Multidrug-resistant nontuberculous mycobacteria isolated from cystic fibrosis patients.

Worldwide, nontuberculous mycobacteria (NTM) have become emergent pathogens of pulmonary infections in cystic fibrosis (CF) patients, with an estimated prevalence ranging from 5 to 20%. This work investigated the presence of NTM in sputum samples of 129 CF patients (2 to 18 years old) submitted to longitudinal clinical supervision at a regional reference center in Rio de Janeiro, Brazil. From June 2009 to March 2012, 36 NTM isolates recovered from 10 (7.75%) out of 129 children were obtained. Molecular identification of NTM was performed by using PCR restriction analysis targeting the hsp65 gene (PRA-hsp65) and sequencing of the rpoB gene, and susceptibility tests were performed that followed Clinical and Laboratory Standards Institute recommendations. For evaluating the genotypic diversity, pulsed-field gel electrophoresis (PFGE) and/or enterobacterial repetitive intergenic consensus sequence PCR (ERIC-PCR) was performed. The species identified were Mycobacterium abscessus subsp. bolletii (n = 24), M. abscessus subsp. abscessus (n = 6), Mycobacterium fortuitum (n = 3), Mycobacterium marseillense (n = 2), and Mycobacterium timonense (n = 1). Most of the isolates presented resistance to five or more of the antimicrobials tested. Typing profiles were mainly patient specific. The PFGE profiles indicated the presence of two clonal groups for M. abscessus subsp. abscessus and five clonal groups for M. abscesssus subsp. bolletii, with just one clone detected in two patients. Given the observed multidrug resistance patterns and the possibility of transmission between patients, we suggest the implementation of continuous and routine investigation of NTM infection or colonization in CF patients, including countries with a high burden of tuberculosis disease.

Classification and regression tree (CART) model to predict pulmonary tuberculosis in hospitalized patients.

BACKGROUND: Tuberculosis (TB) remains a public health issue worldwide. The lack of specific clinical symptoms to diagnose TB makes the correct decision to admit patients to respiratory isolation a difficult task for the clinician. Isolation of patients without the disease is common and increases health costs. Decision models for the diagnosis of TB in patients attending hospitals can increase the quality of care and decrease costs, without the risk of hospital transmission. We present a predictive model for predicting pulmonary TB in hospitalized patients in a high prevalence area in order to contribute to a more rational use of isolation rooms without increasing the risk of transmission. METHODS: Cross sectional study of patients admitted to CFFH from March 2003 to December 2004. A classification and regression tree (CART) model was generated and validated. The area under the ROC curve (AUC), sensitivity, specificity, positive and negative predictive values were used to evaluate the performance of model. Validation of the model was performed with a different sample of patients admitted to the same hospital from January to December 2005. RESULTS: We studied 290 patients admitted with clinical suspicion of TB. Diagnosis was confirmed in 26.5% of them. Pulmonary TB was present in 83.7% of the patients with TB (62.3% with positive sputum smear) and HIV/AIDS was present in 56.9% of patients. The validated CART model showed sensitivity, specificity, positive predictive value and negative predictive value of 60.00%, 76.16%, 33.33%, and 90.55%, respectively. The AUC was 79.70%. CONCLUSIONS: The CART model developed for these hospitalized patients with clinical suspicion of TB had fair to good predictive performance for pulmonary TB. The most important variable for prediction of TB diagnosis was chest radiograph results. Prospective validation is still necessary, but our model offer an alternative for decision making in whether to isolate patients with clinical suspicion of TB in tertiary health facilities in countries with limited resources.

Photoelastic analysis of stresses transmitted by universal cast to long abutment on implant-supported single restorations under static occlusal loads.

OBJECTIVES: The aim of this study was to compare the stresses resulting from cemented or screw-retained dental prostheses using universal cast to long abutment by the photoelastic method. MATERIAL AND METHODS: A photoelastic resin model was fabricated to simulate a segment of the mandibular arch with resin replicas of a first premolar and a second molar, and two 3.75 × 11-mm implants replacing the second premolar and the first molar. Vertical static loads were individually applied on the occlusal surface of the premolar and the molar (5 kgf) and simultaneously on both crowns (10 kgf). RESULTS: Results found variable stress patterns around each implant and concentrated stresses in the individually loaded crowns. Force transfer characteristics of each situation and quantification of the isochromatic fringes were evaluated. CONCLUSIONS: Within the limitations of this study and based on the results obtained for implant-supported prosthesis with internal hexagon connection/universal cast to long abutment, it could be concluded that single adjacent screw-retained prosthetic restorations lead to higher stresses around the implants when compared with cement-retained restorations.

