Importância do controle de qualidade para a redução das amostras insatisfatórias cérvico-vaginais / The importance of quality control to reduce unsatisfactory cervicl smears

O objetivo deste estudo foi analisar as não-conformidades analíticas dos exames citopatológicos realizados no Setor de Citologia Oncótica, da Divisão de Patologia do Instituto Adolfo Lutz (SCO-IAL), e discutir ações corretivas para minimizar essas ocorrências. O SCO-IAL recebeu 44.197 amostras citopatológicas cérvico-vaginais enviadas pelas Unidades de Saúde (US), de setembro de 2005 a fevereiro de 2007, que foram coradas pelo método de Papanicolaou e classificadas segundo a Nomenclatura Brasileira recomendada pelo Ministério da Saúde. Do total, 1.155 (2,61%) foram classificadas como insatisfatórias, sendo: 351 por artefatos de dessecamento; 198 pela presença de piócitos; 98 por material insuficiente; 47 pela presença de sangue e 12 por superposição celular. Em 449 casos, houve associação de duas ou mais causas; sendo o dessecamento presente em 351 casos. Das 198 amostras insatisfatórias pela presença de piócitos, 37 apresentaram agentes infecciosos. Observou-se também nesse mesmo período que dos 1.558(3.52%) casos de atipias de significado indeterminado, 371 foram limitados em seu diagnóstico. Os resultados obtidos demonstram que programas de treinamento nas US são de melhor estratégia para melhoria na qualidade das amostras. O controle de qualidade interno e externo, desde a colheita até a emissão dos laudos, é fundamental para o sucesso dos programas de rastreamento citológico.

Acute water ingestion increases arterial blood pressure in hypertensive and normotensive subjects.

In patients with severe autonomic dysfunction, water ingestion elicits an acute pressor response. Hypertension may be associated with changes in cardiovascular autonomic modulation, but there is no information on the acute effects of water ingestion in patients with hypertension. In this study, we compared the effect of acute water ingestion on haemodynamic and autonomic responses of hypertensive and normotensive individuals. Eight patients with mild hypertension were compared to 10 normotensive individuals. After 30 min resting in the supine position all subjects ingested 500 ml of water. At baseline and after water ingestion, venous blood samples for plasma volume determination were collected, and electrocardiographic tracings, finger blood pressure, forearm blood flow and muscle sympathetic nerve activity (MSNA) were obtained. Water ingestion resulted in similar and minor reduction in plasma volume. Systolic and diastolic blood pressure increased in both hypertensive (mean+/-s.d.: 19/14+/-6/3 mm Hg) and normotensive subjects (17/14+/-6/3 mm Hg). There was an increase in forearm vascular resistance and in MSNA. Heart rate was reduced (hypertensive: 5+/-1 beats/min, normotensive: 5+/-6 beats/min) and the high-frequency component of heart rate and systolic blood pressure variability was increased. In hypertensive and normotensive individuals, acute water ingestion elicits a pressor response, an effect that is most likely determined by an increased vasoconstrictor sympathetic activity, and is counterbalanced by an increase in blood pressure and heart rate vagal modulation.

Confirmation that heparin is an alternative means of promoting early reperfusion.

BACKGROUND: New strategies to increase coronary patency rate before primary angioplasty are under discussion. We tested the hypothesis that use of a high dose of a standard heparin bolus could achieve an acceptable rate of re-opening occluded infarct-related arteries thus providing an alternative to chemical thrombolysis before admission of the patient to hospital, and a pretreatment for primary angioplasty. METHODS: Forty-eight patients who presented within 12 h of acute myocardial infarction with ST segment elevation were assigned randomly to groups to receive aspirin (200 mg orally) and high-dose standard heparin 300 U/kg as an intravenous bolus (n = 25), or aspirin and placebo bolus (n = 23). Thereafter, all patients underwent coronary arteriography to assess their suitability for primary angioplasty. RESULTS: The high-dose heparin group had greater patency rate (Thrombolysis in Myocardial Infarction grade 2 or 3 flow in the infarct-related artery) than the placebo group (52% compared with 13%, P = 0.006). Hemorrhages related to the puncture site that required blood transfusion occurred in two of 25 and in one of 23 patients in the high-dose heparin and placebo groups, respectively. CONCLUSION: Our study suggests that high-dose standard heparin does have a thrombolytic action when administered as an intravenous bolus.

[Expectations of hospitalized patients as to their relationship with the nursing team]. / Expectativas dos clientes hospitalizados frente ao relacionamento com a equipe de enfermagem.

This research has been made in infectious-parasitary disease sector of a public university hospital in Rio de Janeiro on the first semester of 1995. The logbook research has been introduced to 5 adult clients, from both sexes, who had been interned in the construction of two categories, which are: a) Category I: Feelings and expectations of the client and; b) Category II: Communication and relationship between client and nurse. The results found in the first category were: 1) Lack of affection; 2) Affection, fear and anxiety; 3) Loneliness and depression; 4) Reflection; 5) Insecurity; 6) Worry about the equipment, to be cut, to be impersonally treated, lose self-control and physical dependence. The results found in the second category were: 1) Doubts and interests in information about their disease, its evolution and how long they will stay in hospital: 2) Opportunity to express feelings and ideas; 3) Comprehension of the message given by the nurse. We emphasize the increase of interchange of information, ideas, beliefs, feelings and acts in nurse-client interaction to develop the therapeutic relationship aiming at helping the client to fulfill his basic needs.