The Best Protocol to Treat Equine Skin Wounds by Second Intention Healing: A Scoping Review of the Literature.

Equine skin wound treatment continues to be a challenge for veterinarians. Despite being a frequent practice, it remains difficult to choose an evidence-based treatment protocol. This study aimed to comprehensively explore the literature and provide a scoping review of therapeutic strategies for equine skin wounds and identify knowledge gaps and opportunities for future research. This review was conducted using specific criteria to select literature that described methods to manage second intention wound healing. After removing duplicates and screening papers for suitability, 81 manuscripts were included for data extraction. Of these, 59 articles were experimental studies, 10 were case reports, 9 were case series, and 3 were clinical studies. The most frequent wound location was the distal limbs. Macroscopic assessment was the main tool used to evaluate treatment effectiveness. All of the case reports, case series, and clinical studies reported positive outcomes with regard to the treatment used, while only 36% of the experimental studies found significant healing improvement in treated wounds compared to control groups. It was found that there are many treatments that have exhibited controversial results, and there exists a lack of evidence for the adoption of specific treatment protocols.

Adjuvant Botulinum Toxin Type A on the Management of Giant Hiatal Hernia: A Case Report.

The management of giant hiatal hernias (HHs) remains challenging and is associated with a high risk of recurrence. Currently, several strategies are used to reduce recurrence, and a newly proposed trend is the administration of adjuvant botulinum toxin type A (BTX), a procedure already performed in complex ventral hernias. Here, we present a case of a 63-year-old man with a giant paraesophageal HH type IV containing the entire stomach and transverse colon with loss of domain, who underwent adjuvant BTX and subsequently laparoscopic hiatoplasty with a biological mesh with partial fundoplication. At six months' follow-up, the patient reported a significant improvement in the quality of life without dysphagia or gastroesophageal reflux and with a good respiratory function. A control computed tomography was performed, which documented a partial recurrence of HH, completely asymptomatic. This clinical case showed the successful treatment of a giant HH using adjuvant BTX injection to increase abdominal wall compliance as had already been described in the treatment of complex ventral hernia. Thus, the use of BTX is a promising strategy for selected cases of giant HHs mainly if there is a loss of domain; however, more case series and controlled trials are needed to show the reproducibility of the benefit of this strategy.

Enxerto ósseo alveolar autógeno associado a biomateriais em fissura lábio palatina / Injerto óseo alveolar autógeno asociado a biomateriales en labio y paladar hendido / Autogenous alveolar bone graft associated with biomaterials in cleft lip and palate

Objetivo: Discutir a utilização do enxerto ósseo autógeno associado a biomateriais na reconstrução de defeito ósseo alveolar em paciente com fissura lábio palatina. Relato de caso: Paciente, 09 anos de idade, em tratamento no Serviço Integrado de Reabilitação de Anomalias Craniofaciais do Hospital São Marcos, Teresina - Piauí - Brasil, apresentando fissura lábio palatina unilateral, completa à esquerda, não sindrômica, submetido à queiloplastia aos 03 meses de idade, e palatoplastia aos 18 meses, resultando como sequela uma fístula oronasal, corrigida cirurgicamente quando a paciente completou 07 anos de idade. Aos 09 anos, realizou-se a cirurgia com enxerto ósseo alveolar, com osso autógeno associado a osso mineral tipo (Bio-Oss, Geistlich), protegido com membrana de colágeno (Bio-Gide, Geistlich) e membrana de Fibrina Rica em Plaqueta (PRF). Conclusão: O enxerto ósseo alveolar utilizando osso autógeno associado a osso mineral bovino, membrana de colágeno e membrana de Fibrina Rica em Plaquetas (PRF) assim como a intervenção cirúrgica na faixa etária citada na literatura mostraram-se eficientes para se atingir o sucesso terapêutico... (AU)

Objetivo: Discutir el uso de injerto óseo autógeno asociado a biomateriales en la reconstrucción del defecto óseo alveolar en un paciente con labio y paladar hendido. Reporte de caso: Paciente de 09 años de edad, en tratamiento en el Servicio Integrado de Rehabilitación de Anomalías Craneofaciales del Hospital São Marcos, Teresina - Piauí - Brasil, presentando labio y paladar hendido unilateral, completo a la izquierda, no sindrómico, sometido a queiloplastia a los 03 meses de edad, y palatoplastia a los 18 meses, resultando como secuela una fístula oronasal, corregida quirúrgicamente cuando el paciente completó 07 años de edad. A los 09 años de edad, se realizó una intervención quirúrgica con injerto óseo alveolar, con hueso autógeno asociado de tipo mineral (Bio-Oss, Geistlich), protegido con membrana de colágeno (Bio-Gide, Geistlich) y Membrana de Fibrina Rica en Plaquetas (PRF). Conclusión: El injerto óseo alveolar utilizando hueso autógeno asociado a hueso mineral bovino, membrana de colágeno y Membrana de Fibrina Rica en Plaquetas (PRF), así como la intervención quirúrgica en el rango de edad citado en la literatura, se mostraron eficientes para lograr el éxito terapéutico... (AU)

