Biofilme em parafusos ortopédicos prontos para uso adquiridos por meio de sistema de consiganação/comodato / Biopelícula en tornillos ortopédicos listos para uso adquiridos por medio del sistema de consignación/comodato / Biofilm on patient-ready orthopaedic screws acquired through the loaner system

Resumo Objetivo Avaliar a integridade da superfície e as condições microbiológicas de parafusos prontos para uso em bandejas ortopédicas após múltiplos processamentos. Métodos Após o processamento completo, as bandejas utilizadas em cirurgias de pequenos fragmentos, fornecidas por meio de sistema de consignação/comodato em um hospital brasileiro, foram selecionadas aleatoriamente durante quatro meses. Os parafusos mais utilizados (números 14, 16 e 18 - Grupo 1) e menos utilizados (números 10 e 38 - Grupo 2), portanto, os mais e menos expostos a agentes biológicos, químicos e físicos, foram aleatoriamente removidos e submetidos a inspeção visual (n=126), seguido de cultura bacteriana (n=6 parafusos/bandeja, 9 bandejas), teste de proteínas (n=6 parafusos/bandeja, 9 bandejas) e Microscopia Eletrônica de Varredura (MEV) (n=2 parafusos/bandeja, 9 bandejas). As culturas positivas foram submetidas a métodos automatizados de identificação bacteriana e suscetibilidade antimicrobiana. Resultados Foram detectadas ranhuras em 8,7% dos parafusos, predominantemente no Grupo 2 (8/11). Proteína residual foi detectada em 96,3%, e não houve diferença estatisticamente significativa na quantidade de proteína entre os grupos (P=0,07). Crescimento bacteriano foi identificado em 3/54 parafusos. Danos na superfície e presença de sujidade foram visualizados em todos os parafusos submetidos a MEV. Formação de biofilmes extensos foi detectada em oito parafusos, três do Grupo 1 e cinco do Grupo 2. Conclusão Recuperação de bactérias viáveis, acúmulo de biofilme e danos na superfície foram detectados nos parafusos prontos para uso. Os parafusos costumam permanecer nas bandejas cirúrgicas e serem submetidos a múltiplos processamento, sendo expostos a contaminação e danos repetidas vezes. Esses achados apontam para a necessidade de discutir e repensar a forma como esses implantes de uso único são atualmente disponibilizados para cirurgias.

Resumen Objetivo Evaluar la integridad de la superficie y las condiciones microbiológicas de tornillos listos para uso en bandejas ortopédicas después de múltiples procesamientos. Métodos Después del procesamiento completo, fueron seleccionadas aleatoriamente durante cuatro meses las bandejas utilizadas en cirugías de pequeños fragmentos, proporcionadas mediante el sistema de consignación/comodato en un hospital brasileño. Los tornillos más utilizados (números 14, 16 y 18 - Grupo 1) y menos utilizados (números 10 y 38 - Grupo 2), por lo tanto, los más y menos expuestos a agentes biológicos, químicos y físicos, fueron quitados aleatoriamente y sometidos a inspección visual (n=126), seguido de cultivo bacteriano (n=6 tornillos/bandeja, 9 bandejas), prueba de proteínas (n=6 tornillos/bandeja, 9 bandejas) y microscopía electrónica de barrido (MEB) (n=2 tornillos/bandeja, 9 bandejas). Los cultivos positivos fueron sometidos a métodos automatizados de identificación bacteriana y susceptibilidad antimicrobiana. Resultados Se detectaron ranuras en el 8,7 % de los tornillos, predominantemente en el Grupo 2 (8/11). Se detectó proteína residual en el 96,3 % y no se encontró diferencia estadísticamente significativa en la cantidad de proteína entre los grupos (P=0,07). En 3/54 tornillos se identificó crecimiento bacteriano. Se visualizaron daños en la superficie y presencia de suciedad en todos los tornillos sometidos a MEB. En ocho tornillos se detectó la formación de biopelículas, tres del Grupo 1 y cinco del Grupo 2. Conclusión Se detectó recuperación de bacterias viables, acumulación de biopelícula y daños en la superficie en los tornillos listos para uso. Los tornillos suelen permanecer en las bandejas quirúrgicas y son sometidos a múltiples procesamientos, donde están expuestos a contaminación y daños repetidas veces. Estos descubrimientos señalan la necesidad de discutir y repensar la forma como estos implantes de uso único se ponen a disposición para cirugía actualmente.

