Effect of translucency and eggshell color on broiler breeder egg hatchability and hatch chick weight.

A successful hatch has a considerable economic impact on all poultry companies. The aim of the current study was to describe the possible effects of shell translucency (T score) and coloration lightness (L* value) on shell thickness, hatchability, and chick weight. A total of 4,320 eggs from 4 commercial Ross 708 breeder flocks (50-55-wk old) were used. Eggs were selected for T score and L* value. A 3-point subjective scoring system was used for T score (1 = low, 2 = medium, 3 = high), and an electronic colorimeter for L* value, sorting the eggs as light (avg. L* = 80.7) or dark (avg. L* = 76.0). Data were analyzed using the GLIMMIX procedure of SAS (V9.4) and Tukey's HSD test was performed to separate means, a significant difference was considered when P ≤ 0.05. Results suggest that the color of the eggshell was related to the egg weight on the day of collection (P = 0.0056) and at transfer (P = 0.0211), in both cases dark eggs were 0.6 g heavier than light eggs. Dark eggs had a 3.8% increased hatchability of egg set (P = 0.0481) and yielded 6 µm thicker shells (P = 0.0019) when compared to light eggs. Regarding translucency, egg weight at transfer was 0.8 g heavier for T score 1 eggs compared to T score 3 (P = 0.0358). The translucency score of 1 had a 6.9% higher hatchability of eggs set (P = 0.0127) and 0.7 g heavier chick weight (P = 0.0385) compared to T score 3. However, T score 1 eggs had shells 28 µm thinner than the T score 2 and 34 µm thinner than T score 3 (P < 0.0001). An interaction effect was observed for eggshell thickness, L* value, and T score, where eggs classified as light with T score 1 had thinner eggshells compared to those that were dark with T score 3 (P = 0.0292). These results suggest that eggshell translucency and coloration lightness can be good noninvasive indicators of eggshell thickness, hatchability, and chick weight in broiler breeder flocks.

Constipation in Chemotherapy Patients: A Diagnostic Accuracy Study.

OBJECTIVE: To analyze the accuracy of clinical indicators of constipation in cancer patients undergoing chemotherapy. METHODS: A diagnostic accuracy study was conducted from February to September 2018, with 240 cancer patients undergoing chemotherapy. The data collection instrument was a form with sociodemographic and clinical variables, and clinical indicators of constipation. The sensitivity and specificity of the clinical indicators of interest were calculated using a latent class analysis approach. RESULT: The prevalence of constipation in the sample was 86.6%. The most sensitive clinical indicators were straining with defecation (100.0%), and hypoactive bowel sounds (75.0%), while headache (99.9%), abdominal pain (75.0%), pain with defecation (75.0%), straining with defecation (99.9%) and liquid stool (78.1%) were indicators with high specificity. CONCLUSION: A set of six clinical indicators was significantly associated with the occurrence of constipation in cancer patients undergoing chemotherapy, especially straining with defecation. These indicators can be used by nurses to identify constipation and propose prompt and effective interventions.

The Diagnostic Accuracy of Delayed Development in Adolescents.

INTRODUCTION: The early identification of developmental delay in adolescents by health professionals is relevant for a good prognosis. However, the clinical indicators of development delay are unclear in nursing science. PURPOSE: To analyze the clinical indicators of delayed development in school adolescents. METHODS: A diagnostic accuracy study that investigated delayed development among 385 adolescents in public schools between July and September of 2017. The accuracy measures were analyzed using a latent class analysis based on sensitivity and specificity values. FINDINGS: The delayed development is present in 18.26% of school adolescents. The best accuracy values were as follows: low self-esteem (0.9838), dissatisfaction with own image (0.8400), impaired daily activities (0.9815), internalization behavior (0.8304), outsourcing behavior (0.6367), eating disorders (1.0000), emotional insecurity (0.7093), dependent behavior (0.9836), and altered sexual maturation (0.6085). CONCLUSION: Thus, this set of nine clinical indicators can be used by nurse practitioners to confirm delayed development in school adolescents. IMPLICATIONS FOR NURSING PRACTICE: This research contributes by providing accurate clinical indicators of delayed development in adolescents. Thus, nurses should recognize delayed development in adolescents through accurate clinical indicators and propose nursing interventions that have positive health results.

Efficacy of Trace Mineral-Amino Acid Complexes in a Necrotic Enteritis Challenge Model.

