The Contribution of the Triage Nurse in the Optimisation of Door-to-Computed-Tomography Time in Stroke.

A stroke is a time-sensitive emergency, so diagnosing and treating the victim promptly is extremely important. Therefore, the purpose of this study was to identify the influence of the Stroke Code Protocol's activation on the door-to-computed-tomography (door-to-CT) time and determine whether factors such as previous Modified Rankin Scale (mRS), age, and gender influence its activation. A retrospective study was conducted in a Medical-Surgical Emergency Department in the centre of Portugal from 1 January 2021 to 31 December 2022. The sample was selected according to the diagnosis assigned at the time of clinical discharge from the Emergency Department and the Stroke Code Protocol activation criteria. It was observed that 113 (50%) suspected stroke victims who met the activation criteria for the Stroke Code Protocol did not have the protocol activated, which had a highly significant influence (p < 0.001) on door-to-CT time. It was determined that activation at triage has an average door-to-CT time of 35 ± 18 min, post-triage activation has an average door-to-CT time of 38 ± 26 min, and non-activation has an average door-to-CT time of 1 h 04 ± 45 min. The need to implement an institutional protocol for activating the Stroke Code Protocol and provide specialised training for the multidisciplinary team is reiterated.

Time trend prevalence of helicobacter pylori infection and endoscopic findings in symptomatic children in Portugal: A retrospective study based on three time points in 2009, 2014, and 2019.

BACKGROUND: Helicobacter pylori infection acquisition occurs mainly in childhood and may be a critical factor in developing long-term complications. In contrast to other developed countries, previous studies have reported a relatively high H. pylori infection prevalence in Portugal, both in children and adults. However, there are no recent data concerning pediatric population. MATERIALS AND METHODS: We performed a retrospective observational study concerning an 11 years period (2009, 2014, 2019), that included patients under 18 years old who underwent upper endoscopy at a pediatric tertiary center. Demographic, clinical-pathological, and microbiological data were collected. RESULTS: Four hundred and sixty one children were included. The average age was 11.7 ± 4.4 years. In total, H. pylori infection was confirmed in 37.3% of cases (histology and/or culture) and a decreasing infection trend was observed (p = .027). The most common indication for endoscopy was abdominal pain, which was a good predictor of infection. Antral nodularity was present in 72.2% of the infected children (p < .001). In the oldest age groups, moderate/severe chronic inflammation, H. pylori density and lymphoid aggregates/follicles were positive predictors for the presence of antral nodularity. For all ages, the presence of antral nodularity, neutrophilic activity in the antrum and corpus and lymphoid follicles/aggregates in the antrum were positive predictors for the presence of H. pylori infection. Among the 139 strains tested for antibiotic susceptibility, 48.9% were susceptible to all tested antibiotics. Resistance to clarithromycin, metronidazole, and both was detected in 23.0%, 12.9%, and 6.5% of the strains, respectively; furthermore, resistance to ciprofloxacin and to amoxicillin was observed in 5.0% and 1.4% of the strains, respectively. CONCLUSIONS: The present study reports (for the first time in Portugal) a significant decreasing trend in the prevalence of pediatric H. pylori infection, although it remains relatively high compared to the recently reported prevalence in other South European countries. We confirmed a previously recognized positive association of some endoscopic and histological features with H. pylori infection, as well as a high prevalence rate of resistance to clarithromycin and to metronidazole. The clinical relevance of these findings requires confirmation with further studies at a national level, taking into account the high incidence rate of gastric cancer in Portugal and the potential need for country-specific intervention strategies.

Fatty acids composition in yellow-legged (Larus michahellis) and lesser black-backed (Larus fuscus) gulls from natural and urban habitats in relation to the ingestion of anthropogenic materials.

