Encephalitis associated with anti-mGluR5 antibodies.

A 30-year-old woman had 5 days of visual hallucinations, nystagmus, memory impairment and mutism. On examination, she was disorientated with reduced attention span, gaze-evoked nystagmus, paratonia and abnormal frontal reflexes. Cerebrospinal fluid (CSF) showed 80 cells, protein 0.41 g/L and glucose 3.2 mmol/L (plasma glucose 5.0 mmol/L). MR scan of the brain showed involvement of limbic and extra-limbic regions and brainstem. Commercial cell-based assays were negative, but tissue-based assays showed neuropil staining, and cell-based assays for anti-metabotropic glutamate receptor 5 (mGluR5) antibodies were positive in serum and CSF. Six months later, she was diagnosed with Hodgkin's lymphoma. This case emphasises the broader clinical spectrum of anti-mGluR5 encephalitis, challenging its initial characterisation as Ophelia syndrome. It underscores the significance of interpreting commercial cell-based assays and advocates for tissue-based assay testing followed by cell-based assay testing in serum and CSF for diagnosing rare autoimmune encephalitis.

Evaluation of dietary lignin on broiler performance, nutrient digestibility, cholesterol and triglycerides concentrations, gut morphometry, and lipid oxidation.

Two trials were performed in order to evaluate the effects of dietary Kraft lignin inclusion on broiler performance, ileal nutrient digestibility, blood lipid profile, intestinal morphometry, and lipid oxidation of meat. Trial 1 was conducted in order to evaluate performance and ileal digestibility for the period of 1 to 21 d of age, randomly distributing 490 day-old broiler chicks across 5 dietary treatments with 14 replicates containing 7 birds each in metabolic cages, while trial 2 was executed in order to evaluate performance, blood parameters, intestinal morphometry, carcass yield and abdominal fat, and lipid oxidation for the period of 1 to 42 d of age, randomly distributing 900 day-old broiler chicks across 5 dietary treatments with 15 replicates of 12 birds each in floor pens, being each bird in trial 2 challenged with coccidiosis vaccine at 10 d of age. The treatments used in both trials were: positive control (PC): basal diet + antimicrobial; negative control (NC): Basal diet; NC1: NC + 1% lignin; NC2: NC + 2% lignin; NC3: NC + 3% lignin. For trial 1, it was observed that birds fed diets containing 1% lignin had a significant positive effect for BW, feed intake (FI), average daily weight gain (BWG) and feed conversion rate (FCR), similar to the PC, but also showing better EE, CP and AAs ileal digestibility percentages when compared to other treatments. For trial 2, it was observed that during the period of 21 to 35 d, the inclusion of lignin in the diet provided better results in animal performance, similar to the PC group, but at 42 d, animals fed with dietary lignin showed results lower than animals fed the PC diet (P < 0.05). Animals fed with increasing lignin concentrations showed decreasing levels of HDL (P < 0.05). As of intestinal morphometry, animals fed with 1% and 3% lignin showed longer intestinal length (P < 0.05). At 14 d of age, it was observed that animals fed with lignin showed oxidation levels similar to the control treatments. The inclusion of up to 1% lignin in the diet provides beneficial effects on productive performance and nutrient digestibility, while the inclusion of 2% lignin provided lower cholesterol levels, lower villus/crypt ratio, and better internal organ development, therefore, it can be considered an alternative to performance-enhancing antimicrobials in broiler chicken diets.

Β-glucans and MOS, essential oil, and probiotics in diets of broilers challenged with Eimeria spp. and Clostridium perfringens.

The aim of this study was to evaluate the effectiveness of ß-glucans and MOS, essential oil (mixture of carvacrol and thymol), and the probiotic based on Saccharomyces boulardi, as an alternative to anticoccidial agents. In this experiment, six hundred seventy-two 1-day-old male broiler chicks were housed in batteries for 28 d. The experimental design of 4 randomized blocks with 24 cages each, and 7 birds per cage, consisted of an initial phase from 1 to 14 d of age, and a growth phase, from 15 to 28 d of age. The rations were formulated based on corn and soybean meal as energy and protein ingredients, respectively. All birds were inoculated with Eimeria spp and C. Perfringes at 14 d of age, and with C. Perfringes only at 21 d of age. The results showed the best weight gain in the initial phase when the anticoccidial agent was applied, whereas the use of additives in growth and entire experimental phases showed superior results in all treatments for this parameter. The birds that did not receive additives in the rations had the worst feed conversion in both phases and along raising. The results showed no significant differences between the treatments for the scores of lesions in the digestive tract and counts in the cecum, however, the red lesions increased numerically in the duodenum and jejunum of birds fed diets without the inclusion of additives. The use of additives indicated effectiveness for the parameters of performance in broilers challenged with C. Perfringes and Eimeria spp. at 14 d of age, and with C. Perfringes at 21 d of age.

