Evidence-based guidelines for the use of tracheostomy in critically ill patients.

OBJECTIVES: To provide evidence-based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. METHODS: A taskforce composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified, of which 226 publications were chosen. The taskforce generated a total of 19 recommendations, 10 positive (1B, 3; 2C, 3; 2D, 4) and 9 negative (1B, 8; 2C, 1). A recommendation was not possible in 6 questions. CONCLUSIONS: Percutaneous techniques are associated with a lower risk of infections compared with surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.

[Stability of anthocyanins in pasteurized juice of blackberry ((Rubus glaucus benth]. / Estabilidad de antocianinas en jugos pasteurizados de mora (Rubus glaucus Benth).

In this research the chemical stability of total anthocyanins in three pasteurized juices elaborated from 12% of blackberry (Rubus glaucus Benth) pulp, and addition of ascorbic acid (Formulation A: 0.1%, Formulation B: 0.05% and Formulation C: 0.01%), was evaluated by means of absorption visible spectra (400-580 nm). Physicol-chemical characterization (acidity, soluble solids content in degree Brix, pH), and count of mesophilic microorganism, fungi, yeasts, fecal coliforms (PMN/mL) and Escherichia coli, were evaluated. Sensorial parameters (color, smell, flavor) were investigated by means of un-trained panel using a hedonic scale (Fridman, P < 0.05). The study was performed during storage for 9 days. The total anthocyanins were reported as pelargonidin-3-glycoside g/L, and no significant differences were founded among the evaluated in each formulation during storage (P > 0.05). Bactocromic effect due to oxidation as not observed. Acidity (6.0-7.2 mL NaOH 0.079 N), soluble solids content (9.0-9.8 degrees Brix) and pH (3.4) did not show significant differences (P > 0.05). The microbiological evaluation showed minimum values for pasturized products (fungi CFU/mL < 10, yeast CFU/mL < 10, fecal coliforms CFU/mL < 10 and mesophilic microorganism CFU/mL between 120-140 on first day in storage). Sensorial analysis did not show significant differences (Fridman, P > 0.05).

Precarização do trabalho e efeitos subjetivos: interlocuções entre práticas de pesquisa / Work precarization and subjective effects: interlocutions between research practices / Precarización del trabajo y efectos subjetivos: interlocuciones entre prácticas de investigación / Précarisation du travail et effets subjectifs: interlocutions entre pratiques de recherche

Neste artigo, procurou-se observar os efeitos subjetivos do processo de precarização do trabalho na contemporaneidade. Para tal, promoveu-se a articulação dos resultados de três pesquisas realizadas com diferentes sujeitos que têm, em sua singularidade, um ponto de interseção: a imersão nesse contexto de precarização. Como procedimento de análise de dados, foi adotada a Psicodinâmica do Trabalho a partir da qual propôsse uma reflexão sobre as formas precarizadas de trabalho e seus desdobramentos. As pesquisas articuladas envolvem psicoterapeutas que atendem em clínicas vinculadas a planos de saúde, trabalhadoras e trabalhadores terceirizados do Departamento de Trânsito do Estado do Rio de Janeiro - e aspectos legislativos da terceirização no Brasil - e funcionários subcontratados de uma universidade pública. Observou-se que as práticas flexíveis que constituem o cenário de precarização do trabalho tendem a instrumentalizar o fazer singular de cada sujeito, dificultar a formação de coletivos e movimentos de resistência que visam o reconhecimento de direitos e afirmam a criação de formas de trabalho que estejam a favor da vida em suas dimensões ético-políticas.

In this article, we seek to observe the subjective effects of the process of work precarization in the contemporaneity. For that, we promote the articulation of the results of three researches conducted with different subjects that have, in their singularity, a point of intersection: the immersion in this context of precarization. The Psycho-dynamics of Work was adopted as a data analysis procedure from which we intend to propose a reflection about the precarious forms of work and its consequences. The articulated researches involve psychotherapists who work in clinics linked to health plans, outsourced employees from DETRAN/RJ - and legal aspects about outsourcing process in Brazil - and subcontracted workers of a public university. Therefore, we observe that the flexible practices that constitute the scenario of the work precarization tend to instrumentalize the singular work of each subject, to hinder the formation of collectives and resistance movements that aim at the recognition of rights and affirm the creation of forms of work that are linked to life in its ethical-political dimensions.