Objective: To discuss the use of autogenous bone graft associated with biomaterials in the reconstruction of alveolar bone defect in a patient with cleft lip and palate. Case Report: Patient, 09 years old, under treatment at the Integrated Service for Rehabilitation of Craniofacial Anomalies of the Hospital São Marcos, Teresina - Piauí - Brazil, presenting unilateral cleft lip and palate, complete to the left, not syndromic, underwent cheiloplasty at 03 months of age, and palatoplasty at 18 months, resulting as a sequela an oronasal fistula, surgically corrected when the patient turned 07 years old. At 09 years of age, surgery was performed with alveolar bone grafting, with autogenous bone associated with mineral bone type (Bio-Oss, Geistlich), protected with collagen membrane (Bio-Gide, Geistlich) and Platelet Rich Fibrin (PRF) membrane. Conclusion: Alveolar bone grafting using autogenous bone associated with bovine mineral bone, collagen membrane and Platelet Rich Fibrin Membrane (PRF) as well as surgical intervention in the age range cited in the literature were shown to be efficient in achieving therapeutic success... (AU)

Minimally invasive vessel-preservation spleen preserving distal pancreatectomy-how I do it, tips and tricks and clinical results.

BACKGROUND: Minimally invasive spleen-preserving distal pancreatectomy (SPDP) has emerged as a parenchyma-preserving approach and has become the standard treatment for pancreatic benign and low-grade malignant lesions. Nevertheless, minimally invasive SPDP is still technically challenging, especially when vessel preservation is intended. This study aims to describe the technique and outcomes of laparoscopic (LSPDP) and robot-assisted spleen-preserving distal pancreatectomy (RSPDP) with intended vessel preservation, highlighting the important tips and tricks to overcome technical obstacles and optimize surgical outcomes. METHODS: A retrospective observational study of consecutive patients undergoing LSPDP and RSPDP with intended vessel preservation by a single surgeon in two different centers. A video demonstrating both surgical techniques is attached. RESULTS: A total of 50 patients who underwent minimally invasive SPDP were included of which 88% underwent LSPDP and 12% RSPDP. Splenic vessels were preserved in 37 patients (74%) while a salvage vessel-resecting technique was performed in 13 patients (26%). The average surgery time was 178 ± 74 min for the vessel-preserving and 188 ± 57 for the vessel-resecting technique (p = 0.706) with an estimated blood loss of 100 mL in both groups (p = 0.663). The overall complication rate was 46% (n = 23) with major complications (Clavien Dindo ≥ III) observed in 14% (n = 7) of the patients. No conversions occurred. The median length of hospital stay was 4 days. CONCLUSION: This study presented the results after minimally invasive SPDP with intended vessel preservation by a highly experienced pancreatic surgeon. It provided tips and tricks to successfully accomplish a minimally invasive SPDP, which can contribute to quick patient rehabilitation and optimal postoperative results.

Thromboembolic Complications After Bariatric Surgery: Is the High Risk Real?

INTRODUCTION: Nowadays, a large number of bariatric surgery (BS) procedures are undertaken worldwide as surgery has become an efficient strategy to treat the obesity epidemic. The risk of venous thromboembolism (VTE) is increased in patients undergoing BS not only due to the intrinsic surgical risk but also because patients with obesity have a 2-3-fold higher risk of VTE. The optimal strategy for VTE prevention in BS setting, including optimal dose and thromboprophylaxis regimen, is still not fully clarified. The aim of this study was to report a bariatric high-volume center experience and to propose a practical thromboprophylaxis protocol for this population. METHODS: A single-center, observational, retrospective, and longitudinal study was conducted from January 2018 to December 2020, a total of 901 patients who underwent primary and revisional bariatric surgery were included. RESULTS: The overall frequency of VTE events was 0.44% (n=4), one patient had pulmonary embolism (PE) during index hospital admission; another patient had simultaneous deep venous thrombosis (DVT) and PE, two months after surgery; and two other patients had DVT, nine and 16 months after surgery. The median time for VTE was four months. The incidence of females was 75% (n=3) and the median age was 57 years. Only one female patient was using oral contraception. None had a previous history of thromboembolic events, chronic venous insufficiency, or other known diseases that could increase the VTE risk. CONCLUSION: Considering the outcomes reported by this experienced center with low rates of thromboembolic events, we suggest a thromboprophylaxis protocol that can be easily applied to the majority of bariatric patients.

Acute Pericarditis Hiding an Esophageal Perforation.

Esophageal perforations due to foreign body ingestion are uncommon; however, they can be associated with extremely high mortality rate. The most dreadful complication of this entity is the infection of adjacent structures, namely, the mediastinum and the pericardium. A prompt diagnosis and a precocious start of treatment are essential to the prognosis. Thus, a high degree of suspicion is required, especially in older patients. Therapeutic options are highly variable, depend on several factors, and should be individualized to every patient and their clinical status. Surgical treatment with esophageal exclusion and diversion, in extreme circumstances, is mandatory to control the infection source site and prevent further contamination. We report a case of esophageal perforation, presenting 48 hours after onset, that led to multifactorial shock (septic and cardiogenic) due to pericarditis with pericardial and pleural effusion.