Bloqueio neuromuscular residual em pacientes cirúrgicos: conhecimento da equipe de enfermagem da recuperação anestésica / Residual neuromuscular blockade in surgical patients: knowledge of the nursing team at the anesthetic recovery / Bloqueo neuromuscular residual en pacientes quirúrgicos: conocimiento del equipo de enfermería sobre la recuperación anestésica

Objetivo: Identificar o conhecimento da equipe de enfermagem que atua na recuperação anestésica acerca da avaliação do bloqueio neuromuscular residual (BNMR) em pacientes cirúrgicos. Método: Estudo quantitativo, transversal, realizado em um hospital privado de São Paulo. Amostra composta por 50 profissionais, sendo 18 enfermeiros e 32 técnicos de enfermagem, que responderam um questionário validado por um corpo de cinco juízes. Coleta realizada de janeiro a março de 2022, utilizando-se a plataforma REDCap. Realizadas análises descritiva e inferencial, medidas de tendência central e de dispersão, testes de correlação de Pearson e t-Student, considerando-se nível de significância de 5%. Pesquisa conduzida segundo a Resolução 466/2012. Resultados: A média de acertos geral foi de 43%, sendo 44,4% entre enfermeiros e 42,2% entre técnicos. Seis (12%) profissionais já tinham feito algum treinamento sobre bloqueio neuromuscular e 10 (20%) relataram já ter atendido pacientes com BNMR. Não foram observadas diferenças estatisticamente significativas entre a média de acerto das questões e o tempo de formação e atuação profissional, especialização, experiência prévia ou execução de treinamentos. Conclusão: O estudo evidenciou déficits de conhecimento da equipe de enfermagem acerca do BNMR e a assistência durante esta intercorrência. Ressalta-se a importância de ações de educação permanente, com vista à capacitação dos profissionais para o atendimento desta complicação e melhoria dos cuidados de enfermagem prestados na recuperação anestésica para garantia da segurança do paciente

Objective: To identify the knowledge of the nursing team involved in anesthetic recovery regarding the assessment of residual neuromuscular blockage (RNB) in surgical patients. Method: This is a quantitative, cross-sectional study conducted in a private hospital in the state of São Paulo, Brazil. The sample com-prised 50 professionals, 18 nurses and 32 nursing technicians, who answered a questionnaire validated by five judges. The collection was carried out from January to March 2022, using the REDCap platform. Descriptive and inferential analyses, central tendency and dispersion measures, Pearson's correlation and Student's t-test were performed, considering a significance level of 5%. The research was conducted in accordance with Resolution 466/2012. Results: The average num-ber of correct answers was 43%, 44.4% among nurses and 42.2% among technicians. Six (12%) professionals had already took some training on neuromuscular blockade and 10 (20%) reported having treated patients with RNB. We observed no statistically significant differences between the average of correct answers of the questions and the length of training and professional performance, specialization, previous experience, or carrying out training. Conclusions: We identified deficits in the nursing team's knowledge of the RNB and care during this procedure. The importance of continuing education actions is emphasized, with a view to training professionals to treat this complication and improve the nursing care provided during anesthetic recovery to guarantee patient safety

Objetivo: Identificar el conocimiento del equipo de enfermería que trabaja en la recuperación anestésica respecto a la evaluación del bloqueo neuromuscular residual (BNMR) en pacientes quirúrgicos. Método: Estudio cuantitativo, transversal, realizado en un hospital privado de São Paulo. Muestra compuesta por 50 profesionales, 18 enfermeros y 32 técnicos de enfermería, quienes respondieron un cuestionario validado por un panel de cinco jueces. Recolección realizada de enero a marzo de 2022, utilizando la plataforma REDCap. Se realizaron análisis descriptivos e inferenciales, medidas de tendencia central y dispersión, pruebas de correlación de Pearson y t-Student, considerando un nivel de significancia del 5%. Investigación realizada según Resolución 466/2012. Resultados: El promedio global de aciertos fue del 43%, 44,4% entre enfermeros y 42,2% entre técnicos. Seis (12%) profesiona-les ya habían recibido algún entrenamiento en bloqueo neuromuscular y 10 (20%) informaron haber tratado ya pacientes con BNMR. No se observaron diferencias estadísticamente significativas entre el número medio de respuestas a las preguntas y el tiempo de formación y desempeño profesional, espe-cialización, experiencia previa o ejecución de la formación. Conclusión: El estudio destacó déficits de conocimiento entre el equipo de enfermería sobre el BNMR y la asistencia durante este incidente. Se destaca la importancia de acciones de educación continua, con miras a capacitar profesionales para enfrentar esta complicación y mejorar los cuidados de enfermería brindados durante la recuperación anestésica para garantizar la seguridad del paciente

Maternal supplementation of different trace mineral sources on broiler breeder production and progeny growth and gut health.