Autologous bone marrow-derived mononuclear cell therapy in three patients with severe asthma.

BACKGROUND: Despite recent advances in understanding its pathophysiology and development of novel therapies, asthma remains a serious public health issue worldwide. Combination therapy with inhaled corticosteroids and long-acting ß2-adrenoceptor agonists results in disease control for many patients, but those who exhibit severe asthma are often unresponsive to conventional treatment, experiencing worse quality of life, frequent exacerbations, and increasing healthcare costs. Bone marrow-derived mononuclear cell (BMMC) transplantation has been shown to reduce airway inflammation and remodeling and improve lung function in experimental models of allergic asthma. METHODS: This is a case series of three patients who presented severe asthma, unresponsive to conventional therapy and omalizumab. They received a single intravenous dose of autologous BMMCs (2 × 107) and were periodically evaluated for 1 year after the procedure. Endpoint assessments included physical examination, quality of life questionnaires, imaging (computed tomography, single-photon emission computed tomography, and ventilation/perfusion scan), lung function tests, and a 6-min walk test. RESULTS: All patients completed the follow-up protocol. No serious adverse events attributable to BMMC transplantation were observed during or after the procedure. Lung function remained stable throughout. A slight increase in ventilation of the right lung was observed on day 120 after BMMC transplantation in one patient. All three patients reported improvement in quality of life in the early post-procedure course. CONCLUSIONS: This paper described for the first time the effects of BMMC therapy in patients with severe asthma, providing a basis for subsequent trials to assess the efficacy of this therapy.

An alternative section method for casting and posterior laser welding of metallic frameworks for an implant-supported prosthesis.

PURPOSE: The aim of this study was to compare the accuracy of fit of three types of implant-supported frameworks cast in Ni-Cr alloy: specifically, a framework cast as one piece compared to frameworks cast separately in sections to the transverse or the diagonal axis, and later laser welded. MATERIALS AND METHODS: Three sets of similar implant-supported frameworks were constructed. The first group of six 3-unit implant-supported frameworks were cast as one piece, the second group of six were sectioned in the transverse axis of the pontic region prior to casting, and the last group of six were sectioned in the diagonal axis of the pontic region prior to casting. The sectioned frameworks were positioned in the matrix (10 N.cm torque) and laser welded. To evaluate passive fit, readings were made with an optical microscope with both screws tightened and with only one-screw tightened. Data were submitted to ANOVA and Tukey-Kramer's test (p < 0.05). RESULTS: When both screws were tightened, no differences were found between the three groups (p > 0.05). In the single-screw-tightened test, with readings made opposite to the tightened side, the group cast as one piece (57.02 +/- 33.48 mum) was significantly different (p < 0.05) from the group sectioned diagonally (18.92 +/- 4.75 microm) but no different (p > 0.05) from the group transversally sectioned (31.42 +/- 20.68 microm). On the tightened side, no significant differences were found between the groups (p > 0.05). CONCLUSIONS: Results of this study showed that casting diagonally sectioned frameworks lowers misfit levels of prosthetic implant-supported frameworks and also improves the levels of passivity to the same frameworks when compared to structures cast as one piece.

Pacientes em pós-operatório imediato: recepção na unidade clínico-cirúrgica / Patients in the immediate postoperative period: admission to the clinical and surgical unit

Objetivo: Analisar a demanda de enfermagem nos cuidados de pacientes em pós-operatório imediato, desde sua recepção do centro cirúrgico até sua acomodação ao leito na unidade de internação. Métodos: Estudo prospectivo e analítico. A população foi constituída por pacientes adultos, egressos do centro cirúrgico. A amostra foi calculada considerando-se que o serviço realiza uma média de 118 cirurgias ao mês. Considerando que a amostra mínima seria de 91 pacientes com um intervalo de confiança de 95%, optou-se por trabalhar com amostra de 100 pacientes. Os dados foram coletados no momento em que os pacientes eram recebidos da SRPA. Resultados: Os grupos cirúrgicos Angiologia, Coloproctologia, Otorrinolaringologia e Urologia demandaram no máximo dois profissionais de enfermagem. Os grupos de Cirurgia de Cabeça e Pescoço, Cirurgia Plástica, Nefrologia e Ortopedia demandaram pelo menos dois profissionais. O grupo da Coloproctologia teve maior média de tempo de acomodação ao leito. Cerca de 15% dos pacientes demandaram oxigenoterapia, quase 50% receberam analgésicos e 34% estavam usando cateter vesical de demora. Conclusão: O tempo destinado à acomodação dos pacientes variou de 5 a 30 minutos, com média de 15,19 ± 4,7. Não há indícios de que mais ou menos profissionais atuando juntos alterem o tempo de acomodação do paciente. Descritores: Admissão do paciente; Transferência do paciente; Cuidados de enfermagem; Enfermagem perioperatória.

