Recall of substandard medicines in Brazil during the period 2010-2018.

BACKGROUND: Even with all the care taken during the production process, the pharmaceutical industries are still subject to manufacturing medicines with quality deviations, generating commercialized products without the required quality and necessitating their subsequent recall from the market. The objective of this study was to evaluate the reasons that led to the recall of medicines in Brazil in the period evaluated. METHODS: This is a descriptive study (using document analysis), on the recall of substandard medicines registered on the website of the National Health Surveillance Agency (ANVISA), from 2010 to 2018. The variables studied were the type of medicine (reference, generic, similar, specific, biological, herbal, simplified notification, new and radiopharmaceutical), type of pharmaceutical dosage form (solid, liquid, semi-solid and parenteral preparation), and reason for recall (Good manufacturing practices, quality and quality/good manufacturing practices). RESULTS: A total of n = 3,056 recalls of substandard medicine were recorded. Similar medicines had a higher recall index (30.1%), followed by generics (21.3%), simplified notification (20.7%) and reference (12.2%). Different dosage forms had similar recalls: solids (35.2%), liquids (31.2%) and parenteral preparations (30.0%), with the exception of semi-solids (3.4%). The reasons for the highest occurrences were related to good manufacturing practices (58.4%) and quality (40.4%). CONCLUSION: The probable cause for this high number of recalls is the fact that, even with all the quality controls and processes in accordance with good manufacturing practices, errors can occur, both human and in automated processes, thus causing the release of batches that should not have been approved. In summary, it is necessary for manufacturers to implement a robust and well structured quality system in order to avoid such deviations, and it is up to ANVISA to apply greater oversight in the post marketing of these products.

Uma análise das representações sociais da obesidade por profissionais de saúde na atenção primária à saúde / An analysis of social representations of obesity by health professionals in primary health care

Introdução: A compreensão do que seja obesidade vai influenciar a maneira como estruturamos as políticas públicas, o processo formativo dos profissionais de saúde e, principalmente, as práticas de cuidado. Objetivo: Analisar as representações sociais sobre obesidade para profissionais de saúde da Atenção Primária do estado da Bahia, Brasil. Método: Esta comunicação breve refere-se a uma pesquisa qualitativa, ancorada na Teoria das Representações Sociais, desenvolvida no contexto de um curso sobre a qualificação do cuidado às pessoas com sobrepeso e obesidade. Para a produção dos dados, utilizaram-se um questionário semiestruturado on-line e a Técnica de Associação Livre de Palavras, a partir do estímulo "Escreva as três primeiras palavras que vêm a sua mente quando você pensa em obesidade". A análise prototípica foi realizada com a ajuda do software OpenEvoc. Resultados: Os resultados indicam que o núcleo central das representações sociais sobre obesidade foi formado pelos elementos doença, alimentação, sobrepeso e gordura, enquanto os vocábulos saúde mental, qualidade de vida, atividade física, estigma, saúde e multifatorialidade compõem o sistema periférico. Revelaram que há predominância da perspectiva patológica e individualizada, em que pesem a ampliação do conhecimento científico moderno e das orientações institucionais sobre a obesidade; a assunção dos fatores psicoemocionais no desenvolvimento da obesidade; assim como a incipiência da abordagem multifatorial, ecológica e/ou sindêmica da obesidade. Conclusão: Este estudo sugere que pesquisas aprofundem o estudo de tais representações sociais, suas motivações no campo formativo, laboral e social, bem como a análise do que consolida e provoca as novas narrativas anunciadas.

Introduction: The understanding of whatobesity is will influence the way we structure public policies, the training process of health professionals, and, mainly, care practices. Objective: To analyze the social representations of obesity among Primary Health Care professionals in the state of Bahia, Brazil. Method: This brief communication refers to qualitative research, anchored in the Theory of Social Representations, developed in the context of a course on the qualification of care for people with overweight and obesity. For data production, we used an online semi-structured questionnaire and the Free Word Association Technique, based on the stimulus "Write the first three words that come to your mind when you think about obesity". The prototypical analysis was carried out with the assistance of the OpenEvoc software. Results: The results indicate that the central core of social representations about obesity was formed by the elements disease, food, overweight and fat, while the words mental health, quality of life, physical activity, stigma, health, and multifactorial constitute the peripheral system. They revealed that the pathological and individualized perspective is predominant, despite the enhancement of modern scientific knowledge and institutional guidelines on obesity; the assumption of psycho-emotional factors in the development of obesity; as well as the incipience of the multifactorial, ecological, and/or syndemic approach to obesity. Conclusion: This study suggests that research deepens the study of such social representations, and their motivations in the educational, labor, and social field, like the analysis of what consolidates and provokes the newly announced narratives.

