Factors Associated with Reported Infection and Lymphedema Symptoms among Individuals with Extremity Lymphedema.

PURPOSE: This study aimed to examine factors associated with reported infection and symptoms among individuals with extremity lymphedema. DESIGN: A cross-sectional study was used. METHODS: Data were collected from a survey supported by the National Lymphedema Network from March 2006 through January 2010. A total of 1837 participants reported having extremity lymphedema. Logistic regression analyses were used. FINDINGS: Factors associated with reported infection among individuals with extremity lymphedema included male gender, decreased annual household income, decreased self-care, self-report of heaviness, and lower extremity as opposed to upper extremity. Factors associated with symptoms included infection, decreased self-care, lower knowledge level of self-care, decreased annual household income, and presence of secondary lower extremity lymphedema. CONCLUSIONS/CLINICAL RELEVANCE: Select factors of income, self-care status, and site of lymphedema were associated with increased occurrence of infection and symptoms among individuals with extremity lymphedema. Longitudinal studies are needed to identify risk factors contributing to infections and symptoms in individuals with lymphedema.

Complicações com o uso do cateter totalmente implantável em pacientes oncológicos: revisão integrativa / Complications of the use of the totally implantable catheter in oncological patients: an integrative review / Complicaciones con el uso del catéter totalmente implantable en pacientes oncológicos: revisión integrativa

O estudo objetivou fazer um levantamento da produção científica sobre as complicações com o uso do cateter totalmente implantável-CTI, considerando sua relevância no tratamento de pacientes oncológicos. A seleção foi feita através de busca eletrônica e manual de artigos publicados entre o período de 1998 a março de 2008, no final foram selecionados 12 artigos para compor esta revisão integrativa. Os principais resultados encontrados foram: há pouca participação de enfermeiros na produção científica sobre o tema; 11 artigos mostravam de forma bem estruturada seus objetivos, resultados e conclusão; sete artigos utilizaram metodologia retrospectiva, quatro prospectiva e um utilizou ambos os métodos. As complicações mais frequentes, em ordem decrescente, foram: infecção, trombose, obstrução, hematoma, mal posicionamento, bacteriemia, extravasamento, pneumotórax. Os artigos analisados mostraram resultados satisfatórios quanto ao uso do CTI, concluindo que seu uso por pacientes oncológicos apresenta baixos índices de complicação.

The study aimed to conduct a survey of scientific literature about the complications with the use of totally implantable catheters-TIC, considering its importance in the treatment of cancer patients. The selection was made through manual and electronic search of articles published from 1998 to March 2008. Finally, 12 articles were selected to compose this integrative review. The main results found were that, there is little involvement of nurses in the scientific production about the theme; 11 articles showed their objectives, results and conclusion in a well-structured form; seven articles used retrospective method, four used prospective method and one used both methods. Among the most common complications, there may be highlighted, in decreasing order, infection, thrombosis, obstruction, haematoma, inappropriate placement, bacteremia, extravasation, pneumothorax. The analyzed articles showed satisfactory results on the use of TIC, and it may be concluded that its use in oncological patients presents low index of complications.

El estudio objetivó hacer un levantamiento de la producción científica sobre las complicaciones con el uso del catéter totalmente implantable-CTI, considerando su relevancia en el tratamiento de pacientes oncológicos. La selección fue hecha por medio de búsqueda electrónica y manual de artículos publicados entre el período de 1998 a marzo de 2008, al final fueron seleccionados 12 artículos para componer esta revisión integrativa. Los resultados principales fueron: existe poca participación de enfermeros en la producción científica sobre el tema; 11 artículos demostraron de forma bien estructurada sus objetivos, resultados y conclusión; siete artículos utilizaron la metodología retrospectiva, 4 prospectiva y 1 utilizó ambos métodos. Las complicaciones más frecuentes, en orden decreciente, fueron: infección, trombosis, obstrucción, hematoma, mal posicionamiento, bacteriemia, extravasación, neumotórax. Los artículos analizados mostraron resultados satisfactorios cuánto al uso del CTI, concluyendo que su utilización en pacientes oncológicos presenta bajos índices de complicación.

Acupuncture treatment in geriatric rehabilitation: a retrospective study.