Objective: To analyze the nursing demand in the care of patients in the immediate postoperative period, from their admission to the surgical center to their accommodation in bed in the admission unit. Methods: Prospective and analytical study. The population consisted of adult patients, discharged from the surgical center. The sample was calculated considering that the service performs an average of 118 surgeries per month. Considering that the minimum sample would be 91 patients at a 95% confidence interval, we chose to work with a sample of 100 patients. Data were collected at the time patients were received from the PACU. Results: The Angiology, Coloproctology, Otorhinolaryngology and Urology surgical groups required a maximum of two nursing professionals. The Head and Neck Surgery, Plastic Surgery, Nephrology and Orthopedics groups required at least two professionals. The Coloproctology group had a higher average time of accommodation in bed. About 15% of the patients required oxygen therapy, almost 50% received analgesics and 34% were using an indwelling urinary catheter. Conclusion: The time allocated to the accommodation of patients ranged from 5 to 30 minutes, with an average of 15.19 ± 4.7. There are no indications that a greater or lesser number of professionals acting together alter the accommodation time of the patient. Descriptors: Patient admission; Patient transfer; Nursing care; Perioperative nursing.

Development of two artificial neural network models to support the diagnosis of pulmonary tuberculosis in hospitalized patients in Rio de Janeiro, Brazil.

Pulmonary tuberculosis (PTB) remains a worldwide public health problem. Diagnostic algorithms to identify the best combination of diagnostic tests for PTB in each setting are needed for resource optimization. We developed one artificial neural network model for classification (multilayer perceptron-MLP) and another risk group assignment (self-organizing map-SOM) for PTB in hospitalized patients in a high complexity hospital in Rio de Janeiro City, using clinical and radiologic data collected from 315 presumed PTB cases admitted to isolation rooms from March 2003 to December 2004 (TB prevalence = 21.5 %). The MLP model included 7 variables-radiologic classification, age, gender, cough, night sweats, weight loss and anorexia. The sensitivity of the MLP model was 96.0 % (95 % CI ±2.0), the specificity was 89.0 % (95 % CI ±2.0), the positive predictive value was 72.5 % (95 % CI ±3.5) and the negative predictive value was 98.5 % (95 % CI ±0.5). The variable with the highest discriminative power was the radiologic classification. The high negative predictive value found in the MLP model suggests that the use of this model at the moment of hospital admission is safe. SOM model was able to correctly assign high-, medium- and low-risk groups to patients. If prospective validation in other series is confirmed, these models can become a tool for decision-making in tertiary health facilities in countries with limited resources.

Perfil da tuberculose em populações vulneráveis: pessoas privadas de liberdade e em situação de rua / Tuberculosis profile in vulnerable people: people deprived of liberty and homeless population

Objetivo: descrever o perfil sociodemográfico e epidemiológico das pessoas privadas de liberdade e da população em situação de rua com tuberculose em Belo Horizonte. Metodologia: estudo ecológico descritivo. A fonte de dados foi o Sistema de Informação de Agravos de Notificação do município de Belo Horizonte-MG, de 2015 a 2017. Resultados: observou-se 43 casos de tuberculose em pessoas privadas de liberdade e 188 na população em situação de rua, sendo a maioria do sexo masculino, raça preta ou parda e com idade média de 38 e 40 anos, respectivamente. Nos dois públicos a escolaridade foi inferior a 12 anos e a maioria não era beneficiária de auxílio financeiro. Como comorbidades destaca-se a coinfecção HIV/TB, o alcoolismo e o tabagismo. A ocorrência de tuberculose multidrogarresistente foi de 5% entre os privados de liberdade. Destaca-se a baixa realização do teste rápido molecular. O tratamento diretamente observado foi pouco implementado nos dois grupos e o abandono foi a principal situação de encerramento na população de rua. Conclusões: o perfil sociodemográfico identificado apresenta características de grupos em situação de vulnerabilidade, com menos acesso a diagnóstico e tratamento de qualidade e desfechos mais desfavoráveis na tuberculose. Espera-se mais atuação das autoridades sobre os determinantes sociais de vulnerabilidade, visando sucesso na cura e controle da tuberculose.

