Intervenções de enfermagem para gerir a dor na canulação da fístula arteriovenosa ­ scoping review / Nursing interventions to manage pain in arteriovenous fistula cannulation - scoping review

O presente relatório de estágio, foi elaborado no âmbito do Mestrado em Enfermagem Médico-Cirúrgica da Escola Superior de Saúde do Instituto Politécnico de Bragança, alusivo ao período entre setembro de 2020 e abril de 2021, realizado em três serviços distintos ­ Serviço de Urgência Médico-Cirúrgica, Unidade de Cuidados Intensivos e Bloco Operatório ­ que proporcionou o aprimoramento de competências clínicas e de pesquisa como enfermeiro especialista. A pesquisa pelo progresso no conhecimento demanda uma prática fundamentada nas evidências mais recentes, orientada para resultados sensíveis aos cuidados de enfermagem. O enfermeiro especialista assume um papel central como líder em projetos de formação, consultoria e investigação, conforme o regulamento da Ordem dos Enfermeiros (OE n.º 429/2018 de julho, p.19360). A atuação do Enfermeiro Especialista em Enfermagem Médico-Cirúrgica perante pacientes em estado crítico demanda conhecimentos precisos e competências específicas. O estágio concentrou-se no desenvolvimento de competências comuns e específicas em enfermagem Médico-Cirúrgica na área da pessoa em situação critica, desde a gestão de doenças críticas até a atuação em emergências, conforme os regulamentos nº 140/2019 e nº429/2018 da OE. O estágio realizado na Unidade Local de Saúde do Litoral Alentejano, abrangeu os serviços de Urgência Médico-Cirúrgica, Bloco Operatório e Unidade de Cuidados Intensivos. Os objetivos gerais incluíram consolidar e analisar competências adquiridas, identificar situações e dificuldades na prática clínica, elaborar uma reflexão aprofundada sobre as práticas nos diferentes serviços e contribuir para a aquisição do Grau de Mestre em Enfermagem Médico-Cirúrgica. Durante o estágio foi incentivado a prática baseada na evidencia e, por esse mesmo motivo, foi realizado um artigo científico com o tema - "Intervenções de Enfermagem para Gerir a Dor na Canulação da Fistula Arteriovenosa ­ Scoping Review" - submetido à Revista Referência. O relatório em conjunto com o artigo científico, representa a síntese do percurso educacional e profissional, visando aprimorar competências práticas e contribuir para o avanço do conhecimento.

Diagnosis of gynecologic malignancy after the treatment of presumed benign fibroid disease with interventional radiology procedures: a retrospective cohort study.

OBJECTIVE: To ascertain the finding of future diagnosis of malignancy in women who undergo nonsurgical treatment for uterine fibroid disease with interventional radiology (IR) procedures. DESIGN: Mixed-methods retrospective cohort study. SETTING: Two tertiary care academic hospitals in Boston, Massachusetts. PATIENT(S): A total of 491 women who underwent radiologic intervention for fibroids between 2006 and 2016. INTERVENTION(S): Uterine artery embolization or high-intensity focused ultrasound ablation. MAIN OUTCOME MEASURE(S): Subsequent surgical interventions and diagnosis of gynecologic malignancy after the IR procedure. RESULT(S): During the study period, 491 women underwent treatment of fibroids with IR procedures; follow-up information was available for 346 cases. The mean age was 45.3 ± 4.8 years, and 69.7% were between the ages of 40 and 49 years. Regarding ethnicity, 58.9% of patients were white, and 26.1% were black. The most common symptoms were abnormal uterine bleeding (87%), pelvic pressure (62.3%), and pelvic pain (60.9%). A total of 106 patients underwent subsequent surgical treatment of fibroids. Of the 346 patients who had follow-up, 4 (1.2%) were diagnosed with leiomyosarcoma after their interventional treatment for fibroids. An additional 2 cases of endometrial adenocarcinoma and 1 case of a premalignant lesion of the endometrium were noted. CONCLUSION(S): The proportion of patients who went on to be diagnosed with leiomyosarcoma after conservative IR treatments appears to be higher than previously reported. A thorough preprocedural workup and patient counseling regarding the possibility of underlying uterine malignancy should be undertaken.