Impactos das tecnologias de informação e comunicação como estratégia de educação permanente em saúde para os profissionais de enfermagem / Impacts of information and communication technologies as a permanent health education strategy for nursing professionals / Impactos de las tecnologías de la información y la comunicación como estrategia de educación permanente en salud para los profesionales de enfermeira

Introdução:As Tecnologias da Informação eComunicaçãosão úteis no processamento, noarmazenamento e na transmissão de informação.Nocampo da saúdeelas proporcionam a melhoria na qualidade de vida dos sujeitose avanços no processo de trabalho dos profissionais ao otimizarem recursos e promoverem a inovação tecnológica de alto impacto social. Objetivo:Identificar na literatura quais osimpactos das Tecnologias de Informação e Comunicação na educação permanenteem saúde para os profissionais de enfermagem. Metodologia:Trata-se de uma revisão integrativa da literatura que possui a seguinte questão norteadora: "Quaisos impactos das tecnologias de informação e comunicação como estratégia de educação permanente em saúde para os profissionais de enfermagem?".O levantamento das publicações ocorreu no período de setembro aoutubro de 2020, nas bases de dados PubMed Central: PMC, Web of Science, CINAHL, SCOPUSe EMBASE. Fora localizados 2.296 artigos, e apósa aplicação dos critérios de inclusão: artigos de pesquisa originais, que a temática respondesse à pergunta norteadora, open accesse que estivesse dentro do intervalo de 2016 a 2020, foi realizada a leitura e análise dos artigos,e7artigos foram selecionados para a amostra final. Resultados:Após a análise dos estudos formaram3 categorizações temáticas: "Vantagens da educação permanente por meio da Tecnologia da informação e comunicação"; "Os desafios da educação permanente através do modelo e-learning"; e "Aprimoramento da educação permanente por meio da Tecnologia da informação e comunicação".Conclusões:Identifica-seodesempenho positivo do uso das Tecnologias de Informação e Comunicação como ferramenta utilizada pelos enfermeiros na educação permanente,grande praticidade e maior acessibilidade aos mais variados temas abordados nesses processos de aprendizagem (AU).

Introduction:Information and communication technologies are useful in the processing, storage, and transmission of information.In the field of health, they provide an improvement in the quality of life of peopleand advances in the work process of professionals through the optimization of resources and the promotion of technological innovation with high social impact. Objective:Identify in the literature the impacts of information and communication technologies in permanent health education for nursing professionals.Method:It is an integrative review of the literature that has the following guiding question: "What are the impacts of information and communication technologies as a permanent health education strategy for nursing professionals?".The compilation of publications was carried out from September to October 2020, in the PubMed Central databases:PMC, Web of Science, CINAHL, SCOPUS y EMBASE.2,296 articles were found, and then the inclusion criteria were applied:original research articles, that the subject answered the guiding question, open access, and that they were within the range from 2016 to 2020.The articles were read and analyzed, and 7 were selected for the final sample.Results: After analyzing the studies, 3 thematic categorizations were formed: "Advantages of lifelong education through Information and Communication Technologies"; "The challenges of permanent education through the e-learning model"; and "Improvement of permanent education through Information and Communication Technologies". Conclusion:The positive performance of the use of Information and Communication Technologies is identified as a tool used by nurses in permanent education, great practicality and better accessibility to the most varied topics addressed in these learning processes (AU).

Introducción:Las tecnologías de la información y la comunicaciónson útiles en el procesamiento, almacenamiento y transmisión de información.En el ámbito de la salud, aportan una mejora en la calidad de vida de los sujetos y avances en el proceso de trabajo de los profesionalesmediante la optimización de recursos y la promoción de la innovación tecnológica de alto impacto social. Objetivo:Identificar en la literatura los impactos de las tecnologías de la información y la comunicación en la educación permanente en salud paralos profesionales de enfermería. Metodología:Se trata de una revisión integradora de la literatura que tiene la siguiente pregunta orientadora: "¿Cuáles son los impactos de las tecnologías de la información y la comunicación como estrategia de educación permanente en salud para los profesionales de enfermería?".El compilado de publicaciones se realizó de septiembre a octubre de 2020, en las bases de datos de PubMed Central: PMC, Web of Science, CINAHL, SCOPUS yEMBASE.Se encontraron 2.296 artículos, y luego seaplicólos criterios de inclusión:artículos de investigación originales, que la temática respondieraa la pregunta orientadora, open access, y que estuvierandentro del rango de 2016 a 2020. Los artículos fueron leídos y analizados, y se seleccionaron 7 para la muestra final. Resultados:Luego de analizar los estudios, se formaron 3 categorizaciones temáticas: "Ventajas de la educación permanente por intermediode las Tecnologías de la Información y la Comunicación"; "Los desafíos de la educación permanente a través del modelo e-learning"; y "Mejoramiento de la educación permanente por intermedio de las Tecnologías de la Información y la Comunicación". Conclusiones:Se identifica el desempeño positivo del uso de lasTecnologías de la Información y la Comunicación como una herramienta utilizada por los enfermeros en la educación permanente, gran practicidad y mejor accesibilidad a los más variados temas abordados en estos procesos de aprendizaje (AU).