Objective: to describe the sociodemographic and epidemiological profile of people deprived of their liberty and the homeless population with tuberculosis in Belo Horizonte. Methodology: descriptive ecological study. The data source was the Information System for Notifiable Diseases in the city of Belo Horizonte-MG, from 2015 to 2017. Results: 43 cases of tuberculosis in people deprived of their liberty and 188 in the homeless population, being the majority male, black or brown and with an average age of 38 and 40 years, respectively. In both publics, schooling was less than 12 years and most were not beneficiaries of financial aid. As comorbidities, HIV/ TB co-infection, alcoholism and smoking stand out. The occurrence of multidrug-resistant tuberculosis was 5% among those deprived of their liberty. The low performance of the rapid molecular test stands out. The directly observed treatment was poorly implemented in both groups and abandonment was the main situation of closure in the homeless population. Conclusion: the sociodemographic profile identified presents characteristics of groups in situations of vulnerability, with less access to quality diagnosis and treatment and more unfavorable outcomes in tuberculosis. It is expected more work of authorities on the social determinants of vulnerability, aiming at success in healing and control of tuberculosis.

Liquid vs Solid Culture Medium to Evaluate Proportion and Time to Change in Management of Suspects of Tuberculosis-A Pragmatic Randomized Trial in Secondary and Tertiary Health Care Units in Brazil.

BACKGROUND: The use of liquid medium (MGIT960) for tuberculosis (TB) diagnosis was recommended by WHO in 2007. However, there has been no evaluation of its effectiveness on clinically important outcomes. METHODS AND FINDINGS: A pragmatic trial was carried out in a tertiary hospital and a secondary health care unit in Rio de Janeiro City, Brazil. Participants were 16 years or older, suspected of having TB. They were excluded if only cerebral spinal fluid or blood specimens were available for analysis. MGIT960 technique was compared with the Lowenstein-Jensen (LJ) method for laboratory diagnosis of active TB. Primary outcome was the proportion of patients who had their initial medical management changed within 2 months after randomisation. Secondary outcomes were: mean time for changing the procedure, patient satisfaction with the overall treatment and adverse events. Data were analysed by intention-to-treat. Between April 2008 and September 2011, 693 patients were enrolled (348 to MGIT, 345 to LJ). Smear and culture results were positive for 10% and 15.7% of participants, respectively. Patients in the MGIT arm had their initial medical management changed more frequently than those in the LJ group (10.1% MGIT vs 3.8% LJ, RR 2.67 95% CI 1.44-.96, p = 0.002, NNT 16, 95% CI 10-39). Mean time for changing the initial procedure was greater in LJ group at both sites: 20.0 and 29.6 days in MGIT group and 52.2 and 64.3 in LJ group (MD 33.5, 95% CI 30.6-36.4, p = 0.0001). No other important differences were observed. CONCLUSIONS: This study suggests that opting for the MGIT960 system for TB diagnosis provides a promising case management model for improving the quality of care and control of TB. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN79888843.

Implementação da política de saúde pública e seus desafios na era digital / Implementación de la política de salud pública y sus desafíos en la era digital / Implementation of public health policy and its challenges in the digital age

Resumo Analisa-se a implementação da política pública de regulação de leitos em Unidades de Terapia Intensiva, considerando-se a política formulada, as condições institucionais e as estratégias utilizadas pelo estado e municípios baianos. Realiza-se revisão bibliográfica à luz do neoinstitucionalismo da escola da escolha racional e estudo de natureza qualitativa com três grupos de burocratas de médio escalão. Os resultados evidenciam um gap entre a política formulada e a implementada, a influência dos burocratas na implementação da política pública e uso das tecnologias da informação e comunicação, utilização de semelhantes estratégias de regulação, sendo a estratégia clientelística, associada ao uso do WhatsApp, encontrada na regulação paralela de leitos, indicativo de que, mesmo sob a égide do estado gerencial, persistem as práticas clientelísticas e patrimonialistas.