En este artículo tratamos de observar los efectos subjetivos del proceso de precarización del trabajo en la contemporaneidad. Para eso, promovemos la articulación de los resultados de tres investigaciones realizadas con diferentes sujetos que tienen, en su singularidad, un punto de intersección: la inmersión en ese contexto de precarización. Como procedimiento de análisis de datos, se adoptó la Psicodinámica del Trabajo a partir de la cual buscamos proponer una reflexión sobre las formas precarizadas de trabajo y sus desdoblamientos. Las investigaciones articuladas implican a psicoterapeutas que atienden en clínicas vinculadas a planes de salud, trabajadores y trabajadoras tercerizados del DETRAN/RJ - y aspectos legislativos de la tercerización en Brasil - y empleados subcontratados de una universidad pública. Observamos, por lo tanto, que las prácticas flexibles que constituyen el escenario de precarización del trabajo tienden a instrumentalizar el hacer singular de cada sujeto, dificultar la formación de colectivos y movimientos de resistencia que apuntan al reconocimiento de derechos y afirman la creación de formas de trabajo que están a favor de la vida en sus dimensiones ético-políticas.

Dans cet article, nous avons cherché à observer les effets subjectifs du processus de précarisation du travail à l'époque contemporaine. À cette fin, nous avons favorisé l'articulation des résultats de trois enquêtes menées auprès de sujets différents qui ont, dans leur singularité, un point d'intersection: l'immersion dans ce contexte de précarité. En tant que procédure d'analyse des données, il a été adopté la psychodynamique du travail à partir de laquelle une réflexion sur les formes de travail précaires et son déroulement a été proposée Les enquêtes impliquent des psychothérapeutes qui fréquentent des cliniques liées à des régimes de soins de santé complementaria, des travailleurs soustraités du Département de la Circulation de l'État de Rio de Janeiro - ainsi que les aspects législatifs de la soustraitance au Brésil - et des employés soustraités d'une université publique. Il a été observé que les pratiques flexibles qui constituent le scénario de précarisation du travail tendent à instrumentaliser la pratique singulière de chaque sujet, à entraver la formation de mouvements collectifs et de mouvements de résistance visant à la reconnaissance des droits et affirmant la création de formes de travail en faveur de la vie dans ses dimensions éthiques et politiques.

O trabalho, a terceirização e o Legislativo brasileiro: paradoxos e controvérsias / Work, outsourcing, and the brazilian Legislature: paradoxes and controversies / El trabajo, la subcontratación y el Legislativo brasileño: paradojas y controversias

O objetivo deste artigo é analisar o Legislativo brasileiro frente à terceirização como modelo de gestão e suas implicações quanto à precarização e à flexibilização do trabalho. Inicialmente, situamos algumas mudanças do mundo do trabalho na forma de exploração do capital humano advindas dos sistemas taylorista e fordista. Observamos a crise estrutural dos anos 1970 e seus efeitos nas relações entre trabalho e trabalhadores, com uma breve análise dos anos 1980, período em que houve a implantação da acumulação flexível do capital e,como consequência, uma radical transformação na área de tecnologia e a mundialização da economia. Discute-se o funcionamento do Legislativo brasileiro e conclui-se com apontamentos sobre o Projeto de Lei 4.330/2004, de autoria do deputado Sandro Mabel (PMDB-GO), cujo principal encaminhamento é a permissão da terceirização nas denominadas atividades-fim.

The objective of this article is to analyze the Brazilian Legislature in relation to outsourcing as a management model and its implications for making work more informal and flexible. Initially, we situate some changes that occurred in the world of work in the form of exploitation of human capital, arising from the Taylor and Ford systems. We have analyzed the structural crisis of the '70s and its effects on relations between work and workers, with a brief analysis of the '80s, when flexible capital accumulation was implemented, and as a result, globalization of the economy and a radical technological transformation took place. The article discusses the functioning of the Brazilian Legislature and concludes with notes on the Law 4.330/2004 Project, by Rep.Sandro Mabel (PMDB-GO), whose principal characteristic is to permit outsourcing in so-called end-activities.