Laryngeal perforation during Sistrunk procedure.

Thyroglossal duct cyst (TGDC) is the most common congenital neck anomaly in childhood, although it can be diagnosed at any age group. Ultrasound of the thyroid gland and the neck structures is an appropriate tool for diagnosis. The authors aim to report a rare case of a 22-year-old male with a laryngeal perforation during a TGDC excision and raise awareness to this potentially life-threatening complication. The Sistrunk procedure is the surgical treatment of choice with a low morbidity and recurrence rates.

Oromandibular Limb Hypogenesis Syndrome: Overlap of Moebius and Ankyloglossia Superior With Severe Limb Defects.

The oromandibular limb hypogenesis syndromes (OLHS) represent a group of rare conditions characterized by congenital malformations involving the tongue, mandible, and limbs. In this report, we describe a newborn girl with paralysis of abducens and facial nerves, transverse agenesis of the distal segments of the limbs, micrognathia, cleft lip and palate, and ankyloglossia superior. This observation confirms an overlap between Moebius syndrome and ankyloglossia superior syndrome with severe limb defects. The etiology of the OLHS is not clearly understood. The intriguing link between facial and limb anomalies can result from their simultaneous development from the fourth to eighth week of gestation, making both areas susceptible to the same teratogenic stimuli. There is an overlap between OLHS conditions, supporting a clustering, rather than a divided nosology and requiring an appropriate classification of these conditions. Patients with OLHS can be successfully managed using a multidisciplinary approach.

Adenomyomatous Hyperplasia of Ampulla of Vater and a Concomitant Renal Tumor: A Case Report.

Adenomyomatous hyperplasia is an extremely rare lesion encountered in the ampulla of Vater. Less than 50 cases have been described, most of them with clinical consequences of biliary obstruction, misdiagnosing it as a malignancy. The authors present a concomitant case with a renal tumor, its diagnosis, management, and clinical relevance, as well as a brief revision of the literature. Ampullar and renal tumors were found in a 74-year-old female, in the imagiologic study of a low back pain, in the emergency department. Both were considered malign after further study, and pancreatoduodenectomy with partial nephrectomy was proposed. There is no accurate diagnostic tool to differentiate the benign nature of adenomyomatous hyperplasia and extensive operations are often performed. As an incidental finding in the study of another tumor, this case raises the concern about which and how to treat both tumors, taking into account the morbidity of the respective interventions.

Large mucinous cystic neoplasm of the pancreas during pregnancy: a case report.

Mucinous cystic neoplasms (MCNs) of the pancreas occurring during pregnancy constitute a rare condition requiring special management due to its large size, malignant potential and the risk of fetal growth restriction. The key points to manage MCNs are to perform a correct diagnosis, accurately evaluate the grade of malignant potential in order to establish the right time for pancreatic surgery and to choose the most appropriate fetal mode of delivery. We describe a case of an incidental abdominal mass detected in a third-trimester pregnant woman. At surgery, a huge pancreatic cystic tumour was found and a distal pancreatectomy with splenic preservation was performed. The histopathological analysis revealed an MCN of the pancreas with low-grade dysplasia. To our knowledge, this is the largest pancreatic MCN detected in a pregnant woman reported in the literature and one of the few successfully resected after vaginal delivery.

End-of-Life Nursing Knowledge Among Nursing Students.

BACKGROUND: The U.S. health care system is poorly designed to meet the needs of patients at the end of life (EOL) and their families. Nursing students often have reported feeling inadequate to provide EOL care. METHOD: Following an EOL simulation, reflective journals were collected from junior and senior nursing students and analyzed for themes using qualitative content analysis. The condensed meaning units were abstracted into codes based on Carper's fundamental patterns of knowing. RESULTS: Thirty-one junior and senior nursing students (mean age, 21.04 ± 0.52 years, 96.2% female) in a baccalaureate program participated in the study. The broad themes of student reflections included empirics (theoretical or natural historical) aesthetics (transformative nursing action), personal (interpersonal process of nurse-patient interaction), and ethics (emotion influences actions). CONCLUSION: Student perception and participation in all roles contributes to the gestalt of the experience of a highly emotional EOL simulation for both students and faculty. [J Nurs Educ. 2020;59(3):154-157.].