Resumen Se analiza la implementación de la política pública en materia de regulación de plazas en las unidades de cuidados intensivos, teniendo en cuenta la política formulada, las condiciones institucionales y las estrategias utilizadas por el Estado y los municipios. Se llevó a cabo una revisión de la literatura a la luz del neoinstitucionalismo de la escuela de la elección racional, y estudio cualitativo con tres grupos de burócratas a nivel de calle. Los resultados revelan una brecha entre la política formulada y aplicada, la influencia de burócratas en la implementación de la política pública y el uso de tecnologías de la información y la comunicación, con uso de estrategias de regulación similares. La estrategia clientelista, que se asocia con el uso de WhatsApp, fue encontrada en la regulación paralela de las plazas, lo que indica que, incluso bajo los auspicios del estado gerencial, persisten las prácticas clientelistas y patrimoniales.

Abstract This article analyzes the implementation of public policy on regulation of beds in intensive care units, considering the formulated policy, the institutional conditions and the strategies used by the state and municipalities of Bahia, Brazil. A literature review is carried out, based on the rational choice institutionalism, as well as a qualitative study with three groups of street-level bureaucrats. Results show a gap between the policies formulated and implemented and the influence of bureaucrats in the implementation of public policies in health. In addition, the research observed the use of information and communication technology such as social media (WhatsApp) as regulation strategies. The informal control and assignment of beds using WhatsApp is a clientelistic strategy, indicating that, even under the aegis of the managerial state, clientelistic and patrimonial practices persist.

O uso da combinação LABA/LAMA em pacientes com DPOC / LABA/LAMA combination in COPD

Neste artigo de atualização discutiremos, à luz dos mais recentes e relevantes trabalhos, a terapia dupla com broncodilatadores de longa ação para os pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC) no período estável, destacando sua proteção quanto a exacerbações, dispneia, qualidade de vida, utilizando como orientador de sua oportunidade de uso a recomendação mais recente do Iniciativa Global para Doenças Pulmonares (GOLD) da sigla em língua inglesa.

In this update article we will discuss the light of the most recent and relevant studies on dual therapy with long acting bronchodilators for patients with chronic obstructive pulmonary disease (COPD) in the stable period, highlighting their protection against exacerbations, dyspnea, quality of life, Using the most recent recommendation of the Global Initiative for Lung Disease (GOLD) as the guideline of their opportunity to use the English acronym.

ACREDITAÇÃO HOSPITALAR: A IMPORTÂNCIA DA COMUNICAÇÃO E DA INFORMAÇÃO PARA A SEGURANÇA DO PACIENTE / HOSPITAL ACCREDITATION: THE IMPORTANCE OF COMMUNICATION AND INFORMATION FOR PATIENT SAFETY / ACREDITACIÓN HOSPITALARIA: LA IMPORTANCIA DE LA COMUNICACIÓN Y DE LA INFORMACIÓN PARA LA SEGURIDAD DEL PACIENTE

Este artigo objetiva discutir a importância da Comunicação e da Informação para os processos de Acreditação Hospitalar e para a segurança do paciente, partindo do pressuposto de que o sucesso em tais processos demanda profundas modificações na cultura organizacional desse tipo de organização e que a Comunicação figura entre um dos atributos culturais de uma organização, capaz de contribuir para a segurança do paciente. Realizou-se estudo qualitativo e descritivo, com revisão bibliográfica e estudo de caso, utilizando-se de entrevistas com informantes-chave para a coleta de dados. A pesquisa de campo foi realizada em dois hospitais baianos de grande porte: um acreditado pela metodologia da ONA e outro, à época em processo de acreditação pela mesma organização, mas que não foi acreditado. Os resultados indicam que a gestão organizacional orientada para a Comunicação e a Informação resulta na sinergia interdepartamental indispensável ao alcance dos objetivos de padronização dos processos e homogeneização da linguagem, necessários a uma organização hospitalar em processo de Acreditação. No entanto, mesmo favorecendo a segurança do paciente e viabilizando os processos assistenciais, a Comunicação e a Informação ainda são entendidas como atividades de menor importância no ambiente hospitalar. Os resultados deste trabalho visam a contribuir com esta área do conhecimento ao possibilitar uma análise dos efeitos de uma política de Comunicação e Informação orientada à Acreditação como veículos para o sucesso da iniciativa e segurança do paciente.