Urban habitats offer spatially and temporally predictable anthropogenic food sources for opportunistic species, such as several species of gulls that are known to exploit urban areas and take advantage of accessible and diverse food sources, reducing foraging time and energy expenditure. However, human-derived food may have a poorer nutritional quality than the typical natural food resources and foraging in urban habitats may increase birds' susceptibility of ingesting anthropogenic debris materials, with unknown physiological consequences for urban dwellers. Here we compare the fatty acids (FA) composition of two opportunistic gull species (the yellow-legged gull, Larus michahellis, and the lesser black-backed gull, Larus fuscus) from areas with different levels of urbanization, to assess differences in birds' diet quality among foraging habitats, and we investigate the effects of ingesting anthropogenic materials, a toxicological stressor, on gulls' FA composition. Using GC-MS, 23 FAs were identified in the adipose tissue of both gull species. Significant differences in gulls' FA composition were detected among the three urbanization levels, mainly due to physiologically important highly unsaturated FAs that had lower percentages in gulls from the most urbanized habitats, consistent with a diet based on anthropogenic food resources. The deficiency in omega (ω)-3 FAs and the higher ω-6:ω-3 FAs ratio in gulls from the most urbanized location may indicate a diet-induced susceptibility to inflammation. No significant differences in overall FA composition were detected between gull species. While we were unable to detect any effect of ingested anthropogenic materials on gulls' FA composition, these data constitute a valuable contribution to the limited FA literature in gulls. We encourage studies to explore the long-term physiological effects of the lower nutritional quality diet for urban dwellers, and to detect the sub-lethal impacts of the ingestion of anthropogenic materials.

Discriminative auditory fear learning requires both tuned and nontuned auditory pathways to the amygdala.

The auditory system has two parallel streams in the brain that have been implicated in auditory fear learning. The lemniscal stream has selective neurons that are tonotopically organized and is thought to be important for sound discrimination. The nonlemniscal stream has less selective neurons, which are not tonotopically organized, and is thought to be important for multimodal processing and for several forms of learning. Therefore, it has been hypothesized that the lemniscal, but not the nonlemniscal, pathway supports discriminative fear to auditory cues. To test this hypothesis we assessed the effect of electrolytic lesions to the ventral, or medial, division of the medial geniculate nucleus (MGv or MGm, which correspond, respectively, to the lemniscal and the nonlemniscal auditory pathway to amygdala) on the acquisition, expression and extinction of fear responses in discriminative auditory fear conditioning, where one tone is followed by shock (conditioned stimulus, CS(+)), and another is not (CS(-)). Here we show that with single-trial conditioning control, MGv- and MGm-lesioned male rats acquire nondiscriminative fear of both the CS(+) and the CS(-). However, after multiple-trial conditioning, control rats discriminate between the CS(+) and CS(-), whereas MGv- and MGm-lesioned do not. Furthermore, post-training lesions of MGm, but not MGv, lead to impaired expression of discriminative fear. Finally, MGm-lesioned rats display high levels of freezing to both the CS(+) and CS(-) even after an extinction session to the CS(+). In summary, our findings suggest that the lemniscal pathway is important for discriminative learning, whereas the nonlemniscal is important for negatively regulating fear responses.

Satisfações e insatisfações no trabalho do agente comunitário de saúde / Satisfacciones e insatisfacciones en el trabajo del agente comunitario de salud / Satisfactions and dissatisfactions of the community health agent work

Este estudo descritivo e de abordagem qualitativa teve como objetivo investigar fatores geradores de satisfaçãoe insatisfação em um grupo de Agentes Comunitários de Saúde, bem como identificar dificuldades vivenciadas em seuprocesso de trabalho. Foram entrevistados 22 Agentes Comunitários de Saúde de um município no noroeste do Estado doRio Grande do Sul, utilizando-se um instrumento com cinco perguntas norteadoras. As respostas foram interpretadasmediante análise temática, demonstrando-se satisfações e insatisfações destes trabalhadores, e de onde emergiram seiscategorias. Observou-se que a falta de reconhecimento profissional é uma fonte de insatisfação e que o saber socializadoé fator de realização profissional. Acredita-se que a construção de ambiências favoráveis no trabalho deste profissionalpode contribuir para o fortalecimento de sua identidade profissional e cidadã.