Hemoptysis and endometriosis: An unusual association - case report and review of the literature / Hemoptise e endometriose: uma associação não usual - relato de caso e revisão da literatura

Abstract Thoracic endometriosis syndrome is a rare condition that includes four entities: catamenial pneumothorax, catamenial hemothorax, catamenial hemoptysis and lung nodules. We describe the case of a 23-year-old woman with complaints of hemoptysis during menstrual period in the two years prior to the appointment. Initially, a treatment for tuberculosis was established with no success. Further investigation showed a 4 mmnodule in the right lung, and the transvaginal ultrasonography indicated the presence of deep endometriosis. Considering the occurrence of symptoms only during menses, an empirical therapy was instituted with remission of the complaints.

Resumo A síndrome da endometriose torácica é uma condição rara que inclui quatro entidades: pneumotórax catamenial, hemotórax catamenial, hemoptise catamenial e nódulos pulmonares. Descrevemos o caso de umamulher de 23 anos de idade comqueixas de hemoptise durante o período menstrual por 2 anos. Inicialmente, um tratamento para a tuberculose foi estabelecido sem sucesso. Uma investigação adicional mostrou um nódulo de 4 mm no pulmão direito, e a ultrassonografia transvaginal indicou a presença de endometriose profunda. Considerando a ocorrência de sintomas somente durante a menstruação, uma terapia empírica foi instituída com remissão das queixas.

Hemoptysis and Endometriosis: An Unusual Association - Case Report and Review of the Literature.

Thoracic endometriosis syndrome is a rare condition that includes four entities: catamenial pneumothorax, catamenial hemothorax, catamenial hemoptysis and lung nodules. We describe the case of a 23-year-old woman with complaints of hemoptysis during menstrual period in the two years prior to the appointment. Initially, a treatment for tuberculosis was established with no success. Further investigation showed a 4 mm nodule in the right lung, and the transvaginal ultrasonography indicated the presence of deep endometriosis. Considering the occurrence of symptoms only during menses, an empirical therapy was instituted with remission of the complaints.

A síndrome da endometriose torácica é uma condição rara que inclui quatro entidades: pneumotórax catamenial, hemotórax catamenial, hemoptise catamenial e nódulos pulmonares. Descrevemos o caso de uma mulher de 23 anos de idade com queixas de hemoptise durante o período menstrual por 2 anos. Inicialmente, um tratamento para a tuberculose foi estabelecido sem sucesso. Uma investigação adicional mostrou um nódulo de 4 mm no pulmão direito, e a ultrassonografia transvaginal indicou a presença de endometriose profunda. Considerando a ocorrência de sintomas somente durante a menstruação, uma terapia empírica foi instituída com remissão das queixas.

Dienogest and deep infiltrating endometriosis: The remission of symptoms is not related to endometriosis nodule remission.

OBJECTIVE: To evaluate the effectiveness of dienogest in controlling pain caused by deep infiltrating endometriosis (DIE), its influence on the quality of live (QoL) of women affected by the disease, and the effect of the drug on the volume of endometriotic lesions. STUDY DESIGN: A prospective cohort study including 30 women with a sonographic diagnosis of DIE (intestinal and posterior fornix) treated with dienogest 2mg per day for 12 months. We evaluated the pain symptoms and the volume of the intestinal and posterior fornix lesions before and after 12 months of use of dienogest. To perform the statistical analysis, we used the Wilcoxon signed-rank test, and the relationship between the data was tested using the Spearman correlation coefficient. RESULTS: Women were on average 36.13±6.24years old. Pain symptoms most commonly reported were dyspareunia (83.3%), dysmenorrhea (73.3%), and pelvic pain (66.7%). After 12 months of treatment with dienogest, there was significant improvement of various symptoms (dyspareunia p=0.0093, dysmenorrhea p<0.0001; pelvic pain p=0.0007; and bowel pain p<0.0001), without a reduction in the volume of endometriotic nodules. There were significant improvements in the parameters that comprise the QoL (physical p<0.0001; p=0.0007 psychological) and the self-assessment of QoL (p=0.0069) and health (p=0.0001). CONCLUSION: Dienogest is an effective medication to control symptoms of pain related to DIE, even without reducing the volume of DIE nodules.

The paroxetine effect on exercise performance depends on the aerobic capacity of exercising individuals.

