História da construção de saberes em enfermagem traumato-ortopédica / History of knowledge construction in trauma and orthopedic nursing care / Historia de la construcción del conocimiento en enfermería traumatológica ortopédica

Objetivo: analisar o desenvolvimento da enfermagem traumato-ortopédica a partir da primeira turma de residentes de um hospital especializado. Método: o estudo seguiu a metodologia histórica com abordagem qualitativa. As fontes foram documentos escritos e orais. Resultados: trabalhar em uma instituição especializada foi o ponto de partida para a busca por especialização de enfermeiras atuantes no cuidado traumato-ortopédico, que perceberam o saber/poder adquirido no trabalho assistencial, além da intenção de qualificar a assistência e elevar o hospital a instituto. Estratégias empregadas reúnem a busca por parcerias com instituições universitárias e associativas, além da criação de uma associação própria. Considerações finais: a enfermagem traumato-ortopédica ampliou seu espaço científico ao criar um curso de especialização com uma unidade acadêmica. Foi possível delimitar o poder acadêmico e institucional da enfermagem na instituição de saúde pela formação de enfermeiras especialistas constituindo um grupo de reconhecido pelo saber científico.

Objective: to analyze the development of trauma and orthopedic nursing care from the very first class of residents of a specialized hospital. Method: historical methodology study with a qualitative approach. The sources consisted of written and oral documents. Results: working in a specialized institution was the starting point for nurses who were seeking specialization in the field of trauma and orthopedic care as they noticed the power-knowledge acquired through care work, plus they were willing to improve assistance and take the hospital up to an institute level. Strategies used include the search for partnerships with universities and associative-type institutions, in addition to creating their own association. Final considerations: trauma and orthopedic nursing care expanded its scientific space by creating a specialization course together with an academic unit. It was possible to define the academic and institutional power of the nursing staff in the health institution by considering the training process of its nurse specialists, who consisted of a group recognized for their scientific knowledge.

Objetivo: analizar el desarrollo de la enfermería traumatológica ortopédica a partir del primer grupo de residentes de un hospital especializado. Método: estudio con metodología histórica con un enfoque cualitativo. Las fuentes fueron documentos escritos y orales. Resultados: el trabajo en una institución especializada fue el punto de partida para la búsqueda de la especialización de las enfermeras que trabajaban en la atención traumatológica ortopédica, quienes notaron el saber/poder adquirido en el trabajo asistencial, además de la intención de cualificar la atención y elevar el hospital al nivel de instituto. Las estrategias empleadas incluyen la búsqueda de alianzas con instituciones universitarias y asociaciones, y la creación de una asociación propia. Consideraciones finales: la enfermería traumatológica ortopédica amplió su espacio científico mediante la creación de un curso de especialización con una unidad académica. Se logró delimitar el poder académico e institucional de la enfermería en la institución de salud a través de la formación de enfermeros especialistas, que es un grupo reconocido por el conocimiento científico.

Formação da identidade profissional de enfermeiros para o trabalho no sistema prisional / Development of the professional identity of nurses to work in the prisonal system / Formación de la identidad profesional de los enfermeros para trabajar en el sistema penitenciario

Objetivo:analisar elementos motivadores da construção da identidade profissional de enfermeiros do sistema prisional. Método: estudo histórico-social, qualitativo, sob o método de triangulação de fontes orais e documentais coletados de maio a dezembro de 2020, iluminado pelo referencial foucaultiano. Protocolo de pesquisa aprovado pelo Comitê de Ética e Pesquisa da instituição signatária. Resultados: a realização de concurso público para o sistema prisional foi motivada pela aquisição de estabilidade. Os enfermeiros concursados eram despreparados para cuidar de pessoas presas. A disciplina e os poderes exercidos pelos guardas e presos surpreenderam estes enfermeiros, que precisaram se adaptar ao sistema num contexto social marcado pela violência urbana. Considerações finais: destaca-se, na construção da identidade destes profissionais, a capacidade para contornar medos e inseguranças, exercício de poder disciplinar e normatização do cuidado para o enfrentamento do cotidiano do trabalho. Emerge a necessidade de capacitação de enfermeiros nesta área na formação profissional(AU)

Objective: to analyze elements that motivate the construction of the professional identity of nurses in the prison system. Method: historical-social, qualitative study, under the method of triangulation of oral and documental sources collected from May to December 2020, illuminated by the Foucaultian reference. Approved by the Ethics and Research Committee. Results: the holding of a public tender for the prison system was motivated by the acquisition of stability. The registered nurses were unprepared to take care of prisoners. The discipline and powers exercised by guards and prisoners surprised these nurses, who had to adapt to the system in a social context marked by urban violence. Final considerations: in the construction of the identity of these professionals, the ability to overcome fears and insecurities, exercising disciplinary Power and standardizing care for coping with daily work is highlighted. The need to train nurses in thisarea in professional training emerges(AU)

Objetivo: analizar elementos que motivan la construcción de la identidad profesional de las enfermeras en el sistema penitenciario. Método: estudio histórico-social, cualitativo, iluminado por el referente foucaultiano, que utiliza el método de triangulación de fuentes orales y documentales recolectadas de mayo a 20 de diciembre. El Comité de Ética en Investigación de la institución firmante aprobó el protocolo de investigación. Resultados: la realización de un concurso público para el sistema penitenciario estuvo motivada por la adquisición de estabilidad. Los enfermeros aprobados por ese concurso público no estaban preparados para cuidar a los presos. La disciplina y los poderes que ejercían los guardias y presos sorprendieron a estos enfermeros, que debieron adaptarse al sistema en un contexto social marcado por la violencia urbana. Consideraciones finales: en la construcción de la identidad de estos profesionales se destaca la capacidad de superación de miedos e inseguridades, ejercicio de poder disciplinario y estandarización de los cuidados para hacer frente al cotidiano del trabajo. Surge la necesidad de capacitar a enfermeros en esta área en la formación profesional(AU)

A model of zinc dynamics evoked by intense stimulation at the cleft of hippocampal mossy fiber synapses.

