Negative neuromuscular and functional repercussion of forced swimming after axonotmesis.

Peripheral nerve injuries are cause of sensory disturbances and in functional abilities, and are associated personal and social costs. Strategies that maximize nerve regeneration and functional recovery are necessary, the exercise is an option. This study evaluated the effects of forced swimming exercise on neuromuscular histomorphometry and on functional recovery in a median nerve crush model. Sixteen Wistar rats underwent median nerve crush and were divided into control group (CG) and swimming group (SG). The forced swimming protocol started one week after the injury and was performed for 1 hr a day, 5 days per week, for 2 weeks. The rats swam with an overload of 5% and 10% of body weight in the first and second week, respectively. The functional recovery was assessed in three moments using the grasping test. On day 21, fragments of the median nerve and of the forearm flexors muscles were removed for histomorphometric analysis. The SG had functional recovery impaired (P<0.001) and presented lower myelinated fibers number, fiber and axon minimal diameter, myelin thickness and g-ratio in the proximal e distal segments of the median nerve (P<0.005) and area muscle fiber (P<0.005) than CG. Also, the SG presented a number of capillaries in the proximal segments of the median nerve greater than CG (P<0.005). The exercise protocol used in this study impaired the regeneration of the median nerve and negatively influenced the functional recovery.

Educação em saúde sexual e reprodutiva na adolescência / Sexual and reproductive health education in adolescence

Objetivo: Relatar a experiência de discentes de enfermagem em oficinas com foco na saúde sexual e reprodutiva de adolescentes. Metodologia: Trata-se de um estudo descritivo, do tipo relato de experiência, realizado em ambiente escolar com a participação de adolescentes entre 15 e 17 anos. As atividades desenvolvidas consistiram em oficinas sobre Mudanças Biopsicossociais, Sexualidade, Violência Sexual, Gravidez na Adolescência e Infecções Sexualmente Transmissíveis. Para o desenvolvimento das oficinas, foram considerados os preceitos éticos da Resolução n° 466/2012 não havendo variáveis que possibilitem a identificação dos participantes da oficina. Resultados: Verificou-se a participação assídua do público alvo com diversos questionamentos e a aplicabilidade positiva das oficinas na prevenção e promoção da saúde. Destacou-se o papel do enfermeiro como principal mediador em promover educação em saúde nas escolas e nas comunidades. Conclusão: A implementação de atividades de educação sexual e reprodutiva na adolescência mostrou-se relevante para a redução de vulnerabilidades, esclarecimentos de dúvidas e conscientização dessa população.

Objective: To report the experience of nursing students in workshops focusing on the sexual and reproductive health of adolescents. Methodology: This is a descriptive, experience-type study conducted in a school environment with the participation of adolescents between 15 and 17 years of age. The activities developed consisted of workshops about Biopsychosocial Changes, Sexuality, Sexual Violence, Teen Pregnancy and Sexually Transmitted Infections. For the development of the workshops, the ethical precepts of Resolution No. 466/2012 were considered and there were no variables that allowed the identification of workshop participants. Results: It was verified the assiduous participation of the target public with several questions and the positive applicability of the workshops in the prevention and promotion of health. The role of the nurse as the main mediator in promoting health education in schools and in communities was highlighted. Conclusion: The implementation of sexual and reproductive education activities in adolescence was relevant for the reduction of vulnerabilities, clarification of doubts and awareness of this population.

Expression of VanA-type vancomycin resistance in a clinical isolate of Enterococcus faecium showing insertion of IS19 in the vanS gene.

The characteristics of an unusual clinical isolate of Enterococcus faecium (CL-6729) showing insertion of IS19 (also known as ISEfm1) in the vanS gene while maintaining a constitutive VanA phenotype are described. This isolate was obtained from a hospital-acquired urinary tract infection, showed multidrug resistance by antimicrobial susceptibility testing, and belongs to ST78 based on multilocus sequence typing (MLST). Except for the vanS gene, all the other genes of the vanA gene cluster were intact according to conventional PCR, overlapping PCR and genome sequencing. By quantitative reverse transcription PCR (RT-qPCR), the isolate showed similar expression of the vanA, vanR and vanS genes in the presence and absence of vancomycin. The results suggest that insertion of IS19 in the vanS gene may be associated with constitutive expression of resistance to vancomycin in clinical isolate CL-6729, either by not impairing VanS activity or by inducing the emergence of another pathway that acts on vanA expression, which still needs to be fully investigated.