This study aimed to investigate factors leading to satisfaction and dissatisfaction among a group of CommunityHealth Agents, and to identify difficulties experienced in their work process. We interviewed 22 Community Health Agentsof a city in the northwest of the state of Rio Grande do Sul (BR), using an instrument with five questions. The responseswere interpreted using the thematic analysis technique, showing up satisfaction and dissatisfaction of these workers.Then, six categories arose. It was observed that one of the sources of dissatisfaction arise from the lack of professionalrecognition and that the shared knowledge is a factor of professional fulfillment. We believe that the construction offavorable environments for these workers can contribute to the strengthening of its civic and professional identity.

Este estudio descriptivo y de abordaje cualitativo tuvo como objetivo investigar los factores generadores desatisfacción e insatisfacción en un grupo de Agentes Comunitarios de Salud, bien como identificar dificultadesexperimentadas en su proceso de trabajo. Fueron entrevistados 22 Agentes Comunitarios de Salud de un municipio en elnoroeste del estado de Rio Grande del Sur (BR), utilizándose un instrumento con cinco preguntas guía. Las respuestasfueron interpretadas mediante análisis temático, demostrándose satisfacciones e insatisfacciones de estos trabajadores,y de donde surgieron seis categorías. Se observó que la falta de reconocimiento profesional es una fuente de insatisfaccióny que el saber socializado es factor de realización profesional. Se cree que la construcción de ambientes favorables en eltrabajo de este profesional puede contribuir para el fortalecimiento de su identidad profesional y cívica.

Hormonal anticipation of territorial challenges in cichlid fish.

In many territorial species androgens respond to social interactions. This response has been interpreted as a mechanism for adjusting aggressive motivation to a changing social environment. Therefore, it would be adaptive to anticipate social challenges and reacting to their clues with an anticipatory androgen response to adjust agonistic motivation to an imminent social challenge. Here we test the hypothesis of an anticipatory androgen response to territorial intrusions using classical conditioning to establish an association between a conditioned stimulus (CS = light) and an unconditioned stimulus (US = intruder male) in male cichlid fish (Oreochromis mossambicus). During the training phase conditioned males (CS-US paired presentations) showed a higher decrease in latency for agonistic response toward the intruder than unconditioned males (CS-US unpaired presentations). In the test trial, conditioned males showed an increase in androgen levels (i.e., testosterone and 11-ketotestosterone) relative to baseline, in response to the CS alone. This increase was similar to that of control males exposed to real intruders after CS, whereas unconditioned males showed a decrease in androgen levels in response to the CS. Furthermore, conditioned males were significantly more aggressive than unconditioned males during the post-CS period on test trial, even though the intruder male was not present during this period. These results reveal the occurrence of a conditioned androgen response that may give territorial males an advantage in mounting a defense to upcoming territorial intrusions, if the ability to readily elevate androgens does not co-vary with other traits that bear costs.

Avaliação comparativa entre o diâmetro de cones estandardizados e cones secundários b8 calibrados por régua calibradora, distando 1mm das suas pontas (d1) / Comparative evaluation between the diameter of standardized cones and secondary cones b8 calibrated by special scale, measuring 1mm from its tips (d1)

Introdução e Objetivo: O presente estudo teve por objetivo avaliar e comparar as medidas do diâmetro D1 de cones estandardizados e secundários calibrados com régua calibradora através da medição do primeiro milímetro dos cones, com um paquímetro digital. Material e Métodos: utilizou-se dez cones de guta-percha estandardizados de cada calibre #25, #30, #35 e #40 das marcas Dentsply/Maillefer e Tanari, e cones secundários B8 calibrados por régua calibradora, perfazendo um total de 160 cones. Com o auxílio de um paquímetro digital eletrônico foi verificado o diâmetro a um milímetro da ponta do cone (D1). Resultados: obteve-se que em uma das marcas houve diferença significativa entre os cones padronizados e os calibrados. Quando comparado o calibre dos cones padronizados das duas marcas, também ocorreu diferença estatística, não ocorrendo quando os cones foram calibrados por régua calibradora. Conclusão: os cones Tanari, em média, tiveram um resultado superior aos cones calibrados e Dentsply, nessa ordem.