This article aims to discuss the importance of Communication and Information for the Hospital Accreditation process and patient safety, based on the assumption that success in such processes demands profound modifications in the organizational culture of this type of organization, and that Communication is one of the cultural attributes of an organization that contributes to patient safety. A qualitative and descriptive study was conducted, with a literature review and a case study, interviewing key informants to collect data. The field research was carried out in two hospitals in Bahia, one accredited by the methodology of the ONA and the other, at the time, still in the accreditation process by the same organization, but failed to succeed. The results indicate that the organizational management oriented to the Communication and Information culminates in the interdepartmental synergy, indispensable to reach the objectives of standardization of the processes and homogenization of the language, necessary to a hospital organization in process of Accreditation. However, even promoting patient safety and enabling the care processes, the communication is still perceived as a minor activity in the hospital. The results of this study are intended to contribute to this area of knowledge by enabling an analysis of the effects of an Accreditation-oriented communication policy as a vehicle for the success of the initiative and the safety of the patient.

Este artículo tiene como objetivo discutir la importancia de la comunicación y de la información para el proceso de acreditación hospitalaria y la seguridad del paciente. Se ha llevado a cabo un estudio cualitativo y descriptivo, con revisión de la literatura y estudio de caso, utilizando de entrevistas con informantes clave para recopilar datos. La investigación de campo fue realizada en dos hospitales de Bahía, acreditados por la metodología de la ONA. La investigación de campo se llevó a cabo en dos hospitales de Bahía, un acreditado por la metodología de la ONA y otro en proceso de acreditación por la misma organización en la época de la recogida de datos, pero sin éxito. Los resultados indican que la gestión organizacional orientada a la comunicación y información resulta en la sinergia entre departamentos, esencial para el logro de los objetivos de la estandarización de los procesos y del lenguaje, necesarios a los procesos de acreditación hospitalaria. Los resultados de este estudio tienen por objetivo contribuir con esta área del conocimiento, permitiendo un análisis de los efectos de una política de comunicación orientada a la acreditación como un vehículo para el éxito de la iniciativa y de la seguridad del paciente.

Consciously transfusion of blood products. Systematic review of indicative factors for blood components infusion's trigger.

BACKGROUND AND OBJECTIVES: With the surgical and anesthetic technology advance the indications for intervention are expanding, as well as the need for blood transfusions. Because of its great scientific value, the content to be exposed is subject for endless discussions that provide different guidelines in various clinical and laboratory aspects. The objective of this review is to determine the clinical, laboratorial, and monitoring signs that should guide blood transfusion initiation, avoiding any risk and unnecessary use of resources, as well as the delay on starting therapy, determining tissue hypoxia and its corollaries. CONTENT: Scientific articles of clinical trials and reviews were used to range various subjects approached in the present content. These subjects were divided according to clinical and laboratorial aspects. Once the described search finished, 2,608 papers were identified, but only 17 original references were selected by inclusion criteria. CONCLUSIONS: Literature is unclear about clinical criteria on the ideal moment to begin the transfusion therapy in order to optimize the relations risk/ and cost/benefit. Studies show that there is no significant difference of oxygen supply (O(2)) in a comparison of hemoglobin (Hb) levels between 6 and 10g.dL(-1), mainly by reduced blood viscosity, facilitating the vascular flow to tissues. However, there is a tendency to recommend the transfusion trigger (TT) when it reaches low values as 6-7g.dL(-1). This same tendency indicates that red blood cells should never be administered with Hb levels > 10g.dL(-1), except in special situations.

Direitos do paciente, comunicação e a obrigação de informar / Patient rights, communication and reporting obligation / Derechos del paciente, la comunicación y la obligación de presentar informes

Este trabalho discute o direito do usuário à informação, à comunicação e a obrigatoriedade dos serviços de informarem. Apresentam-se os marcos regulatórios sobre a temática no Brasil e a percepção do representante dos usuários no Conselho Municipal de Saúde de Salvador, Bahia. A legislação prevê a participação dos usuários na interlocução com profissionais de saúde, gestores e pesquisadores, como estratégia para adesão ao cuidado e garantia da qualidade da atenção à saúde. O Programa Nacional de Segurança do Paciente preconiza a implantação de instrumentos para a gestão de informações e implementação de fluxos e canais de comunicação que assegurem o direito à informação. Contudo, verifica-se que, apesar da vasta legislação e das Tecnologias de Informação e Comunicação disponíveis, a realidade enfrentada pelos usuários e seus familiares na busca por informações é divergente do normatizado. O acesso à informação é entendido pelo representante dos usuários como precário, e a falta de comunicação, bem como a sonegação de informações são tidas como barreiras a serem enfrentados na busca da atenção à saúde eficaz. A transparência e a disponibilização das informações podem contribuir na adoção de práticas mais seguras e custo efetivas nos serviços de saúde, fazendo cumprir a sua obrigação de informar.