Efeito da suplementação de própolis verde no câncer de pâncreas: um relato de caso / Effect of green propolis supplementation on pancreas cancer: a case report

Introdução: O aumento da incidência de doenças crônicas não transmissíveis e a mortalidade associada a estas causas têm se destacado mundialmente. Entre essas doenças, destaca-se o câncer de pâncreas, que é caracterizado por tendência à evolução com metástase e baixa sobrevida. Relato de caso: As terapias oncológicas podem afetar a qualidade de vida e o estado nutricional dos pacientes e, por essa razão, a utilização de terapias alternativas e complementares, como o uso da própolis, podem auxiliar na melhoria da qualidade do tratamento, através da diminuição na proliferação de células neoplásicas e dos efeitos tóxicos da quimioterapia, devido às características epigenéticas, antitumorais, apoptóticas, antioxidantes e imunomodulatórias. Este relato de caso aborda o acompanhamento clínico e nutricional de um paciente idoso do sexo masculino, portador de câncer pancreático em tratamento quimioterápico, sob aconselhamento nutricional associado à suplementação de extrato hidroalcoólico de própolis verde. Conclusão: Observou-se com este relato de caso, a melhora da qualidade de vida e aumento da taxa de sobrevida do paciente de 12 meses para três anos e meio, além de estabilização da progressão tumoral. (AU)

Introduction: The increase in the incidence of chronic noncommunicable diseases has been highlighted in terms of worldwide mortality rates. Among these diseases, pancreatic cancer stands out, which is characterized by a tendency towards the evolution of metastasis and low survival. Weight loss is associated with increased basal energy expenditure, decreased energy consumption and malabsorption of nutrients. Case report: Oncological therapies can affect to quality of life and nutritional status of individuals, due to the toxic and immunosuppressive effects. For this reason, the use of alternative and complementary therapies, such as the use of propolis, can help to improve the quality of treatment, by decreasing the proliferation of neoplastic cells and the toxic effects of chemotherapy, due to the epigenetic, antitumor, apoptotic characteristics, antioxidants and immunomodulatory. This case report addresses the clinical and nutritional monitoring of an elderly male patient, with pancreatic cancer undergoing chemotherapy, under nutritional advice associated with the supplementation of hydroalcoholic extract of green propolis. Conclusion: There was an improvement in the quality of life and an increase in the patient’s survival rate from 12 months to three years, in addition to stabilization of tumor progression. (AU)

Macrolide-lincosamide-streptogramin B resistance phenotypes and their associated genotypes in Staphylococcus aureus isolates from a tertiary level public hospital of Uruguay / Fenotipos de resistencia a macrólidos lincosamidas-estreptograminas B y sus genotipos asociados en Staphylococcus aureus aislados en un hospital público de nivel terciario en Uruguay

Abstract This study was undertaken to investígate the resistance phenotypes to macrolide-lincosamide-streptogramin B (MLSb) antibiotics and their associated genotypes in isolates of Staphylococcus aureus. We analyzed one hundred, consecutive, non-duplicate isolates (methicillin-susceptible MSSA, n = 53 and methicillin-resistant MRSA, n =47) obtained from var-ious clinical samples between July 2012 to December 2013. The resistance profile to MLSb antibiotics was determined by phenotypic methods and the resistance genes were detected by PCR assays. All of the isolates were subjected to pulsed-field gel electrophoresis (SmaI-PFGE). The overall prevalence of resistance to MLSb antibiotics was 38% and the resistance phenotype distribution was as follows: cMLSb, 22%; iMLSB, 10%; MSb, 5% and L, 1%. We detected ermA, ermC, ermB and mrsA/B genes in these resistant isolates. The single ermA gene was commonly observed mainly in those with a cMLSb R phenotype, whereas the combination ermA and ermC was more commonly observed in isolates with inducible expression. The patterns of SmaI-PFGE suggest a great genetic diversity in both MRSA and MSSA resistant to MLSb antibiotics. The results demonstrate the local presence of S. aureus resistant to MLSb antibiotics and its most frequently described responsible genes. Some of these isolates, especially those with the iMLSB phenotype, may be associated with therapeutic failure. Therefore, efforts should be directed to the correct detection of all MLSb resistant isolates using appropriate laboratory tests. PFGE results reveal a wide spread of resistance genes rather than the circulation of S. aureus clones resistant to MLSb antibiotics.