Trace mineral minerals Zn, Cu, and Mn play important roles in breeder production and progeny performance. The objective of this study was to determine maternal supplementation of trace mineral minerals on breeder production and progeny growth and development. A total of 540 broiler breeders, Cobb 500 (Slow feathering; 0-66 weeks old) were assigned to one of three treatment groups with the same basal diet and three different supplemental trace minerals: ITM-inorganic trace minerals in sulfates: 100, 16, and 100 ppm of Zn, Cu, and Mn respectively; MMHAC -mineral methionine hydroxy analog chelate: 50, 8, and 50 ppm of bis-chelated MINTREX®Zn, Cu and Mn (Novus International, Inc.), and TMAAC - trace minerals amino acid complex: 50, 8, and 50 ppm of Zn, Cu, and Mn. At 28 weeks of age, eggs from breeder treatments were hatched for progeny trial, 10 pens with 6 males and 6 female birds per pen were fed a common diet with ITM for 45 days. Breeder production, egg quality, progeny growth performance, mRNA expression of gut health associated genes in breeder and progeny chicks were measured. Data were analyzed by one-way ANOVA; means were separated by Fisher's protected LSD test. A p-Value ≤ 0.05 was considered statistically different and 0.1 was considered numerical trend. Breeders on ITM treatment had higher (p < 0.05) body weight (BW), weight gain and lower (p < 0.05) feed conversion ratio (FCR) from 0 to 10 weeks, when compared to birds fed MMHAC. MMHAC significantly improved egg mass by 3 g (p < 0.05) and FCR by 34 points (0.05 < p < 0.1) throughout the reproductive period (26-66 weeks) in comparison to ITM. MMHAC improved (p < 0.01) egg yolk color versus (vs.) ITM and TMAAC in all periods, except 28 weeks, increased (p < 0.01) eggshell thickness and resistance vs. TMAAC at 58 weeks, and reduced (p < 0.05) jejunal NF-κB gene expression vs. TMAAC at 24 weeks. There was a significant reduction in tibial dry matter weight, Seedor index and resistance for the breeders that received MMHAC and/or TMAAC when compared to ITM at 18 weeks. Lower seedor index but numerically wider tibial circumference was seen in hens fed MMHAC at 24 weeks, and wider tibial circumference but lower tibial resistance in hens fed TMAAC at 66 weeks. Maternal supplementation of MMHAC in breeder hens increased (p < 0.0001) BW vs. ITM and TMAAC at hatching, reduced (p < 0.05) feed intake vs. ITM at d14 and d28, and improved (p < 0.01) FCR and performance index vs. TMAAC at d28, reduced (p < 0.01) NF-κB gene expression and increased (p < 0.05) A20 gene expression vs. TMAAC on d0 and vs. ITM on d14, reduced (p < 0.05) TLR2 gene expression vs. ITM on d0 and vs. TMAAC on d14, increased (p < 0.05) MUC2 gene expression vs. both ITM and TMAAC on d45 in progeny jejunum. Overall, these results suggest that supplementation with lower levels of MHA-chelated trace minerals improved breeder production and egg quality and reduced breeder jejunal inflammation while maintaining tibial development in comparison to those receiving higher inorganic mineral supplementation, and it also carried over the benefits to progeny with better growth performance, less jejunal inflammation and better innate immune response and gut barrier function in comparison to ITM and/or TMAAC.

Reduced rank analysis of morphometric and functional traits in Campolina horses.

Multitrait models can increase the accuracy of breeding value prediction and reduce bias due to selection by using traits measured before and after it has occurred. However, as the number of traits grows, a similar trend is expected for the number of parameters to be estimated, which directly affects the computing power and the amount of data required. The aim of the present study was to apply reduced rank (principal components model-PCM) and factor analytical models (FAM), to estimate (co)variance components for nineteen traits, jointly evaluated in a single analysis in Campolina horses. A total of 18 morphometric traits (MT) and one gait visual score (GtS), along with genealogical records of 48,806 horses, were analysed under a restricted maximum likelihood framework. Nine PCM, nine FAM and one standard multitrait model (MTM) were fitted to the data and compared to find the best suitable model. Based on Bayesian information criterion, the best model was the FAM option, considering five common factors (FAM5). After performing an intraclass analysis, none of MT were genetically negatively correlated, whereas GtS was negatively related to all MT, except for the genetic correlations among GtS and BLL, and between GtS and BLLBL (0.01 and 0.10 respectively). From all MT, two traits were derived computing ratios involving other traits, those had negative correlations with others MT, but all favourable for selection. Similar patterns were observed between the genetic parameters obtained from MTM and FAM5 respectively. The heritability estimates ranged from 0.09 (head width) to 0.47 (height at withers). Our results indicated that FAM was efficient to reduce the multitrait analysis dimensionality, and therefore, traits can be combined based on the first three eigenvectors from the additive genetic (co)variance matrix. In addition, there was sufficient genetic variation for selection, benefiting its potential implementation in a breeding program.

Patients with epilepsy during the COVID-19 pandemic: Depressive symptoms and their association with healthcare access.

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak impacted the lives of worldwide people with epilepsy (PWE) in various aspects, particularly in those countries most significantly affected by this pandemic, such as Brazil. We aimed to investigate the prevalence of depressive symptoms in PWE and their correlation with epilepsy features and access to treatment. METHODS: PWE were invited to answer a cross-sectional online-based survey to assess and rate depressive symptoms using the NDDI-E during the first year of the COVID-19 pandemic and its relation to multiple lifestyles epilepsy clinical aspects. RESULTS: A total of 490 PWE were recruited. The prevalence of depressive symptoms during the COVID-19 pandemic was 35.3% (cutoff score > 15 on NDDI-E). The factors associated with higher NDDI-E scores were: female sex, increased seizure frequency, barriers to access to their treating physician and antiseizure medication, and unemployment. Regarding the pandemic impact on PWE healthcare, 29.2% reported restricted access to their medication, 46.1% barriers to access their physicians, 94.2% had their consultations canceled due to the pandemic, and 28.4% had seizure worsening in this period. CONCLUSION: The COVID-19 pandemic affected PWE access to the healthcare system. Depressive symptoms were more severe in patients with higher seizure frequency who had difficulties obtaining proper medical care. The COVID-19 pandemic may impact the healthcare and mental wellbeing of patients with chronic diseases such as epilepsy. Nevertheless, prospective studies on epilepsy and COVID-19 are still lacking.

