Pulmonary arteriovenous malformations in Rendu-Osler-Weber syndrome.

Rendu-Osler-Weber syndrome, also known as hereditary hemorrhagic telangiectasia, is an autosomal dominant hereditary disorder. It is characterized by presence of multiple arteriovenous malformations (AVMs) and telangiectasias. This article reports two cases of patients with Rendu-Osler-Weber syndrome who had pulmonary AVMs and underwent successful endovascular treatment. A brief review of the literature shows that up to 50% of patients with the syndrome have pulmonary AVMs and there is usually a positive family history in these patients. These pulmonary AVMs are multiple in 30% of cases and are associated with the most severe disease complications. Most patients are asymptomatic, even in the presence of AVMs with right-left shunts. When these shunts exceed 25% of the total blood volume, dyspnea, cyanosis, digital clubbing, and extracardiac murmurs may occur. Endovascular treatment is safe and offers control of complications from hereditary hemorrhagic telangiectasia and is currently the treatment of choice for these lesions.

Malformações arteriovenosas pulmonares na síndrome de Rendu-Osler-Weber / Pulmonary arteriovenous malformations in Rendu-Osler-Weber syndrome

Resumo A síndrome de Rendu-Osler-Weber, também conhecida como telangiectasia hemorrágica hereditária, é uma doença hereditária autossômica dominante. Ela é caracterizada pela presença de múltiplas malformações arteriovenosas e telangiectasias. Este artigo relata dois casos de pacientes com síndrome de Rendu-Osler-Weber que apresentaram malformações arteriovenosas pulmonares e foram submetidos a tratamento endovascular com sucesso. Uma breve revisão da literatura mostra que até 50% dos pacientes com a síndrome têm malformações arteriovenosas pulmonares e geralmente há um histórico familiar positivo nesses pacientes. Em 30% dos casos, elas são múltiplas e estão associadas a complicações mais graves da doença. A maioria dos pacientes é assintomática, mesmo na presença de malformações arteriovenosas com shunt direito-esquerdo. Quando esses shunts excedem 25% do volume total de sangue, podem surgir dispneia, cianose, baqueteamento digital e sopros extracardíacos. O tratamento endovascular oferece segurança e controle das complicações da telangiectasia hemorrágica hereditária, sendo atualmente o tratamento de escolha para essas lesões.

Abstract Rendu-Osler-Weber syndrome, also known as hereditary hemorrhagic telangiectasia, is an autosomal dominant hereditary disorder. It is characterized by presence of multiple arteriovenous malformations (AVMs) and telangiectasias. This article reports two cases of patients with Rendu-Osler-Weber syndrome who had pulmonary AVMs and underwent successful endovascular treatment. A brief review of the literature shows that up to 50% of patients with the syndrome have pulmonary AVMs and there is usually a positive family history in these patients. These pulmonary AVMs are multiple in 30% of cases and are associated with the most severe disease complications. Most patients are asymptomatic, even in the presence of AVMs with right-left shunts. When these shunts exceed 25% of the total blood volume, dyspnea, cyanosis, digital clubbing, and extracardiac murmurs may occur. Endovascular treatment is safe and offers control of complications from hereditary hemorrhagic telangiectasia and is currently the treatment of choice for these lesions.

Right iliac arteriovenous fistula due to aneurysm rupture and left iliac artery aneurysm: hybrid treatment.

An arteriovenous fistula (AVF) is an uncommon sequela of spontaneous arterial aneurysm rupture into the adjacent venous system. We describe the case of a 74-year-old patient who underwent endovascular treatment of a right iliac AVF caused by a ruptured common iliac artery (CIA) aneurysm and a distal left CIA aneurysm. Surgery preserved the lumbar and inferior mesenteric arteries because of the need to simultaneously exclude the hypogastric arteries. Dynamic fluid balance phenomena provoked by closure of the AVF are described. The patient had a benign postoperative course with normalization of the severe hemodynamic changes presented prior to the intervention and resolution of respiratory symptoms attributed to pulmonary arterial hypertension.

Revisiting carotid endarterectomy: Neobulb technique using external carotid artery as a patch.

OBJECTIVES: This study describes an alternative carotid bifurcation endarterectomy technique in which the external carotid artery is used as a suture patch. METHODS: Charts of ten patients with atherosclerotic carotid stenosis that were treated using the neobulb technique between 2002 and 2019 were reviewed. RESULTS: No major surgical adverse event was observed in the postoperative assessments. No postoperative common or internal carotid stenosis was observed in the mid- or long-term follow-up. CONCLUSIONS: The neobulb technique allows carotid endarterectomy closure without a synthetic or venous patch, using the external carotid artery as an autologous patch, while preserving distal flow into the external carotid artery branches.