Resumen Los objetivos de este estudio fueron investigar en Staphylococcus aureus la presencia de fenotipos resistentes a los antibióticos macrólidos, lincosamidas y estreptograminas tipoB (MLSb) y conocer sus genotipos responsables. Analizamos 100 aislamientos consecutivos, no duplicados (53 sensibles a meticilina [MSSA] y 47 resistentes a meticilina [MRSA]), obtenidos entre 2012 y 2013 a partir de diferentes muestras clínicas. El perfil de resistencia a los antibióticos MLSb fue determinado por métodos fenotípicos y los genes de resistencia se detectaron por PCR. Todos los aislamientos fueron comparados por SmaI-PFGE. La prevalencia global de resistencia a los antibióticos MLSB fue del 38% y la distribución de los fenotipos de resistencia fue la siguiente: cMLSB, 22%; iMLSB, 10%; MSB, 5%; L, 1%. Se detectaron los genes ermA, ermC y mrsA/B en los aislamientos resistentes. El gen ermA se observó, sobre todo, en aislamientos con fenotipo resistente constitutivo R (cMLSB), mientras que la combinación ermA y ermC se detectó principalmente en aislamientos con resistencia inducible (iMLSB). Los patrones de Smal-PFGE sugieren una gran diversidad genética en los aislamientos resistentes a los antibióticos MLSb, tanto MRSA como MSSA. Los resultados demuestran la presencia local de S. aureus resistentes a los antibióticos MLSB y de sus genes responsables más frecuentemente descritos. Estos cultivos, especialmente aquellos con fenotipo resistente iMLSB, pueden asociarse con fallas terapéuticas. Por lo tanto, los esfuerzos deben dirigirse a la correcta detección de todos los cultivos resistentes a MLSB utilizando pruebas de laboratorio adecuadas. Los resultados de Smal-PFGE sugieren una amplia diseminación de genes de resistencia, más que la circulación de clones resistentes a los antibióticos MLSB.

Presence of genes encoding enterotoxins in Staphylococcus aureus isolates recovered from food, food establishment surfaces and cases of foodborne diseases.

The aim of this study was to describe the microbiological characteristics and profile of genes encoding enterotoxins in 95 Staphylococcus aureus isolates obtained between April 2011 and December 2014 from foodstuffs, persons and surfaces of retail food stores. After microbiological identification and antimicrobial susceptibility testing, polymerase chain reactions (PCR) were performed, targeting sea, seb, sec, sed and see genes that code for classical enterotoxins (ET) A-E, and three additional genes: seg , seh and sei , coding for so-called "new enterotoxins" G, H and I. The isolates were characterized by Pulsed Field Gel Electrophoresis (PFGE), and five selected isolates were further analyzed through Multi Locus Sequence Typing (MLST). It is noteworthy that 54.7% of the examined isolates harbored one or more of the investigated ET gene types. Most positive isolates carried more than one ET gene up to five types; seg was the most frequent ET gene, followed by sei. Five enterotoxin-coding isolates also coded for some antimicrobial resistance genes. Two of them, and four additional non-enterotoxic isolates carried erm genes expressing inducible clindamycin resistance. PFGE-types were numerous and diverse, even among enterotoxin-coding strains, because most isolates did not belong to known foodborne outbreaks and the sampling period was long. MLST profiles were also varied, and a new ST 3840 was described within this species. ST 88 and ST 72 enterotoxin-coding isolates have been identified in other regions in association with foodborne outbreaks. This manuscript reports the first systematic investigation of enterotoxin genes in S. aureus isolates obtained from foodstuffs and infected people in Uruguay.

