Patients' perceptions of the post-pancreatectomy discharge process.

BACKGROUND: Complications after pancreatectomies contribute to poor outcomes. Patients are expected to identify signs/symptoms leading to these complications but may be poorly educated on how to identify them. We assessed the impact of an educational tool on patient perceptions of, and satisfaction with the discharge process, and its effect on readmission rates. METHODS: A prospective cohort study with retrospective chart review including patients who underwent pancreatic resection was undertaken. An interactive educational module (iBook) that provided information about the procedure, possible complications, and peri-discharge information was implemented. English-speaking patients were equally divided into the pre- and post-iBook cohorts. Primary outcome was patients' satisfaction with discharge; Secondary outcomes were 30- and 90-day readmission rates. RESULTS: 100 patients were included. Mean age was 65.5 ± 12.6, 46% were female, and 92.3% were white. Most patients underwent Whipple procedures (72%), and distal pancreatectomies (26%). In the post-implementation group, 92% were satisfied with the discharge process, and 89% reported it was a good tool. There were no statistical differences in 30- and 90-day readmission rates between cohorts. CONCLUSION: The iBook positively impacted patients' satisfaction and preparedness for discharge. Readmission rates were not statistically significantly impacted but could be investigated with further studies of greater sample sizes.

Use of biometrics in the prediction of body weight in crossbred lambs / [Uso da biometria na predição do peso corporal de cordeiros mestiços]

O objetivo deste trabalho foi propor um modelo matemático para predição do peso corporal de cordeiros com base nas medidas biométricas. Foram utilizados dados de 51 cordeiros, com composição genética de pelo menos 50% da raça Santa Inês. O peso corporal (PC) dos animais foi acompanhado durante 91 dias por meio de pesagens semanais. Após as pesagens, foram tomadas as medidas: altura anterior (AA); altura posterior (AP); comprimento corporal (CC); largura de peito (LP); largura de garupa (LG); perímetro torácico (PT) e perímetro de barril (PB). Essas medidas foram utilizadas como variáveis de entrada do modelo. Foi observado correlações positivas e significativas (P<0,05) entre todas as variáveis biométricas com o PC. No entanto, o PC apresentou uma alta correlação com o PT (0,836), seguido do PB (0,818) e AP (0,740). Dessa forma, essas três medidas foram significativas para estimativa do PC. Portanto, o modelo para predizer o PC dos cordeiros foi: Peso (kg)=0,4455* PT - 0,5794 * PB + 0,0019 * AP2 + 0.0053* PB2. O perímetro torácico, perímetro de barril e altura de posterior podem ser utilizados como variáveis preditoras do peso corporal em ovinos mestiços, independente do sexo.(AU)

Emotional and behavioral problems in children and adolescents with lower urinary tract dysfunction: a population-based study.

BACKGROUND: An association has been found between lower urinary tract dysfunction (LUTD) and emotional and behavioral problems, particularly in cases of urinary incontinence. Other associated symptoms and the coexistence of functional constipation require further investigation. OBJECTIVE: To assess whether emotional and behavioral problems are more common in children and adolescents with LUTD. STUDY DESIGN: A multicenter, cross-sectional, population-based study conducted in public places. Parents answered questions on urinary and psychological symptoms in their children aged 5-14 years. Children/adolescents with neurological problems or anatomical urinary tract abnormalities were excluded. The Dysfunctional Voiding Scoring System was used for assessing urinary symptoms, the Rome III Diagnostic Criteria for evaluating bowel symptoms, and the Strengths and Difficulties Questionnaire (SDQ) for evaluating emotional and behavioral problems. RESULTS: Of the 806 children/adolescents included, 53% were female. The mean age was 9.1 ± 2.7 years. The prevalence of LUTD was 16.4%. Overall, 26.2% had abnormal scores in the overall SDQ scale, 29.2% in the emotional problems subscale, and 30% in the conduct problems subscale. Of the children with LUTD, 40.5% screened positive for emotional/behavioral problems, with a significant association being found for the overall SDQ scale (P < 0.001) and for the emotional problems (P < 0.001), conduct problems (P < 0.001), and hyperactivity (P = 0.037) subscales. Urinary urgency, urinary incontinence, and voiding postponement were significantly associated with a greater prevalence of abnormalities in the overall SDQ score (P = 0.05; P = 0.004, and P = 0.012, respectively). Bladder and bowel dysfunction was an aggravator of emotional and behavioral problems, with more intense symptoms, both in the overall SDQ scale and in the subscales. In the multivariate analysis, the factors independently associated with the presence of emotional and behavioral problems were LUTD (odds ratio [OR] = 1.91), constipation (OR = 1.7), studying in a government-funded school (OR = 2.2), and poor education of the head of the family (OR = 1.9). CONCLUSIONS: Children and adolescents with LUTD have more emotional and behavioral problems, with bladder and bowel dysfunction being an aggravating factor for this association.