Fístula arteriovenosa ilíaca à direita por rotura de aneurisma e aneurisma de artéria ilíaca esquerda: tratamento híbrido / Right iliac arteriovenous fistula due to aneurysm rupture and left iliac artery aneurysm: hybrid treatment

Resumo A fístula arteriovenosa (FAV) é uma sequela incomum de rotura espontânea de aneurisma arterial dentro do sistema venoso adjacente. Descrevemos, em um paciente de 74 anos, o tratamento endovascular de FAV ilíaca à direita por aneurisma de artéria ilíaca comum (AIC) roto associado a aneurisma de AIC distal à esquerda, em cuja cirurgia foram preservadas as artérias lombares e mesentérica inferior por necessidade de excluir simultaneamente as artérias hipogástricas. Foram demonstrados os fenômenos na dinâmica do balanço hídrico ocorridos em decorrência da interrupção da FAV. A evolução do paciente foi benigna, com normalização das graves alterações hemodinâmicas que apresentava e com desaparecimento dos sintomas respiratórios atribuídos à hipertensão arterial pulmonar.

Abstract An arteriovenous fistula (AVF) is an uncommon sequela of spontaneous arterial aneurysm rupture into the adjacent venous system. We describe the case of a 74-year-old patient who underwent endovascular treatment of a right iliac AVF caused by a ruptured common iliac artery (CIA) aneurysm and a distal left CIA aneurysm. Surgery preserved the lumbar and inferior mesenteric arteries because of the need to simultaneously exclude the hypogastric arteries. Dynamic fluid balance phenomena provoked by closure of the AVF are described. The patient had a benign postoperative course with normalization of the severe hemodynamic changes presented prior to the intervention and resolution of respiratory symptoms attributed to pulmonary arterial hypertension.

Superficial femoral vein transposition as a solution for hemodialysis vascular access.

The significant growth in the number of individuals dependent on hemodialysis for renal replacement therapy and unrestricted use of short and long-term catheters have challenged vascular surgeons in search of solutions for patients whose options for access via the upper limbs have been exhausted and for the increasing rates of central venous stenosis in these patients. When access via the upper limbs is impossible, exceptional techniques can be used and the lower limbs offer feasible alternative vascular access sites for hemodialysis. This article reports a case of superficial femoral vein transposition to make a loop arteriovenous fistula in a patient with no possibility of access via the upper limbs and presents a literature review on this technique that remains little used.

Transposição de veia femoral superficial como solução de acesso vascular para hemodiálise / Superficial femoral vein transposition as a solution for hemodialysis vascular access

Resumo O crescimento significativo do número de indivíduos dependentes de hemodiálise para terapia renal substitutiva e o uso irrestrito de cateteres de curta e longa permanência têm desafiado os cirurgiões vasculares em busca de soluções para a exaustão de acessos nos membros superiores e taxas crescentes de estenose venosa central nesses pacientes. Na impossibilidade do acesso em membros superiores, técnicas excepcionais podem ser utilizadas, e os membros inferiores são uma alternativa factível como sítio de acesso vascular para hemodiálise. Este artigo relata um caso de transposição de veia femoral superficial para confecção de uma fístula arteriovenosa em alça em um paciente sem possibilidade de acessos nos membros superiores, além de fazer uma revisão da literatura sobre essa técnica ainda pouco utilizada.

Abstract The significant growth in the number of individuals dependent on hemodialysis for renal replacement therapy and unrestricted use of short and long-term catheters have challenged vascular surgeons in search of solutions for patients whose options for access via the upper limbs have been exhausted and for the increasing rates of central venous stenosis in these patients. When access via the upper limbs is impossible, exceptional techniques can be used and the lower limbs offer feasible alternative vascular access sites for hemodialysis. This article reports a case of superficial femoral vein transposition to make a loop arteriovenous fistula in a patient with no possibility of access via the upper limbs and presents a literature review on this technique that remains little used.

Radiofrequency Ablation for Axial Reflux Associated with Foam Sclerotherapy for Varicosities in One-Step Approach: A Prospective Cohort Study Comprising Large Diameters Saphenous Veins.

OBJECTIVE: This study assessed the outcomes and impact on the quality of life following one-step outpatient radiofrequency ablation (RFA) and ultrasound guided foam sclerotherapy (USGFS) for large reflux with varicosities in the great saphenous vein (GSV). DESIGN: Prospective, single-centre, analytical cohort. MATERIALS AND METHODS: Thirty symptomatic patients having reflux in the GSV and varicosities (CEAP C3 to C6) were treated with RFA and USGFS simultaneously, in a single-step procedure, from March 2016 to December 2016. They were followed up at 1 week, 6 months, 1 and 3 years. Clinical outcomes, changes in the Quality of Life (QOL) questionnaires SF-36™, VCSS and AVVQ, evolutive vein occlusion rates were assessed by duplex ultrasound, and ulcer closure was checked. RESULTS: The sample was divided into two groups: (Group 1) GSV diameter ≥13.0 mm (median 19.0 [14-24]), 17 subjects, and (Group 2) GSV diameter ≤12.9 mm (median 10.3 [10-12]), 16 subjects. No major adverse event was observed, and the postoperative minor adverse event rates were similar between the two groups. A significant improvement was observed in VCSS and AVVQ from the preoperative levels to the sixth month and the third-year follow-up. Twelve of 13 ulcers had healed at 1 year and remained closed until 3 years. The entire sample had a significant increase in all short form 36 domains, except for mental health in the Group 2 (GSV ≥ 13.0 mm). Overall first week occlusion rate for the whole sample was 90.9% and 69.7% at the 3-year follow-up. No difference in occlusion rate was observed between the two groups at any time. CONCLUSION: Exclusively outpatient combined techniques were safe and feasible in this study with no major adverse events, despite the large diameters of the GSV or ulcer presence. Within 3 years, both diameter groups showed equivalent improvement in all QOL parameters, satisfactory axial occlusion, and maintained ulcer closure.