Macrolide-lincosamide-streptogramin B resistance phenotypes and their associated genotypes in Staphylococcus aureus isolates from a tertiary level public hospital of Uruguay.

This study was undertaken to investigate the resistance phenotypes to macrolide-lincosamide-streptogramin B (MLSB) antibiotics and their associated genotypes in isolates of Staphylococcus aureus. We analyzed one hundred, consecutive, non-duplicate isolates (methicillin-susceptible MSSA, n=53 and methicillin-resistant MRSA, n=47) obtained from various clinical samples between July 2012 to December 2013. The resistance profile to MLSB antibiotics was determined by phenotypic methods and the resistance genes were detected by PCR assays. All of the isolates were subjected to pulsed-field gel electrophoresis (SmaI-PFGE). The overall prevalence of resistance to MLSB antibiotics was 38% and the resistance phenotype distribution was as follows: cMLSB, 22%; iMLSB, 10%; MSB, 5% and L, 1%. We detected ermA, ermC, ermB and mrsA/B genes in these resistant isolates. The single ermA gene was commonly observed mainly in those with a cMLSB R phenotype, whereas the combination ermA and ermC was more commonly observed in isolates with inducible expression. The patterns of SmaI-PFGE suggest a great genetic diversity in both MRSA and MSSA resistant to MLSB antibiotics. The results demonstrate the local presence of S. aureus resistant to MLSB antibiotics and its most frequently described responsible genes. Some of these isolates, especially those with the iMLSB phenotype, may be associated with therapeutic failure. Therefore, efforts should be directed to the correct detection of all MLSB resistant isolates using appropriate laboratory tests. PFGE results reveal a wide spread of resistance genes rather than the circulation of S. aureus clones resistant to MLSB antibiotics.

A percepção dos comensais de um restaurante universitário como equipamento de segurança alimentar e nutricional / The perception of the dinners of a university restaurant as food and nutritional security equipment

Considerando o Restaurante Universitário (RU) como promotor da Segurança Alimentar e Nutricional (SAN), este trabalho aborda a percepção de estudantes quanto a importância do RU como equipamento de SAN. Os dados da pesquisa foram obtidos a partir da aplicação de formulário online (Google Forms) e teste de evocação de palavras, utilizando o instrumento open Evoc. Verificou-se que os aspectos que compõem o conceito de SAN foram avaliados positivamente pelos usuários. Porém, o núcleo central da representação social do RU é composto por comida, fila, alimentação e barato, evidenciando aspectos referentes ao acesso à alimentação. Os resultados apontam para a necessidade de ações educativas que contribuam para a valorização do RU como mecanismo de garantia da SAN que considere o seu conceito mais ampliado.

Psicologia Sócio-histórica como fundamento para a compreensão das significações da atividade docente / Socio-historical Psychology as the basis for understanding teaching practice

Este artigo apresenta e discute a importância de produzir conhecimento a respeito dos aspectos subjetivos que constituem a atividade docente, buscando compreendê-la para além de sua aparência, em suas contradições e mediações. Propõe--se aqui a discussão dos pressupostos teóricos da Psicologia Sócio-histórica, a qual, por sua vez, fundamenta-se no Materialismo Histórico e Dialético. Estes dois últimos orientam as pesquisas realizadas pelo grupo "Atividade docente e subjetividade", o qual tem contribuído para a produção de conhecimento crítico na área da educação. Para tanto, inicia-se discutindo categorias como: Mediação, Historicidade, Atividade, Sentidos, Significados e Subjetividade. Em seguida, passa-se aos conceitos "real da atividade" e "atividade real" e os procedimentos de Autoconfrontação Simples e Cruzada propostos por Yves Clot. Enfatiza-se a importância do referencial teórico em todas as etapas da pesquisa, visto ser um critério de cientificidade do conhecimento produzido, e a necessária articulação entre todos esses momentos.(AU)