Zinc is a transition metal that is particularly abundant in the mossy fibers of the hippocampal CA3 area. Despite the large number of studies about the zinc role in mossy fibers, the action of zinc in synaptic mechanisms is only partly known. The use of computational models can be a useful tool for this study. In a previous work, a model was developed to evaluate zinc dynamics at the mossy fiber synaptic cleft, following weak stimulation, insufficient to evoke zinc entry into postsynaptic neurons. For intense stimulation, cleft zinc effluxes must be considered. Therefore, the initial model was extended to include postsynaptic zinc effluxes based on the Goldman-Hodgkin-Katz current equation combined with Hodgkin and Huxley conductance changes. These effluxes occur through different postsynaptic escape routes, namely L- and N-types voltage-dependent calcium channels and NMDA receptors. For that purpose, various stimulations were assumed to induce high concentrations of cleft free zinc, named as intense (10 µM), very intense (100 µM) and extreme (500 µM). It was observed that the main postsynaptic escape routes of cleft zinc are the L-type calcium channels, followed by the NMDA receptor channels and by N-type calcium channels. However, their relative contribution for cleft zinc clearance was relatively small and decreased for higher amounts of zinc, most likely due to the blockade action of zinc in postsynaptic receptors and channels. Therefore, it can be concluded that the larger the zinc release, the more predominant the zinc uptake process will be in the cleft zinc clearance.

Residência multiprofissional em saúde mental: atuação de enfermeiros no processo de ensino-aprendizagem / Residencia multiprofesional en salud mental: el papel del enfermero en el proceso de enseñanza-aprendizaje / Multiprofessional residence in mental health: nursing of the nurses in the teaching-learning process

Na saúde mental nos deparamos com desafios ao longo dos anos, avançamos com políticas públicas direcionadas ao atendimento dos pressupostos da Reforma Psiquiátrica Brasileira. Com a ampliação de redes substitutivas a psiquiatria, novas práticas foram produzidas, influenciando o processo de formação de enfermeiros desde a graduação quanto na pós-graduação. Objetivo: analisar estratégias de enfermeiros para a integração ensino-assistência junto à residentes multiprofissionais em Saúde Mental. Métodos: Estudo qualitativo, descritivo, com dez enfermeiros de uma instituição psiquiátrica universitária. Os dados foram coletados de fevereiro/17 a maio/17, por entrevista semiestruturada e submetidos à análise de conteúdo, na modalidade temática. Resultados: Identificamos como estratégias: interação interprofissional; trabalho em equipe; estímulo ao cuidado psicossocial. Conclusão: Os enfermeiros atuam como facilitadores do processo de ensino-aprendizagem independentemente de serem preceptores ou não, porquanto permanentemente atuam na assistência. Sugerimos a formalidade no preparo de enfermeiros-preceptores utilizadores de metodologias de ensino apropriadas para o campo da saúde mental.(AU)

In mental health we have faced challenges over the years, we have advanced with public policies aimed at meeting the assumptions of the Brazilian Psychiatric Reform. With the expansion of substitutive networks for psychiatry, new practices were produced, influencing the process of training nurses from undergraduate and graduate levels. Objective: to analyze nurses' strategies for teaching-care integration with multiprofessional residents in Mental Health. Methods: Qualitative, descriptive study with ten nurses from a university psychiatric institution. Data were collected from February/17 to May/17, through semi-structured interviews and submitted to content analysis, in the thematic mode. Results: We identified as strategies: interprofessional interaction; team work; stimulus to psychosocial care. Conclusion: Nurses act as facilitators of the teaching-learning process regardless of whether they are preceptors or not, as they permanently work in care. We suggest formality in the preparation of nurse-preceptors who use appropriate teaching methodologies for the field of mental health.(AU)

En salud mental hemos enfrentado desafíos a lo largo de los años, hemos avanzado con políticas públicas dirigidas a cumplir con los presupuestos de la Reforma Psiquiátrica Brasileña. Con la expansión de las redes sustitutivas de la psiquiatría, se produjeron nuevas prácticas que influyeron en el proceso de formación de enfermeros de pregrado y posgrado. Objetivo: analizar las estrategias de los enfermeros para la integración enseñanza-cuidado con residentes multiprofesionales en Salud Mental. Métodos: Estudio cualitativo, descriptivo con diez enfermeras de una institución psiquiátrica universitaria. Los datos fueron recolectados del 17/02 al 17/05, por medio de entrevista semiestructurada y sometidos a análisis de contenido, en la modalidad temática. Resultados: Identificamos como estrategias: interacción interprofesional; trabajo en equipo; estímulo a la atención psicosocial. Conclusión: Los enfermeros actúan como facilitadores del proceso de enseñanza-aprendizaje independientemente de que sean preceptores o no, ya que actúan permanentemente en el cuidado. Sugerimos formalidad en la preparación de enfermeros-preceptores que utilicen metodologías de enseñanza adecuadas al campo de la salud mental.(AU)

Protocolos para atendimento de saúde mental na atenção primária: subsídios para transformação da assistência / Protocols for mental health care in primary-level services: subsidies for transforming the assistance provided / Protocolos para la atención de la salud mental en la atención primaria: contribuciones para transformar la atención

RESUMO Objetivo: analisar as repercussões no atendimento em saúde mental pela implantação de Protocolos de Conduta Assistencial em Unidade Básica de Saúde, em Juiz de Fora - MG - BR. Método: estudo histórico-social, realizado no ano de 2018, tendo por fontes diretas, documentos escritos e depoimentos orais, analisadas pelos pressupostos da Reforma Psiquiátrica. Resultados: apresentam-se as categorias: a) Reorganização da assistência em saúde mental por implantação de Protocolos de Conduta; b) Processo de referência e contrarreferência entre Unidade Básica de Saúde e serviços de atenção especializada em saúde mental; c) Transformação da assistência em saúde mental. Conclusão: protocolos organizaram a rede de atenção em saúde mental, sustentando a capacitação multiprofissional, introduzindo atenção primária à saúde como porta de entrada para acolhimento, tratamento e acompanhamento em saúde mental territorial.

ABSTRACT Objective: to analyze the repercussions on mental health care due to the implementation of Care Conduct Protocols in a Basic Health Unit from Juiz de Fora (Minas Gerais - Brazil). Method: a historical-social study carried out in 2018, having as direct sources written documents and oral testimonies analyzed according to the assumptions of the Psychiatric Reform. Results: the following categories are presented: a) Reorganization of mental health care through the implementation of Conduct Protocols; b) Referral and counter-referral process between Basic Health Units and specialized mental health care services; and c) Transformation of mental health care. Conclusion: the protocols organized the mental health care network, supporting multiprofessional training, introducing Primary Health Care as a gateway to welcoming, treatment and monitoring in territorial mental health.