AVALIAÇÃO DO CONHECIMENTO DE ESTUDANTES DE ODONTOLOGIA SOBRE MARKETING DIGITAL / ASSESSMENT OF DENTISTRY STUDENTS KNOWLEDGE ABOUT DIGITAL MARKETING

Os meios de comunicação digitais tornaram-se uma ferramenta amplamente utilizada para fins pessoais e profissionais por grande parte da população. Diante dessa realidade contemporânea, o marketing digital vem trazendo facilidades e vantagens para o cotidiano, sendo considerado uma excelente proposta de divulgaçãopor parte dos cirurgiões-dentistas em busca de melhores resultados na odontologia.Com base nessa perspectiva, o presente estudo avaliou o conhecimento de estudantes de odontologia sobre a importância do marketing digital para o sucesso e bom desenvolvimento na prática odontológica. A coleta de dados foi realizada no Centro Universitário Serra dos Órgãos ­ UNIFESO, localizado no município de Teresópolis-RJ. Participaram do estudo, 151 estudantes devidamente matriculados no 1º ao 5º ano do curso de graduação em odontologia, que responderam um questionário, pré testado, contendo 10 perguntas do tipo objetivas diretas. Com base nos resultados, observou-se respostas consideravelmente proporcionais quando comparadas por diferentes anos da graduação, não demonstrando crescente avanço no conteúdo com o decorrer do curso de graduação, portanto, cabe ressaltar que o assunto precisa ser melhor abordado, devendo ser considerada e analisada essa possibilidade pelas diversas instituições por todo o país.

The digital media became a widely used tool for personal and professional purposes by much of the population. Before this contemporary reality, digital marketing has brought daily facilities and advantages, being considered an excellent proposal of disclosure by dentists in search of better results in dentistry. Based on this perspective, this study evaluated dentistry students knowledge of the importance of digital marketing for success and good development in dental practice. The data collection was performed at the Serra dos Orgãos University Center - UNIFESO, located in the municipality of Teresópolis-RJ. The study included 151 students properly enrolled in the 1st to 5th year of the undergraduate course in dentistry, who answered a pre-testedquestionnairecontaining 10 direct objective questions. Based on the results, it was observed considerably proportional responses when compared for different years of graduation, not demonstrating increasing progress in content over the course of the undergraduate, therefore, it may to stand out that the topic needs to be better approached, this possibility should be considered and analyzed by the various institutions throughout the country.

Amamentação cruzada no cenário da precarização do trabalho em saúde: atuação do enfermeiro / Cross-breastfeeding in the scenario of precarization of health work: nurse's role / Lactancia cruzada en el escenario de precarización del trabajo de salud: papel de la enfermera

Objetivo: investigar a atuação dos enfermeiros frente à amamentação cruzada e correlacionar com a atual questão da precarização do trabalho. Método: estudo qualitativo do tipo descritivo com base metodológica de análise do discurso, realizado com seis enfermeiras da Estratégia de Saúde da Família (ESF) por meio de um grupo focal. Resultados: o tema amamentação cruzada é apresentado como um indicador de conflitos ético-profissionais no processo de trabalho, expressando-se nos seguintes aspectos: conhecimento das prescrições de contraindicação, sensação de dificuldade em intervir e transferência à nutriz por qualquer dano à saúde da criança. Considerações finais: no cotejo entre esses resultados e uma organização de trabalho com normas e rotinas institucionalizadas, discutem-se como efeitos da não utilização de técnicas de aconselhamento, a fragilização da autonomia da nutriz, de forma imperceptível, reproduzidas por enfermeiros na assistência.

Objective: to investigate nurses' role related to cross-breastfeeding and to correlate with the current issue of precarious work.Method: descriptive andqualitative study based on methodological discourse analysis, carried out with six nurses from Estratégia de Saúde da Família (ESF) Program through a focus group. Results: cross-breastfeeding topic is presented as an indicator of ethical-professional conflicts in the work process, expressing itself in the following aspects: knowledge of prescriptions of contraindication, feeling of difficulty in intervening and transference to the nursing mother for any harm to the child's health. Final considerations: in the comparison between these results and a work organization with institutionalized norms and routines, we discuss the effects of not using counseling techniques, the fragility of nurses' autonomy, imperceptibly reproduced by nurses in care.