Necrotic enteritis (NE) is a common and costly disease of poultry caused by virulent toxigenic strains of Clostridium perfringens. Although the importance of trace minerals for intestinal integrity and health is well documented, there is little information on their role in ameliorating the effects of NE. The two studies reported here examined the effects of replacing a portion of the dietary zinc (Zn), copper (Cu), and manganese (Mn) supplied as sulfates in the control diets with metal-amino acid-complexed minerals in a NE-challenge model consisting of coccidiosis and Clostridium perfringens. In a 28-day battery study, the treatments were the following: (1) no additional Zn or Mn, unchallenged (negative control); (2) no added Zn or Mn, challenged (positive control); (3) added ZnSO4 and MnSO4 at 100 ppm each, challenged; (4) additional ZnSO4 at 60 ppm, Availa-Zn at 40 ppm (Low), and MnSO4 at 100 ppm, challenged; (5) added ZnSO4 at 60 ppm, Availa-Zn at 60 ppm (high), and MnSO4 at 100 ppm, challenged; and (6) added ZnSO4 at 60 ppm, Availa-Zn at 40 ppm, MnSO4 at 60 ppm, and Availa-Mn at 40 ppm, challenged. None of the treatments ameliorated gross lesion scores, but all reduced NE-associated mortality compared with the positive control. At 28 days, the group supplemented with Availa-Zn at 40 ppm (low) had a lower body weight than challenged groups supplemented with Zn and the negative control. In a floor pen study, the five treatment groups were the following: (1) Zn, Mn, and Cu from sulfate sources at 100, 100, and 20 ppm respectively; (2) Zn, Mn, and Cu from sulfate sources at 40, 100, and 20 ppm, respectively, plus Zn from Availa-Zn at 60 ppm; (3) Zn and Mn from sulfate sources at 40 and 100 ppm, respectively, plus Zn from Availa-Zn at 60 ppm and Cu from Availa-Cu at 10 ppm; (4) Zn, Mn, and Cu from sulfate sources at 60, 60, and 20 ppm, respectively, plus Zn and Mn from Availa-Zn/Mn at 40 and 40 ppm, respectively; and (5) bacitracin methylene disalicylate at 55 g/metric ton with Zn, Mn, and Cu from sulfate sources at 100, 100, and 20 ppm, respectively (Zoetis, Inc., Kalamazoo, MI). None of the treatments reduced lesion scores. The Availa-Zn and Availa-Zn/Mn had lower mortality than the sulfate-supplemented feed, whereas Availa-Zn/Cu and bacitracin methylene disalicylate were intermediate and did not differ from the other groups. Considering both trials together, and by using NE mortality as the discriminating factor, we found that adding Zn and Mn exceeding National Research Council requirements reduced NE-associated mortality, and in the floor pen study, complexed Zn and complexed Zn plus Mn appeared to be superior to sulfates.

Chemical cleaning methods for prostheses colonized by Candida spp.: A systematic review.

STATEMENT OF PROBLEM: Different chemical agents have been used to clean and decontaminate dentures. However, consensus on their effectiveness and protocol for use is lacking. PURPOSE: The purpose of this systematic review was to evaluate chemical cleaning methods used to promote a reduction in or elimination of Candida spp. from dental prostheses. MATERIAL AND METHODS: Searches were performed in the electronic databases MEDLINE, Cochrane Library, Elsevier, Embase, SciELO, Scopus, Web of Science, Bvsalud, and Google Scholar. Manual searches were also performed. There were no restrictions on date of publication or language. Randomized clinical trials on the reduction of prosthesis surface colonization by Candida spp. by using chemical agents compared with distilled water were included. RESULTS: After the first screening, 52 studies were included, of which 5 were included for quality assessment. The studies evaluated the efficacy of alkaline peroxides, chlorhexidine, and chlorine dioxide. Among the studied solutions, alkaline peroxides demonstrated no effect on the decrease of Candida spp. on prostheses. Chlorhexidine and chlorine dioxide significantly reduced colony-forming unit (CFU) rates of these microorganisms. CONCLUSIONS: The evaluated studies presented a high risk of bias and weak evidence of the effects of chemical agents to reduce CFU counts of Candida spp. Only chlorhexidine and chlorine dioxide demonstrated some evidence of a reduction in Candida spp. colonization. Clinical trials with better methodological designs should be performed to clarify the effectiveness of these solutions in prosthesis decontamination.

First-in-Human Endo-Bentall Procedure for Simultaneous Treatment of the Ascending Aorta and Aortic Valve.

We describe the endovascular management of a middle-aged woman who developed a bleeding suprasternal fistula after conventional aortic valve replacement. The patient's condition was considered inoperable. A customized stent attached to a transcatheter valve was successfully used to treat the individual, this being the first-in-human case of the promising Endo-Bentall procedure. (Level of Difficulty: Advanced.).