This article seeks to address the importance of producing knowledge about the subjective aspects of teaching practice in order to understand it beyond its theoretical definitions, i.e., to acknowledge its contradictions and mediations. This study presents a discussion of the theoretical assumptions of Socio-historical Psychology, which is rooted in the dialectical and historical materialism, which, in turn, are the basis for the studies conducted by the research group "Teaching practice and subjectivity". These studies have made major contributions to the critical knowledge in education. The present article initially discusses categories such as Mediation, Historicity, Activity, Senses, Meanings, and Subjectivity. Subsequently, the concepts of "real practice" and "real life practice" are introduced, followed by the simple and crossed self-confrontation techniques proposed by Yves Clot. It is essential to highlight the importance of the theoretical framework to support the entire process of the research since it is a scientificity criterion of the produced knowledge and the required coordination between all research steps.(AU)

Psicologia sócio-histórica como fundamento para a compreensão das significações da atividade docente / Socio-historical psychology as the basis for understanding teaching practice

Este artigo apresenta e discute a importância de produzir conhecimento a respeito dos aspectos subjetivos que constituem a atividade docente, buscando compreendê-la para além de sua aparência, em suas contradições e mediações. Propõe--se aqui a discussão dos pressupostos teóricos da Psicologia Sócio histórica, a qual, por sua vez, fundamenta-se no Materialismo Histórico e Dialético. Estes dois últimos orientam as pesquisas realizadas pelo grupo "Atividade docente e subjetividade", o qual tem contribuído para a produção de conhecimento crítico na área da educação. Para tanto, inicia-se discutindo categorias como: Mediação, Historicidade, Atividade, Sentidos, Significados e Subjetividade. Em seguida, passa-se aos conceitos "real da atividade" e "atividade real" e os procedimentos de Auto confrontação Simples e Cruzada propostos por Yves Clot. Enfatiza-se a importância do referencial teórico em todas as etapas da pesquisa, visto ser um critério de cientificidade do conhecimento produzido, e a necessária articulação entre todos esses momentos.

This article seeks to address the importance of producing knowledge about the subjective aspects of teaching practice in order to understand it beyond its theoretical definitions, i.e., to acknowledge its contradictions and mediations. This study presents a discussion of the theoretical assumptions of Socio-historical Psychology, which is rooted in the dialectical and historical materialism, which, in turn, are the basis for the studies conducted by the research group "Teaching practice and subjectivity". These studies have made major contributions to the critical knowledge in education. The present article initially discusses categories such as Mediation, Historicity, Activity, Senses, Meanings, and Subjectivity. Subsequently, the concepts of "real practice" and "real life practice" are introduced, followed by the simple and crossed self-confrontation techniques proposed by Yves Clot. It is essential to highlight the importance of the theoretical framework to support the entire process of the research since it is a scientificity criterion of the produced knowledge and the required coordination between all research steps.

Perinatal ischemic stroke: a five-year retrospective study in a level-III maternity.

OBJECTIVE: To study the incidence, clinical presentation, risk factors, imaging diagnosis, and clinical outcome of perinatal stroke. METHODS: Data was retrospectively collected from full-term newborns admitted to the neonatal unit of a level III maternity in Lisbon with cerebral stroke, from January 2007 to December 2011. RESULTS: There were 11 cases of stroke: nine were arterial ischemic stroke and two were cerebral venous sinus thrombosis. We estimated an incidence of arterial ischemic stroke of 1.6/5,000 births and of cerebral venous sinus thrombosis of 7.2/100,000 births. There were two cases of recurrent stroke. Eight patients presented with symptoms while the remaining three were asymptomatic and incidentally diagnosed. The most frequently registered symptoms (8/11) were seizures; in that, generalized clonic (3/8) and focal clonic (5/8). Strokes were more commonly left-sided (9/11), and the most affected artery was the left middle cerebral artery (8/11). Transfontanelle ultrasound was positive in most of the patients (10/11), and stroke was confirmed by cerebral magnetic resonance in all patients. Electroencephalographic recordings were carried out in five patients and were abnormal in three (focal abnormalities n=2, burst-suppression pattern n=1). Eight patients had previously identified risk factors for neonatal stroke which included obstetric and neonatal causes. Ten patients were followed up at outpatients setting; four patients developed motor deficits and one presented with epilepsy. CONCLUSIONS: Although a modest and heterogeneous sample, this study emphasizes the need for a high level of suspicion when it comes to neonatal stroke, primarily in the presence of risk factors. The prevalence of neurological sequelae in our series supports the need of long-term follow-up and early intervention strategies.