Objetivo: investigar el papel de las enfermeras relacionadas con la lactancia cruzada y su correlación con el tema actual del trabajo precario. Método: estudio descriptivo y cualitativo basado en el análisis metodológico del discurso, realizado con seis enfermeras del Programa Estratégia de Saúse da Familia (ESF) através de un grupo focal. Resultados: el tema de la lactancia cruzada se presenta como un indicador de conflictos ético-profesionales en el proceso de trabajo, expresándose en los siguientes aspectos: conocimiento de prescripciones de contraindicación, sensación de dificultad para intervenir y transferencia a la madre lactante por cualquier daño a la salud del niño Consideraciones finales: en la comparación entre estos resultados y una organización de trabajo con normas y rutinas institucionalizadas, discutimos los efectos de no utilizar técnicas de asesoramiento, la fragilidad de la autonomía de las enfermeras, reproducida imperceptiblemente por las enfermeras bajo cuidado.

Silenciamento dos enfermeiros sobre os motivos da não recomendação da amamentação cruzada / Silencing of nurses on the reasons for not recommending cross-breastfeeding

Objetivo: identificar qual a conduta assistencial do enfermeiro frente à amamentação cruzada. Metodologia: estudo qualitativo, realizado com seis enfermeiras atuantes da Estratégia de saúde da família por meio de um grupo focal em de Duque de Caxias. Resultados: aponta a carência do aconselhamento na conduta assistencial frente à amamentação cruzada e o silenciamento sobre os motivos da não recomendação da mesma. Conclusão: Recomenda-se mudança nos discursos dos enfermeiros para a busca dos motivos que desencadearam a prática da amamentação cruzada para assim poderem intervir, visto que na maioria das vezes é praticada pela não efetividade de seus direitos. (AU)

Objective: identify the nurse's care practice towards cross-breastfeeding.Methodology: a qualitative study carried out with six nurses working in the Family Health Strategy through a focus group in Duque de Caxias. Results: points out the lack of counseling in the care practice regarding cross-breastfeeding and the silencing of the reasons for not recommending it.Conclusion: it is recommended to change the nurses's discourses to search for the reasons that triggered the practice of cross-breastfeeding in order to intervene, considering that most of the time it is practiced for the non-effectiveness of their rights. (AU)

Objetivo: identificar cuál es la conducta asistencial del enfermero frente a la lactancia cruzada. Metodología: estudio cualitativo, realizado con seis enfermeras actuantes de la Estrategia de salud de la familia por medio de un grupo focal en el Duque de Caxias. Resultados: apunta la carencia del asesoramiento en la conducta asistencial frente a la lactancia cruzada y el silenciamiento sobre los motivos de la no recomendación de la misma. Conclusión: Se recomienda cambiar en los discursos de los enfermeros para la búsqueda de los motivos que desencadenaron la práctica de la lactancia cruzada para así poder intervenir, ya que la mayoría de las veces es practicada por la no efectividad de sus derechos. (AU)

Time trends and social security burden of temporary work disability due to chronic venous disease in Brazil.

BACKGROUND: Chronic venous disease (CVD) and disability are worldwide problems and have significant socioeconomic implications. This study aims to analyze the time trends and social security burden of temporary work disability due to CVD in Brazil. METHODS: An ecological time series study using the Brazilian Social Security System database was performed from 2005 to 2014. Data from all benefits granted to workers with temporary disability due to CVD were analyzed. The cases were identified using diagnosis codes I83-I83.9 of the International Classification of Diseases 10th Revision (ICD-10). The time trend analyses were performed by the Joinpoint Regression Model, with sex, age, regions, income, and category of affiliation as variables. Crude and age-standardized rates were calculated. RESULTS: A total of 429,438 benefits were granted for temporary work disability due to CVD from 2005 to 2014, with a growing trend and an age-standardized annual percent change (APC) of 3.4 (95% CI: 2.6-4.2) (p < 0.05). Social security expense increased 3.5-fold, and the number of days in benefit doubled from 2005 to 2014. In total, 27,017,818 working days were lost. The average duration of benefits was 55.3 days. The majority of workers were women (68.2%) (p < 0.001), between 30 and 59 years old, employed, had a monthly income ≤2 minimum wages (MW) (83.2%), and lived in the regions southeast (53.6%) and south (29.3%). Significantly higher APCs were observed for women than for men (APC: 4.9, 95% CI: 4.0-5.7 versus APC: 1.2, 95% CI: 0.1-2.4). All regions in Brazil had a significant growing trend, except in the north. No significant growth was observed in the age group of 60-69 years. A decreasing trend was observed in workers with monthly incomes above 2 MW (p < 0.05). CONCLUSIONS: Temporary work disability due to CVD and social security burden showed increasing trends with millions of working days lost, particularly among women and low-income workers. Preventing disability is challenging, and public policies are needed to reduce the social and economic impact of disability. Therefore, measures for promoting health at the workplace should be encouraged.

Elastic compression after ultrasound-guided foam sclerotherapy in overweight patients does not improve primary venous hemodynamics outcomes.