The main goal of geriatric rehabilitation reconditioning following an acute illness is rapid restoration of normal activity. Key elements are pain control, restoration of bowel function, sleep, appetite and general well being, alongside physical activity. The aim of this retrospective study was to assess the effect of acupuncture as an adjunct to medical and physical rehabilitation in geriatric patients. The setting was a university-affiliated large city general hospital. The participants comprised 27 consenting consecutive patients in a subacute geriatric rehabilitation department. The interventions consisted of biweekly acupuncture treatment in conjunction with medical and physical therapy. The outcome measures of pain, appetite, quality of sleep, bowel function and general well being were assessed using a 10-point Likert scale at the onset and close of treatment. The results showed that a significant post-treatment improvement was seen in pain (p=0.005), appetite (p=0.0034), bowel function (p=0.029) and general well being (p=0.0012) scores in patients' treatment when compared with pretreatment baseline scores. The "quality of sleep" score showed a trend towards improvement (p=0.073). In conclusion, acupuncture may be beneficial as an adjunctive treatment in geriatric postacute illness rehabilitation. Randomized controlled trials are needed to further assess the role of acupuncture as part of treatment management for restoring normal physical activity in geriatric patients.

Illness, injury, and disability among Shiwiar forager-horticulturalists: implications of health-risk buffering for the evolution of human life history.

Human life history is distinguished by long lifespan, delayed reproduction, intergenerational asymmetric benefit transfers from adults to juveniles and between adults, and a large brain able to engage in unprecedented levels of learning, reasoning, and insight. The evolution of these traits depends on relatively low human mortality. Understanding why humans have low mortality is therefore critical for understanding the evolution of key human traits. One explanation is that the evolution of food provisioning during periods of health crisis reduced mortality. This hypothesis turns on health risk having posed a significant adaptive problem that could be effectively buffered by healthcare provisioning. Unfortunately, the frequency, duration, and fitness effects of temporary disability are difficult to estimate based on osteological evidence alone, and systematic ethno-biological research on these issues among extant small-scale societies with little access to Western medical care is lacking. Here I present data on 678 injuries and illnesses suffered by 40 Shiwiar forager-horticulturalists, based on physical evidence and informant reports. A subsample of 17 individuals provided data on incidence and duration of disability for 215 pathological incidents. Results indicate that injury and illness occur frequently across the lifespan. Most living individuals have suffered temporarily disabling health crises likely to have been lethal without provisioning. The fitness effects of surviving these episodes are high, suggesting that the Shiwiar population structure and lifeway are dependent on infrequent extended provisioning to temporarily disabled individuals, and that provisioning of aid during healthcare crises effectively lowers mortality in this small-scale society.

Fatores preditivos de infeccão em pacientes com fraturas expostas nos membros inferiores / Predictable factors of infection in patients with open fractures in lower limbs

134 pacientes com fraturas expostas dos membros inferiores dos tipos II, IIIA, IIIB e IIIC foram estudados prospectivamente entre fevereiro de 1998 e maio de 2000 no Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo para determinar os fatores de risco de infeccão previsíveis Todos os pacientes foram registrados em um protocolo no qual eles tiveram amostras de fragmentos ósseos iniciais coletadas para cultura bacteriana, avaliacão de condicões clínica e administracão precoce de antibiótico. Durante a abordagem inicial, as causas das fraturas, o tempo de exposicão da fratura e o local onde os primeiros socorros foram recebidos foram observados. Durante o debridamento inicial, o volume de transfusão sangüínea, a classificacão clinica ASA, o tempo cirúrgico, o ferimento cirurgico e o tipo de estabilizacão esquelética foram observados. Uma análise univariável foi realizada para identificar os riscos pervisíveis estatisticamente significantes para o desenvolvimento de infeccões, com os seguintes resultados: tempo de exposicão da fratura (p=0.0201), local dos primeiros socorros (p=0.400), tipo de fratura (p=0.0130), classificacão ASA (p=0.0005), volume de transfusão de sangue (p=0.0002) tipo de osso fraturado (p=0.0052), tipo de acidente (p=0.0450), ferimento cirúrgico (p=0.0024), estabilizacão esquelética (p=0.0446), cultura bacteriana positiva na admissão (p=0.5290) e cirurgias concomitantes (p=0.1867). As variáveis com associacão significante com a infeccão foram introduzidas em uma equacão de regresão multivariada (modelo logístico) para identificar as com efeitos independentes dos outros fatores. O modelo logístico final foi obtido e demonstrou as probabilidades de infeccão nas fratruras expostas estudadas. Os riscos relativos revelados no modelo logístico final foram : volume de transfusão sangüínea (mais do que 1 unidade) - 6.4;classificacão ASA nível III - 5.2; fixacão interna do osso (imediata) - 3.9; osso fraturado (femur) - 3.5 and ferimento aberto - 3.0.