Proposta de reuso da água utilizada no pré-preparo de hortifrutigranjeiros e na higienização de pratos e talheres em um restaurante universitário no Estado do Rio de Janeiro / Prpoposal for reuse of water for the pre-preparation of fruit and vegetables and the sanitization of dishes and flatware in a university restaurant in the state of Rio de Janeiro

Objetivo: O presente estudo teve como objetivo elaborar uma proposta para o reuso de água em um restaurante universitário no Estado do Rio de Janeiro, além de propor medidas para redução do seu consumo. Metodologia: Foi aplicado um formulário para quantificação do consumo de água nas etapas de pré-preparo de hortifrutigranjeiros e na higienização de pratos e talheres, em um período de 9 e 13 dias, respectivamente. Em seguida, foi estimado o volume, em litros, de água potável utilizado diariamente em cada etapa. Resultados: Na etapa de pré-preparo de hortifrutigranjeiros, calculouse que são utilizados 2.400 litros por dia; e na etapa de higienização de pratos e talheres, estimou-se o uso de 478 litros por dia. Desta forma, pôde-se calcular o volume total de 2.878 litros por dia que ficarão armazenados para o reuso com fins não potáveis, como por exemplo, a higienização do piso dos refeitórios do restaurante, o que representa 31,97% da quantidade necessária para limpeza de todo o restaurante universitário. Além disso, realizou-se a quantificação dos pontos de água para possível instalação de arejadores nas torneiras, no intuito de reduzir o consumo. Em seguida, elaborou-se o projeto do reservatório de água para reuso. Conclusão: Por fim, atestou-se a importância da proposta apresentada, tendo em vista a significativa quantidade de água com possibilidade de reuso que é desperdiçada diariamente, contribuindo-se assim com a preservação ambiental e diminuição dos custos do restaurante universitário. (AU)

Objective: The aim of the present study was to propose the reuse of water in a university restaurant in the state of Rio de Janeiro, as well as measures to reduce consumption. Methods: A form was applied to quantify water consumption during the pre-preparation of fresh produce and the sanitization of dishes and flatware, within a period of 9 and 13 days, respectively. Later, the volume of potable water used daily was estimated in liters. Results: The estimated volume of water used per day was 2.400 liters for pre-preparation of fresh produce and 478 liters of water per day for sanitization of dishes and flatware. Thus, a total volume of 2.878 liters of water per day for non-potable reuse was estimated, such as, for example, for the sanitization of the dining hall floor of the restaurant. In addition, the quantification of water points for possible installation of faucet aerators was made aiming to reduce consumption. Next, a project of the storage container for the reuse of water was developed. Conclusion: It may be concluded that the importance of the proposal is related to the significant quantity of daily wasted water that could be reused and thus, contribute to environmental preservation and decrease the water expenses of the university restaurant. (AU)

Lung Nodule and Food Bolus Impaction: Can They Be Related?

Achalasia is a rare primary disorder of esophageal motility characterized by insufficient lower esophageal sphincter relaxation and loss of esophageal peristalsis. This results in patient complaints of dysphagia to solids and liquids, regurgitation, chest pain, and weight loss. However, achalasia may also present with respiratory symptoms, such as aspiration pneumonia, due to remarkable regurgitation. In untreated patients and a long period of evolution, respiratory symptoms may even be the initial manifestation of achalasia. An endoscopic finding of retained food and saliva with a puckered gastroesophageal junction or barium swallow showing dilated esophagus with birds beaking in a symptomatic patient should prompt appropriate diagnostic and therapeutic strategies. We describe an atypical presentation of a rare disease in a young man with a history of symptoms caused by the late manifestation of achalasia.

Práticas educativas de gestão ambiental nos serviços de alimentação permissionários dos campi de Universidade Pública do Estado do Rio de Janeiro / Educational practices of environmental management in food services permission holders of the Campuses of Public University of the State of Rio de Janeiro

A realização de práticas educativas de sustentabilidade com gestores do processo produtivo de refeições pode resultar em ações para minimizar a geração de resíduos orgânicos e inorgânicos e, com isso, acarretar menor impacto ambiental negativo, porém é um grande desafio a adoção de procedimentos adequados de Gestão Ambiental. Este estudo objetivou desenvolver Práticas Educativas sobre Gestão Ambiental com os gestores dos Serviços de Alimentação Permissionários (SAP) de uma Universidade Pública localizada no Estado do Rio de Janeiro. Essa ação, denominada Encontro Educativo, foi realizada em dois dias consecutivos com os gestores dos SAP para disseminar conhecimento e despertar o interesse em desenvolver procedimentos, na rotina dos seus serviços, voltados para a Gestão Ambiental, como o manejo e o descarte correto dos resíduos orgânicos e inorgânicos, uso racional de água e da energia elétrica e aproveitamento integral dos alimentos. Ao final do segundo dia do Encontro Educativo foi aplicado um questionário aos participantes contendo sete perguntas relativas às atividades realizadas nesses dois dias. Observou-se interesse dos mesmos em desenvolver ações sobre essa temática na rotina dos seus Serviços de Alimentação, porém relataram falta de apoio, de estrutura e de diálogo com os setores competentes. Todos os participantes demonstraram interesse em participar de outros encontros e sugeriram temas afins e que reforçaram a necessidade de ações educativas sistemáticas para que novos procedimentos sejam adotados, reduzindo a geração de resíduos, de consumo de água e de energia elétrica e, consequentemente, menor o impacto ambiental.