Evaluation of a Brazilian's cardiovascular anesthesia fellowship by its former trainees / Avaliação do programa de aprimoramento em anestesia cardiovascular por seus ex-estagiários

Abstract Background: After advancement of cardiovascular surgery, there is also exponential development of anesthetic techniques in this field. Patients with increasing clinical complexity challenge cardiac anesthesiologists to keep constantly updated. An evaluation of Brazilian's cardiovascular anesthesia fellowship at Dante Pazzanese Institute of Cardiology has been made and information has been collected to evaluate the fellowship program in cardiovascular anesthesia. Method: Target participants were made up of former fellowships, contacted via e-mail containing an invitation to voluntarily participate. Explanation of the survey's purpose was provided. This communication was signed by the authors and contained a hyperlink to the survey, which was constructed on and hosted on a web platform. The survey was composed of 10 objectives questions designed to describe training and subsequent career. Results: The adjusted survey response rate was 71%. Two-thirds of respondents agreed that fellowship training provided them an advantage in the job market and 93% of respondents currently work with cardiac anesthesia. At least 87% of participants would recommend the course to other anesthesiologists. Conclusion: Fellowship graduates judge their technical training as excellent and incorporated the knowledge acquired in their daily practice. However, there are improvements to be made. We believe this document may be useful as a reference for other institutions to develop their own cardiovascular anesthesia fellowship programs.

Resumo Justificativa: Com o avanço da cirurgia cardiovascular nos últimos anos, houve também um desenvolvimento exponencial das técnicas anestésicas. Pacientes com complexidade clínica crescente desafiam os anestesiologistas cardíacos a se manterem constantemente atualizados. Uma avaliação do programa de aprimoramento em anestesia cardiovascular brasileira do Instituto Dante Pazzanese de Cardiologia foi feita e informações foram coletadas para avaliar o programa. Método: Os participantes-alvo eram formados por ex-aprimorandos, contatados via e-mail com um convite para participação voluntária. A explicação do objetivo da pesquisa foi fornecida. Essa comunicação foi assinada pelos autores e continha um link para a pesquisa, que foi construída e hospedada em uma plataforma web. A pesquisa foi composta por 10 questões objetivas destinadas a descrever o treinamento e a carreira subsequente. Resultados: A taxa de resposta ajustada para a pesquisa foi de 71%. Dois terços dos entrevistados concordaram que o treinamento do programa lhes proporcionou uma vantagem no mercado de trabalho e 93% dos entrevistados trabalham atualmente com anestesia cardíaca. Pelo menos 87% dos participantes recomendariam o curso a outros anestesiologistas. Conclusão: Os graduados do programa de aprimoramento julgam sua formação técnica como excelente e incorporaram os conhecimentos adquiridos em sua prática diária. No entanto, há melhorias a serem feitas. Acreditamos que este documento possa ser útil como referência para outras instituições desenvolverem seus próprios programas de aprimoramento em anestesia cardiovascular.

[Evaluation of a Brazilian's cardiovascular anesthesia fellowship by its former trainees]. / Avaliação do programa de aprimoramento em anestesia cardiovascular por seus ex­estagiários.

BACKGROUND: After advancement of cardiovascular surgery, there is also exponential development of anesthetic techniques in this field. Patients with increasing clinical complexity challenge cardiac anesthesiologists to keep constantly updated. An evaluation of Brazilian's cardiovascular anesthesia fellowship at Dante Pazzanese Institute of Cardiology has been made and information has been collected to evaluate the fellowship program in cardiovascular anesthesia. METHOD: Target participants were made up of former fellowships, contacted via e-mail containing an invitation to voluntarily participate. Explanation of the survey's purpose was provided. This communication was signed by the authors and contained a hyperlink to the survey, which was constructed on and hosted on a web platform. The survey was composed of 10 objectives questions designed to describe training and subsequent career. RESULTS: The adjusted survey response rate was 71%. Two-thirds of respondents agreed that fellowship training provided them an advantage in the job market and 93% of respondents currently work with cardiac anesthesia. At least 87% of participants would recommend the course to other anesthesiologists. CONCLUSION: Fellowship graduates judge their technical training as excellent and incorporated the knowledge acquired in their daily practice. However, there are improvements to be made. We believe this document may be useful as a reference for other institutions to develop their own cardiovascular anesthesia fellowship programs.

Fatores de risco e conhecimento de idosos sobre doença renal crônica / Risk factors and knowledge of the elderly people about chronic kidney disease

Objetivo: analisar a relação entre os fatores de risco e o conhecimento dos idosos sobre a doença renal crônica. Métodos: estudo transversal, realizado com 100 idosos cadastrados em unidades básicas, utilizando entrevista semiestruturada. Os dados foram analisados com recurso à estatística descritiva e inferencial. Resultados: a maioria dos idosos detinha conhecimento adequado sobre a doença e a prevenção, mas conhecimento deficiente sobre a hemodiálise. Em relação aos fatores de risco presentes nos idosos destacam-se os valores aumentados e com significância estatística da circunferência abdominal (p=0,049), tabagismo (p=0,022) e o etilismo (p=0,013). Conclusão: identificaram-se relações entre os fatores de risco tabagismo, etilismo, circunferência abdominal aumentada, e o conhecimento dos idosos sobre a doença renal crônica. (AU)

Prevalent Signs and Symptoms in Patients with Skin Cancer and Nursing Diagnoses.