Mapeamento epidemiológico das hepatites hospitalares / Epidemiological mapping of hospital hepatites / Mapeo epidemiológico de las hepatitis hospitalarias

Objetivo: Analisar os aspectos sociodemográficos e epidemiológicos de pacientes com hepatite B e/ou C atendidos em um hospital universitário do Nordeste brasileiro. Métodos: Estudo transversal, descritivo e analítico, realizado no Hospital Universitário do Piauí com 98 pacientes diagnosticados com hepatite B e/ou C de julho/2014 a dezembro/2017. Os dados foram coletados a partir das fichas de investigação de hepatites virais e analisados através do SPSS. Resultados: A maioria dos participantes tinha mais de 60 anos (48,0%, n=47), era do sexo masculino (67,3%, n=66), de cor parda (77,6%, n=76), com ensino fundamental completo ou menos (58,1%, n=57), procedente da zona urbana (88,8%, n=87) e aposentado (28,6%, n=28). Verificou-se que 58,2% (n=57) não possuía vacinação contra hepatite B e, entre os portadores do vírus C, prevaleceram os genótipos 1 e 3. A hepatite crônica se fez presente em 75,5% (n=74) dos casos e como fontes mais frequentes de infecção predominaram a via transfusional e sexual e o uso de drogas. Identificou-se associação estatística significativa para o vírus B entre: pacientes com idade de 40 a 59 anos, procedentes de outros municípios, de zona urbana e transmissão sexual; e, para o vírus C, entre: idosos, procedentes de Teresina, de zona urbana, forma crônica da doença e transmissão transfusional. Conclusão: Constatou-se uma maior prevalência das hepatites virais hospitalares em pacientes idosos, do sexo masculino e com baixa escolaridade, que já se apresentava na forma crônica da doença, sendo o vírus C o mais frequente. (AU)

Tecnologias não invasivas de cuidado: percepção das puérperas / Non-invasive care technologies: perception of puerperal women

Objetivo: analisar a satisfação de puérperas acerca das tecnologias não invasivas de cuidados a elas prestados. Método: estudo qualitativo, descritivo, exploratório, com 15 puérperas por meio de entrevista individual utilizando um formulário semiestruturado. Após a saturação dos dados, o resultado foi organizado por categorias e similaridade. Resultados: percebeu-se a satisfação das puérperas em relação aos cuidados prestados aliviando a dor, proporcionando bem-estar e diminuindo o tempo de espera durante o trabalho de parto. Conclusão: em razão dos benefícios consequentes desse novo modelo de assistência obstétrica, que vem sendo preconizado com o uso das TNIC, é imprescindível que essas práticas sejam executadas em todos os serviços de saúde de obstetrícia, principalmente porque, em alguns tipos de serviço, a atuação da Enfermagem Obstétrica é prestada de maneira mais autônoma sendo, assim, preponderante para a oferta desse cuidado pautado nessa assistência humanizada.(AU)

Abordagem não-farmacológica na cefaleia do tipo tensional: efeitos da hidroterapia sobre a dor e a qualidade de vida / Non-pharmacological approach in tension-type headache: effects of hydrotherapy on pain and quality of life

Há poucos relatos na literatura de abordagens não-farmacológicas para o tratamento da cefaleia do tipo tensional (CTT), problema comum que gera impacto negativo na vida dos portadores, e nenhum sobre o protocolo de hidroterapia proposto. O objetivo do estudo foi verificar os efeitos da hidroterapia sobre a intensidade da dor e frequência das crises, bem como sua interferência na qualidade de vida dos portadores. Um protocolo de hidroterapia com 12 sessões de 60 minutos em piscina aquecida a 31º, contemplando aquecimento, alongamentos, exercícios aeróbicos e exercícios de relaxamento foi utilizado em três indivíduos com diagnóstico médico de CTT. A terapia promoveu melhora no Headache Impact Test (HIT-6), na Es- cala de sonolência de Epworth e no questionário de disfunção temporomandibular (RDC/TMD). Através do diário de dor de cabeça foi verificada redução da frequência da CTT nos três indivíduos durante a terapia e essa redução foi mantida após trinta dias do tratamento. Um indivíduo apresentou diminuição da intensidade da dor durante e após 30 dias do tratamento. O estudo sugere que a hidroterapia pode ser indicada para diminuir a frequência da CTT, bem como para melhorar a qualidade de vida dos portadores.