RESUMEN Objetivo: analizar las repercusiones que tiene sobre la atención en salud mental la implantación de Protocolos de Conducta Asistencial en una Unidad Básica de Salud de Juiz de Fora (Minas Gerais - Brasil). Método: estudio histórico-social, realizado en 2018, cuyas fuentes directas son los documentos escritos y testimonios orales analizados según los presupuestos de la Reforma Psiquiátrica. Resultados: se presentan las categorías: a) Reorganización de la atención en salud mental a través de la implantación de Protocolos de Conducta; b) Proceso de derivación y contraderivación entre la Unidad Básica de Salud y los servicios de atención especializada en salud mental; c) Transformación de la atención en salud mental. Conclusión: los protocolos organizaron la red de atención en salud mental, apoyando la formación multidisciplinaria, instaurando la Atención Primaria de la Salud como puerta de entrada para la recepción, el tratamiento y seguimiento de la salud mental del territorio.

Working conditions of a nursing team in mental health facility / Condiciones de trabajo del equipo de enfermería en dispositivo de salud mental / Condições de trabalho da equipe de enfermagem em dispositivo de saúde mental

ABSTRACT Objective: To analyze how the nursing team from a Psychosocial Care Center II relates its insertion in the service with the work process. Methods: Descriptive, analytical research outlined as a case study with a qualitative approach. The data were collected through semi-structured interviews with nursing professionals and went through content analysis subsidized by Bardin's work. Results: Two thematic categories emerged: a) Ways of intake in the nursing services at the Psychosocial Care Center; b) Setbacks in nursing routine at the Psychosocial Care Center. Final considerations: The fact that the professionals have not planned to work in mental health nor have training impacts the rhythm of psychosocial care development at the Psychosocial Care Center, forcing them to seek training in the field after admission. Unmotivated by the working conditions, the nursing team suffers from the absence of an interdisciplinary partnership and goes to great lengths to approach psychosocial care.

RESUMEN Objetivo: Analizar como equipo de enfermería de un Centro de Atención Psicosocial II relaciona su inserción en el servicio con el proceso de trabajo. Métodos: Investigación descriptiva, analítica, delineada como estudio de caso, con abordaje cualitativo. Datos recogidos por entrevista semiestructurada con profesionales de enfermería y pasaron por análisis de contenido subsidiada en Bardin. Resultados: Emergieron dos categorías temáticas: a) Formas de ingreso en el servicio de enfermería del Centro de Atención Psicosocial; b) Contratiempos en el cotidiano de la enfermería en Centro de Atención Psicosocial. Consideraciones finales: El hecho de los profesionales no tener planeado actuar en salud mental ni disponer de preparación, impacta considerablemente el ritmo del desarrollo del cuidado psicosocial en Centro de Atención Psicosocial, forzándolos a buscar capacitación en el área después admisión. Desmotivada por condiciones de trabajo, el equipo de enfermería sufre por la ausencia de colaboración interdisciplinar y redoblarse para aproximarse del cuidado psicosocial.

RESUMO Objetivo: Analisar como a equipe de enfermagem de um Centro de Atenção Psicossocial II relaciona sua inserção no serviço com o processo de trabalho. Métodos: Pesquisa descritiva, analítica, delineada como estudo de caso, com abordagem qualitativa. Os dados foram coletados por entrevista semiestruturada com profissionais de enfermagem e passaram pela análise de conteúdo subsidiada pela obra de Bardin. Resultados: Emergiram duas categorias temáticas: a) Formas de ingresso no serviço de enfermagem do Centro de Atenção Psicossocial; b) Contratempos no cotidiano da enfermagem em Centro de Atenção Psicossocial. Considerações finais: O fato de os profissionais não terem planejado atuar na saúde mental nem disporem de preparação impacta consideravelmente o ritmo do desenvolvimento do cuidado psicossocial no Centro de Atenção Psicossocial, forçando-os a buscar capacitação na área após admissão. Desmotivada pelas condições de trabalho, a equipe de enfermagem sofre pela ausência de parceria interdisciplinar e desdobra-se para aproximar-se do cuidado psicossocial.

Plano de alta hospitalar em saúde mental como estratégia de cuidado integrado à família: uma pesquisa convergente assistencial / Hospital discharge plan in mental health as a family-integrated care strategy: a convergent care research

A família do usuário de serviços de saúde mental apresenta-se, no proposto pela Reforma Psiquiátrica, como elemento essencial, no que diz respeito às intervenções ampliadas, junto ao usuário e à equipe multidisciplinar. Este estudo tem como objeto, a proposição de um plano de orientação intermediário para a alta da internação psiquiátrica para uso como um guia para o cuidado de enfermagem à família do usuário com transtorno mental e anseia: Redimensionar saberes e práticas do Enfermeiro no referente à orientação dada à família do egresso da internação psiquiátrica, no processo de alta; Descrever o conhecimento da família do usuário em práticas cotidianas de vida e saúde mental, no referente à alta da internação psiquiátrica; Elaborar um plano de orientação intermediário para a alta, construído pelos usuários, pela família e pelos Enfermeiros, buscando a reabilitação psicossocial. Apresentamos como pressuposto, o fato de que a integração dos saberes e práticas de Enfermeiros, usuários e família, para a construção de um plano de orientação de alta é um recurso que subsidia cada categoria no desenvolvimento de correspondentes papéis na reinserção social. Pesquisa subsidiada pelos conceitos de família, território, reabilitação psicossocial, ao olhar conceitual da Teoria da Relação Interpessoal de Joyce Travelbee. Sustentada no método da PCA, a investigação no cenário das enfermarias de internação psiquiátrica, onde os 16 participantes Enfermeiros, 10 usuários de serviço e seus 10 familiares vivenciam a internação, trouxe a confecção de um produto tecnológico de cuidado orientado à perspectiva do convívio familiar e seu usuário em comunidade, contribuindo para a permanência em território, diminuição de internações e gestão consciente do cuidado, pela família, apresentando a tese de que a elaboração e aplicação de um plano intermediário de orientação para alta da internação, dirigido à família do usuário em processo de alta da internação psiquiátrica, construído a partir da integração dos saberes e práticas de Enfermeiro, usuário e família, é um recurso potencialmente capaz de aprimorar o relacionamento interpessoal, facilitando o processo de reabilitação psicossocial, mantendo o usuário, no seu território.