Perinatal ischemic stroke: a five-year retrospective study in a level-III maternity / Acidente vascular cerebral isquêmico perinatal: estudo retrospectivo de 5 anos em maternidade nível III

Objective To study the incidence, clinical presentation, risk factors, imaging diagnosis, and clinical outcome of perinatal stroke. Methods Data was retrospectively collected from full-term newborns admitted to the neonatal unit of a level III maternity in Lisbon with cerebral stroke, from January 2007 to December 2011. Results There were 11 cases of stroke: nine were arterial ischemic stroke and two were cerebral venous sinus thrombosis. We estimated an incidence of arterial ischemic stroke of 1.6/5,000 births and of cerebral venous sinus thrombosis of 7.2/100,000 births. There were two cases of recurrent stroke. Eight patients presented with symptoms while the remaining three were asymptomatic and incidentally diagnosed. The most frequently registered symptoms (8/11) were seizures; in that, generalized clonic (3/8) and focal clonic (5/8). Strokes were more commonly left-sided (9/11), and the most affected artery was the left middle cerebral artery (8/11). Transfontanelle ultrasound was positive in most of the patients (10/11), and stroke was confirmed by cerebral magnetic resonance in all patients. Electroencephalographic recordings were carried out in five patients and were abnormal in three (focal abnormalities n=2, burst-suppression pattern n=1). Eight patients had previously identified risk factors for neonatal stroke which included obstetric and neonatal causes. Ten patients were followed up at outpatients setting; four patients developed motor deficits and one presented with epilepsy. Conclusions Although a modest and heterogeneous sample, this study emphasizes the need for a high level of suspicion when it comes to neonatal stroke, primarily in the presence of risk factors. The prevalence of neurological sequelae in our series supports the need of long-term follow-up and early intervention strategies. .

Objetivo Estudar incidência, apresentação clínica, fatores de risco, resultado de exames de imagem e desfecho clínico do acidente vascular cerebral perinatal. Métodos Análise retrospectiva dos prontuários de recém-nascidos a termo internados com o diagnóstico de acidente vascular cerebral perinatal no Serviço de Neonatologia, de uma maternidade nível III, em Lisboa, de janeiro de 2007 a dezembro de 2011. Resultados Houve 11 casos de acidente vascular cerebral: nove isquêmicos arteriais e duas tromboses dos seios venosos. As incidências foram estimadas: para acidente vascular cerebral isquêmico arterial de 1,6/5.000 nascimentos; para trombose dos seios venosos de 7,2/100.000 nascimentos. Houve dois casos de recorrência. Oito doentes foram sintomáticos e três assintomáticos, com diagnóstico incidental. As convulsões foram o sintoma mais frequente (8/11): clônicas generalizadas (3/8) e clônicas focais (5/8). O território vascular esquerdo foi o mais afetado (9/11), particularmente a artéria cerebral média esquerda (8/11). A ecografia transfontanelar foi positiva na maioria dos doentes (10/11), sendo o diagnóstico confirmado por ressonância magnética cerebral em todos. Dos cinco doentes que realizam eletroencefalograma, três apresentaram alterações (alterações focais n=2 e padrão de surto-supressão n=1). Oito doentes apresentaram fatores de risco para acidente vascular cerebral neonatal, incluindo causas obstétricas e neonatais. Dez doentes foram acompanhados em ambulatório, dos quais quatro apresentaram défice motores e um apresentou epilepsia. Conclusão Apesar de uma amostra limitada e heterogênea, este estudo reforça a necessidade de um elevado nível de suspeita para acidente vascular cerebral perinatal, particularmente na presença de fatores de risco. A prevalência de sequelas neurológicas em nossa série reforça a necessidade de seguimento a longo prazo e de estratégias de intervenção precoces. .

[Children who leave the Emergency Department: missing opportunities?]. / Crianças que Abandonam a Urgência Pediátrica: Oportunidades Perdidas?