Gestão de custos no centro cirúrgico: impacto financeiro e perda de receita / Cost management at the operating room: financial impact and loss of revenue / Gestión de costos en el quirófano: impacto financiero y pérdida de ingresos

Objetivo: Elencar os materiais de maior impacto financeiro no centro cirúrgico e estimar a perda de receita que representaram para a instituição. Método: Pesquisa retrospectiva e quantitativa, com coleta em banco de dados e planilhas do centro cirúrgico e garantia da receita dos anos de 2015 e 2018 de uma instituição privada de extra porte de São Paulo. Resultados: Os materiais que causaram maior impacto financeiro foram: Sevorane®, Plasma Lyte®, manta térmica, sensor de monitor bispectral, máscara de anestesia, caneta para bisturi, perneira Sequel® e placa para bisturi. Representaram perda financeira de R$ 342.473,00 em 2015, quando ainda não havia a prática de auditoria in loco, comparada ao valor de R$ 114.157,00, em 2018, após ação de conferências em sala operatória. Conclusão: Houve benefício financeiro alcançado com a prática da auditoria in loco, com declínio de 66,6% na quantidade de materiais e medicamentos excluídos pela auditoria em razão da elevação da qualidade das anotações em prontuário.

Objective: To list the materials of greatest financial impact in the operating room and to estimate the loss of revenue they represented for the institution. Method: Retrospective and quantitative research, with collection in the database and spreadsheets of the surgical center and revenue guarantee for the years 2015 and 2018 of a private and large institution in São Paulo. Results: The materials that had the greatest financial impact were: Sevorane®, Plasma Lyte®, thermal blanket, bispectral monitor sensor, anesthesia mask, eletric scalpel pen, Sequel® leg protector, and electrosurgical plate. They represented a financial loss of BRL 342,473.00 in 2015, when there was still no on-site audit practice, compared with the amount of BRL 114,157.00, in 2018, after implementing checking initiatives in the operating room. Conclusion: There was a financial benefit achieved with the practice of on-site audit, with a 66.6% decline in the amount of materials and medicines excluded by the audit due to the enhancement in the quality of the notes found in medical records.

Objetivo: Enumerar los materiales con mayor impacto financiero en el Centro Quirúrgico y estimar la pérdida de ingresos que representaron para la institución. Método: Investigación retrospectiva y cuantitativa, con recolección en la base de datos y hojas de cálculo del Centro Quirúrgico y garantía de los ingresos para los años 2015 y 2018, de una institución privada extra grande de São Paulo. Resultados: Los materiales que causaron mayor impacto económico fueron: Sevorane®, Plasma Lyte®, Manta térmica, Sensor monitor biespectral, Máscara de anestesia, Pluma para bisturí, Perneira Sequel® y Placa para bisturí. Representaron una pérdida económica de R$ 342.473,00 en 2015, cuando aún no existía la práctica de auditoría in situ, frente al valor de R$ 114.157, en 2018, tras la acción de conferencias en el quirófano. Conclusión: Se logró un beneficio económico con la práctica de la auditoría in situ, con una disminución del 66,6% en la cantidad de materiales y medicamentos excluidos por la auditoría, debido al aumento en la calidad de las notas en las historias clínicas.

Implementation of a surgical safety checklist in Brazil: cross-sectional study.

OBJECTIVE: to identify the implementation process of the World Health Organization Surgical Safety Checklist in Brazilian hospitals. METHODS: this is a cross-sectional study with 531 participants during a Congress of Perioperative Nursing, promoted by the Brazilian Association of Operating Room Nurses, Anesthetic Recovery and Material and Sterilization Center, in 2017. RESULTS: among the nursing professionals included, 84.27% reported the checklist implementation in the workplace. Regarding daily application in the Sign-in stage, 79.65% of professionals confirmed patient identification with two indicators; in the Time-out stage, 51.36% of surgeries started regardless of confirmation of one of the items. In the Sign-out stage, 69.34% of professionals did not count or occasionally counted the surgical instruments and suture needles, and only 36.36% reviewed concerns about postoperative recovery. CONCLUSION: this study identified needs for improvements in applying the checklist in the Brazilian reality, to guarantee safer surgical procedures.