BACKGROUND: Skin cancer has a remarkable importance given the high incidence in the population. In Brazil, it is estimated that there were 98,420 new cases of nonmelanoma skin cancer among men and 83,710 new cases among women in 2014. OBJECTIVES: To verify signs and symptoms present in patients with skin neoplasms according to the literature and relate them to the nursing diagnoses of NANDA International. MATERIALS AND METHODS: Integrative literature review carried out from March to May 2015 in the databases: Cumulative Index to Nursing and Allied Health Literature, SCOPUS, National Library of Medicine and Nattional Institutes of Health, Latin American and Caribbean Sciences of Health and Web of Science. The descriptors used were: 'Signs and Symptoms' and 'Skin Neoplasms'. Sixteen articles were identified as the final sample. After review, the signs and symptoms of skin cancer identified in the literature were related to the defining characteristics present in NANDA International, with the aim to trace possible nursing diagnoses. RESULTS: The most prevalent signs and symptoms were: asymmetric and well circumscribed nodules with irregular borders; speckles with modified color aspect; ulcerations; blisters; pain; itching; and bleeding. The principal nursing diagnoses outlined were: risk for impaired skin integrity; impaired skin integrity; acute pain; risk of shock; and impaired comfort. CONCLUSIONS: The identification of signs and symptoms present in patients with skin cancer and the relationships of these with the nursing diagnoses of NANDA International provide a basis for qualified and systematized nursing care to this clientele.

Hipertermia maligna no Brasil: análise da atividade do hotline em 2009 / Malignant hyperthermia in Brazil: analysis of hotline activity in 2009 / Hipertermia maligna en Brasil: análisis de la actividad del hotline en 2009

JUSTIFICATIVA E OBJETIVOS: Hipertermia maligna (HM) é doença farmacogenética, com reação hipermetabólica anormal a anestésicos halogenados e/ou relaxantes musculares despolarizantes. Desde 1991 há um serviço hotline de atendimento telefônico para HM no Brasil, disponível 24 horas por dia, em São Paulo. Este artigo analisa a atividade do serviço brasileiro de hotline para HM em 2009. MÉTODOS: Análise prospectiva de todas chamadas telefônicas paria maligna (HM) é doença farmacogenética, com reação hipermetabólica anormal a anestésicos halogenados e/ou relaxantes musculares despolarizantes. Desde 1991 há um serviço hotline de atendimento telefônico para HM no Brasil, disponível 24 horas por dia, em São Paulo. Este art go analisa a at vidade do serviço brasileiro de hotline para HM em 2009a o serviço brasileiro de hotline para HM, de janeiro a dezembro de 2009. RESULTADOS: Foram recebidas 22 ligações; 21 provenientes do Sul-Sudeste do Brasil e uma do Norte. Quinze eram pedidos de informações gerais sobre HM. Sete foram suspeitas de crises agudas de HM, das quais duas não foram consideradas como HM. Nas cinco crises compatíveis com HM, todos os pacientes receberam anestésicos inalatórios halogenados (2 isoflurano, 3 sevoflurano) e um usou também succinilcolina; havia quatro homens e uma mulher, com média de idade de 18 anos (2-27). Problemas descritos nas cinco crises de HM: taquicardia (cinco), aumento do gás carbônico expirado (quatro), hipertermia (três), acidemia (um), rabdomiólise (um) e mioglobinúria (um). Um paciente recebeu dantrolene. Todos os cinco pacientes com crises de HM foram seguidos em unidade de terapia intensiva e recuperaram-se sem sequelas. A suscetibilidade à HM foi posteriormente confirmada em dois pacientes por meio do teste de contratura muscular in vitro. CONCLUSÕES: O número de chamadas por ano no serviço brasileiro de hotline para HM ainda é reduzido. As características das crises foram similares às descritas em outros países. É preciso aumentar o conhecimento sobre HM no Brasil.

BACKGROUND AND OBJECTIVES: Malignant hyperthermia (MH) is a pharmacogenetic disease that causes abnormal hypermetabolic reaction to halogenated anesthetics and/or depolarizing muscle relaxants. In Brazil, there is a hotline telephone service for MH since 1991, available 24 hours a day in São Paulo. This article analyzes the activity of the Brazilian hotline service for MH in 2009. METHODS: Prospective analysis of all phone calls made to the Brazilian hotline service for MH from January to December 2009. RESULTS: Twenty-two phone calls were received: 21 from the South/Southeast region of Brazil and one from the North region. Fifteen calls were requests for general information about MH. Seven were about suspected MH acute episodes, two of which were not considered as MH. In five episodes compatible with MH, all patients received halogenated volatile anesthetics (2, isoflurane; 3, sevoflurane) and one also used succinylcholine; there were four men and one woman, with a mean age of 18 years (2-27). The problems described in the five MH episodes were tachycardia (5), increased expired carbon dioxide (4), hyperthermia (3), acidemia (1), rhabdomyolysis (1), and myoglobinuria (1). One patient received dantrolene. All five patients with MH episodes were follow-up in the intensive care unit and recovered without sequelae. Susceptibility to MH was later confirmed in two patients by in vitro muscle contracture test. CONCLUSIONS: The number of calls per year in the Brazilian hotline service for MH is still low. The characteristics of MH episode were similar to those reported in other countries. The knowledge of MH in Brazil needs to be increased.