The family of patients with mental disorders presents itself, as proposed by the Psychiatric Reform, as an essential element, with regard to expanded interventions, with the user and the multidisciplinary team. This study aims to develop an intermediary guidance plan for discharge from psychiatric hospitalization to be used as a guide for nursing care to the family of users with mental disorders and who want to: Resize nurses' knowledge and practices regarding guidance given to the family of the person discharged from the psychiatric hospital, during the discharge process; Describe the knowledge of the user's family in daily life and mental health practices, with regard to discharge from psychiatric hospitalization; Develop an intermediate guidance plan for discharge, built by the users, the family and the nurses, seeking psychosocial rehabilitation. We present as a premise the fact that the integration of knowledge and practices of nurses, users and families, for the construction of a discharge guidance plan, is a resource that supports each category in the development of corresponding roles in social reintegration. Qualitative, descriptive and exploratory research, supported by the concepts of family, territory, psychosocial rehabilitation, from the conceptual perspective of Joyce Travelbee's Theory of Interpersonal Relationship. Based on the PCA method, the investigation in the scenario of psychiatric inpatient wards, where nursing participants, service users and their families experience hospitalization, brought about the creation of a technological care product oriented to the perspective of family life and its user in the community, contributing to the permanence in the territory, reduction of hospitalizations and conscientious management of care by the family.

La familia de pacientes con trastornos mentales se presenta, como propone la Reforma Psiquiátrica, como un elemento imprescindible, en cuanto a intervenciones ampliadas, con el usuario y el equipo multidisciplinar. El presente estudio tiene como objetivo desarrollar un plan de orientación intermedio para el alta de la hospitalización psiquiátrica que sirva de guía para el cuidado de enfermería a la familia de los usuarios frente a los trastornos mentales y aquellos que deseen: Redimensionar los conocimientos y prácticas de la orientación del enfermero a la familia de la persona dada de alta de la hospitalización psiquiátrica, durante el proceso de alta; Describir el conocimiento de la familia del usuario en las prácticas de la vida diaria con la salud mental, en relación al alta de la hospitalización psiquiátrica; Desarrollar un plan de orientación intermedio para el bachillerato, construido por los usuarios, la familia y las enfermeras, en busca de rehabilitación psicosocial. Presentamos como premisa que la integración de conocimientos y prácticas de enfermeros, usuarios y familias, para la construcción de un plan de alta orientación, es un recurso que apoya a cada categoría en el desarrollo de roles correspondientes en la rehabilitación psicosocial. Investigación cualitativa, descriptiva y exploratoria, sustentada en conceptos de familia, territorio, rehabilitación psicosocial, desde la perspectiva conceptual de la Teoría de la Relación Interpersonal de Joyce Travelbee. Con base en el método PCA, la investigación en el escenario de las salas de hospitalización psiquiátrica, desde donde los participantes de enfermería, los usuarios del servicio y sus familias experimentando con la hospitalización, propició la creación de un producto de atención tecnológica orientado a la perspectiva de su vida familiar. y tu usuario en la comunidad. , contribuyendo a la permanencia en el territorio, reducción de hospitalizaciones y gestión concienzuda de los cuidados por parte de la familia.

Disseminated Bacillus Calmette-Guérin (BCG) infection with pulmonary and renal involvement: A rare complication of BCG immunotherapy. A case report and narrative review.

Intravesical Bacillus Calmette-Guérin (BCG) instillation is a mainstay of adjunctive therapy for superficial bladder cancer that increases length of disease progression-free survival. Although usually well tolerated, moderate to severe local and systemic infectious complications can occur with this immunotherapy. Diagnosis is difficult and often based on high clinical suspicion since in many cases Mycobacterium bovis is not isolated. Treatment is not fully standardized but the combination of anti-tuberculosis drugs and corticosteroids is advocated in severe cases. The authors present an unusual case of a severe infectious complication following intravesical BCG instillation with pulmonary and kidney involvement. Prompt anti-tuberculosis treatment associated to corticosteroid resulted in a marked clinical and radiological improvement, supporting the diagnosis of disseminated BCG infection. Based on this, the authors aimed to review the literature on this exceptional complication of this immunotherapy.

Concepções teórico-metodológicas de John Thompson: análise de produções e contribuição para a pesquisa em enfermagem / The theoretical-methodological conceptions of John Thompson: production analysis and its contribution for the nursing research field / Concepciones teórico-metodológicas de John Thompson: análisis de producciones y contribución para la in vestigación en enfermeria

Objetivo: Identificar produções acadêmicas, nos programas stricto sensu de enfermagem, onde se adota referencial de Thompson e discutir concepções teórico-metodológicas e contribuição de Thompson para o conhecimento e prática da Enfermagem. Método: Estudo descritivo-documental, reflexivo, cuja análise constituiu-se por resumos de teses/dissertações por enfermeiros no Brasil, relacionadas às concepções teórico-metodológicas de Thompson. Resultados: Identificou-se 17 produções, 07 teses de doutorado (41,17%), 10 dissertações de mestrado acadêmico (58,83%), com destaque para a Escola de Enfermagem Anna Nery da Universidade Federal do Rio de Janeiro. Conclusão: Estudos de enfermagem permeados pela sociologia ampliam a visão de que uma técnica, uma estratégia educativa, uma tecnologia emergem em razão do cenário social, das necessidades permeadas por valores e da dinâmica existente entre ciência e sociedade. Acredita-se ser importante para o cenário cientifico e investigativo de enfermagem, compreender as modificações inerentes ao cuidar, advindas de um produto crítico-reflexivo social, que pode ser contemplado por adotarmos como norteador de análise, teóricos imersos no viés da sociologia

Objective: The study's purpose has been to identify academic productions, in the stricto sensu nursing programs, where Thompson's reference is adopted, and also to discuss the Thompson's theoreticalmethodological conceptions and its contribution to both Nursing knowledge and practice. Methods: It is a descriptive study with a documentary basis, also reflexive, whose analysis consisted of theses/dissertations abstracts done by nurses in Brazil, which were related to Thompson's theoretical-methodological conceptions. Results: 17 productions were identified, 07 doctoral theses (41.17%), 10 masters' dissertations (58.83%), with emphasis on the Escola de Enfermagem Anna Nery from the Universidade Federal do Rio de Janeiro. Conclusion: The nursing studies permeated by sociology can expand the view that a technique, an educational strategy, and a technology may emerge due to the social scenario, furthermore, the needs permeated by values and the dynamics between science and society. It is assumed to be important for both the scientific and nursing research scenario, understanding the inherent modifications of care that come from a critical-social reflexive product, which can be contemplated by adopting as the analysis guiding principle, then being seen as theorists immersed in the sociology trendline