The realization of educational practices with managers directly involved in the generation of organic and inorganic waste can be deployed in actions to minimize environmental impact, since the productive process of meals generates expressive amounts of these residues and the great challenge is to adopt adequate procedures of Environmental management. This study aimed to develop Educational Practices on Environmental Management with Perpetual Feeding Services (SAP) managers of a Public University located in the State of Rio de Janeiro. This action, called the Educational Meeting, was held in two consecutive days with the managers of the SAP to add knowledge and raise interest in developing procedures, in the routine of their services, aimed at Environmental Management, such as handling and correct waste disposal organic and inorganic, rational use of water and 27 Higiene Alimentar - Vol.32 - nº 284/285 - Setembro/Outubro de 2018 electricity and full use of food. At the end of the second day of the Educational Meeting a questionnaire was applied to the participants containing seven questions regarding the activities carried out on those two days. They were interested in developing actions on this subject in the routine of their Food Services, but reported lack of support, structure and dialogue with the relevant sectors. All participants demonstrated an interest in participating in other meetings such as this and suggested similar themes and reinforced the need for systematic educational actions so that new procedures could be adopted to reduce environmental impact.

Gestão de resíduos sólidos orgânicos no setor de alimentação coletiva: revisão / Management of organic solid waste in the collective feeding sector: review

A implementação de um plano de gestão ambiental nos Serviços de Alimentação e Nutrição é relevante no contexto do Gerenciamento Integrado de Resíduos Sólidos Urbanos, pois essa atividade gera um montante cada vez maior de resíduos, que muitas vezes não têm a destinação ou a disposição final adequadas. O nutricionista do Setor de Alimentação Coletiva pode minimizar os impactos gerados ao meio ambiente por meio do uso de ferramentas de gerenciamento e controle do processo produtivo de refeições, como manutenção das Fichas Técnicas de Preparo, introdução da coleta seletiva e aplicação de checklist relacionado às Boas Práticas Ambientais. Este estudo foi desenvolvido por meio de uma revisão bibliográfica sobre a gestão de resíduos orgânicos nos Serviços de Alimentação Coletiva, para um levantamento qualitativo da situação nesse Setor em relação às adequações esperadas à luz da legislação ambiental e à adoção de práticas sustentáveis de produção de refeições. O recorte temporal dos estudos analisados compreendeu o período de 2007 a 2017 e foram utilizados os seguintes descritores para as buscas nas plataformas: alimentação coletiva; sustentabilidade; gestão ambiental; resíduos sólidos. Os resultados obtidos revelaram que ainda há barreiras para a aplicação do sistema de gestão ambiental integrado entre os gestores do Setor de Alimentação, devido a fatores como custo, falta de conhecimento, dificuldade de treinamento de colaboradores e resistência da clientela a mudanças no cardápio. No entanto, alguns profissionais efetivaram mudanças significativas no processo de produção e obtiveram certificações ambientais, além da redução do desperdício de insumos, dos custos com o uso da água e da energia e maior nível de conscientização ambiental entre os clientes e os funcionários.

The implementation of an environmental management plan in the food science and nutrition field is relevant in the context of integrated management of municipal solid organic residues since it generates an ever growing amount of waste, which often doesn't get adequately disposed of. The nutritionist in the collective feeding sector may act in such way as to minimize it's environmental impact using management tools and production control measures, such as adequate maintenance of technical charting, introducing selective collection of such waste and implementing adequate sustainability practices. This article consists of literary revision of organic residue waste management in the collective feeding field, to gather qualitative information in regards to compliance with environmental legislature and adopting sustainable production methods. The temporal cut of the analyzed studies comprises the period from 2007 to 2017 and the following descriptors were used for the searches on the platforms: collective feeding; sustainability; environmental management; solid waste. The information gathered in this revision shows that there's still resistance in implememting the integrated environmental management system amongst food industry managers due to cost, lack of knowledge on the subject, difficulty in training personnel, and customer resistance to menu changes. However, some of the revised authors encountered businesses which made the necessary changes to the production process, and obtained environmental certification, in addition to decrease in waste of supplies, decrease in water and electricity cost and developing environmental awareness for both clients and personnel.