JUSTIFICATIVA Y OBJETIVOS: La Hipertermia Maligna (HM) es una enfermedad farmacogenética, con una reacción hipermetabólica anormal a los anestésicos halogenados y/o relajantes musculares despolarizantes. Desde 1991 existe un servicio hotline de atención telefónica para la HM en Brasil a disposición las 24 horas del día en São Paulo. Este artículo analiza la actividad del servicio brasileño de hotline para la HM en el 2009. MÉTODOS: Análisis prospectivo de todas las llamadas telefónicas realizadas al servicio brasileño de hotline para la HM, desde enero a diciembre de 2009. RESULTADOS: Se recibieron 22 llamadas; 21 provenientes del Sur y Sudeste de Brasil y una del Norte. Quince eran solicitudes de informaciones generales sobre la HM. Siete fueron sobre sospechas de crisis agudas de HM, de las cuales dos no fueron consideradas como HM. En las cinco crisis compatibles con la HM, todos los pacientes recibieron anestésicos inhalatorios halogenados (2 isoflurano, 3 sevoflurano) y uno también usó succinilcolina. Había cuatro hombres y una mujer, con un promedio de edad de 18 años (2-27). Los problemas descritos en las cinco crisis de HM: taquicardia (cinco), aumento del gas carbónico espirado (cuatro), hipertermia (tres), acidemia (uno), rabdomiólisis (uno) y mioglobinuria (uno). Un paciente recibió dantrolene. Todos los cinco pacientes con crisis de HM recibieron acompañamiento en la unidad de cuidados intensivos y se recuperaron sin secuelas. La susceptibilidad a la HM fue posteriormente confirmada en dos pacientes por medio del test de la contractura muscular in vitro. CONCLUSIONES: El número de llamadas por año al servicio brasileño de hotline para la HM todavía es pequeño. Las características de las crisis fueron similares a las descritas en otros países. Es necesario aumentar el conocimiento que se tiene sobre la HM en Brasil.

Malignant hyperthermia in Brazil: analysis of hotline activity in 2009.

BACKGROUND AND OBJECTIVES: Malignant hyperthermia (MH) is a pharmacogenetic disease that causes abnormal hypermetabolic reaction to halogenated anesthetics and/or depolarizing muscle relaxants. In Brazil, there is a hotline telephone service for MH since 1991, available 24 hours a day in São Paulo. This article analyzes the activity of the Brazilian hotline service for MH in 2009. METHODS: Prospective analysis of all phone calls made to the Brazilian hotline service for MH from January to December 2009. RESULTS: Twenty-two phone calls were received: 21 from the South/Southeast region of Brazil and one from the North region. Fifteen calls were requests for general information about MH. Seven were about suspected MH acute episodes, two of which were not considered as MH. In five episodes compatible with MH, all patients received halogenated volatile anesthetics (2, isoflurane; 3, sevoflurane) and one also used succinylcholine; there were four men and one woman, with a mean age of 18 years (2-27). The problems described in the five MH episodes were tachycardia (5), increased expired carbon dioxide (4), hyperthermia (3), acidemia (1), rhabdomyolysis (1), and myoglobinuria (1). One patient received dantrolene. All five patients with MH episodes were follow-up in the intensive care unit and recovered without sequelae. Susceptibility to MH was later confirmed in two patients by in vitro muscle contracture test. CONCLUSIONS: The number of calls per year in the Brazilian hotline service for MH is still low. The characteristics of MH episode were similar to those reported in other countries. The knowledge of MH in Brazil needs to be increased.

Indicadores e ganhos em saúde (grau de dependência dos utentes, desde a admissão até à alta de uma unidade de cuidados continuados de longa duração) / Indicators and health gains (degree of dependence of users, from admission to discharge from a long-term care unit)