Objetivo: Identificar producciones académicas, en los programas stricto sensu de enfermería, donde se adopta referencial de Thompson y discutir concepciones teórico-metodológicas y contribución de Thompson para el conocimiento y práctica de la Enfermería. Método: Estudio descriptivodocumental, reflexivo, cuyo análisis se constituyó por resúmenes de tesis / disertaciones por enfermeros en Brasil, relacionadas a las concepciones teórico-metodológicas de Thompson. Resultados: Se identificaron 17 producciones, 07 tesis de doctorado (41,17%), 10 disertaciones de maestría académica (58,83%), con destaque para la Escuela de Enfermería Anna Nery de la Universidad Federal de Río de Janeiro. Conclusión: Estudios de enfermería permeados por la sociología amplían la visión de que una técnica, una estrategia educativa, una tecnología emergen en razón del escenario social, de las necesidades impregnadas de valores y de la dinámica existente entre ciencia y sociedad. Se cree que es importante para el escenario científico e investigador de enfermería, comprender las modificaciones inherentes al cuidar, provenientes de un producto crítico-reflexivo social, que puede ser contemplado por adoptar como orientador de análisis, teóricos inmersos en el sesgo de la sociología

Atendimento em saúde mental na atenção primária à saúde no período pré-reforma psiquiátrica / Mental health care in primary health care during the psychiatric pre-reform period / La atención en salud mental en la atención primaria durante la pre-reforma psiquiátrica

INTRODUÇÃO: analisar a atenção em saúde mental na atenção primária à saúde em um município mineiro, na década de 1980. MÉTODO: estudo qualitativo, na perspectiva da história do tempo presente. Fontes: documentos escritos e orais obtidos por entrevista com seis profissionais de uma unidade básica de saúde (UBS). Utilizou-se o método indutivo que parte da postura crítica interna e externa das fontes, estabelecendo as relações com o contexto histórico-social em que estavam inseridas. RESULTADOS: os dados resultaram em duas categorias: revelando a realidade manicomial em Juiz de Fora pela narrativa dos profissionais da unidade básica de saúde e relatos dos profissionais sobre dificuldades de compreensão da proposta da reforma e consequências na organização dos serviços e na assistência. DISCUSSÃO: no período pré-reforma psiquiátrica, o processo de desospitalização determinou uma demanda de atendimento em saúde mental na UBS, a qual não foi devidamente acolhida devido ao despreparo da equipe de saúde. A lógica manicomial guiava o atendimento e não contemplou suficientemente o cuidado às pessoas com transtornos mentais, limitando-se à reprodução de prescrições médicas e encaminhamentos para serviços especializados. CONCLUSÃO: a equipe enfrentou, dentro do possível, as dificuldades encontradas e a UBS estudada foi pioneira em atendimento extra-hospitalar em saúde mental, o que mais tarde seria qualificado pela Secretaria Municipal de Saúde Mental de Juiz de Fora.(AU)

Introduction: to analyze the mental health care in primary health care in a Minas Gerais municipality, in the 1980s. Method: a qualitative study, from the perspective of the history of the present time. Sources: Written and oral documents obtained by an interview with six professionals from a basic health unit (BHU). We used the inductive method that starts from the internal and external critical posture of the sources, establishing the relationships with the historical-social context in which they were inserted. Results: the data resulted in two categories: revealing the asylum reality in Juiz de Fora through the narrative of the professionals of the basic health unit and the professionals' reports about difficulties in understanding the reform proposal and consequences in the organization of services and care. Discussion: in the pre-psychiatric retirement period, the de-hospitalization process determined the demand for mental health care at the BHU, which was not properly received due to the unpreparedness of the health team. The asylum logic guided the care and did not sufficiently contemplate the care of people with mental disorders, being limited to the reproduction of medical prescriptions and referrals to specialized services. Conclusion: the team faced, as far as possible, the difficulties found, and the BHU studied was a pioneer in out-of-hospital mental health care, which would later be qualified by the Municipal Secretariat of Mental Health of Juiz de Fora.(AU)

Introducción: analizar la atención en salud mental en la atención primaria en un municipio de Minas Gerais, en la década de 1980. Método: estudio cualitativo, desde la perspectiva de la historia de la actualidad. Fuentes: documentos escritos y orales obtenidos por entrevista con seis profesionales de una unidad básica de salud (UBS). Se utilizó el método inductivo que parte de la postura crítica interna y externa de las fuentes, estableciendo las relaciones con el contexto histórico-social en el que se insertaron. Resultados: los datos dieron como resultado dos categorías: revelando la realidad del manicomio en Juiz de Fora a través de la narrativa de los profesionales de la unidad básica de salud y los informes de los profesionales sobre las dificultades para comprender la propuesta de reforma y las consecuencias en la organización de los servicios y en la atención. Discusión: en el período previo a la reforma psiquiátrica, el proceso de deshospitalización determinó una demanda de atención de salud mental en la UBS que, debido a la falta de preparación del personal de salud, no fue recibida adecuadamente. La atención de las UBS seguía la lógica del manicomio y no contempló suficientemente los cuidados de las personas con trastornos mentales, limitándose a la reproducción de recetas médicas y derivaciones a los servicios especializados. Conclusión: el equipo enfrentó, en la medida de lo posible, las dificultades encontradas y la UBS estudiada fue pionera en la atención de salud mental extrahospitalaria, después calificado por la Secretaría Municipal de Salud Mental de Juiz de Fora.(AU)

Ponatinib induces a sustained deep molecular response in a chronic myeloid leukaemia patient with an early relapse with a T315I mutation following allogeneic hematopoietic stem cell transplantation: a case report.

BACKGROUND: Atypical BCR-ABL1 transcripts are detected in less than 5% of patients diagnosed with chronic myeloid leukaemia (CML), of which e19a2 is the most frequently observed, with breakpoints in the micro breakpoint cluster region (µ-BCR) and coding for the p230 BCR-ABL1 protein. p230 CML is associated with various clinical presentations and courses with variable responses to first-line imatinib. CASE PRESENTATION: Here we report a case of imatinib resistance due to an E255V mutation, followed by early post-transplant relapse with a T315I mutation that achieved a persistent negative deep molecular response (MR5.0) after treatment with single-agent ponatinib. Using CastPCR, we could trace back the presence of the T315I mutation to all the RNA samples up to the detection of T315 mutation by Sanger sequencing shortly after allogeneic hematopoietic stem cell transplantation (HSCT). CONCLUSION: This case illustrates the major interest of ponatinib as a valid treatment option for e19a2 CML patients who present a T315I mutation following relapse after HSCT.