Implementation of a surgical safety checklist in Brazil: cross-sectional study / Implementación de la lista de verificación de seguridad quirúrgica en Brasil: estúdio transversal / Implementação de checklist de segurança cirúrgica no Brasil: estudo transversal

ABSTRACT Objective: to identify the implementation process of the World Health Organization Surgical Safety Checklist in Brazilian hospitals. Methods: this is a cross-sectional study with 531 participants during a Congress of Perioperative Nursing, promoted by the Brazilian Association of Operating Room Nurses, Anesthetic Recovery and Material and Sterilization Center, in 2017. Results: among the nursing professionals included, 84.27% reported the checklist implementation in the workplace. Regarding daily application in the Sign-in stage, 79.65% of professionals confirmed patient identification with two indicators; in the Time-out stage, 51.36% of surgeries started regardless of confirmation of one of the items. In the Sign-out stage, 69.34% of professionals did not count or occasionally counted the surgical instruments and suture needles, and only 36.36% reviewed concerns about postoperative recovery. Conclusion: this study identified needs for improvements in applying the checklist in the Brazilian reality, to guarantee safer surgical procedures.

RESUMEN Objetivo: identificar el proceso de implementación de la Lista de Verificación de Seguridad Quirúrgica de la Organización Mundial de la Salud en los hospitales brasileños. Métodos: estudio transversal con 531 participantes durante un Congreso de Enfermería Perioperatoria, promovido por la Asociación Brasileña de Enfermeras del Centro Quirúrgico, Centro de Recuperación y Esterilización de Anestesia y Material, en 2017. Resultados: entre los profesionales de enfermería incluidos, el 84,27% informó la implementación de la lista de verificación en el lugar de trabajo. En cuanto a la aplicación diaria en la etapa de Sign-in, el 79,65% de los profesionales confirmaron la identificación del paciente con dos indicadores; en la etapa de Time-out, el 51,36% de las cirugías se iniciaron independientemente de la confirmación de alguno de los ítems. En la etapa de Sign-out, el 69,34% de los profesionales no contaba u ocasionalmente el instrumental quirúrgico y las agujas de sutura. Solo el 36,36% revisó las preocupaciones sobre la recuperación postoperatoria. Conclusión: este estudio identificó necesidades de mejoras en la aplicación del checklist en la realidad brasileña, para asegurar procedimientos quirúrgicos más seguros.

RESUMO Objetivo: identificar o processo de implantação da Lista de Verificação de Segurança Cirúrgica da Organização Mundial da Saúde em hospitais brasileiros. Métodos: estudo transversal com 531 participantes durante um Congresso de Enfermagem Perioperatória, promovido pela Associação Brasileira dos Enfermeiros de Centro Cirúrgico, Centro de Recuperação Anestésica e Material e Esterilização, em 2017. Resultados: dentre os profissionais de enfermagem incluídos, 84,27% relataram a implantação do checklist no ambiente de trabalho. Em relação à aplicação diária na etapa Sign-in, 79,65% dos profissionais confirmaram a identificação do paciente com dois indicadores; na etapa Time-out, 51,36% das cirurgias foram iniciadas independentemente da confirmação de um dos itens. Na etapa Sign-out, 69,34% dos profissionais não contaram ou ocasionalmente contaram os instrumentos cirúrgicos e agulhas de sutura. Apenas 36,36% revisaram preocupações sobre a recuperação pós-operatória. Conclusão: este estudo identificou necessidades de melhorias na aplicação do checklist na realidade brasileira, para garantir procedimentos cirúrgicos mais seguros.

Satisfação profissional de enfermeiros que atuam no bloco cirúrgico de um hospital de excelência / Professional satisfaction of nurses at a surgicenter in an excellence hospital / Satisfacción profesional de enfermeras que trabajan en centro quirúrgico de un hospital de excelencia

Objetivos: Analisar e comparar o índice de satisfação profissional (ISP) de enfermeiros do bloco cirúrgico (BC). Método: Estudo de campo, comparativo e quantitativo que utilizou o ISP na avaliação da autonomia, interação, remuneração, normas organizacionais, status profissional e requisitos do trabalho de enfermeiros atuantes do BC de um hospital privado de São Paulo. Resultados: Dos 49 enfermeiros da amostra, 39 atuavam em centro cirúrgico (CC) e sala de recuperação pós-anestésica (SRPA) e 10 no centro de material e esterilização (CME). A interação foi o componente de maior importância, e o status profissional, o de menor, no entanto status profissional obteve o maior nível de satisfação, e requisitos do trabalho, o menor. O ISP foi 11,04 (baixo nível), considerando possível variação entre 0,9 e 37,1. Houve diferença significante para interação, com maior satisfação dos enfermeiros do CC/SRPA em comparação com os do CME. Conclusão: A satisfação profissional de enfermeiros do BC avaliada pelo ISP foi baixa. Conhecer os fatores que influenciam nesse índice é importante, pois a satisfação interfere diretamente na qualidade da assistência, previne doenças ocupacionais, além de ser indicador de resultados no processo de trabalho.