Perfil epidemiológico da hanseníase em Itabuna - Bahia / Epidemiological profile of leprosy in Itabuna - Bahia

Objetivo: analisar o perfil epidemiológico dos novos registros de hanseníase na cidade de Itabuna,Bahia no período de 2010 a 2014. Métodos: estudo exploratório, descritivo e quantitativo, através dacoleta de dados secundários registrados no Sistema de Informação de Agravos de Notificação.Resultados: houve tendência de decréscimo no número de casos entre 2010 e 2014, predominou osexo masculino (56,1%), a faixa etária entre 50 a 64 anos (23,5%), cor da pele parda (58,7%), ensinofundamental incompleto (40,2%) Conclusão: a Hanseníase em Itabuna-BA ocorre mais comumente emadultos e idosos, prevalecendo indivíduos com mais de 50 anos, de cor de pele parda e com baixaescolaridade, indicando pessoas que geralmente são economicamente ativas e com pouco acesso àinformação.

Objective: to analyze the epidemiological profile of the new records of leprosy in the city of Itabuna,Bahia from 2010 to 2014. Methods: exploratory, descriptive and quantitative study was conductedby collecting secondary data recorded in the Information System Notifiable Diseases. Results: therewas a decrease in the number of cases between 2010 and 2014, the predominance of males (56,1%),age between 50 to 64 years (23,5%), brown skin color (58,7%), incomplete elementary school (40,2%).Conclusions: leprosy in Itabuna-BA occurs most commonly in adults and the elderly, with individualsover 50 years of age, from the brown skin color and with low low schooling, indicating people whoare generally economically active and with little access to information.

Continuous extraction of alpha- and beta-amylases from Zea mays malt in a PEG4000/CaCl2 ATPS.

In the present work, alpha- and beta-amylase enzymes from Zea mays malt were recovered by continuous extraction in a PEG/CaCl2 aqueous two-phase system (ATPS). The influences of the flux rate (RQ), free area of vane (A(free)) and vane rotation (RV) on enzyme recovery were studied by optimization using response surface methodology (RSM). The protein content and enzyme activity were measured from time to time in the extract and refined fluxes. RSM curves showed a squared dependence of recovery index with the RQ, A(free) and RV. The best system for recovering the maize malt enzymes was with low vane rotation and flux rate and high free area of vane. Alpha- and beta-amylases were purified 130-fold in the salt-rich phase.

Purification by expanded bed adsorption and characterization of an alpha-amylases FORILASE NTL from A. niger.

In this work the purification and biochemistry characterization of alpha-amylases from Aspergillus niger (FORILASE NTL) were studied. The effects of expansion degree of resin bed on enzyme purification by expanded bed adsorption (EBA) have also been studied. Residence time distributions (RTD) studies were done to achieve the optimal conditions of the amylases recovery on ion-exchange resin, and glucose solution was used as a new tracer. Results showed that height equivalent of the theoretical plates (HETP), axial dispersion and the Prandt number increased with bed height, bed voidage and linear velocity. The adsorption capacity of alpha-amylases, on the resin, increased with bed height and the best condition was at four-expansion degree. alpha-Amylase characterization showed that this enzyme has high affinity with soluble starch, good hydrolysis potential and molecular weight of 116 kDa.

[Randomized clinical trial of intravenous magnesium sulfate versus salbutamol in early management of severe acute asthma in children] / Estudo controlado do uso endovenoso de sulfato de magnésio ou de salbutamol no tratamento precoce da crise de asma aguda grave em crianças.