INTRODUCTION: Children who leave the Emergency Department may be at risk for preventable health problems related to the lack of timely assessment. OBJECTIVE: The aim of this study was to evaluate and characterize the cases of children leaving our Emergency Department and to determine their clinical outcome. MATERIAL AND METHODS: A retrospective and descriptive review of the patient's medical records was conducted. All children leaving the Emergency Department of Hospital de São Bernardo between January 1 and December 31, 2012, were included in the study. RESULTS: A total of 538 children abandoned the Emergency Department (1.35 % of all admissions). The majority (89.5%) had no criteria for urgent assessment and abandoned before medical observation (82.7%). The percentage of leaving was higher in the months of December, January and February (64%), on Tuesday (19.3%) and in the afternoon shift (60.8%). These periods coincided with the peak inflow of patients to the Emergency Department. The waiting time for medical observation was in most cases (94.4%) appropriate to the clinical severity. Six patients returned within 72 hours, 2 requiring hospitalization. DISCUSSION: The percentage of patients that walked-out from the Emergency Department was within the excepted range. A non-urgent triage level and prolonged waiting times were predisposing factors to abandonment. CONCLUSION: Overcrowding of the Emergency Department with children with non-urgent problems, that increase waiting times, can lead to abandonment with unfavorable outcome, which in our series occurred in only 2 cases.

Introdução: As crianças que abandonam a Unidade de Urgência Pediátrica antes do seu processo de atendimento estar terminado podem apresentar um agravamento clínico posterior, relacionado com a falta de avaliação médica atempada.Objectivos: Este estudo teve como objectivo avaliar os casos de abandono na nossa Unidade de Urgência Pediátrica, caracterizar este grupo de crianças e a sua evolução clínica.Material e Métodos: Análise retrospectiva e descritiva dos processos de urgência das crianças que abandonaram a Unidade de Urgência Pediátrica do Hospital de São Bernardo antes de terminar o processo de atendimento, entre 1 de Janeiro e 31 de Dezembro de 2012.Resultados: Um total de 538 crianças abandonou a Unidade de Urgência Pediátrica (1,35% de todas as admissões). A maioria (89,5%) não apresentava critério de observação urgente e abandonou antes da observação médica inicial (82,7%). A percentagem de abandonos foi maior nos meses de Dezembro, Janeiro e Fevereiro (64%), à terça-feira (19,3%) e durante o turno da tarde (60,8%). Estes períodos coincidiram com os picos de maior afluência à Unidade de Urgência Pediátrica. O tempo de espera para observação médica foi na maioria (94,4%) adequado à gravidade clínica. Seis doentes regressaram nas 72 horas seguintes, dos quais dois necessitaram de internamento.Discussão: Verificou-se uma percentagem de abandonos dentro do expectável. A menor gravidade aferida na triagem e os tempos de espera prolongados foram factores predisponentes ao abandono.Conclusão: A sobrelotação das Urgências Pediátricas com doentes sem critérios de urgência, que aumentam os tempos de espera, pode conduzir ao abandono com posterior readmissão em situação clínica de agravamento, o que na nossa série aconteceu em apenas dois casos.

Community-associated methicillin-resistant Staphylococcus aureus in children treated in Uruguay.

INTRODUCTION: Staphylococcus aureus produces a variety of diseases among children, ranging from skin and soft tissue infections to invasive life-threatening diseases. Since 1990, an increasing number of diseases produced by community-associated methicillin-resistant S. aureus (CA-MRSA) isolates have been reported. The aim of this study was to describe the importance and the microbiological characteristics of S. aureus isolates recovered from children treated at the Hospital Pediátrico del Centro Hospitalario "Pereira Rossell" (HP-CHPR); focusing on invasive diseases caused by CA-MRSA isolates, as well as some clinical aspects of the diseases they have produced. METHODOLOGY: One hundred and twenty-five S. aureus isolates recovered from the HP-CHPR between 2003 and 2006 from children with invasive (n=89) and superficial diseases (n=36) were included. Genotypic and phenotypic characteristics of S. aureus isolates and relevant clinical aspects of each child were studied. RESULTS: CA-MRSA isolates accounted for 73% of all S. aureus recovered from invasive (mainly bone and joint) infections, pneumonia and bacteraemia. The most common CA-MRSA strain recovered from invasive (n=65) and superficial (n=36) diseases had the following features: pulsotype A (type USA1100), SCCmec cassette type IV, Panton-Valentine Leukocidin genes positive, susceptibility to trimethoprim-sulfamethoxazole without the inducible macrolide-lincosamide-streptogramin B (iMLSB) resistance phenotype. No association between genotypic characteristics of invasive CA-MRSA isolates and clinical outcomes was found. CONCLUSIONS: CA-MRSA isolates produced a wide spectrum of invasive diseases in a public paediatric hospital between 2003 and 2006. Microbiologic characterization suggests the spread of an adapted CA-MRSA clone lacking erm genes.