Abstract Objective Assess the surface integrity and microbiological conditions of patient-ready screws in orthopaedic trays that had been multiply reprocessed. Methods After full reprocessing, clinical trays used for small fragment surgery provided through a loaner system to a Brazilian hospital were randomly selected during four months. The most (numbers 14, 16 and 18 - Group 1) and least (numbers 10 and 38 - Group 2) frequently implanted screws, therefore, the ones estimated to be the most and least exposed to biological, chemical and physical agents, were randomly removed and subjected to visual inspection (n=126), followed by bacterial culture (n=6 screws/tray, 9 trays), protein test (n=6 screws/tray, 9 trays) and Scanning Electron Microscopy (SEM) (n=2 screws/tray, 9 trays). Positive cultures were subjected to automated bacterial identification and antimicrobial susceptibility tests. Results Grooves were detected on 8.7% screws, predominantly in Group 2 (8/11). Residual protein was detected on 96,3%, and there was no statistically significant difference in the amount of protein between the groups (P=0.07). Bacterial growth was identified in 3/54 screws. Surface damage and soil were visualized on all screws subjected to SEM. Extensive biofilms were detected on eight screws, three from Group 1 and five from Group 2. Conclusion Recovery of bacteria, biofilm accumulation and surface damage were detected on patient-ready screws. Screws frequently remain in surgical trays for multiple reprocessing; thus they are repeatedly exposed to contamination and damage. These findings point to the need to discuss and review the way these single-use implants are currently made available for surgeries.

Management of surgical instruments at loaner companies in upper-middle and high-income countries: The other side of the coin.

BACKGROUND: The complex and specific surgical instruments (SI) acquired from loaner companies are provided non-sterile and must be reprocessed before each use. We evaluated the management practices of SI in loaner companies in a high (Australia) and a middle-income (Brazil) country. METHODS: Seven company managers in Australia and eight in Brazil replied to the self-administrated survey. RESULTS: Failures to meet recommended practices were detected, including standard operating procedure (SOP) provision, minimum delivery time, transport container and decontamination in loaner companies in both countries. Six of seven loaner companies in each country provided SOP for instrument reprocessing (one company in Brazil did not reply). Solicitation of the SI may occur 12 h before need in Brazil, and delivery of the set could be accepted 4 h before surgery in both countries. Transport of SI on stainless steel/aluminium trays was reported by 42.85% and 28.6% of companies in Brazil and Australia, respectively. In Australia, 57.1% of the loaner companies affirmed they performed cleaning only if the SI were visibly dirty. In Brazil, 62.5% of the companies reported they use alcohol to wipe SI. CONCLUSIONS: There is a need for standardisation of requirements and process verification improvement in loaner SI reprocessing and management.

Reprocessing of loaned surgical instruments/implants in Australia and Brazil: A survey of those at the coalface.

BACKGROUND: Acquisition of surgical instruments (SI) and implants by loaner system is a worldwide practice. Although quality of device reprocessing has been reported to be lower in low and middle-income countries compared with higher income countries, few investigations have been conducted on the management and reprocessing of loaned devices. Thus, in this study we evaluate the practices of management and reprocessing of loaner SI and non-sterile implants (NSI) in a high (Australia) and a middle-income (Brazil) country. METHODS: Cross-sectional surveys (hardcopy or online form) was self-administered by sterilising service unit's personnel of Brazilian and Australian hospitals. Only those units that sourced orthopaedic surgical instruments and non-sterile loaned implants from independent companies were eligible. RESULTS: A total of 65 questionnaires from Australia and 168 from Brazil were analysed. Quality indicators regarding structure and work process for the management and reprocessing of loaned SI and NSI was of a higher standard in Australia than in Brazil. However, failures were detected in both countries, for instance delivery delays and improper point-of-use pre-cleaning practices. CONCLUSION: There are key challenges inherent of the multifaceted reusable medical devices loaner system in both countries, such as communication failures, implementation of non-recommended practices, reprocessing of NSI, and other related to structure and process quality indicators, that must be faced. Initial and ongoing education and training should be provided and should embrace the themes of technical proficiency, effective communication and teamwork, and should include all personnel involved in this process, even loaner company staff.

Morphometry of the human bicipital groove (sulcus intertubercularis).

BACKGROUND: The bicipital groove is located between the greater and lesser tubercles at the proximal extremity of the humerus and extends inferiorly. Citations that anatomic variations of the groove could give rise to sliding of the biceps brachii muscle tendon led us to initiate a morphometric study on this groove. MATERIALS AND METHODS: The study was done on 50 dry humeral bones from adults of both genders and from both sides. A digital caliper rule was used to measure the length, thickness and width of the bicipital groove and the humerus. The angles of the bicipital groove were measured with a goniometer. RESULTS: The average length of the groove was 8.1 cm and it corresponded to 25.2% of the length of the humerus. The width at the midpoint of the groove was 10.1 mm and corresponded to 49.7% to 54.5% of the width of the humerus. The depth was 4.0 mm and corresponded to 18.8% of the depth of the humerus. The mean angle formed by the groove lips was 106 degrees . CONCLUSION: This study confirmed the variability of the measurements presented by the groove in relation to all the aspects considered. LEVEL OF EVIDENCE: Basic Science.