Integrating Fenton's process and ion exchange for olive mill wastewater treatment and iron recovery.

A novel integrated methodology involving Fenton's process followed by ion exchange (IE) was proposed for the treatment of olive mill wastewater. Fenton's process was optimized and it was able to remove up to 81% of chemical oxygen demand when pH 3.5, reaction time 1 h, [Fe2+] = 50 mg L-1 and [Fe2+]/[H2O2] = 0.002 were applied. In spite of the potential of this treatment approach, final iron removal from the liquid typically entails pH increase and iron sludge production. The integration of an IE procedure using Lewatit TP 207 resin was found to be able to overcome this important environmental shortcoming. The resin showed higher affinity toward Fe3+ than to Fe2+. However, the iron removal efficiency of an effluent coming from Fenton's was independent of the type of the initial iron used in the process. The presence of organic matter had no significant effect over the resin iron removal efficiency. Even if some efficiency decrease was observed when a high initial iron load was applied, the adsorbent mass quantity can be easily adapted to reach the desired iron removal. The use of IE is an interesting industrial approach able to surpass Fenton's peroxidation drawback and will surely boost its full-scale application in the treatment of bio-refractory effluents.

Adenoma Detection Rate: I Will Show You Mine if You Show Me Yours.

BACKGROUND: Colorectal cancer (CRC) is the first cause of cancer-related mortality in Portugal. CRC screening reduces disease-specific mortality. Colonoscopy is currently the preferred method for screening as it may contribute to the reduction of CRC incidence. This beneficial effect is strongly associated with the adenoma detection rate (ADR). AIM: Our aim was to evaluate the quality of colonoscopy at our unit by measuring the currently accepted quality parameters and publish them as benchmarking indicators. METHODS: From 5,860 colonoscopies, 654 screening procedures (with and without previous fecal occult blood testing) were analyzed. RESULTS: The mean age of the patients was 66.4 ± 7.8 years, and the gender distribution was 1:1. The overall ADR was 36% (95% confidence interval [CI] 32-39), the mean number of adenomas per colonoscopy was 0.66 (95% CI 0.56-0.77), and the sessile serrate lesion detection rate was 1% (95% CI 0-2). The bowel preparation was rated as adequate in 496 (76%) patients. The adjusted cecal intubation rate (CIR) was 93.7% (95% CI 91.7-95.8). Most colonoscopies were performed under monitored anesthesia care (53%), and 35% were unsedated. The use of sedation (propofol or midazolam based) was associated with a higher CIR with an odds ratio of 3.60 (95% CI 2.02-6.40, p < 0.001). CONCLUSION: Our data show an above-standard ADR. The frequency of poor bowel preparation and the low sessile serrated lesion detection rate were acknowledged, and actions were implemented to improve both indicators. Quality auditing in colonoscopy should be compulsory, and while many units may do so internally, this is the first national report from a high-throughput endoscopy unit.

Resultados del tratamiento de las hernias incisionales con la técnica rives-stoppa en la ii cátedra de clínica quirúrgica / Results of the treatment of incisional hernia with the rives-stoppa technique at the ii service of surgical clinic

Introducción: la reparación de la hernia incisional utilizando la técnica de Rives-Stoppa es una técnica, con bajos índices de recidivas (3 a 12%) y complicaciones (15%). Objetivo: Describir los resultados en la aplicación de la Técnica de Rives-Stoppa en el tratamiento de las hernias incisionales.Pacientes y método: estudio, observacional, descriptivo, retrospectivo, de corte transversal, con muestreo no probabilístico, de casos consecutivos, desde enero 2010 a diciembre 2015. Resultados: n: 38 pacientes, siendo mujeres 33 (86,8%) y varones 5 (13,2%) . La edad promedio 52,5 años ( 20 - 78 ). Las patologías de base: 33 (86,8%). Localización de hernias incisionales, 36 (94,7%) de la línea media y 2 ventrolaterales. Antecedentes quirúrgicos, el más frecuente Cesárea 13 (34,2%). Promedio tiempo quirúrgico 116,7 minutos.Tuvimos 1 (2,6%) complicación local, sangrado tejido celular. Estancia hospitalaria promedio 2,3 días. Conclusión: En la reconstrucción y refuncionalización de la pared abdominal es una opción efectiva.

Introduction: the repair of incisional hernia using Rives-Stoppa technique is a technique, with low rates of recurrence (3 to 12 %) and complications (15 %). Objective: To describe the results in the application of the Rives-Stoppa technique in the treatment of incisional hernias. Patients and methods: study, observational, descriptive, retrospective, cross-sectional, with sampling non-probability, of consecutive cases, from January 2010 to December 2015. Results: n: 38 patients, being 33 (86.8 %) women and men 5 (13.2 %). The age average 52.5 years (20-78). The pathologies... The underlying pathologies: 33 (86.8 %). Location of incisional hernias, 36 (94.7 %) of the middle line and ventrolateral 2. Surgical history, the most frequent cesarean section 13 (34.2 %). Average operative time 116,7 minutes. We had 1 (2.6 %) local complications, bleeding tissue cell. Hospital stay average 2.3 days. Conclusion: In the reconstruction and reorganization of the abdominal wall is an effective option.

Hernia de spiegel. Nuestra experiencia / Spigelian hernia. Our experience

Introducción: La Hernia de Spiegel es una afección parietal rara de la pared abdominal, unilocular, que se localiza en el borde externo de la línea semilunar. La mayoría de las veces se encuentra ubicada bajo el músculo oblicuo mayor y corresponde a una hernia intersticial; por lo que puede pasar desapercibida. Objetivo: Describir nuestra experiencia en el diagnóstico y tratamiento de la hernia de Spiegel. Pacientes y método: estudio observacional, descriptivo, retrospectivo de pacientes con diagnóstico de Hernia de Spiegel, tratados en la II Cátedra Clínica Quirúrgica, en el período de tiempo comprendido desde marzo 1998 a diciembre 2015. Resultados :n 14, fueron del sexo femenino 8 pacientes y 6 del masculino, el promedio de edad 57,4(±50-85). El motivo de consulta: dolor abdominal de tipo difuso, acompañado de una tumoración ventro lateral, reductible. En 10 casos la tumoración se localizó en el lado derecho y en 4 en el lado izquierdo.La sospecha clínica fue confirmada por la ecografía en 8 casos y la tomografía axial computarizada en los 6 restantes, la forma de presentación de 2 casos fue como oclusión intestinal y operados de urgencia y las demás electivas - ambulatorias. En todos los casos se realizó reparación de la pared sin tensión con malla de polipropileno, en 3 pacientes se colocó plug y en 11 pacientes se realizó refuerzo de la fascia del oblicuo mayor sublay, con el mismo material. No tuvimos complicaciones ni recidivas a los 24 meses. Conclusión: El diagnóstico de la hernia de Spiegel no resulta sencillo, debe acompañarse en todos los casos de un estudio de imagen. La técnica quirúrgica sin tensión, colocación de malla sublay, es una opción por sus resultados satisfactorios.