OBJECTIVE: To study the efficacy of intravenous magnesium sulfate and intravenous salbutamol in the treatment of severe asthma in children. METHODS: Randomized, double-blind, placebo-controlled clinical trial, including children above 2 years of age with severe acute asthma admitted to the observation ward of the Pediatric Intensive Care Unit of Hospital São Lucas. All patients received conventional treatment (oxygen, corticoids, beta-adrenergics) on admission, and later received one of the following solutions: a) IVMg (50 mg/kg); b) intravenous salbutamol (1 micro g/kg); c) saline solution. Clinical assessments, electrolyte concentration, and arterial blood gas analyses were recorded before intravenous infusion and one hour after that. RESULTS: Fifty patients participated in this study (of whom 53% were females, mean age = 4.5 years). There were no significant differences among the three groups. The group that received IVMg presented lower blood pressure during administration, which reached normal levels one hour afterwards, along with an increase in serum magnesium (P<0,001) and serum pH, and reduction of PaCO(2). The group that received intravenous salbutamol had lower respiratory rate (P=0.05) and higher blood pressure (P=0.01), and one hour after administration, these patients showed decreased respiratory rate (P=0.02); lower levels of serum potassium (P=0.009); higher pH, and reduced PaCO(2). This group required fewer nebulizations (P=0.009), fewer nebulizations per day (P<0.001) and less oxygen therapy than the IVMg and placebo groups. Acidosis was more persistent (P<0.01) in the placebo group. No difference as to the length of hospital stay was observed in any of the three groups. Artificial ventilation was necessary in 10% of the patients. CONCLUSIONS: The early intravenous administration of magnesium sulfate, especially salbutamol, achieved a rapid clinical response with excellent prognosis and no significant side effects.

[Respiratory failure in the child] / Insuficiência respiratória na criança.

OBJECTIVE: To describe the main physiopathologic mechanism of the respiratory failure in the child, as well as to discuss some aspects of the differential diagnosis and treatment. SOURCE OF DATA: The main national and international textbooks and articles about respiratory failure in the child were used as sources of data for this research. RESULTS: Respiratory failure is defined as the incapacity to maintain a paO(2) over 50 mmHg associated or not to a paCO(2) over 50 mmHg in children breathing ambient air at sea level. This failure may be classified as hypoxemic or hypercapnic, or even as acute or chronic. The main alterations may be hypoventilation, ventilation perfusion mismatch and diffusion defect. It may be secondary to a central origin, upper or lower airway compromise, parenchyma disease, or due to pleural or thorax wall affection. The hypoxemia evaluation may be done by hemoglobin saturation, alveolar capillary gradient of oxygen (D[A-a]O(2)) or by the paO(2) / FiO(2) index. COMMENTS: The knowledge of the physiopathologic mechanisms that cause respiratory failure in the child is important to define the more efficient therapeutic strategy for each cause.

Oral Cancer Case Finding Program (OCCFP).

The aim of the Oral Cancer Case Finding Program (OCCFP) is to reduce the morbidity and mortality rates of oral cancer in Cuba. This program is based on health education of the whole population and a thorough examination of the oral complex, by specially trained stomatologists, of patients attending every stomatological care centre. Between 1983 and 1990, 10,167,999 such patients were examined country-wide and a total of 30,478 were referred as presenting some sort of alteration; 8259 complied with their referral. In this group, 2367 leucoplakias and 853 other precancerous lesions were diagnosed and treated. These 3220 premalignancies should have some influence on the cancer morbidity rates. Five hundred and eighty-one epidermoid carcinomas and 127 other malignant neoplasms were also detected for a total of 708 malignancies. The effectiveness of this program can be evaluated by the increments in diagnoses of Stage I oral cancer from 22.8% to 48.2% on account of the most advanced stages (II, III and IV) which decreased from 77.2% to 51.8%. The object of this paper is to present the results of OCCFP up to 1990.

[Factors related to severe acute asthma in childhood - epidemiologic and clinical aspects]. / Fatores associados com asma aguda grave na infância - aspectos epidemiológicos e clínicos.