OBJECTIVE: Lower extremity varicose veins have a high prevalence and can be associated with significant morbidity in their more advanced presentations; overweight patients tend to present with more severe clinical symptoms and conventional surgical treatment remains challenging. Although the advent of ultrasound-guided foam sclerotherapy (UGFS) increased the treatment options for these patients, the need for elastic compression after UGFS remains controversial. METHODS: Overweight patients with lower extremity varicose veins secondary to great saphenous vein reflux were treated with UGFS and then randomized to use or no use of a 3-week treatment of elastic compression stockings. Follow-up was performed by clinical evaluation and duplex ultrasound examination. The primary outcome measure was the absence of venous reflux in the great saphenous vein. RESULTS: One hundred thirty-five lower limbs were treated; 72 limbs were randomized to elastic compression and 63 limbs to the control group. There were no statistically significant differences in the number of procedures (P = .64) or the mean foam volume per procedure (P = .27) between groups. There was no difference in the reflux rate at either 3 weeks (26% vs 35%; P = .16) or 3 months (25% vs 21%; P = .85). Major complications were venous deep thrombosis (n = 2), neurologic event (n = 1), and ischemic ulceration (n = 1); the overall rate was 3% in both groups-2 of 62 in control patients and 2 of 69 in compression patients (P = .45). Venous diameter reduction was noted in both groups during treatment (P < .05) but with greater decrease in greater saphenous vein diameter in patients treated with compression. CONCLUSIONS: Elastic compression stockings for 3 consecutive weeks after UGFS in overweight patients did not decrease great saphenous vein reflux, need for repeat procedures, or the volume of foam injected. However, UGFS was associated with a greater and uniform reduction in saphenous vein diameter at all times after the procedure.

Evaluation of the Use of Compressive Stockings Impregnated With Hesperetin-Based Nanocapsules in the Healing of Venous Ulcers: A Case Report.

Venous ulcers are a more severe complication of chronic venous insufficiency, significantly compromising patient quality of life (QoL). Compressive stockings are still the gold standard treatment method with alternative therapies currently being evaluated. In this perspective, we investigate the influence of compressive stockings impregnated with hesperetin-based nanocapsules in the healing process of venous ulcers. Compressive stockings impregnated with hesperetin-based nanocapsules were applied to a consenting patient for 6 months following all relevant ethical principles for patient studies. The patient was evaluated at baseline (T0), 3 months (T3), and 6 months (T6), using photographic register (healing) probes to measure skin melanin, erythema and hydration parameters, and venous diameters, followed by questionnaires regarding QoL and pain perception. Healing was observed at the 3-month time point and with 91.6% and 93.1% of retraction area in larger ulcers of the right leg and lateral portion of the left leg, respectively. The deepest ulcer in a medial portion of the left leg healed 47.3%. A reduction of all measured skin parameters was observed, indicating a possible hesperetin effect. The scores of QoL and pain were, respectively, in the ranges of 91.6 to 31.2 and 7 to 0. Reduction in venous diameters also indicates healing function. These preliminary findings suggest that compressive stockings impregnated with hesperetin nanocapsules enhance venous ulcer healing. Further clinical trial controlled by placebo, involving a greater number of patients, is required to confirm the findings of this case report.

Empirical radio propagation model for DTV applied to non-homogeneous paths and different climates using machine learning techniques.

The establishment and improvement of transmission systems rely on models that take into account, (among other factors), the geographical features of the region, as these can lead to signal degradation. This is particularly important in Brazil, where there is a great diversity of scenery and climates. This article proposes an outdoor empirical radio propagation model for Ultra High Frequency (UHF) band, that estimates received power values that can be applied to non-homogeneous paths and different climates, this last being of an innovative character for the UHF band. Different artificial intelligence techniques were chosen on a theoretical and computational basis and made it possible to introduce, organize and describe quantitative and qualitative data quickly and efficiently, and thus determine the received power in a wide range of settings and climates. The proposed model was applied to a city in the Amazon region with heterogeneous paths, wooded urban areas and fractions of freshwater among other factors. Measurement campaigns were conducted to obtain data signals from two digital TV stations in the metropolitan area of the city of Belém, in the State of Pará, to design, compare and validate the model. The results are consistent since the model shows a clear difference between the two seasons of the studied year and small RMS errors in all the cases studied.