Este trabalho foi desenvolvido no âmbito do estágio levado a cabo na Unidade de Cuidados Continuados de Longa Duração e Manutenção Santa Maria Maior de Miranda do Douro. Descreve um conjunto de atividades, incluindo as de carater investigacional, que levaram à concretização dos objetivos inicialmente propostos. Durante os seis meses de estágio pudemos conhecer a Unidade, integrar a equipa multidisciplinar e percecionar o papel do fisioterapeuta inserido na tipologia de uma instituição da Rede Nacional de Cuidados Continuados Integrados. Este período de estágio possibilitou-nos também fazer um balanço da nossa profissão, enquanto fisioterapeuta, refletindo sobre a relevância da sua intervenção prática no contexto específico desta estrutura de cuidados, bem como nos processos terapêuticos em causa desde o momento de referenciação dos utentes até à alta. Por sua vez, o recurso a metodologias de investigação ação permitiram desenvolver capacidades de estudo e aplicação no terreno de conteúdos teóricos com relevância para a melhoria do desempenho profissional, colocando em prática os conhecimentos de investigação adquiridos. A investigação desenvolvida permitiu-nos avaliar o grau de dependência dos utentes desde a sua entrada na Unidade até à sua saída, tendo sido incluídos no estudo todos os utentes desde a abertura da instituição. Assim, os resultados obtidos permitemnos concluir que os utentes na sua grande maioria têm idade superior a 79 anos, 54,10% são do sexo feminino, na sua maioria possuem como patologia de base o Acidente Vascular Cerebral. No que diz respeito à autonomia apresentam um índice de Barthel muito baixo quer aquando da sua admissão quer no momento da saída da Unidade. Contudo, alguns ganhos para a realização do autocuidado foram observados aquando da alta. Estes indicadores, juntamente com um conjunto de problemáticas associadas ao envelhecimento, traduzem uma fragilidade de vida muito acentuada e revelam a necessidades de cuidados de saúde e de apoio social integrado. Releva-se a necessidade de uma avaliação compreensiva dos problemas identificados, bem como de critérios rigorosos de referenciação e de alta que poderão traduzir ganhos na qualidade dos serviços e condições de apoio mais adequadas aos utilizadores desta tipologia de cuidados.

Este trabajo se realizó en la asignatura Prácticas y Trabajo del Proyecto, entre febrero y julio del 2011, en la Unidad de Atención Continuada y Largo Plazo de Mantenimiento de Santa Maria Maior de Miranda do Douro. Se describen un conjunto de acciones que contribuyeran a la consecución de los objetivos inicialmente propuestos. En estos 6 meses de prácticas pude conocer la unidad, integrar su equipo multidisciplinario, y percibir cual el papel del fisioterapeuta cuando integrado en este tipo de instituciones. Este período de prácticas también me permitió hacer un balance de mi profesión y reflexionar sobre la importancia del fisioterapeuta en el contexto específico de esta estructura de atención en salud, así como en los procesos terapéuticos en cuestión, desde la admisión hasta la alta médica. Además, el uso de metodologías de investigación-acción nos han permitido desarrollar habilidades de estudio y la aplicación en el campo de los conceptos teóricos relacionados con la mejora de mi rendimiento técnico, poniendo en práctica todo el conocimiento, a nivel de la investigación, que he adquirido en la escuela. En la investigación desarrollada he estudiado el grado de dependencia de los pacientes internados en la unidad, desde su creación hasta la actualidad. Así, los resultados obtenidos permiten concluir que la gran mayoría de los pacientes son mayores de 79 años, 54,10% son mujeres y la gran mayoría tienen como patología subyacente el accidente cerebrovascular. En cuanto a la autonomía, tienen un índice de Barthel muy bajo ya sea en la admisión ya sea en la salida de la unidad. Sin embargo, se observó una mejoría para la realización del autocuidado en la salida de la unidad. Estas características, junto con todos los factores asociados a la dependencia y el envejecimiento hacen con que estos pacientes presenten una fragilidad muy marcada necesitando de atención de salud y apoyo social integrado. Se señala la necesidad de una evaluación global de los problemas identificados en esta población, así como criterios estrictos en la referencia y alta clínica lo que puede conducir a mejoras en salud, aumentar la calidad de los servicios y condiciones de apoyo más adecuados

Implante valve-in-valve transcateter em posição aórtica: uma mudança de seleção? / Transcatheter aortic valve-in-valve implantation: a selection change?

INTRODUÇÃO: A reoperação para substituição de biopróteses aórticas com disfunção é procedimento que envolve considerável risco. Em alguns casos, a mortalidade é elevada e pode contraindicar o procedimento. O implante minimamente invasivo "valve-in-valve" transcateter de valva aórtica parece ser uma alternativa, reduzindo morbimortalidade. O objetivo deste estudo foi avaliar esses implantes utilizando a prótese Braile Inovare. MÉTODOS: A prótese Braile Inovare, transcateter, balão expansível foi utilizada em 14 casos. Euroscore médio foi de 42,9%. Todos os pacientes eram portadores de dupla disfunção de bioprótese aórtica. Os procedimentos foram realizados em ambiente cirúrgico híbrido, sob controle ecocardiográfico e fluoroscópico. Por meio de minitoracotomia esquerda, as próteses foram implantadas através do ápice ventricular, sob estimulação ventricular de alta frequência. Foram realizados controles clínicos e ecocardiográficos seriados. O seguimento variou de 1 a 30 meses. RESULTADOS: A correta liberação protética foi possível em todos os casos. Não ocorreu conversão. Não houve mortalidade operatória. A mortalidade em 30 dias foi de 14,3% (dois casos). A fração de ejeção apresentou aumento significativo após o 7º pós-operatório e o gradiente aórtico apresentou redução significativa. A insuficiência aórtica residual não esteve presente. Não ocorreu complicação vascular periférica ou bloqueio atrioventricular total. CONCLUSÕES: O implante "valve-in-valve" de valva aórtica transcateter em biopróteses com disfunção é um procedimento seguro e com morbimortalidade baixa. Essa possibilidade poderá alterar a indicação de seleção de prótese no procedimento inicial, favorecendo próteses biológicas.

