve the diagnosis and provide adequate clinical management of patients with this immunodeficiency. A patient with selective IgA deficiency is characterized by recurrent infections of the gastrointestinal and respiratory tracts, in association with allergic and autoimmune manifestations in individuals older than four years. Serum IgA levels are less than 7 mg/dL, with normal levels of IgG and IgM, and defects related to T lymphocytes or other causes of hypogammaglobulinemia have been ruled out. Regarding clinical management, vaccination schedules should be adjusted and antibiotic prophylaxis should be implemented in severe and recurrent infections. Additionally, to improve prognosis, patient care should be performed by an interdisciplinary medical team and continuous monitoring for a prolonged period of time.

Control of Conyza spp. with sequential application of glufosinate in soybean pre-sowing / Controle de Conyza spp. com aplicação sequencial de glufosinate em pré-semeadura da soja

ABSTRACT: Conyza spp. is among the main weeds reported worldwide. Due to its aggressiveness, such as high seed production and dispersion, and the growing reports of biotypes resistant to glyphosate, paraquat, and other herbicides, different control practices are required. Thus, this study aimed to evaluate the efficacy of herbicides with sequential application of glufosinate in soybean pre-sowing for control of Conyza spp. with indicative of resistant to paraquat. The study was carried out in the field, at Assis Chateaubriand and Palotina, state of Paraná, Brazil, in the 2018/19 season. The experiments were conducted in a randomized block design with four replications. The treatments consisted in application of glyphosate, 2,4-D, saflufenacil, glufosinate, saflufenacil/imazethapyr, diclosulam, paraquat/diuron, paraquat and imazethapyr/flumioxazin, at different combinations, in soybean pre-sowing. Control of Conyza spp., crop injury to soybean plants and variables related to agronomic performance (plant height and yield) were evaluated. All treatments were selective for soybean, which showed stronger crop injury in the presence of diclosulam herbicide, but this did not compromise soybean agronomic performance. In general, control levels were high for the treatments used. Except for paraquat treatments, in the area with the highest frequency of Conyza spp. with indicative of resistant to paraquat, and imazethapyr/flumioxazin treatment in both areas. These control results emphasized the importance of glufosinate in this management system and showed promising results for saflufenacil/imazethapyr.

RESUMO: A planta daninha Conyza spp. está entre as principais encontradas em todo o mundo. Devido a sua agressividade, como elevada produção e dispersão de sementes e os crescentes relatos de biótipos resistentes ao glyphosate, paraquat e outros herbicidas, faz-se necessário o uso de diferentes ferramentas de manejo. Assim, o objetivo deste estudo foi avaliar a eficácia de herbicidas com aplicação sequencial de glufosinate em pré-semeadura da soja, no controle de Conyza spp. com indicativo de resistência ao paraquat. O estudo foi realizado em campo nos municípios de Assis Chateaubriand e Palotina, estado do Paraná (PR), Brasil, na safra 2018/19. O delineamento experimental utilizado foi o de blocos casualizados, com quatro repetições. Os tratamentos foram compostos pela aplicação de glyphosate, 2,4-D, saflufenacil, glufosinate, saflufenacil/imazethapyr, diclosulam, paraquat/diuron, paraquat e imazethapyr/flumioxazin, em diferentes combinações em pré-semeadura da soja. Foram avaliados controle de Conyza spp., sintomas de injúria nas plantas de soja e variáveis relacionadas ao desempenho agronômico (altura de plantas e produtividade). Todos os tratamentos mostraram-se seletivos a soja. Visualizou-se maiores sintomas de injúria quando se tinha a presença do herbicida diclosulam, mas não resultou em danos ao desempenho agronômico da soja. De forma geral os níveis de controle foram altos para os tratamentos utilizados, em exceção para os tratamentos com paraquat na área que apresentava maior frequência de Conyza spp. com indicativo de resistência a este herbicida, e para o tratamento com imazethapyr/flumioxazin nas duas áreas. Estes resultados de controle enfatizam a importância do glufosinate neste sistema de manejo e demostram resultados promissores para saflufenacil/imazethapyr.