O uso terapêutico do LASER de Baixa Intensidade (LBI) em algumas patologias e sua relação com a atuação na Fonoaudiologia / The therapeutic use of low intensity laser (LLLT) in some diseases and its relation to the performance in speech therapy / El uso terapéutico de LÁSER de Baja Intensidad (LBI) en algunas patologías y su relación con la actuación en Fonoaudiología

O uso da luz LASER Terapêutico de Baixa Intensidade (LBI) ou Low Level Laser Therapy (LLLT), é multidisciplinar, sendo este utilizado por vários profissionais: médicos, dentistas, fisioterapeutas, enfermeiros, físicos, biólogos, engenheiros, etc. A Fonoaudiologia começa a despertar o interesse em integrar esse grupo de profissionais, sendo um recurso totalmente terapêutico, não invasivo, sem efeitos tóxicos e colaterais que agrega no trabalho terapêutico e estabelece um prognóstico excelente de reabilitação. Por esse motivo, objetivou-se coletar alguns artigos científicos que abordam os fundamentos físicos e bioquímicos da interação da luz do LASER com o tecido biológico vivo e sua aplicabilidade terapêutica nas especialidades da saúde onde encontramos também a atuação da Fonoaudiologia. Para isso foram selecionadas algumas patologias relacionando-as ao uso do LBI: disfunção temporomandibular (DTM), paralisia facial, disfagias por disfunção motora, cicatrização tecidual incluindo as fissuras mamilares, principal responsável pelo abandono do aleitamento materno. No escopo das patologias, será descrita a ação do LASER e seu efeito biomodulador nos processos: inflamatórios, álgicos, cicatriciais, edematosos, de reparação nervosa e muscular. Conclui-se que o LBI é um avanço tecnológico e uma importante ferramenta terapêutica em campos distintos, significando uma grande evolução em toda a área da saúde, inclusive na Fonoaudiologia. É fundamental destacar que os artigos apresentam falta de padronização na dosimetria e sugere-se que próximos estudos sejam elaborados com a padronização dos documentos da World Association for Laser Therapy (WALT).

The use of Laser Therapy of Low Intensity (LBI) or Low Level Laser Therapy (LLLT), is multidisciplinary, and is used by many professionals: doctors, dentists, physiotherapists, nurses, physicists, biologists, engineers, etc. The Speech Therapy begins to awaken the interest in joining this group of professionals, with a totally therapeutic use, non-invasive, no toxic side effects that adds to the therapeutic work and establishes an excellent rehabilitation prognosis. Therefore, we aimed to collect some research papers that address the physical and biochemical fundamentals of laser light interaction with the living biological tissue and its therapeutic applicability in health specialties where we also find the work of Speech Therapy. For this, we selected some pathology relating the use of LLLT: temporomandibular disorders (TMD), facial palsy, dysphagia by motor dysfunction, tissue healing including the mammillary fissures responsible for abandonment of breastfeeding. In the scope of the conditions, the action of the LASER will be described and its effect on biomodulator processes: inflammatory, nociceptive, scarring, edematous, nerve and muscle repair. We conclude that LLLT is a technological breakthrough and an important tool in different fields, meaning a major evolution in health procedures, even in speech therapy. It is essential to note that the articles present lack of standardization in dosimetry and we suggest that further studies are developed with the standardization of the documents World Association for Laser Therapy (WALT).

El uso de la luz LÁSER Terapéutico de Baja Intensidad (LBI) o Low Level Laser Therapy (LLLT), es multidisciplinar, utilizado por varios profesionales: médicos, dentistas, fisioterapeutas, enfermeros, biólogos, físicos, ingenieros, etc. En la Fonoaudiología también se empieza a tener interés en formar parte de este grupo de profesionales, para el uso de ese recurso terapéutico, sin efectos secundarios, tóxicos y colaterales que se suma al trabajo terapêutico con excelente pronóstico de rehabilitación. Por ese motivo se recogieron articulos científicos que abordan los fundamentos físicos y bioquímicos de la interacción de la luz láser con el tejido biológico vivo y su aplicabilidad terapéutica en especialidades de la salud, donde se encuentra también la actuación Fonoaudiológica. Para tanto se seleccionaron algunas patologias relacionadas al uso de LBI: disfunción temporomandibular (DTM), parálisis facial, disfagia por disfunción motora, cicatrización del tejido incluyendo fisuras mamilares, principal responsable del abandono de la lactancia materna. En el ámbito de las patologias, se describió la acción del LASER y su efecto biomodulador el los procesos: inflamatorios, nociceptivos, cicatrización, edematosos, de reparación nerviosa y muscular. Se concluyó que el LBI es un avance tecnológico y una importante herramienta terapéutica en diferentes campos, significado una evolución importante en toda la salud incluso en la Fonoadiología. Es importante tener en cuenta que los artículos presentes falta de estandarización en la dosimetría y se sugiere que más estudios se realizen con la estandarización de los documentos de la World Association for Laser Therapy (WALT).