Biochemical assessment of oxidative stress by the use of açai (Euterpe oleracea Martius) gel in physically active individuals

Abstract The relation between oxidative stress and inflammation induced by diseases and exercise has increased the interest in the benefits of antioxidant supplements in the improvement of health and physical and mental performance. The aim of this study was to evaluate the effectiveness of açai gel in reducing oxidative stress in individuals engaged in physical activities as well as their acceptance. Sensory evaluation was performed to determine its acceptability and the biochemical parameters related to immune profile and biomarkers of muscle, liver and oxidative stress, with and without the use of gel were evaluated. The appearance, sweetness and overall impression of the açai gel were considered good. It was observed a significant increase in CK enzyme, without the gel as well as the oxidative stress biomarkers, it was observed that the MDA (with and without gel) a significant increase (p < 0.05). Through biochemical evaluation, it is concluded that the gel provided protection for some of parameters studied, since it modulated the immunological parameter reducing the lymphocyte activity and muscular stress. However, more studies must be carried out with a larger number of individuals to confirm the gel functionality.

Percepção sobre a higiene dos manipuladores de alimentos e perfil microbiológico em restaurante universitário / Perception of hygiene of food handlers and the microbiological profile in a university kitchen

Resumo Este trabalho teve por objetivo analisar a percepção dos manipuladores de alimentos em relação às práticas de higiene no local de trabalho e a correlacionar com os resultados das análises bacteriológicas e das observações sistematizadas, em um Restaurante Universitário no Rio de Janeiro. A percepção da higiene foi investigada por meio de questionários de autorresposta. As práticas operacionais foram analisadas por meio de pesquisa observacional sistemática. Na pesquisa bacteriológica, dividida em duas etapas, buscou-se identificar a presença de Coliformes a 45°C, de Clostridium Sulfito Redutor, Staphylococcus coagulase positiva e Bactérias Heterotróficas Aeróbias Mesófilas nas mãos, nos Equipamentos de Proteção Individual e nos utensílios. Nos resultados da percepção dos manipuladores sobre a higiene pessoal, a higiene ambiental e a manipulação dos alimentos, obtiveram-se valores médios de 86.11; 96.73 e 83.76, respectivamente. Na pesquisa bacteriológica para mãos e Equipamentos de Proteção Individual, obteve-se 61,36% de resultados positivos, para as bactérias pesquisadas; quanto aos utensílios, 25% dos resultados foram positivos para as bactérias pesquisadas. Conclui-se que o serviço possui falhas, com riscos à saúde do consumidor.

Abstract The objective of this study was to analyze the perception of food handlers in relation to hygiene practices in the workplace and to correlate the findings with the results of bacteriological analyses and systematic observations in a University Restaurant in Rio de Janeiro. The perception of hygiene practices was assessed using a questionnaire with objective questions. Operational practices were analyzed through systematic observational research. The bacteriological investigation was divided into two steps to detect the presence of Coliforms at 45ºC, Sulphite-Reducing Clostridia, Coagulase-Positive Staphylococcus and Aerobic Mesophilic Heterotrophic Bacteria on hands, personal protective equipment and utensils. The results of the perceptions of handlers regarding personal hygiene, environmental hygiene and hygiene in the preparation of foods obtained mean scores of 86.11, 96.73 and 83.76, respectively. In the bacteriological investigation of hands and protective equipment, 61.36% of samples produced positive results for the bacteria surveyed. For utensils, 25% of samples gave positive results. The conclusion is that the service has flaws that pose health hazards to consumers.

Sentidos da Saúde numa Perspectiva de Gênero: um Estudo com Homens da Cidade de Natal/RN / Health senses a gender perspective: a study of men in the city of Natal/RN / La salud detecta una perspectiva de género: un estudio de hombres en la ciudad de Natal/RN

Resumo O presente trabalho objetivou investigar os sentidos atribuídos à saúde por homens da cidade de Natal/RN, em dois contextos: uma Unidade Básica de Saúde (UBS) de um bairro de classe média e uma Unidade de Saúde da Família (USF) de um bairro popular. Metodologicamente, realizamos entrevistas semiestruturadas junto a 24 homens, sendo 12 de cada serviço, com faixa etária de 25 a 59 anos, abordados nas unidades de saúde de cada bairro. A análise dos dados deu-se a partir da perspectiva de Spink (2000), e Spink e Frezza (2000) e Spink e Medrado (2000), no tocante às práticas discursivas e os estudos de gênero. Os dados encontrados acompanham a tendência de estudos já realizados no campo, especialmente ao identificar como as posições sociais de gênero conformam os sentidos que os homens investigados construíram em relação à saúde, atribuindo a esta a importância de proporcionar as condições de exercício de uma masculinidade voltada para o provimento do lar e da família. Houve diferença acerca dos sentidos sobre a resolução de problemas de saúde no tocante aos serviços investigados: a maioria do grupo da UBS apontou para pouca resolutividade, gerando sentidos de ineficácia do serviço. Na USF, os sentidos apresentaram uma positividade em relação ao serviço, que julgamos ter relação com a natureza da Estratégia de Saúde da Família. Finalmente, identificamos como a busca pelos serviços de saúde no nível de atenção básica é limitada, fato que segue os estudos de que os homens buscam os serviços de saúde quando esta se encontra demandando atenção especializada. Concluímos que a PNAISH pode ter uma importante contribuição na medida em que se efetive como política de saúde, sensibilizando a toda a rede de atores e serviços envolvidos na busca por novos sentidos e práticas em torno da relação gênero-saúde....(AU)