Ações de Cuidados para Alta Hospitalar do Paciente Cirúrgico / Care Actions for Surgical Patients Discharge

Esta cartilha é destinada aos usuários que se submeteram a intervençõescirúrgicasinternados nas Unidades de Terapia Intensiva do Hospital de Alta Complexidade Dr. Carlos Macieira, São Luís/MA. O objetivo é repassar de forma clara e objetiva informações simples e seguras sobre os cuidados no pós-operatório durante seu processo de reabilitaçãoem domicílio.Este informativo foi construído num coletivo composto por profissionais das áreas de enfermagem, nutrição, odontologia e fisioterapia do Programa de Residência Multiprofissional em Terapia Intensiva da Secretaria de Estado do Maranhãocomapoio da Empresa Maranhense de Serviços hospitalares (EMSERH).

Hipotermia terapêutica: efeitos adversos, complicações e cuidados de Enfermagem / Therapeutic hypothermia: adverse effects, complications and nursing care

Objetivo: conhecer os efeitos adversos e complicações vivenciadas pela equipe de saúde e conhecer os cuidados de enfermagem realizados durante a aplicação da hipotermia terapêutica. Metodologia: pesquisa com abordagem qualitativa, realizada em 2014, mediante entrevistas semiestruturadas com trabalhadores da saúde de Unidades de Terapia Intensiva de dois hospitais do extremo sul do Brasil, em que é aplicada a hipotermia terapêutica pós-parada cardiorrespiratória. Utilizouse a análise textual discursiva. Resultados: Dentre os efeitos adversos, foram destacados tremores, bradicardia, hipotensão e complicações como queimaduras de pele. Os cuidados de enfermagem direcionam-se aos cuidados com a pele e extremidades, uso do gelo, sedação e conforto. Conclusão: a hipotermia terapêutica é possível de ser aplicada, na realidade das instituições pesquisadas, de maneira segura, eficaz e com baixo custo, fazendo-se relevante, entretanto, a realização de qualificação das equipes, a fim de esclarecer dúvidas e favorecer a adesão e os cuidados necessários de serem prestados.

Summary: to know the adverse effects and complications experienced by the health team and cognize the nursing care performed during the application of therapeutic hypothermia. Methodology: this research was developed with a qualitative approach, conducted in 2014, with semi-structured interviews with health workers from Intensive Care Units of two hospitals in the extreme south of Brazil, which applied therapeutic hypothermia after cardiorespiratory arrest. The textual discursive analysis was used. Results: Adverse effects included tremors, bradycardia, hypotension and complications such as skin burns. Nursing care is mainly dedicated to skin and extremity care, ice use, sedation and comfort. Conclusion: Therapeutic hypothermia is possible to be applied, in the reality of the researched institutions, in a safe, effective and with low cost way, however, it is necessary to carry out the qualification of the teams, in order to clarify doubts and favor adherence and the necessary care to be provided.

Resumen: conocer los efectos adversos y complicaciones vivenciadas por el equipo de salud y conocer los cuidados de enfermería realizados durante la aplicación de la hipotermia terapéutica. Metodología: investigación con abordaje cualitativo, realizada en 2014, con entrevistas semiestructuradas con trabajadores de la salud de Unidades de Terapia Intensiva de dos hospitales del extremo sur de Brasil, en que se aplica la hipotermia terapéutica post-parada cardiorrespiratoria. Se utilizó el análisis textual discursivo. Resultados: Entre los efectos adversos, fueron destacados temblores, bradicardia, hipotensión y complicaciones como quemaduras de piel. Los cuidados de enfermería se dirigen a los cuidados con la piel y extremidades, uso del hielo, sedación y confort. Conclusión: la hipotermia terapéutica es posible de ser aplicada, en la realidad de las instituciones investigadas, de manera segura, eficaz y con bajo costo, haciéndose necesaria, sin embargo, la realización de calificación de los equipos, a fin de aclarar dudas y favorecer la adhesión y los cuidados necesarios para ser prestados.

Predictive ability of the EVARUCI scale and COMHON index for pressure injury risk in critically ill patients: A diagnostic accuracy study.