There are few reports in the literature of non-pharmacological approaches for the treatment of tension-type headache, common problem that generates significant negative impact on quality of life of patients, and none about therapeutic protocol proposed by this study. The aim of the study was to assess the effects of hydrotherapy on the reduction of pain intensity and frequency of crises and their interference in the quality of life of patients. A hydrotherapy protocol with 12 sessions of 60 minutes in pool heated to 31 degrees contemplating heating, stretching, aerobic and relaxation exercise was applied in three patients with clinical diagnosis of tension-type headache. The therapy promoted improvement in the Headache Impact Test (HIT-6), in the Epworth Sleepiness Scale and in the Temporomandibular Dysfunction Questionnaire (RDC / TMD). Through of a daily of headache a reduction in the frequency of tension-type headache was observed in the three individuals during therapy and this reduction was maintained after thirty days of treatment. An individual had a decrease in pain intensity during and after 30 days of treatment. The study suggests that hydrotherapy can be indicated to decrease the frequency of tension-type headache, as well as to improve the quality of life of individuals.

MLVA Typing of Streptococcus pneumoniae Isolates with Emphasis on Serotypes 14, 9N and 9V: Comparison of Previously Described Panels and Proposal of a Novel 7 VNTR Loci-Based Simplified Scheme.

Streptococcus pneumoniae remains as an important cause of community-acquired bacterial infections, and the nasopharynx of asymptomatic carriers is the major reservoir of this microorganism. Pneumococcal strains of serotype 14 and serogroup 9 are among the most frequently isolated from both asymptomatic carriers and patients with invasive disease living in Brazil. Internationally disseminated clones belonging to such serotypes have been associated with the emergence and spread of antimicrobial resistance in our setting, highlighting the need for epidemiological tracking of these isolates. In this scenario, Multiple Loci VNTR Analysis (MLVA) has emerged as an alternative tool for the molecular characterization of pneumococci, in addition to more traditional techniques such as Multi-Locus Sequence Typing (MLST) and Pulsed-Field Gel Electrophoresis (PFGE). In the present study, 18 VNTR loci, as well as other previously described reduced MLVA panels (7 VNTR loci), were evaluated as tools to characterize pneumococcal strains of serotypes 14, 9N and 9V belonging to international and regional clones isolated in Brazil. The 18 VNTR loci panel was highly congruent with MLST and PFGE, being also useful for indicating the genetic relationship with international clones and for discriminating among strains with indistinguishable STs and PFGE profiles. Analysis of the results also allowed deducing a novel shorter 7 VNTR loci panel, keeping a high discriminatory power for isolates of the serotypes investigated and a high congruence level with MLST and PFGE. The newly proposed simplified panel was then evaluated for typing pneumococcal strains of other commonly isolated serotypes. The results indicate that MLVA is a faster and easier to perform, reliable approach for the molecular characterization of S. pneumoniae isolates, with potential for cost-effective application, especially in resource-limited countries.

Emergence and characterisation of vanB vancomycin-resistant Enterococcus faecalis in Rio de Janeiro, Brazil.

Here we describe the detection and characterisation of three isolates of vancomycin-resistant VanB-type Enterococcus faecalis. Sequence analysis suggested that these isolates harboured the vanB1 gene. The isolates were susceptible to the majority of antimicrobial agents tested, with the exception of chloramphenicol, erythromycin and vancomycin, and showed distinct profiles of high-level resistance to aminoglycosides. Analysis of the clonal relatedness of the vanB E. faecalis isolates showed similar pulsed-field gel electrophoresis profiles. To our knowledge, this is the first report of the occurrence of enterococcal strains carrying vanB genes in Brazil.

Emergence and characterisation of vanB vancomycin-resistant Enterococcus faecalis in Rio de Janeiro, Brazil

Here we describe the detection and characterisation of three isolates of vancomycin-resistant VanB-type Enterococcus faecalis. Sequence analysis suggested that these isolates harboured the vanB1 gene. The isolates were susceptible to the majority of antimicrobial agents tested, with the exception of chloramphenicol, erythromycin and vancomycin, and showed distinct profiles of high-level resistance to aminoglycosides. Analysis of the clonal relatedness of the vanB E. faecalis isolates showed similar pulsed-field gel electrophoresis profiles. To our knowledge, this is the first report of the occurrence of enterococcal strains carrying vanB genes in Brazil.

Caesarean section greatly increases risk of scar endometriosis.