OBJECTIVE: To study the epidemiologic and clinical factors related to severe acute asthma in patients hospitalized in pediatric intensive care unit (PICU). STUDY PROFILE: Prospective, epidemiologic. All admissions were observed. PATIENTS AND METHODS: All children with severe asthma admitted to PICU-HSL-PUCRS between January, 1994, and December, 1994. Their parents were asked to answer a questionnaire about clinical history and precipitating factors of bronchospasm. Clinical evolution was observed in each patient. RESULTS: 31 children were admitted on 42 occasions to the PICU for the treatment of severe asthma (7.3% of all admissions). The male: female ratio was 1.2:1.0 and the age mean was 25 months. Respiratory viral infections were the main precipitating factor of asthma attacks (74%). Family history of asthma, atopy or tabagism were observed in 97% of the cases. A longer hospitalization period was associated with less than 1 year age (p=0.0005), family history of tabagism (OR= 2.3) and occurrence of pneumonitis (p= 0.03). The long stay in PICU was associated with previous PICU admission (p=0.03), family history of tabagism (OR=2.0) and occurrence of pneumonitis (p=0.02). The main complication observed, especially in patients under 1 year receiving public health care, was pneumonitis, that was diagnosed in 42% of these children. Patients assisted by a private doctor had a shorter hospitalization period and less pneumonitis complication. Mechanical ventilation was necessary in 10% of these patients. There was no death in our series. CONCLUSIONS: The incidence of severe acute asthma, associated with long staying in PICU and hospitalization, is related to low age (under 1 year), previous hospitalization due to bronchospasm, family history of asthma, atopy or tabagism, and ineffective medical care. These factors seem related to frequent crises causing more hospitalization indications. These children frequently present pneumonitis during their clinical evolution. Early and aggressive management in general benefit the clinical course of severe acute asthma. The mortality ratio for children with acute asthma who need PICU admissions is small.

[Autonomic dysfunction in Guillain-Barré Syndrome: a 13 year experience in pediatric intensive care unit]. / Distúrbios autonômicos na Síndrome de Guillain-Barré: experiência de 13 anos em UTI pediátrica.

The acute inflammatory demyelinating polyneuropathy (Guillain-Barré Syndrome) might have a severe presentation but a good prognosis in children. It is an immune-mediated and inflammatory disorder of the peripheral nervous system. This retrospective study observed that GBS is frequently complicated by hypertension and other autonomic disorders. Cardiovascular instability is due to the involvement of the autonomic nervous system and results in labile blood pressure, cardiac dysrhythmias and hypovolemia. During a 13-year period (1982-1995), 21 children were admitted to the Pediatric Intensive Care Unit of São Lucas Hospital, Porto Alegre, south of Brazil. Eight patients were mechanically ventilated. Symptoms of autonomic disturbance were frequently seen, especially in patients with severe clinical evolution. Previous investigations of the mechanism of hypertension associated with GBS did not evaluate the etiology of these phenomena. With modern pediatric intensive care support the deaths are rare. There is no death in this studied group.

[Mixed papillary follicular carcinoma of the thyroid gland in childhood. Report of a case]. / Carcinoma misto papilar-folicular de tireóide na infância: relato de um caso.

The authors have reported a case of childhood Thyroid Carcinoma at a Pediatric Service. This report has been justified since this is an uncommon pathology in children and a very unusual clinical picture for children. The etiology and diagnostic have been reviewed by the authors. The clinical investigation as well as the clinical course of the disease has been present. The literature for thyroid cancer in children has also been reviewed. The need for a careful investigation in children with unusual radiologic finding has been emphasized; being the thyroid carcinoma metastasis diagnosis one of the possibilities.

Prevalence of oral leukoplakia in Havana City, Cuba.

A survey related to the detection of precancerous lesions of the oral cavity has been done in Cuba for the first time. The sample comprised 749 randomly selected workers from Havana City Province, taking into account the census records of the Cuban population up to 1979. Prevalence of lesions and their relation to age, sex and predisposing factors, such as smoking, alcohol habits and mechanical trauma were studied. 4.4% of leukoplakia and preleukoplakia considered together and 2.1% leukoplakia alone, and two cases of oral lichen planus and leukokeratosis nicotina palati (0.1% of each) were found. The former lesions were more frequently encountered in people above 50 years old, specially in males and specifically among those who had smoked for more than 10 years. Sites of location most frequently encountered were the buccal mucosa and the labial commissures.