Objectives: To analyze and compare the professional satisfaction index (PSI) of surgical block (SB) nurses. Method: Comparative and quantitative field study that used the PSI in the evaluation of autonomy, interaction, compensation, organizational standards, professional status and work requirements of nurses working in the SB of a private hospital in São Paulo. Results: Of the 49 nurses in the sample, 39 worked in the operating room (OR) and post-anesthesia recovery room (PARR) and 10 worked in the material and sterilization center (MSC). Interaction was the most important component, and professional status was the least important. However, professional status obtained the highest level of satisfaction, while work requirements received the lowest. The PSI was 11.04 (low level), considering possible variation between 0.9 and 37.1. There was a significant difference for interaction, with greater satisfaction of OR/PARR nurses compared to MSC nurses. Conclusion: Professional satisfaction of SB nurses assessed by PSI was low. It is important to have knowledge of the factors that influence this index, as satisfaction directly interferes in the quality of care and prevents occupational diseases, besides being an indicator of results in the work process.

Objetivos: analizar y comparar el índice de satisfacción profesional (ISP) de las enfermeras en el quirófano. Método: Estudio de campo, comparativo y cuantitativo que utilizó el ISP en la evaluación de autonomía, interacción, remuneración, normas organizacionales, estatus profesional y requisitos de trabajo de enfermeras que trabajan en el BC de un hospital privado en São Paulo. Resultados: De las 49 enfermeras de la muestra, 39 trabajaron en el centro quirúrgico (CQ) y la sala de recuperación postanestésica (SRPA) y 10 en el centro de material y esterilización (CME). La interacción fue el componente más importante, y el estado profesional, el más bajo, sin embargo, el estado profesional obtuvo el mayor nivel de satisfacción y los requisitos laborales, el más bajo. El ISP fue 11.04 (nivel bajo), considerando una posible variación entre 0.9 y 37.1. Hubo una diferencia significativa en la interacción, con una mayor satisfacción de las enfermeras de CQ/SRPA en comparación con las de CME. Conclusión: La satisfacción profesional de las enfermeras de quirófano evaluadas por el ISP fue baja. Es importante conocer los factores que influyen en este índice, ya que la satisfacción interfiere directamente con la calidad de la atención, previene enfermedades ocupacionales, además de ser un indicador de resultados en el proceso de trabajo.

Pancreatitis as a severe complication of leptospirosis with fatal outcome: a case report.

Leptospirosis is a globally distributed zoonosis with a broad clinical spectrum. This disease mostly affects liver and kidney tissues. Other organs such as the pancreas, can be affected by leptospirosis-induced vasculitis. In addition, cardiac manifestations are common, and the presence of transient ECG abnormalities can be found in 70% of the patients. We report a male patient who presented with an atypical leptospirosis that progressed with severe acute pancreatitis, acute kidney injury and atrial fibrillation. Early diagnosis and adequate supportive therapy are crucial for the appropriated management of symptoms.

Uso do ultrassom portátil para detecção de retenção urinária por enfermeiros na recuperação anestésica / Use of portable ultrasound to detect urinary retention by nurses in anesthesia recovery / Uso del ultrasom portátil para detección de retención urinaria por enfermeros em la recuperación anestésica

Objetivo: Verificar a opinião dos enfermeiros em relação à utilização do ultrassom portátil para detectar retenção urinária na recuperação anestésica. Método: Pesquisa de campo, descritivo-exploratória, quantitativa; com 34 enfermeiros de dois blocos cirúrgicos de um hospital privado de São Paulo; aplicado questionário com duas partes: caracterização do profissional e questões sobre o uso do ultrassom portátil. A coleta deu-se entre maio e junho de 2018, após cumpridas as recomendações da Resolução nº 466/2012. Resultados descritos e analisados quantitativamente, utilizando-se técnicas estatísticas e apresentados em tabelas; avaliados individualmente e comparativamente, de forma horizontal e vertical. Resultados: Todos os enfermeiros opinaram em alternativas que demonstraram que a tecnologia do ultrassom é facilitadora no diagnóstico da retenção; o grau de confiança e segurança constatado foi alto e muito alto; se mostraram satisfeitos com a tecnologia; consideraram importante seu uso para autonomia do enfermeiro e opinaram que o uso do ultrassom portátil para detecção de retenção urinária na recuperação anestésica só apresentou vantagens. Em relação ao treinamento, a maioria considerou que o tempo foi suficiente, se mostrou satisfeita com os materiais apresentados e teve facilidade em usar o dispositivo. Conclusão: Os resultados demonstraram que a tecnologia é eficaz na prática clínica dos enfermeiros da recuperação anestésica da instituição pesquisada. O tema é pertinente à realização de novos trabalhos e intervenções para melhoria contínua dos processos de enfermagem, oferecendo maior segurança e menor dificuldade no manuseio do dispositivo.

Objective: To assess the opinion of nurses as to the use of portable ultrasounds to detect urinary retention during patients' recovery from anesthesia. Method: Field research, descriptive-exploratory and quantitative study; conducted with 34 nurses from two surgical suites at a private hospital in São Paulo. A questionnaire with two parts was applied: the characterization of professionals and questions about the use of portable ultrasounds. The collection took place between May and June 2018, after complying with the recommendations of Resolution No. 466/2012. The results were described and analyzed quantitatively, using statistical techniques and presented in tables; they were evaluated individually and comparatively, horizontally and vertically. Results: All nurses expressed their opinion on alternatives, which showed that ultrasound technology enables the diagnose of urinary retention. The confidence and reliability levels were high and very high. Nurses stated they were satisfied with the technology and considered their use important for the autonomy of nurses. Moreover, the use of portable ultrasounds to detect urinary retention during recovery from anesthesia was said to present only advantages. As to the training, most considered the time enough and approved the presented material. The device was easy to use. Conclusion: Regarding recovery from anesthesia, results showed that the technology is effective in the clinical practice of nurses at the research institution. The theme is pertinent to the accomplishment of new studies and interventions for continuous improvement of nursing processes, offering greater reliability and less difficulty to handle the device.