Introduction and Objective: The present study had for objective to evaluate and to compare the measures of the D1 diameter of calibrated standardized and secondary cones calibrated using a special scale through the measurement of the first millimeter of the cones, with one digital caliper. Material and Methods: Ten standardized gutta-percha cones of each type had been used: #25, #30, #35 and #40. The manufacturers were Dentsply/Maillefer and Tanari, and secondary cones B8 calibrated by a special scale, making a total of 160 cones. With the aid of a digital electronic caliper was verified the diameter to the one millimeter back from the tip of the cone (D1). Results: one of the manufacturers brand had significant difference between the standardized cones and the calibrated ones. When compared, the caliber of the standardized cones of both brands presented difference in statistics, not occurring when the cones had been calibrated by the special scale. Conclusion: the Tanari cones, on average, had a superior result compared to the calibrated cones and Dentsply, in this order.

Evolução das varizes esofagogástricas após anastomose esplenorrenal proximal versus esplenorrenal distal / Esophagogastric variceal evolution after proximal vs distal splenorenal shunt

Avaliou-se, retrospectivamente, a evolução pós-operatória das varizes esofagogástricas em 40 pacientes submetidos a um dos seguintes procedimentos cirúrgicos: a (n=27) derivação esplenorrenal distal (ERD) e B (n=13) derivação esplenorrenal proximal (ERP). Todos os pacientes tinham hipertensão porta esquistossomótica com diagnóstico prévio de varizes do esôfago, presentes ou não no estômago, com um ou mais episódios de sangramento. os pacientes foram submetidos a um dos procedimentos cirúrgicos de acordo com a preferência do cirurgião assistente. Foram realizadas, nesses pacientes, endoscopias no período pré-operatório e aos seis, 12 e 18 meses no pós-operatório. Os dados de cada endoscopia foram coletados e comparados entre os grupos, verificando-se a presença de varizes do esôfago e estômago nos diferentes períodos, comparando esses achados através do teste do qui-quadrado, com significância para p<0,05. Os resultados obtidos não mostraram casos de ressangramento até o 18§ mês pós-operatório, nem casos de encefalopatia. Foram diagnosticadas varizes esofágicas, no pré-operatório, em 100 por cento dos pacientes nos dois grupos. No período pós-operatório, houve redução significativa das varizes do esôfago, quando estudados os dois grupos conjuntamente, para 40 por cento no sexto mês (p=0,0002), 30 por cento no 12§ mês (p=0,003) e 27,5 por cento no 18§ mês (p=0,003). No sexto mês pós-operatório, a incidência de varizes do esôfago foi maior nos pacientes com ERD quando comparados àqueles com ERP (51,9 por cento vs. 15,4 por cento, p=0,03). Quando estudadas as varizes aos 12 e 18 meses não foi observada diferença significativa entre pacientes submetidos a ERD ou ERP (12§ mês, 37 por cento vs. 15,4 por cento; 18§ mês, 25,9 por cento vs. 30,8 por cento). Foram vistas varizes gástricas em 37,5 por cento dos pacientes, com redução significativa no sexto mês (2,5 por cento, p=0,005). Entretanto, quando comparada com a frequência do sexto mês, houve aumento significativo no 12§ mês (5 por cento, p=0,00001) e 18§ mês (7,5 por cento, p=0,02). Quando comparados os grupos, no período pré-operatório, estas varizes estiveram presentes mais frequentemente no grupo submetido a ERP (69,2 por cento vs. 26 por cento, p=0,0005), sem diferença significativa no período pós-operatório (6§ mês, 16,6 por cento vs. 0 por cento; 12§ mês, 33,3 por cento vs. 0 por cento; 18§ mês, 33,3 por cento vs. 11,1 por cento)...