Abstract This work had the objective of investigating the senses attributed by men to health in the city of Natal/RN, in two different contexts: one in a Basic Health Unity from a middle class neighborhood, and another in a Family Heath Unity of a popular neighborhood. We conducted semi-structured interviews with 24 men, between 25 and 59 years old, 12 from each group. The data analysis for the discursive practices and for the gender studies was done using Spink’s perspective (200 & Frezza, 2000; Sink & Medrado, 2000). The found data follow the tendency of other researches already done in this area, especially when it comes to identify how gender social positions create the senses that the interviewed men built about “health”, attributing to it the importance of providing the conditions for a masculinity exercise oriented to supporting their families and homes. There was a difference concerning the senses of resolution of problems related to health when it comes to the investigated services: the majority of the Basic Health Unity pointed to a small solving, creating senses of ineffectiveness of the service. In the Family Health Unity, however, the senses present a bigger positivity concerning the services. We believe that is explained by the nature of the “Family Health Strategy”. Finally, we identified that the search for health services in the basic levels is limited, a fact that follows a study showing that men look for health services only when they are demanding specialized care. We conclude that the PNAISH could be an important contribution if turned into a health policy, sensitizing the entire network of actors and services involved in the search for new meanings and practices around the gender-health relationship....(AU)

Resumen El presente trabajo tiene como objetivo investigar los sentidos atribuidos a la salud por hombres de la ciudad de Natal/RN, en dos contextos: una Unidad Básica de Salud (UBS) de un barrio de clase media y una Unidad de Salud de la Familia (USF) de un barrio popular. Metodológicamente, realizamos entrevistas semiestructuradas a 24 hombres, 12 de cada servicio, con edades entre 25 y 59 años, abordados en las unidades de salud de cada barrio. El análisis de los datos se realizó desde la perspectiva de Spink (2000 & Frezza, 2000; Spink & Medrado, 2000) en lo que se refiere a las prácticas discursivas y los estudios de género. Los datos encontrados acompañan la tendencia de los estudios ya realizados en el campo, especialmente al identificar cómo las posiciones sociales de género conforman los sentidos que los hombres investigados construyeron en relación a la salud, atribuyendo a esta la importancia de proporcionar las condiciones de ejercicio de una masculinidad orientada hacia el proveimiento del hogar y de la familia. Hubo diferencia en los sentidos atribuidos a la resolución de problemas de salud en lo que se refiere a los servicios investigados: la mayoría del grupo de la UBS señaló poca capacidad de resolución de problemas, generando sentido de ineficacia del servicio. En la USF, los sentidos presentaron positividad en relación a los servicios, que creemos que tienen relación con la naturaleza de la Estrategia de Salud de la Familia. Finalmente, constatamos que es limitada la búsqueda de servicios de salud en el nivel de la atención básica, hecho que concuerda con los estudios que constatan que los hombres buscan los servicios de salud cuando se encuentran demandando atención especializada. Llegamos a la conclusión de que el PNAISH puede hacer una contribución importante si se hace efectivo como política de salud, sensibilizando a toda la red de actores y servicios implicados en la búsqueda de nuevos significados y prácticas en torno a la relación salud-género....(AU)

Fístula oronasal após palatoplastia em pacientes fissurados / Oronasal fistula after palatoplasty in cleft patients

A fístula oronasal (FON) consiste na principal sequela pós-cirúrgica da palatoplastia podendo levar a problemas funcionais, como a fala hipernasal e regurgitação de alimentos pelo nariz. Essa condição compromete o resultado do tratamento da fissura labiopalatina, e seu reparo torna-se um desafio para a equipe multidisciplinar. Este trabalho relata três casos de pacientes com fissura lábio-palatina que apresentaram FON após palatoplastia. Nos casos, foram diagnosticadas FON tipo VII (alveolar na região labial), provocadas pela tensão muscular excessiva sobre a sutura após palatoplastia. O tratamento consistiu em uma cirurgia para fechamento da fístula através da técnica de retalho mucoperiosteal, realizada por um cirurgião bucomaxilofacial. É essencial um planejamento cirúrgico adequado a fim de promover o melhor prognóstico para o paciente, visando a uma melhor qualidade de vida... (AU)

The oronasal fistula (ONF) is the main postoperative sequel of palatoplasty and can leads to functional problems such as hypernasality of voice and regurgitation of food through the nose. This condition affects the outcome of treatment of cleft palate and is challenging for the multidisciplinary team. This paper reports three cases of patients with cleft lip and palate who presented ONF after palatoplasty. In these cases, type VII ONF (alveolar in the labial region) were diagnosed, and were caused by excessive muscle tension on the suture after palatoplasty. The treatment consisted of a surgery for closure of the fistula through the mucoperiosteal flap, which was carried out performed by a maxillofacial surgeon. It is essential an appropriate surgical planning in order to promote better prognosis for the patient aiming better quality of life... (AU)