Objetivo: Verificar la opinión de los enfermeros em relación a la utilización del ultrasonido portátil para detectar retención urinaria em la recuperación anestésica. Método: Investigación de campo, descriptivo-exploratoria, cuantitativa; con 34 enfermeros de dos bloques quirúrgicos de un hospital privado de São Paulo; aplicado cuestionario con dos partes: caracterización del profesional y cuestiones sobre el uso del ultrasonido portátil. La recolección se dio entre mayo y junio de 2018, después de cumplidas las recomendaciones de la Resolución 466/2012. Resultados descritos y analizados cuantitativamente, utilizando técnicas estadísticas y presentadas en tablas; evaluados individualmente y comparativamente, de forma horizontal y vertical. Resultados: Todos los enfermeros opinaron em alternativas que demostraron que la tecnología del ultrasonido es facilitadora en el diagnóstico de la retención; el grado de confianza y seguridad constatado fue alto y muy alto; se mostraron satisfechos con la tecnología; consideraron importante su uso para autonomía del enfermero y opinaron que el uso del ultrasonido portátil para detección de retención urinaria em la recuperación anestésica sólo presentó ventajas. Em cuanto al entrenamiento, la mayoría consideró que el tiempo fue suficiente, se mostró satisfecha con los materiales presentados y tuvo facilidad em usar el dispositivo. Conclusión: Los resultados demostraron que la tecnología es eficaz em la práctica clínica de los enfermeros de la recuperación anestésica de la institución investigada. El tema es pertinente a la realización de nuevos trabajos e intervenciones para la mejora continua de los procesos de enfermería, ofreciendo mayor seguridad y menor dificultad em el manejo del dispositivo

Eventos adversos graves em pacientes cirúrgicos: ocorrência e desfecho / Serious adverse events in surgical patients: occurrences and outcomes / Eventos adversos graves en pacientes quirúrgicos: ocurrencia y desenlace

Objetivo: Identificar a ocorrência de eventos adversos graves (EAG) em pacientes cirúrgicos e seus possíveis desfechos. Método: Estudo retrospectivo, quantitativo, realizado pela análise de prontuários e banco de dados de pacientes no perioperatório, que sofreram EAG em 2016, em um hospital privado de São Paulo. Resultados: Ocorreram 19 EAG, com predominância de pacientes do sexo feminino, entre 40 e 49 anos, internados por patologias do sistema gastroenterológico. As ocorrências mais incidentes foram: lesão de órgãos digestórios, choque hemorrágico e lesão vascular. Quanto aos desfechos, os pacientes foram encaminhados à unidade de terapia intensiva, clínica médico-cirúrgica e hemodinâmica; dois pacientes evoluíram a óbito. Conclusão: Os profissionais da equipe de enfermagem devem estar atentos aos fatores que podem contribuir para a ocorrência de EAG e orientados em relação à notificação, a fim de aperfeiçoar a segurança e a qualidade da assistência prestada aos pacientes cirúrgicos

Objective: To identify the occurrence of serious adverse events (SAE) in surgical patients and their possible outcomes. Method: Retrospective quantitative study, performed by the analysis of records and data of perioperative patients, who suffered SAE in 2016 at a private hospital in São Paulo. Results: There were 19 SAEs, mostly in female patients aged 40 to 49 years, hospitalized by gastroenterological pathologies. The most frequent occurrences were damage in digestive organs, hemorrhagic shock and vascular lesion. Regarding outcomes, patients were referred to the intensive therapy unit, medical-surgical clinic and hemodynamics; two patients died. Conclusion: The nursing staff should be aware of factors that may lead to SAE and receive guidance on notification, so they can improve surgical patients' safety and care.

Objetivo: Identificar la ocurrencia de eventos adversos graves (EAG) en pacientes quirúrgicos y sus posibles desenlaces. Método: Estudio retrospectivo, cuantitativo, realizado por el análisis de prontuarios y banco de datos de pacientes en el perioperatorio, que sufrieron EAG en 2016, en un hospital privado de São Paulo. Resultados: Ocurrieron 19 EAG, con predominancia de pacientes del sexo femenino, entre 40 y 49 años, internados por patologías del sistema gastroenterológico. Las ocurrencias más incidentes fueron: lesión de órganos digestivos, choque hemorrágico y lesión vascular. Cuanto a los desenlaces, los pacientes fueron encaminados a la unidad de terapia intensiva, clínica médico-quirúrgica y hemodinámica; dos pacientes evolucionaron a óbito. Conclusión: Los profesionales del equipo de enfermería deben estar atentos a los factores que pueden contribuir para la ocurrencia de EAG y orientados con relación a la notificación, a fin de perfeccionar la seguridad y la calidad de la asistencia prestada a los pacientes quirúrgicos.