OBJECTIVE: Aortic valve replacement for bioprosthesis dysfunction is a procedure involving considerable risk. In some cases, mortality is high and may contraindicate the procedure. Minimally invasive transcatheter aortic "valve-in-valve" implant appears to be an alternative, reducing morbidity and mortality. The objective is to evaluate aortic valve-in-valve procedure using Braile Inovare prosthesis. METHODS: The Braile Inovare prosthesis, transcatheter, expandable balloon, was used in 14 cases. Average EuroSCORE was 42.9%. All patients had double aortic bioprosthesis dysfunction. Procedures were performed in a surgical hybrid environment under echocardiographic and fluoroscopic guidance. Using left minithoracotomy prostheses were implanted through the ventricular apex under high-frequency ventricular pacing. Serial clinical and echocardiographic controls were performed. Follow-up ranged 1-30 months. RESULTS: Correct prosthetic deployment was obtained in all cases. There was no conversion. There was no operative mortality. The 30-day mortality was 14.3% (two cases). Ejection fraction increased significantly after the 7th postoperative day. Aortic gradient significantly reduced. The residual aortic regurgitation was not present. There were no vascular complications or complete atrioventricular block. CONCLUSION: The transcatheter "valve-in-valve" procedure for bioprosthesis dysfunction is safe with low morbidity. This possibility may change prosthesis choice during the first aortic valve replacement, favoring bioprostheses.

N-acetylcysteine normalizes neurochemical changes in the glutathione-deficient schizophrenia mouse model during development.

BACKGROUND: Glutathione (GSH) is the major cellular redox-regulator and antioxidant. Redox-imbalance due to genetically impaired GSH synthesis is among the risk factors for schizophrenia. Here we used a mouse model with chronic GSH deficit induced by knockout (KO) of the key GSH-synthesizing enzyme, glutamate-cysteine ligase modulatory subunit (GCLM). METHODS: With high-resolution magnetic resonance spectroscopy at 14.1 T, we determined the neurochemical profile of GCLM-KO, heterozygous, and wild-type mice in anterior cortex throughout development in a longitudinal study design. RESULTS: Chronic GSH deficit was accompanied by an elevation of glutamine (Gln), glutamate (Glu), Gln/Glu, N-acetylaspartate, myo-Inositol, lactate, and alanine. Changes were predominantly present at prepubertal ages (postnatal days 20 and 30). Treatment with N-acetylcysteine from gestation on normalized most neurochemical alterations to wild-type level. CONCLUSIONS: Changes observed in GCLM-KO anterior cortex, notably the increase in Gln, Glu, and Gln/Glu, were similar to those reported in early schizophrenia, emphasizing the link between redox imbalance and the disease and validating the model. The data also highlight the prepubertal period as a sensitive time for redox-related neurochemical changes and demonstrate beneficial effects of early N-acetylcysteine treatment. Moreover, the data demonstrate the translational value of magnetic resonance spectroscopy to study brain disease in preclinical models.

Transcatheter aortic valve-in-valve implantation: a selection change?

OBJECTIVE: Aortic valve replacement for bioprosthesis dysfunction is a procedure involving considerable risk. In some cases, mortality is high and may contraindicate the procedure. Minimally invasive transcatheter aortic "valve-in-valve" implant appears to be an alternative, reducing morbidity and mortality. The objective is to evaluate aortic valve-in-valve procedure using Braile Inovare prosthesis. METHODS: The Braile Inovare prosthesis, transcatheter, expandable balloon, was used in 14 cases. Average EuroSCORE was 42.9%. All patients had double aortic bioprosthesis dysfunction. Procedures were performed in a surgical hybrid environment under echocardiographic and fluoroscopic guidance. Using left minithoracotomy prostheses were implanted through the ventricular apex under high-frequency ventricular pacing. Serial clinical and echocardiographic controls were performed. Follow-up ranged 1-30 months. RESULTS: Correct prosthetic deployment was obtained in all cases. There was no conversion. There was no operative mortality. The 30-day mortality was 14.3% (two cases). Ejection fraction increased significantly after the 7th postoperative day. Aortic gradient significantly reduced. The residual aortic regurgitation was not present. There were no vascular complications or complete atrioventricular block. CONCLUSION: The transcatheter "valve-in-valve" procedure for bioprosthesis dysfunction is safe with low morbidity. This possibility may change prosthesis choice during the first aortic valve replacement, favoring bioprostheses.

Transcatheter aortic valve implantation: results of the current development and implantation of a new Brazilian prosthesis.