Introducción: Spigelian Hernia is a rare abdominal wall disease, often localizated in semilunar line. Most of the time it appeas under external oblique muscle, because of that, sometimes the diagnosis can be difficult. Objective: To describe the experience in the diagnosis and treatment of Spigelian Hernia. Patient and methods: An observational, retrospective study of patients with Spigelian Hernia, at the Second Service of Surgery, between March of 1998 to December of 2015. Results: 14 patients were diagnosed of Spigelian Hernia, 8 women and 6 men, with an average age of 57 years (±50-85). The main reason from consultation was abdominal pain with a lateral abdominal tumor. Clinical suspicious was confirm by ultrasonography in 8 cases and CT scan revealed the other 6. Surgical treatment in all cases was performed without tension using a polipropilene mesh; in 3 of them they use a plug and in the other 11 a sublay mesh to reinforce the external oblique fascia. They don´t have any complications. Conclusion: The diagnosis of Spigelian Hernia is not simple, is important to attach a image study. A tension free surgical technique, a sublaymesh, are options to have success.

Construcción del perfil del egresado del ciclo clínico / Construction of the graduate profile of clinical cycle

Esta investigación fue realizada, como parte integrante del Proyecto de Innovación Curricular, con la necesidad de la construcción de un perfil de egresado, en el ciclo o asignaturas clínicas, para posteriormente, realizar el perfil del Egresado de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción (FCM-UNA). La misma, la fuimos construyendo a partir de artículos, documentos y actores relevantes tanto dentro y como fuera de la Institución, que permitió así contribuir en la construcción de una propuesta que optimice la formación universitaria de los estudiantes de la carrera de medicina. Como docentes de la universidad hemos constatado una serie de problemas que se relacionan tanto con el aislamiento de las disciplinas que se manejan en forma totalmente independientes dificultando un aprendizaje integrado de los estudiantes, como su poca formación en gestión, en investigación y la necesidad un estudio exhaustivo y de mejor relacionamiento interhumano con los pacientes y con los propios colegas. Seria apropiada para intencionar los procesos de enseñanza y aprendizaje y el perfil de un médico acorde a las necesidades político- social, cultural y de desarrollo económico. Nuestro objetivo fue analizar e interpretar documentos y percepción de los actores relevantes en cuanto a la formación de médico, que permita aportar datos para levantar una propuesta de perfil del ciclo clínico, integrado y pertinente a través de un diseño cualitativo con un énfasis comprensivo. Para el levantamiento de información se recurrió a la revisión de artículos, donde buscamos el perfil de otras Universidades de medicinas referentes, tantos de MERCOSUR, como Internacionales. Se realizaron focus group en docentes, pacientes y egresado de la FCM-UNA, también se utilizó entrevistas a empleadores del sector privado, público y seguro social. Posteriormente, se realizó el proceso de análisis de contenidos con interés interpretativo. En cuanto al resultado obtenido podemos decir que el egresado clínico debe reunir cierta competencia clínicas, además de buenos relacionamientos con los pacientes, parientes y sus propios colegas y el personal de apoyo. Cabe además señalar algunos actores coinciden en interacción comunicativas y además en incorporar tecnología de avanzadas, actualización permanente en los saberes disciplinares y en la investigación, una formación contextualizada social y que atienda las necesidades de salud de la población. Una demanda expresada convergentemente es la consideración de la gestión como parte del desempeño del médico, asimismo, en la dimensión de la responsabilidad social, pacientes, egresados y empleadores; relevan la necesidad de formar médicos con sentido humanista, comprometidos con el proyecto de justicia social y que sean éticos, advierten del peligro de la mercantilización del acto médico como regulador de la relación médico-paciente, entre otros. Un importante hallazgo de la investigación, fue la aparición de dos dimensiones demandadas en la formación del médico como es la enseñanza/docencia

This research was conducted as part of the Curricular Project Innovation, with the need of building a graduate profile in the clinical cycle or subjects, to then make the profile of the graduate of the Faculty of Medical Science at the National University of Asunción (FCM-UNA). We were building it through articles, documents and relevant actors within and outside the institution, enabling the contribution in building a proposal that optimizes the university education of medical students. As university teachers we have found a series of problems related to both the isolation of the disciplines that are used in totally independent way hindering an integrated learning for students, as the little training in management, research and the need for a thorough study and better inter-human relationship with patients and with colleagues. This would be appropriate to address the teaching and learning and the profile of a doctor according to the social, cultural, political and economic development needs. Our objective was to analyze and interpret documents and perception of stakeholders regarding the medical training, that allow to provide data that would give a proposal of the clinical cycle, integrated and relevant through a qualitative design with a comprehensive focus. A review of articles was used to gather information, which seek the profile of other medical universities, both MERCOSUR and International. focus groups were conducted in teachers, patients and graduated from the FCM-UNA. It was also used interviews with employers from the private, public and social security sectors. Subsequently, the process of content analysis was performed with interpretive interest. As for the results obtained we can say that the clinical graduate must meet certain clinical competence, including good relationship with patients, relatives and their own colleagues and support staff. It should also be noted some actors agree in communicative interaction and also to incorporate advanced technology, continuous updating on the disciplinary knowledge and research, social contextualized training and to address the health needs of the population. A convergent expressed demand is the consideration of management as part of the physician performance, also, in the dimension of social responsibility, patients, alumni and employers; they reveal the need to train physicians with humanistic sense, committed to the project of social justice and ethics, warn against the commodification of the medical act as a regulator of the doctor-patient relationship, among others. An important finding of the research was the appearance of two demanded dimensions in the medical training such as teaching.