The Neotropical sharpshooter genus Ruppeliana Young (Insecta: Hemiptera: Cicadellidae): four new species, key to males, and new synonyms.

Four new Brazilian species of Ruppeliana are described and illustrated: R. barbarensis sp. nov., R. grossii sp. nov., R. longiphallus sp. nov., and R. serrana sp. nov., the first from Minas Gerais State and the other three from Rio de Janeiro State. The new taxa can be easily distinguished from other Ruppeliana species by their color pattern and male genitalia morphology. Ruppeliana coronulifera (Stål, 1862) and R. taschenbergi (Berg, 1899) are synonymized with R. signiceps (Stål, 1862). Additionally, a diagnosis of the genus and a key to species are provided.

Cancelamento de cirurgias: uma revisão integrativa da literatura / Cancellation of surgeries: an integrative literature review / Cancelación de cirugías: una revisión integrativa de literatura

Objetivo: Compilar e analisar informações disponíveis na literatura nacional e internacional sobre cancelamento de cirurgias. Método: Revisão integrativa da literatura de publicações do período de 2010 a junho de 2016, encontradas em periódicos indexados nas bases de dados LILACS, SciELO, BVS, CINAHL, CAPES e SCOPUS, nos idiomas inglês, português e espanhol. Resultados: Foram selecionados 61 artigos, que levantaram taxas de cancelamento de 0,48 até 38%. As causas mais frequentes são similares entre os estudos, sendo as mais comuns: condições clínicas do paciente não favoráveis à cirurgia, problemas relacionados à estrutura e à organização da instituição e o não comparecimento do paciente. Intervenções para reduzir o número de cancelamentos são relatadas, várias delas possuindo resultados eficazes. Conclusão: O cancelamento de cirurgias é uma temática em estudo mundial e que ainda requer investigações e intervenções, por ser prejudicial aos envolvidos e ao sistema de saúde.

Objective: To compile and analyze information available in the national and international literature about cancellation of surgeries. Method: Integrative literature review carried out from 2010 to June 2016, with search performed in indexed databases such as LILACS, SciELO, BVS, CINAHL, CAPES, and SCOPUS, for articles written in English, Portuguese and Spanish. Results: 61 articles were selected, which mentioned cancellation rates from 0.48 to 38%. Most frequent causes are similar among the studies, being the most common: patient's clinical conditions not favorable to surgery, problems related to the institution's structure and organization, and patient non-attendance. Interventions to reduce the number of cancellations are reported, several of them having effective results. Conclusion: The cancellation of surgeries is a worldwide theme that still requires investigations and interventions, as it harms people involved and the health system.

Objetivo: Compilar y analizar informaciones disponibles en la literatura nacional e internacional sobre cancelación de cirugías. Método: Revisión integrativa de la literatura de publicaciones del período de 2010 a junio de 2016, encontradas en periódicos indexados en las bases de datos LILACS, SciELO, BVS, CINAHL, CAPES y SCOPUS, en los idiomas inglés, portugués y español. Resultados: Se seleccionaron 61 artículos, que levantaron tasas de cancelación de 0,48 hasta 38%. Las causas más frecuentes son similares entre los estudios, siendo las más comunes: condiciones clínicas del paciente no favorables a la cirugía, problemas relacionados a la estructura y la organización de la institución y la no ausencia del paciente. Las intervenciones para reducir el número de cancelaciones se reportan, varias de ellas con resultados eficaces. Conclusión: La cancelación de cirugías es una temática en estudio mundial y que aún requiere investigaciones e intervenciones, por ser perjudicial para los involucrados y para el sistema de salud.

Anatomo-radiological mapping of the arrangement of ascending lumbar veins in relation to renal veins: is there a way to predict the risk of intraoperative lesions?

The aim of our study was to describe the critical area for iatrogenic lesions of the lumbar veins during the intraoperative manipulation of the renal veins and propose predictive indications for identifying those veins found in potential risk for iatrogenic lesions. Adult human cadavers were dissected and contrast enhanced images of CT and MR scans were randomly selected and analyzed. The distances from the first lumbar veins to the right and left renal veins were measured, respectively. The diameter of the renal veins and of the inferior vena cava was calculated. Correlation of the distances between the first lumbar veins and the corresponding renal veins, as well as the diameter of the renal veins and the inferior vena cava was performed. We obtained 205 specimens. The average distances between the right and left first lumbar veins and their respective renal veins was 3,5cm and 3,8cm, respectively (p<0.0001). We found 40 (20%), 96 (46%) and 69 (34%) lumbar veins at high, moderate and low risk for intraoperative lesion, on the right side, respectively, and 34 (17%), 86 (42%) and 85 (41%) lumbar veins, on the left side, respectively. The correlation between the size of the renal veins and the first lumbar vein-renal vein distance found a statistically significant difference, only on the left side (p=0.02). We describe the arrangement of the lumbar veins in relation to the renal veins, proposing a way to predict the existence of a ‘risk zone’ for inadvertent, intraoperative vascular lesions

No disponible