Atuação fonoaudiológica em disfunção temporomandibular em dois casos: análise comparativa dos efeitos da terapia tradicional e o uso da bandagem terapêutica associada / Speech therapy in temporomandibular dysfunction in two cases: comparative analysis of the effect of traditional therapy and the use of the therapeutic bandage associated / Actuación fonoaudiológica en trastorno temporomandibular en dos casos: un análisis comparativo de los efectos de la terapia tradicional y del uso de vendaje terapéutico asociado

Objetivo: verificar e comparar os efeitos da terapia fonoaudiológica tradicional e o uso associado da bandagem terapêutica no tratamento de disfunções temporomandibulares musculares em dois casos. Descrição e histórico de procedimentos: O estudo foi composto por dois indivíduos do sexo feminino, ambos com trinta e três anos de idade, diagnosticados com disfunção temporomandibular através do Research Diagnostic Criteria for Temporomandibular Disorders. O primeiro indivíduo denominado como TT foi submetido à terapia fonoaudiológica tradicional em disfunção temporomandibular e o segundo indivíduo denominado como TB, além desses mesmos recursos contou com a utilização de bandagem elástica no músculo masseter bilateral. Os seguintes parâmetros foram verificados de forma qualitativa e descritiva: sinais e sintomas, intensidade de dor e amplitude dos movimentos funcionais mandibulares. Resultados: Os sinais e sintomas presentes no início da terapia foram cessados em ambas as terapêuticas. O paciente TB teve o quadro álgico reduzido em um número reduzido de sessões em relação ao seu par. Ambas as terapêuticas mostram-se efetivas quanto ao aumento de excursões mandibulares. Conclusão: A fonoterapia utilizando-se de técnicas tradicionais e a aplicação da bandagem elástica associada a estas demonstram benefícios terapêuticos em sujeitos com disfunção temporomandibular. O uso da bandagem elástica aparenta ter promovido eficiência terapêutica em menor tempo.

Objective: Verify and compare the effects of traditional speech therapy and the associated use of therapeutic bandage for treating muscle temporomandibular disorders in two cases. Description and history of procedures: The study was composed by two female subjects, both thirty-three years old, diagnosed with temporomandibular dysfunction through the Research Diagnostic Criteria for Temporomandibular Disorders. The first person called as TT underwent traditional speech therapy in temporomandibular disorders and the second individual named as TB, in addition to these resources included the use of elastic bandage in bilateral masseter muscle. The following parameters were verified in qualitative and descriptive form: signs and symptoms, pain intensity and range of mandibular functional movements. Results: The signs and symptoms present at the start of therapy ended on both therapies. The TB patient had reduced pain symptoms in a small number of sessions in relation to its pair. Both therapies demonstrated to be effective in increasing mandibular excursions. Conclusion: speech therapy using traditional techniques and application of elastic bandage associated with these demonstrates therapeutic benefits in subjects with temporomandibular disorders. The use of elastic bandage seems to have promoted therapeutic efficiency in less time.

vendaje terapéutico para el tratamiento de trastornos temporomandibulares musculares en dos casos. Descripción de los procedimientos y de la historia: El estudio se ha compuesto por dos individuos de sexo femenino, ambos con treinta y tres años de edad, diagnosticados con disfunción temporomandibular a través del Research Diagnostic Criteria for Temporomandibular Disorders. El primer individuo nombrado como TT fue sometido a la terapia fonoaudiológica tradicional para trastornos temporomandibulares y el segundo individuo nombrado como TB, además de estos recursos contó con el uso de una venda elástica en el músculo masetero bilateral. Los siguientes parámetros fueron verificados de forma cualitativa y descriptiva: signos y síntomas, la intensidad del dolor y la amplitud de los movimientos funcionales mandibulares. Resultados: Los signos y síntomas presentes al inicio de la terapia se terminaron en ambas terapias. El paciente TB tubo reducción del dolor en un menor número de sesiones en relación con su pareja. Ambas terapias se han demostrado eficaces en el aumento de las excursiones mandibulares. Conclusión: la fonoterapia utilizando técnicas tradicionales y la aplicación asociada de vendaje elástico, demuestró beneficios terapéuticos en indivíduos con transtorno temporomandibulares. El uso de vendaje elástico parece haber promovido la eficiencia terapéutica en menos tiempo.

Amamentação cruzada: contribuição para enfermagem e saúde no campo da bioética / Cross-breastfeeding: contribution to nursing and health in the field of bioethics