Perioperative coagulation profile in living liver donors as assessed by rotational thromboelastometry.

Transient postoperative coagulation abnormalities frequently occur in living liver donors, particularly after right liver resection. Usually, this coagulopathy is diagnosed by alterations in conventional coagulation tests (CCTs) such as the international normalized ratio (INR) of the prothrombin time. However, recent studies using other methods of coagulation monitoring have suggested that postoperative hypercoagulability may also occur in living donors. The rotational thromboelastometry (ROTEM) system is a coagulation monitor based on the viscoelastic properties of blood. The use of ROTEM for perioperative coagulation monitoring in the setting of living liver donors has not been reported. We evaluated the perioperative coagulation profile as assessed by ROTEM in 16 consecutive donors who underwent either right or left liver resection at our institution. ROTEM analysis and CCTs were performed at the baseline (before skin incision) and on postoperative days 1 and 3. According to the CCTs, hypocoagulability was revealed in all but 1 (left liver) donor. The INR was highest on postoperative day 1 [median = 1.67 (interquartile range = 1.37-1.8)]. In contrast, all donors had a normal coagulation profile as assessed by the ROTEM system throughout the study period. In conclusion, this study showed the disagreement between the CCTs and the ROTEM system, as no significant coagulation abnormalities could be revealed with the latter method during the study period. Further studies are needed to confirm the role of the ROTEM system as a perioperative coagulation monitor in this setting and ultimately its influence on the outcome of living donors.

Characteristics of Community-Associated Methicillin-Resistant Staphylococcus aureus (CA-MRSA) Strains Isolated from Skin and Soft-Tissue Infections in Uruguay.

We analyzed 90 nonduplicates community-associated methicillin-resistant S. aureus (CA-MRSA) strains isolated from skin and soft-tissue infections. All strains were mecA positive. Twenty-four of the 90 strains showed inducible macrolide-lincosamide-streptogramin B resistance. All strains produced alpha-toxin; 96% and 100% of them displayed positive results for lukS-F and cna genes, respectively. Eigthy-five strains expressed capsular polysaccharide serotype 8. Six different pulsotypes were discriminated by pulsed-field gel electrophoresis (PFGE) and three predominant groups of CA-MRSA strains (1, 2, and 4) were identified, in agreement with phenotypic and genotypic characteristics. Strains of group 1 (pulsotype A, CP8+, and Panton-Valentine leukocidin (PVL)+) were the most frequently recovered and exhibited a PFGE band pattern identical to other CA-MRSA strains previously isolated in Uruguay and Brazil. Three years after the first local CA-MRSA report, these strains are still producing skin and soft-tissue infections demonstrating the stability over time of this community-associated emerging pathogen.

Doença da membrana hialina / Hyaline membrane disease

Os autores fazem uma abordagem sobre a doença da membrana hialina, cujo conhecimento da fisiopatologia aumentou nas recentes décadas, possibilitando, ao lado de novas técnicas ventilatórias e preparaçöes artificiais do surfactante, uma reduçäo da mortalidade e morbidade dos recém-nascidos

Hipertensäo arterial na gravidez / Arterial hypertension in pregnancy

Os autores fazem uma abordagem sobre as principais formas de hipertensäo arterial que ocorrem no ciclo gravídico, ressaltando aspectos fisiopatológicos, manifestaçöes clínicas e laboratoriais, diagnóstico e conduta terapêutica em cada situaçäo