El objetivo de este estudio es el analizar el Legislativo brasileño ante la subcontratación como un modelo de gestión y sus implicaciones respecto de la precariedad y flexibilización del trabajo.Primeramente, se sitúan algunos cambios que ocurrieron en el mundo del trabajo en materia de explotación del capital humano, resultantes de los sistemas Taylor y Ford. Luego, se analiza la crisis estructural de la década de 1970 y sus efectos en las relaciones entre trabajo y trabajadores. Para ello, hicimos un breve estudio de la década de 1980, período en que hubo la implementación de la acumulación flexible del capital y, consecuentemente, una radical transformación en el área de la tecnología y la globalización de la economía. Se discute el funcionamiento del Legislativo brasileño y se concluye con comentarios referentes al Proyecto de Ley 4.330/2004, de autoría del diputado Sandro Mabel (PMDB-GO), cuyo principal encaminamiento es el permiso de la subcontratación en las denominadas actividades-fin.

La amiloidosis como complicación de la anemia drepanocítica / Amyloidosis as a complication of drepanocytic anemia

Se realizó un estudio ambipectivo, analítico y longitudinal en 15 pacientes con anemia drepanocítica durante el período comprendido entre 1995 y el 2001 con el objetivo de evaluar la existencia de amiloidosis sistémica, mediante la realización de biopsia de la grasa abdominal, se utilizaron las técnicas de Cristal Violeta y Rojo Congo; se consideró como diagnóstico los resultados positivos en ambas coloraciones, lo que sucedió en 6 pacientes (40 %). Se revisaron las microhistorias de seguimiento para determinar el comportamiento clínico-hematológico de la enfermedad, se utilizaron como variables las cifras promedio de hemoglobina y reticulocitos, los niveles de hemoglobina fetal y la frecuencia de crisis vasoclusivas, de transfusiones así como de episodios infecciosos. Se evaluó la relación entre estas variables y la existencia de amiloidosis mediante el cálculo del riesgo relativo, no se encontró relación estadísticamente significativa en ningún caso; aunque pudo demostrarse un aumento del riesgo de amiloidosis relacionado con la frecuencia de infecciones y las crisis vasoclusivas.

An ambiopective, analytical and longitudinal study was conducted in 15 patients with drepanocytic anemia between 1995 and 2001 aimed at evaluating the existance of systemic amyloidosis by performing biopsy of the abdominal fat. The Violet Glass and and Congo Red techniques were used. The positive results in both stainings, which were observed in 6 patients (40 %), were considered as a diagnosis. The microhistories of follow-up were reviewed to determine the clinical and hematological behavior of the disease. The average figures of hemoglobin and reticulocytes, the levels of fetal hemoglobin and the frequency of vasoocclusive crises, of transfusions, as well as of infectious episodes, were used as variables. The relation between these variables and the existance of amyloidosis was evaluated by calculating the relative risk. No statistical significant relation was found in any case, although an increase of the risk for amyloidosis related to the frequency of infections and to the vasoocclusive crises could be proved.

Estabilidad de antocianinas en jugos pasteurizados de mora (Rubus glaucus Benth) / Stability of anthocyanins in pasteurized juice of blackberry (Rubus glaucus benth)

In this research the chemical stability of total anthocyanins in three pasteurized juices elaborated from 12 of blackberry (Rubus glaucus Benth) pulp, and addition of ascorbic acid (Formulation A: 0.1, Formulation B: 0.05 and Formulation C: 0.01), was evaluated by means of absorption visible spectra (400-580 nm). Physicol-chemical characterization (acidity, soluble solids content in degree Brix, pH), and count of mesophilic microorganism, fungi, yeasts, fecal coliforms (PMN/mL) and Escherichia coli, were evaluated. Sensorial parameters (color, smell, flavor) were investigated by means of un-trained panel using a hedonic scale (Fridman, P < 0.05). The study was performed during storage for 9 days. The total anthocyanins were reported as pelargonidin-3-glycoside g/L, and no significant differences were founded among the evaluated in each formulation during storage (P > 0.05). Bactocromic effect due to oxidation as not observed. Acidity (6.0-7.2 mL NaOH 0.079 N), soluble solids content (9.0-9.8 degrees Brix) and pH (3.4) did not show significant differences (P > 0.05). The microbiological evaluation showed minimum values for pasturized products (fungi CFU/mL < 10, yeast CFU/mL < 10, fecal coliforms CFU/mL < 10 and mesophilic microorganism CFU/mL between 120-140 on first day in storage). Sensorial analysis did not show significant differences (Fridman, P > 0.05).