OBJECTIVE: Aortic valve replacement is a routine procedure with acceptable risk, but in some cases, such risk can justify contraindication. Minimally invasive transcatheter aortic valve implantation has emerged as an alternative, with lower morbidity and mortality. The aim of this study was clinical, safety and efficacy assessment. METHODS: Thirty-three high risk patients underwent transcatheter balloon expandable aortic valve implantation. Mean Logistic EuroScore risk was 39.30% and STS score 30.28%. Eight patients presented with dysfunctional bioprosthesis, remaining ones presented calcified aortic stenosis. Procedures were performed in a hybrid OR under fluoroscopic and echocardiography guidance. Using a left minithoracotomy the prosthesis were implanted trough the ventricular apex under rapid ventricular pacing or hemorrhagic shock. Echocardiographic and angiographic controls were performed. RESULTS: Implant was feasible in 30 cases. Three conversions occured. There was only one case of operative death. Median transvalvular aortic gradient reduced from 43.58 mmHg to 10.54 mmHg. Left ventricular function improved in the first 7 postoperative days. Paravalvular aortic regurgitation was mild and present in 30.30%. One case presented major vascular complication and another one permanent pacemaker implant. One major stroke case occurred. Overall 30-day mortality was 18.18%. CONCLUSION: The transapical implantation of catheter mounted bioprosthesis is a safe procedure with acceptable midterm results. Long term follow-up with increased sample power is mandatory in order to access hemodynamic, life quality and survival.

Implante transcateter de valva aórtica: resultados atuais do desenvolvimento e implante de um nova prótese brasileira / Transcatheter aortic valve implantation: results of the current development and implantation of a new Brazilian prosthesis

OBJETIVO: A troca valvar aórtica é procedimento rotineiro com risco aceitável. Em alguns casos, a mortalidade é elevada, contraindicando o procedimento. O implante minimamente invasivo transcateter de valva aórtica parece ser alternativa, reduzindo a morbimortalidade. A avaliação dos resultados clínicos, segurança e eficácia do procedimento são o objetivo desse estudo. MÉTODOS: Uma prótese transcateter, balão expansível foi utilizada em 33 casos de alto risco. EuroScore médio foi de 39,30% e STS score de 30,28%. Oito pacientes apresentavam disfunção de bioprótese e o restante, estenose aórtica calcificada. Os procedimentos foram realizados em ambiente cirúrgico híbrido, sob controle ecocardiográfico e fluoroscópico. Através de minitoracotomia esquerda, as próteses foram implantadas pelo ápice ventricular, sob estimulação de alta frequência ou choque hemorrágico. Foram realizados controles clínicos e ecocardiográficos. RESULTADOS: A correta liberação da prótese foi possível em 30 casos. Três conversões ocorreram. A mortalidade operatória foi de um caso e a mortalidade em 30 dias, 18,18%. O gradiente médio reduziu de 43,58 para 10,54 mmHg. A fração de ejeção apresentou aumento significativo após o 7º pós-operatório. Insuficiência aórtica residual esteve presente em 30,30% dos pacientes. Ocorreu uma complicação vascular periférica e um caso de bloqueio atrioventricular total. Um paciente apresentou acidente vascular cerebral. A mortalidade em 30 dias foi de 18,18%. CONCLUSÃO: O implante transapical de valva aórtica transcateter é procedimento seguro e com resultados de médio prazo satisfatórios. São necessários estudos de longo prazo com maior poder amostral no intuito de determinar resultado hemodinâmico, qualidade de vida e sobrevida em longo prazo.

OBJECTIVE: Aortic valve replacement is a routine procedure with acceptable risk, but in some cases, such risk can justify contraindication. Minimally invasive transcatheter aortic valve implantation has emerged as an alternative, with lower morbidity and mortality. The aim of this study was clinical, safety and efficacy assessment. METHODS: Thirty-three high risk patients underwent transcatheter balloon expandable aortic valve implantation. Mean Logistic EuroScore risk was 39.30% and STS score 30.28%. Eight patients presented with dysfunctional bioprosthesis, remaining ones presented calcified aortic stenosis. Procedures were performed in a hybrid OR under fluoroscopic and echocardiography guidance. Using a left minithoracotomy the prosthesis were implanted trough the ventricular apex under rapid ventricular pacing or hemorrhagic shock. Echocardiographic and angiographic controls were performed. RESULTS: Implant was feasible in 30 cases. Three conversions occured. There was only one case of operative death. Median transvalvular aortic gradient reduced from 43.58 mmHg to 10.54 mmHg. Left ventricular function improved in the first 7 postoperative days. Paravalvular aortic regurgitation was mild and present in 30.30%. One case presented major vascular complication and another one permanent pacemaker implant. One major stroke case occurred. Overall 30-day mortality was 18.18%. CONCLUSION: The transapical implantation of catheter mounted bioprosthesis is a safe procedure with acceptable midterm results. Long term follow-up with increased sample power is mandatory in order to access hemodynamic, life quality and survival.