This study investigated the influence of aerobic capacity on the activation of the central serotonergic system and exercise fatigue in young men that ingested a selective serotonin reuptake inhibitor and were then subjected to moderate-intensity physical exercise. The maximal oxygen consumption of sixteen volunteers was measured during an incremental test. The volunteers were divided into two groups: subjects with higher (HAC) and lower (LAC) aerobic capacities. The volunteers were subjected to four experimental trials in which they ingested either placebo or paroxetine (10, 20 or 40 mg) and, 4.5 h later, cycled at 60% of their maximal power output until reaching fatigue. None of the three paroxetine doses influenced the total exercise time in the LAC group. However, for the HAC group, the time to fatigue in the 20 mg paroxetine condition was 15% less than that in the placebo condition (76.3 ± 5.1 min vs. 90.0 ± 7.9 min; p < 0.05). The time to fatigue was higher in the HAC group than in the LAC group for all treatments. Our results provide additional evidence that aerobic capacity modulates the activity of the serotonergic system. However, contrary to what would be expected considering previous reports, the activation of the serotonergic system in exercising subjects in the HAC group was not less than that in the LAC group. Key pointsThe physical performance of the higher aerobic capacity group after administration of 20 mg of paroxetine decreased relative to that after administration of the placebo, whereas the same dose of paroxetine had no effect in the lower aerobic capacity group.Our results provide additional evidence that aerobic capacity modulates the activity of the serotonergic system.Contrary to what would be expected considering previous reports, the present findings suggest that the activity of the serotonergic system during exercise is not attenuated in individuals with a higher aerobic capacity relative to those that have a lower aerobic capacity.A dose-dependent effect of paroxetine on physical performance was not observed in either group; for example, in the subjects with higher aerobic capacity, 40 mg of paroxetine did not enhance or even reproduce the ergolytic effect caused by 20 mg of paroxetine.None of the peripheral variables measured explain the reduced total exercise time after administration of 20 mg of paroxetine in the subjects with higher aerobic capacity.

Gestação gemelar de mola hidatiforme completa com feto vivo / Twin pregnancy with complete hydatidiform mole and living fetus

A gestação gemelar de uma mola hidatiforme completa coexistindo com um feto vivo é uma entidade rara. Os poucos casos descritos na literatura mostram que, em geral, esse tipo de gestação cursa com risco aumentado de aborto espontâneo, parto prematuro, morte fetal intraútero, sangramento, pré-eclâmpsia e doença trofoblástica persistente. Neste artigo, descreveremos o caso de uma primigesta de 20 anos de idade que apresentou uma gestação gemelar de feto vivo com mola completa, a qual transcorreu sem intercorrências e complicações e cujo diagnóstico diferencial com degeneração da placenta foi feito com anatomopatológico.

Twin pregnancy with a complete hydatidiform mole and a living fetus is a rare entity. According to the few cases described in the literature, this kind of gestation commonly has higher risks of miscarriage, preterm delivery, intrauterine fetal death, bleeding, preeclampsia and persistent trophoblastic disease. This study reports the case of a 20 years old primiparous patient with complete hydatidiform mole and living fetus, whose pregnancy was successfully carried to term. The differential diagnosis with placental degeneration was reached through anatomopathological investigation.

[Socio-demographic features of puerperas and pregnancy follow-up: what has changed in 17 years?]. / Características sócio-demográficas das puérperas e seguimento da gravidez: o que mudou em 17 anos?

In recent years, the time for motherhood has been postponed, which is related to social aspects and can lead to health problems for the pregnant women and the child. An appropriate follow-up of the pregnancy is essential for identification and early treatment of possible complications. The purpose of this study was to evaluate some social and demographic characteristics and the pregnancy follow-up among puerperas, in two different times separated by 17 years (1991 e 2008). In this study, we found that the birth of a first child occurs now later, is more planned and happens more frequently outside of marriage. The postponement of motherhood can be associated with an increased rate of miscarriages. There has been a decrease in the rate of induced abortions, which is probably the result of the implementation of strategies for family planning. We noticed a decline in the number of pregnancies that had not a proper follow-up, demonstrating the improvement of health care. The immigrant population is responsible for about one quarter of the births in the Algarve, with a higher percentage of unplanned pregnancies, which eventually might be related to socio-economic vulnerabilities, but no difference was found in the surveillance of pregnancy, demonstrating a good accessibility of this population to health care. It is essential the existence of information about the risks of a late pregnancy and of social infrastructures to support motherhood at younger ages. Pregnancy surveillance programs have been successful, but there are still gaps in obstetric monitoring. Despite good results in terms of surveillance of pregnancy, the immigrant population may present some vulnerabilities, which means that their access to maternal and child health care should be monitored.