BACKGROUND: Hospital-acquired pressure injuries are a costly and largely preventable complication occurring in a variety of acute care settings. Patients admitted to the intensive care unit are at greater risk of developing pressure injuries. OBJECTIVE: To determine whether the efficiency of scales to measure pressure injury risk increase when a continuously updated 3-day moving average method is used. METHODS: With a retrospective cohort design we recruited 3085 patients treated between June 2011 and February 2015 in the intensive care unit of a tertiary level university hospital. The present study included 2777 patients admitted to the Intensive Care Unit of the Hospital Universitario de Canarias, Spain. Patients were evaluated daily with two scales to measure pressure injury risk: the Current Risk Assessment Scale for Pressure injury in Intensive Care scale (EVARUCI scale) and the Conscious level-Mobility-Haemodynamics-Oxygenation-Nutrition Index (COMHON). The moving average was used to create a series of three day averages from the complete time-data set. The moving average method was used to analyze data points by creating series of averages of three days subsets of the time-data set. We calculated the efficiency of the method as the product of positive (PPV) and negative predicted values (NPV) for each scale. RESULTS: The efficiency using the moving average method was: PPV x NPV=0.483×0.907=0.438 (standard deviation=0.059), for EVARUCI Scale, and. PPV x NPV=0.552×0.806=0.445 (standard deviation=0.075) for COMHON Index. CONCLUSIONS: The efficiency using the moving average method was higher, than the efficiency of other methods previously reported (0.360±0.009 on average). The present study provides a useful procedure for nurses in clinical practice to assess whether a particular patient is protected against the appearance of pressure injury. The instrument should be used focusing on negative predictive value to indicate protection against pressure injury.

Asma e doença periodontal: uma possível associação / Asthma and periodontal disease: a possible association

A asma é uma doença inflamatória crônica das vias aéreas caracterizada por uma hiper-resposta bronquial, limitação reversível do fluxo aéreo e recorrentes episódios de respiração ofegante e curta, opressão torácica e tosse. Tem sido associada com afecções bucais como a doença periodontal, a qual parece contribuir para infecções do trato respiratório, tanto por aspiração de microrganismos patogênicos quanto por desencadear respostas imunológicas importantes. Dessa forma, o objetivo desta revisão de literatura foi investigar a possível associação entre asma e doença periodontal, enfatizando o mecanismo de interação entre essas doenças. Foi realizada uma revisão de 50 artigos no período de 2000 a 2015 nas bases de dados Scielo, PubMed, Medline e LILACS. Foram utilizadas as palavras-chave “higiene bucal”, “doenças periodontais” e “asma” e seus respectivos descritores em inglês oral hygiene, periodontal diseases, asthma e em espanhol, la higiene bucal, enfermedad periodontal y asma. Os resultados mostraram o papel das bactérias bucais na patogênese da asma, assim como foi possível identificar o impacto do tratamento medicamentoso da asma na saúde bucal. Sugere-se que há uma relação plausível entre doença periodontal e asma, devido à patogênese de ambas as doenças, uso de medicação inalatória e mecanismo de interação

Asthma is a chronic inflammatory disease of the air ways characterized by bronchial hyperresponsiveness, reversible air flow limitation and recurrent episodes of wheezing and shortness of breath, chest tightness and coughing. It has been associated with oral diseases such as periodontal diseases that seem to contribute to respiratory tract infections, either by aspiration of pathogenic microrganisms or by triggering importantimmune responses. The aim of this literature review was to investigate the association between asthma and periodontal diseases, emphasizing the mechanism of interaction between these diseases. A total of 50 articles from 2000 to 2015 was foundin databases Scielo,PubMed, Medline andLilacs. There were used keywords in portuguese as “higiene bucal”, “doenças periodontais”, “asma”, descriptorsin English as oralhygiene, periodontal diseases and asthma and in Spanish as la higiene bucal, enfermedad periodontal and asma.The results have showed the role of oral bacteriain the pathogenesis of asthma, as it was possible to demonstrate the impact of their drug treatment of asthma on oral health. It is suggested that there is aplausible relationship between periodontal diseases and asthma due to the pathogenesis of both diseases, inhaled medication and mechanism of interaction.

Erisipela e celulite / Erysipelas and cellulitis

Este artigo tem por objetivo fazer uma revisão a respeito de duas patologias de pele comuns na prática médica. Abordaremos manifestações clínicas, tratamento e principalmente o diagnóstico diferencial entre elas.

This article aims to review two commons skin diseases in medical practices. We will discuss clinical manifestations, treatment and especially the differential diagnosis.