O leite materno é o melhor alimento para a criança, porém, existem situações que contraindicam permanentemente a prática da amamentação, como mães portadoras do vírus HIV (Vírus da imunodeficiência humana). No Brasil, o Ministério da Saúde, através da Portaria nº 2.415/1996, orienta a não prática da amamentação cruzada. Objeto do estudo: os saberes e práticas dos enfermeiros frente à amamentação cruzada. Os objetivos são: compreender os saberes e práticas do enfermeiro frente à amamentação cruzada na perspectiva bioética; Identificar qual a conduta assistencial do enfermeiro frente à amamentação cruzada e correlacionar os saberes e práticas dos enfermeiros à luz da bioética. Metodologia: Trata-se de um estudo com abordagem qualitativa do tipo descritivo com base metodológica de análise do discurso, tendo como cenário o município de Duque de Caxias. Participaram do estudo seis enfermeiras atuantes da Estratégia de saúde da família por meio de um grupo focal no mês de maio. Os dados foram analisados à luz da Análise do Discurso e interpretados com base na Concepção freireana da educação em saúde, pautada na autonomia do processo de aprendizagem e aspectos bioéticos com destaque para a teoria do desenvolvimento moral. Resultados: A análise do discurso dos participantes do estudo levou a três temas geradores: Polifonia: o discurso heterogêneo do enfermeiro; Silenciamento dos enfermeiros sobre os motivos da não recomendação da amamentação cruzada e (Des)implicação do enfermeiro na autonomia da lactante referente à amamentação cruzada. O discurso dos enfermeiros são heterogêneos, pois as vozes dos outros se misturam à voz do sujeito explícito da enunciação. Além disso, ocorre um silenciamento dos enfermeiros sobre os motivos da não recomendação da amamentação cruzada que pode ser identificado pela postura que o profissional se comporta perante a nutriz. Afirmam que fornece todas as informações, mas não há abertura para o diálogo. Utilizam-se de um discurso de culpabilização da nutriz por qualquer dano à saúde da criança, mas não se utilizam de técnicas do aconselhamento para promover uma escolha autônoma. E com isso, se (des)implicam com o pressuposto de que a função do enfermeiro é somente (proibir ou informar) e a função da nutriz é acatar as prescrições/normatizações. Este estudo aponta para discussões de conflitos e dilemas éticos sobre amamentação cruzada articulados aos estágios de desenvolvimento moral de Kohlberg na perspectiva da autonomia da nutriz e do direito da criança à amamentação. Conclui-se que a atuação dos enfermeiros para agir frente aos conflitos e dilemas morais da amamentação cruzada requer atualização e reflexão no campo da bioética para intervir com competência técnica e respeito à autonomia da mulher e proteção à díade mãe-bebê. Os enfermeiros necessitam repensar sua conduta, estabelecendo um diálogo alicerçado em uma postura ética que não reproduza a norma, mas privilegie conhecimentos e atitudes que permitam à mulher realizar escolhas apropriadas ao seu modo de viver.

Breastmilk is considered the best food for the child, but there are situations that permanently contraindicate the practice of breastfeeding, as mothers carrying the HIV virus (human immunodeficiency virus). In Brazil, the Ministry of Health, through its Ordinance No. 2415/1996, guides the non-practice of cross-breastfeeding. Purpose of the study: nurses' knowledge and practices regarding cross-breastfeeding. The objectives are: to understand nurses' knowledge and practices regarding cross-breastfeeding in a bioethical perspective; To identify the nurse's nursing care in relation to cross-breastfeeding and to correlate nurses' knowledge and practices in the light of bioethics. Methodology: This is a qualitative study of a descriptive type based on methodological discourse analysis, in Duque de Caxias municipality. Six nurses participated in the study who work in the Family Health Strategy through a focus group in May. The data were analyzed in the light of Discourse Analysis and interpreted through the Freirean conception of health education, based on the autonomy of the learning process and bioethical aspects with emphasis on the theory of moral development. Results: The study participants' discourse analysis led to three generative themes: Polyphony: the heterogeneous discourse of the nurse; Silencing nurses on the reasons for not recommending cross-breastfeeding and (de)implication of the nurse's over the infant's autonomy regarding cross-breastfeeding. Nurses' discourse is heterogeneous, because the voices of others are mingle with the voice of the explicit subject of enunciation. In addition, there is a silencing of the nurses about the reasons for not recommending cross-breastfeeding, which can be identified by the attitude the professional has towards the nursing mother. They claim all the information is provided, but there is no openness to the dialogue. A nursing guilty discourse is used for any harm to the child's health, but counseling techniques are not used to promote an autonomous choice. And with that, (de) imply with the assumption that the job of the nurse is only (to prohibit or inform) and the function of the nurse is to abide by the prescriptions/normatizations. This study points to discussions of ethical conflicts and dilemmas about cross-breastfeeding articulated to Kohlberg's stages of moral development in the perspective of the nurse's autonomy and the child's right to breastfeeding. It is concluded that the nurses' action to deal with the conflicts and moral dilemmas of cross-breastfeeding requires updating and reflection in the field of bioethics to intervene with technical competence and respect for the women's autonomy and protection of the mother-baby dyad. Nurses need to rethink their behavior, establishing a dialogue based on an ethical stance that does not reproduce the norm, but privileges knowledge and attitudes that allow women to make appropriate choices to their way of life.

Doença de Crohn associada a tumor carcinoide gástrico: relato de caso e revisão de literatura / Crohns disease associated with gastric carcinoid tumor: a case report and literature review

Os tumores carcinoides gástricos são neoplasias raras, derivadas das células enterocromafins e podem associar-se a doenças inflamatórias intestinais, como a doença de Crohn. Atualmente, há aumento da incidência devido a maior realização de endoscopia digestiva alta. A abordagem depende do tipo, tamanho e número de lesões, além da presença de metástases. Este é o relato de caso de um paciente com doença de Crohn associada a tumor carcinoide gástrico.

The gastric carcinoid tumors are rare, derived from the enterochromaffin cells and may be associated with inflammatory bowel diseases such as Crohns disease. Currently, there is increased incidence due to higher performing endoscopy. The approach depends on the type, size, number of lesions and the presence of metastases. This is a case report of a patient with Crohns disease associated with gastric carcinoid tumor.