Non-anesthesiologist administration of propofol sedation for colonoscopy is safe in low risk patients: results of a noninferiority randomized controlled trial.

BACKGROUND AND STUDY AIMS: Propofol provides the best sedation in colonoscopy. The safety of non-anesthesiologist administration of propofol (NAAP) is still a matter of debate. The aim of the current study was to evaluate sedation safety, colonoscopy quality, and patient satisfaction with NAAP. PATIENTS AND METHODS: The study was a single-blinded, noninferiority, randomized controlled trial comparing NAAP (Group A) with anesthesiologist-administered sedation (Group B) performed at a single academic institution. Patients (18 - 80 years) who underwent colonoscopy and were at low anesthetic risk (American Society of Anesthesiologists class I - II) were included. The primary end point was the incidence of adverse events. Secondary end points were propofol dose, patient satisfaction and pain, colonoscopy quality indicators, and procedure and recovery times. RESULTS: A total of 277 patients were included in the analysis. The incidence of adverse events was 39.3 % in Group A and 39.0 % in Group B (absolute difference - 0.3 %, 95 % confidence interval [CI] - 12.0 % to 11.4 %; P = 0.959). There were no sentinel adverse events. The following interventions (Group A vs. Group B) were necessary: atropine administration (0 % vs. 5.5 %; P = 0.004); airway repositioning (8.7 % vs. 4.7 %; P = 0.196); increased oxygen administration (6.7 % vs. 3.9 %; P = 0.317), and increased fluid rate (2.7 % vs. 0.8 %; P = 0.379). There were no differences in cecal intubation and adenoma detection rates. Recovery times were longer in Group B (58 ±â€Š33 vs. 67 ±â€Š29 minutes; P = 0.032). There were no differences in mean propofol dose, withdrawal time, painless colonoscopy, satisfaction, and amnesia. All but two patients (Group B) were willing to repeat the colonoscopy. CONCLUSIONS: NAAP is equivalent to anesthesiologist-administered sedation in the rate of adverse events in a low risk population. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02067065).

Olive mill effluent depuration by ozonation and Fenton processes enhanced by iron wastes.

The aim of the present work was to compare the potential of iron industry wastes to enhance ozone and hydrogen peroxide action on the degradation of olive mill wastewaters (OMWs). The results attained show a higher efficiency for ozonation using a lower catalyst load. Nevertheless, Fenton's process led to a larger amount of chemical oxidation demand (COD) removed per mole of oxidant applied. It was concluded that hydroxyl radicals are responsible for the pollutant abatement. High eco-toxicity decay was observed after the treatments. Furthermore, a preliminary analysis of the iron shavings' stability was made by reusing it in two feed-batch trials. It was concluded that while activity was maintained for Fenton's, a decrease of about 20% was verified for catalytic ozonation. Comparing these results with the ones obtained for the same processes applied to an actual OMW, a lower percentage of COD abatement was achieved. However, when reporting the amount of COD removed per mole of oxidant used, the difference between effluents are not so high. This should be taken into account when deciding which process should be implemented at an industrial scale. With the outcomes of this research it was possible to conclude that integrating waste management with wastewater treatment was feasible.

Integration of traditional systems and advanced oxidation process technologies for the industrial treatment of olive mill wastewaters.

A complete industrial treatment system (involving the integration of coagulation/flocculation and Fenton processes) to depurate real wastewaters coming from two-phase olive oil production mills has been studied. The experimental results indicated that at the end of this combined strategy, involving a primary physical separation stage followed by Fenton's chemical oxidation, chemical oxygen demand (COD) is reduced up to 90% and total polyphenols' concentration is decreased up to 92%. The treated stream biodegradability (BOD5/COD) reached 0.52 and the Total Suspended Solids (TSSs) and Total Dissolved Solids (TDSs) decreased up to 95% and 69%, respectively. Fenton's procedure was optimized bearing in mind the pH adjustment step, different procedures for hydrogen peroxide addition and the use of coagulants instead of the chemical precipitation (by raising pH) to promote iron sludge settling. Our results demonstrated that pH (3.0 ± 0.1) control during the oxidation reaction improves the oxidation efficiency. Moreover, the final NaOH addition is essential to a better sludge formation and consequent precipitation of the residual iron removing also some organic matter.

Refractory Celiac Disease Type II: A Case Report that Demonstrates the Diagnostic and Therapeutic Challenges.

Refractory celiac disease is an uncommon but serious complication of celiac disease. We describe a case of a severe refractory celiac disease type II, complicated with ulcerative jejunoileitis, in a 68 years old female, unresponsive to consecutive treatments with budesonide, prednisolone, cladribine and autologous stem cell transplantation. The patient maintained severe malnutrition, advanced osteoporosis, anaemia, vitamin deficiencies and hydro-electrolytic imbalances, necessitating consecutive hospitalizations for total parenteral nutrition. The patient also developed life-threatening complications, namely respiratory and urinary septic shock and also episodes of haemorrhagic shock secondary to ulcerative jejunoileitis. The progression to enteropathy associated T-cell lymphoma was never demonstrated, but the patient died 7 years after the diagnosis due to a septic shock secondary to a nosocomial pneumonia and osteomyelitis related to a spontaneous hip fracture. This case highlights the difficulties in the diagnostic process, therapeutic management and surveillance of this rare condition associated with very poor prognosis.

A doença celíaca refratária é uma complicação rara mas muito severa da doença celíaca. Apresentamos o caso de uma doente de 68 anos, com doença celíaca refratária tipo II complicada de jejunoileíte ulcerativa, que não respondeu a tratamentos sucessivos com budesonido, prednisolona, cladribina e transplante autólogo de medula óssea. A doente manteve desnutrição e osteoporose severas, deficiências vitamínicas e desequilíbrios hidro-eletrolíticos, necessitando de múltiplas hospitalizações para receber nutrição parentérica total. Também desenvolveu diversas complicações potencialmente fatais nomeadamente sépsis com origem respiratória e urinária e choque hemorrágico secundário à jejunoileíte ulcerativa. Contudo, nunca se demonstrou a presença de um linfoma de células T. A doente faleceu 7 anos após o diagnóstico devido a choque sético secundário a pneumonia nosocomial e osteomielite relacionada com fratura espontânea da anca. Este caso ilustra as dificuldades sentidas no decurso do diagnóstico, terapêutica e vigilância desta entidade clínica rara, a qual está associada a um péssimo prognóstico.