Tratamiento quirúrgico del cáncer infiltrante de cuello uterino. Supervivencia / Surgical treatment of the infiltrative cervical cancer. Survival rate

El cáncer de cuello uterino ocupa el segundo lugar entre los tipos de cáncer de la mujer y el quinto entre todos los tipos de cáncer que afectan al ser humano. Se realizó un estudio retrospectivo y longitudinal a las pacientes con cáncer infiltrante de cuello uterino que recibieron tratamiento quirúrgico entre los años 1988 y 1993 en el Hospital "Abel Santamaría Cuadrado", de Pinar del Río. Para esta investigación se confeccionó encuesta, que fue aplicada a las 37 pacientes estudiadas; los datos fueron obtenidos de las historias clínicas y el interrogatorio a las pacientes. Las variables estudiadas fueron: edad, número de partos, edad del primer coito y del primer parto y la supervivencia. Entre los principales resultados se encontró que el grupo de edades entre los 40-49 años fue el más frecuente en las pacientes estudiadas, todas las pacientes habían parido, más de la mitad de las pacientes comenzaron las relaciones sexuales antes de los 17 años. La adolescencia predominó como edad del primer parto en las pacientes estudiadas y solo una paciente falleció en este periodo.

The cervix cancer takes the second place among the types of cancer in women and the fifth place among all of the types affecting the human being. A retrospective, longitudinal study was performed in patients suffering from infiltrative cervix cancer and they were given surgical treatment between 1988 and 1993 at Abel Santamaría Cuadrado General Hospital in Pinar del Río. A survey was made applying it to 37 patients; data were collected from the clinical records and from the interview to patients. Age, number of deliveries, age at the first coitus and first delivery and survival were the studied variables. It was found that 40-49 year old group was the most frequent among the studied patients, all the patients had given birth, over more than half of patients started sexual relations before 17 years of age. Adolescence prevailed as first - delivery age in patients and only one of them died during this period.

Eficacia y aporte económico de la punción aspirativa con aguja fina en ganglio linfático / Effectiveness and economic contribution of thin-needle aspiration biopsy in lymphatic node

Se tomaron todas las punciones aspirativas con aguja fina (PAAF) de ganglios linfáticos durante 15 años de trabajo y se compararon con los resultados histológicos, en un estudio prospectivo longitudinal, descriptivo en 1221 pacientes, obteniéndose una evaluación del método con una especificidad de un 97,97% y una eficacia de un 94,51%, se comprobó que a medida que se envejece aumenta la posibilidad de enfermar por una neoplasia maligna. En los pacientes diagnosticados como negativos la patología más frecuente fue la adenitis crónica con 560 pacientes y en los casos diagnosticados como positivos las metástasis fueron las más frecuentes con 247 enfermos, seguidas por los linfomas no Hodgkin y Hodgkin. Se calcularon los costos unitarios tanto del acto quirúrgico para la extracción de la muestra como del procesamiento del tejido una vez obtenido, determinando un ahorro total de $37,240.06 en los casos en que el diagnóstico pudo ser concluido sólo mediante la PAAF, sin necesidad de la realización de biopsia por parafina.

All fine needle aspiration biopsies (FNAB) in lymphatic glands performed during 15 years were compared with the histological results in a prospective, longitudinal and descriptive study in 1221 patients, assessing the method with a specificity of 97.97 % and an effectiveness of 94.51 %. It was proved that at the time patients grew older the possibility of suffering from a malignant neoplasm increased. In those patients having a negative diagnosis Chronic Adenitis was the most frequent pathology (560) and in positive diagnosis metastases were the most frequent (247) followed by Non Hodgkin and Hodgkin lymphoma. Unitary costs of the surgical access for sample collection, as well as, the process of obtaining tissue were calculated determining a total saving of 37.240.06 in those cases where the diagnosis could be concluded via FNAB, without necessity of carrying out biopsy through paraffin embedment.