Participação dos microrganismos do gênero enterobacter nas infecções hospitalares / Participation of microorganisms of enterobacter type in hospital infections

Estudo descritivo que teve como objetivos descrever as principais espécies patogênicas de Enterobacter ao ser humano; conhecer de que forma participam significativamente das infecções hospitalares e compreender quais são as medidas que podem influenciar na redução significativa destas infecções causadas por estes microrganismos. Utilizou-se como metodologia o resgate do perfil literário, abordando aspectos gerais da participação dos microrganismos do gênero Enterobacter nas infecções hospitalares.

Deep subfascial space infections.

Infections of the deep subfascial spaces of the hand and wrist are relatively uncommon but well recognized. Potential sites for infection include the interdigital web space, dorsal subaponeurotic space, Parona's space, thenar space, midpalmar space, and hypothenar space. Treatment involves surgical drainage in combination with appropriate systemic antibiotics. Several alternative surgical approaches have been described. Selection is based on the extent and precise location of the infection and surgeon preference. Aggressive hand therapy usually is required in the postoperative period to avoid the complication of tendon adhesions, joint contractures, and hand stiffness. With early recognition and expedient surgical treatment, a satisfactory outcome can be expected for those infections that occur in otherwise healthy, nonimmunocompromised patients.

Estudio del paciente con neutropenia

La neutropenia, definida como disminución de los polimorfo nucleares neutrófilos- neutrófilos o granulocitos- en sangre periférica, similar a la anemia, a la trombocitopenia y a la hipertensión, no es una enfermedad sino un signo que se expresa tanto en la clínica como en el laboratorio. El médico debe definir lo más pronto posible y con la mayor certeza el origen de la neutropenia debido a que el paciente con esta alteración está propenso a presentar infecciones severas que en muchas oportunidades pone en grave riesgo la vida. La neutropenia se puede presentar como resultado de uno o varios de los siguientes mencanismos: 1) por disminución de los neutrófilos en la medula ósea; 2) por aumento en la destrucción de los neutrófilos; y, 3) por distribución alterada de los neutrófilos. Se hace un análisis de la clínica de las principales enfermedades con neutropenia y se definen los criterios mínimos de laboratorio. Se presenta un flujograma para racionalizar el estudio del paciente con neutropenia.

Infección neonatal

Se hace una síntesis de las características inmunológicas de los neonatos a término y prematuros y los factores predisponentes en la edad neonatal para el desarrollo de infecciones. Se revisan las dosis de los antibióticos más conmúnmente usados en recién nacidos (RN) con sus indicaciones y efectos secundarios

Orthostatic reactions and blood volumes after moderate physical activation during acute febrile infections.

In 18 patients suffering from viral, mycoplasma or bacterial infections, orthostatic reaction and total haemoglobin were measured after termination of fever and 1 and 3 months thereafter. The results of the 3 months control were considered to represent the individual's normal values. The patients were randomized into two groups, one of which was subjected to a physical activity programme when febrile and the other, serving as control group, was confined to bed according to traditional clinical routine. The orthostatic reaction was measured as the mean heart rate during 10 min tilting on a tilt table. Plasma and red cell volumes were calculated from total haemoglobin, haemoglobin concentration and erythrocyte volume fraction. After fever heart rate during tilt was, in both groups, significantly higher than at the 3 months control but it was lower in the trained group (86 +/- 4 beats/min) than in the control group (100 +/- 3 beats/min) (P less than 0.05). Plasma volume and red cell volume being both numerically reduced in our patients after fever, showed a significant increase 3 months after illness only in the untrained control group. The results suggests that physical activity during acute febrile infections prevents the illness/bed rest-induced orthostatic deterioration and blood volume reduction.