OBJECTIVE: To estimate the incidence of scar endometriosis after different surgical procedures. STUDY DESIGN: A retrospective study of 72 patients diagnosed with scar endometriosis between 1978 and 2003 was performed. Patient age, site of endometriosis, previous operations, time-gap between last surgery and onset of symptoms, nodule characteristics, and recurrence were evaluated. RESULTS: Age ranged from 16 to 48 years. Location varied according to the previous surgery: 46 caesarean section, one hysterectomy, one in abdominal surgery, 19 episiotomy, one was a relapse and two pelvic floor procedures, two women with no previous surgery. The incidence of scar endometriosis after caesarean section was significantly higher than after episiotomy (0.2 and 0.06%, respectively: p<0.00001) with a relative risk of 3.3. Pain was the most frequent symptom. The mean time between surgery and onset of symptoms was 3.7 years. CONCLUSION: Our findings confirm that scar endometriosis is a rare condition and indicate, probably for the first time, that caesarean section greatly increases the risk of developing scar endometriosis.

Endometriose de cicatriz cirúrgica: estudo retrospectivo de 72 casos / Scar endometriosis: a retrospective study of 72 patients

OBJETIVO: avaliar a freqüência e fatores associados à endometriose de cicatriz cirúrgica. MÉTODOS: foi realizado estudo observacional, tipo coorte retrospectivo, a partir da revisão de prontuários de pacientes do Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG) com diagnóstico anatomopatológico de endometriose de cicatriz cirúrgica, no período de maio de 1978 a dezembro de 2003. RESULTADOS: foram encontrados 72 pacientes com diagnóstico de endometriose de cicatriz. A incidência de endometriose de cicatriz após cesariana foi significativamente maior do que após parto normal (0,2 e 0,06 por cento, respectivamente; p<0,00001), com um risco relativo de 3,3. A idade das mulheres, no momento do diagnóstico, variou de 16 a 48 anos, com média de 30,8 anos. A localização da lesão variou conforme a cirurgia prévia: 46 cesarianas, uma histerectomia e uma abdominoplastia (48 lesões na parede abdominal); 19 partos normais com episiotomias, uma recidiva e duas perineoplastias (22 lesões perineais); duas mulheres sem história de cirurgia ginecológica prévia (uma lesão na cicatriz umbilical e uma na parede vaginal posterior). A dor foi o sintoma mais freqüente (80 por cento), seguido de nódulo (79 por cento), e, em mais de 40 por cento, a dor e o nódulo sofreram modificações com o período menstrual. Outras queixas menos freqüentes foram: dispareunia, infertilidade secundária, dor pélvica, dismenorréia, secreção na cicatriz, menorragia e dor à evacuação. O intervalo de tempo médio entre a cirurgia e o início dos sintomas foi de 3,7 anos. O tamanho médio da lesão foi de 3,07 cm. A hipótese diagnóstica, baseada na avaliação clínica, foi correta em 71 por cento dos casos. O tratamento de escolha em todos os casos foi a exérese cirúrgica. Em apenas uma ocorrência houve recidiva e nova intervenção. CONCLUSÕES: a endometriose de cicatriz cirúrgica é situação rara, originada, na maioria das vezes, a partir de procedimento cirúrgico...

PURPOSE: to identify the incidence and associated factors of surgical scar endometriosis. METHODS: a retrospective cohort observational study performed from the medical records of female patients attended at the Clinical Hospital of Univesidade Federal de Minas Gerais (UFMG) with histopathological diagnosis of scar endometriosis from May 1978 to December 2003. RESULTS: a total of 72 patients were included in the study. The incidence of scar endometriosis after cesarean section was significantly higher than after episiotomy (0.2 percent and 0.06 percent, respectively; p<0.00001) with relative risk of 3.3. The women’s age, when diagnosed, ranged from 16 to 48 years old, (mean=30.8 years old). The scar location varied according to the previous surgery: 46 scars after cesarean sections, one after hysterectomy and one after abdominal surgery (48 lesions in the abdominal wall); 19 scars after episiotomy, one because of relapse and two after pelvic floor surgeries (22 pelvic wounds); two women had not been submitted to previous gynecological surgery (one umbilical endometrioma and one lesion in the posterior vaginal wall). Pain was the most frequent symptom (80 percent), followed by a node (79 percent) and, in more than 40 percent, the pain and the node suffered modification with menstruation. Other less frequent complaints were: dyspareunia, secondary infertility, pelvic pain, dysmenorrhoea, scar secretion, menorrhagia pain when evacuating. The mean time observed between the surgery and the beginning of the symptoms was of 3.7 years. The average size of the endometriomas was 3.07 cm. The diagnosis based on clinic evaluation was correct in 71 percent of the cases. The choice of treatment in all the cases was the surgical excision. In only one incident there was relapse and new intervention. CONCLUSIONS: scar endometriosis is a rare situation originated, in most cases, after obstetrical surgical procedure, with higher risk after cesarean section. It is...