Arterial branches to the temporal muscle.

UNLABELLED: The temporal muscle is greatly used for forming myofascial flaps and transposition in cases of reconstructive and reparative plastic surgery of the face and neck. Despite this important application, lack of success has been reported, probably because of lack of knowledge of the anatomical characteristics of this muscle, such as variations in its blood supply. OBJECTIVES: To investigate the blood supply of the temporal muscle in order to provide an anatomical basis for reconstructive and reparative surgery of the face using flaps from the temporal muscle. This study was conducted by dissecting 21 half faces from cadavers of children (13 male and 8 female) that had been injected with neoprene latex through the common carotid artery. The temporal muscle usually received three or four arterial branches coming from the maxillary and superficial temporal arteries. The branches of the maxillary artery could be separate (anterior deep temporal, posterior deep temporal and accessory deep temporal arteries) or together with other branches of the maxillary artery, forming trunks. The branches of the superficial temporal artery were always separate (middle temporal artery). The anterior deep temporal artery originated in front of the coronoid process and the posterior deep temporal artery behind it. The numbers of arterial branches in the anterior and middle thirds of the muscle were similar and slightly greater than the number in the posterior third. The most frequent arterial branch in the anterior third was the anterior deep temporal artery; in the middle third, it was the posterior deep temporal artery; and in the posterior third, it was the middle temporal artery. The most frequent patterns of arterial branch presence in the temporal muscle were: a) anterior deep temporal, posterior deep temporal and middle temporal arteries; and b) anterior deep temporal, posterior deep temporal, accessory deep temporal and middle temporal arteries. The accessory deep temporal artery is a direct branch from the maxillary artery that originates at the level of the coronoid process of the mandible and participates in irrigating the anterior and middle thirds of the muscle.

Cirrose hepática: parte 2 - exames laboratoriais, diagnóstico, tratamento, complicações e prognóstico / Hepatic cirrhosis: part 2 - laboratorial exams, diagnosis, treatment, complications and prognostic

No presente artigo são revisados os aspectos diagnósticos (exames complementares), terapêuticos e prognósticos (relacionados principalmente às complicações) da cirrose hepática, importante problema de saúde pública no mundo atual

Citomegaloviroses: clínica, diagnóstico e tratamento / Cytomegalovirosis: clinical, diagnosis and treatment

Este artigo tem como objetivo discutir as manifestações da citomegalovirose, enfocando aspectos etiopatogênicos, epidemiológicos, manifestações clínicas, diagnóstico laboratorial, tratamento e profilaxia.

Análise das prescrições geradas pelas equipes do PSF e das unidades de atendimento imediato, em dois distritos sanitários do município de Contagem / MG

Foram analisados neste trabalho os parâmetros técnicos elegais de 3527 prescrições,correspondendo a 25% dasprescrições atendidas no mês de abril de 2000 em trêsFarmácias Comunitárias do SUS Contagem-MG.As prescrições foram geradas por 54 Equiopes de Saúde da Familia e por duass Unidades de Atendiemnto ImediatoemContagem-MG.Os resultados mostraram que amaioria dos usuários (~77%) teve suass receitas aviadas em até dois diasss após receber sua prescriç;o número médio de medicamentos por prescrição foi de 1,95,sendoque a maioria deles (83%,0) constavam na relação municipal de medicamentos essenciais; e onome genéricoapareceem85%,0dosmedicamentos prescritros.Este resultado sãomuito positivos,mas por outro lado a quantidade de informações omitidas nas prescrições estudadas ainda é preocupante,tais como a ausência da posologia(13,5%),da via de administração(21,4%),da duração do tratamento(28,6%) e da concentração domedicamento(43,9%)

Sindrome de Stevens-Johnson em paciente infectado pelo HIV / Stevens-Johnson's Syndrome in human imunodeficiency virus infection - HIV

A sindrome de Stevens-Johnson (SSJ) e um quadro caracterizado por eritema polimorfo cutaneo-mucoso grave, acompanhado de bolhas nas maculas purpuricas ou lesoes em alvo atipicas. No presente trabalho descreve-se o caso de um paciente masculino, branco, de 31 anos, portador da Sindrome de Imunodeficiencia Adquirida (SIDA) ha oito anos, apresentando lesoes dolorosas em palmas e plantas, caracterizadas como lesoes eritemo papulosas com centro vesiculoso tipo "em alvo", pruriginosas, difusas pelo corpo, acometendo inclusive conjuntivas, labios, palato e mucosa da regiao genital, tendo-se associado ao quadro a ocorrencia de episodios febris; foi entao estabelecido o diagnostico de SSJ. A partir do relato do caso e feita uma discussao dos aspectos mais relevantes da SSJ, alertando para a importancia de se estabelecer um diagnostico precoce e para a busca do provavel farmaco causador do quadro