This paper discusses the user's right to information, to communication and the obligation of health care services to report. It presents the regulatory framework on the subject in Brazil and the perception of the representative of the users in the Municipal Health Council of Salvador, Bahia. The legislation provides for the participation of users in the dialogue with health professionals, managers and researchers as a strategy to the adherence to care and to ensure health care quality. The National Patient Safety Program recommends the implementation of tools for managing and implementing information flows and communication channels to ensure the right to information. However, it appears that despite the extensive legislation and the available Information and Communication Technologies, the reality faced by the users and their families in the search for information is divergent from standards. Access to information is understood by the representative of users as precarious, and the lack of communication as well as the withholding of information are seen as barriers to be overcome in the pursuit of attention for effective health. Transparency and availability of information can contribute to the adoption of safer practices and effective cost in health care services, enforcing its obligation to inform.

Este artículo discute el derecho del usuario a la información, la comunicación y la obligación de informar de los servicios de salud. Presenta los marcos regulativos sobre el tema en Brasil y la percepción del representante de los usuarios en el Consejo Municipal de Salud de Salvador, Bahía. La legislación prevé la participación de los usuarios en el diálogo con los profesionales de la salud, gestores e investigadores como una estrategia para la adhesión a la atención y para garantizar la calidad de la atención sanitaria. El Programa Nacional de Seguridad del Paciente recomienda la implantación de herramientas para la gestión y de flujos de información y canales de comunicación para garantizar el derecho a la información. Sin embargo, parece que a pesar de la amplia legislación y de las Tecnologías de la Información disponibles, la realidad que enfrentan los usuarios y sus familias en la búsqueda de información es divergente del estandarizado. El acceso a la información es entendido por el representante de los usuarios como precario, y la falta de comunicación y la retención de información son vistas como obstáculos que se enfrentan en la búsqueda de la atención por una salud eficaz. La transparencia y la disponibilidad de la información pueden contribuir a la adopción de prácticas más seguras y rentables en los servicios de salud, haciendo cumplir su obligación de informar.

Prosthetic misfit of implant-supported prosthesis obtained by an alternative section method.

PURPOSE: Adequate passive-fitting of one-piece cast 3-element implant-supported frameworks is hard to achieve. This short communication aims to present an alternative method for section of one-piece cast frameworks and for casting implant-supported frameworks. MATERIALS AND METHODS: Three-unit implant-supported nickel-chromium (Ni-Cr) frameworks were tested for vertical misfit (n = 6). The frameworks were cast as one-piece (Group A) and later transversally sectioned through a diagonal axis (Group B) and compared to frameworks that were cast diagonally separated (Group C). All separated frameworks were laser welded. Only one side of the frameworks was screwed. RESULTS: The results on the tightened side were significantly lower in Group C (6.43 ± 3.24 µm) when compared to Groups A (16.50 ± 7.55 µm) and B (16.27 ± 1.71 µm) (P<.05). On the opposite side, the diagonal section of the one-piece castings for laser welding showed significant improvement in the levels of misfit of the frameworks (Group A, 58.66±14.30 µm; Group B, 39.48±12.03 µm; Group C, 23.13±8.24 µm) (P<.05). CONCLUSION: Casting diagonally sectioned frameworks lowers the misfit levels. Lower misfit levels for the frameworks can be achieved by diagonally sectioning one-piece frameworks.

Status Asmaticus: lenda ou realidade? Como tratar melhor? / Status Asmathicus: legend or reality? How to treat better?

A história natural do status asmaticus é na maioria das vezes de resolução com mortalidade geral menor que 1%. Cerca de 80% dos pacientes com exacerbação de asma brônquica são liberados da emergência nas primeiras duas horas de tratamento. No entanto, nos pacientes com necessidade de ventilação mecânica a mortalidade pode chegar a 8%. O tratamento rápido e eficaz é essencial para o sucesso do tratamento e a prevenção de complicações. Neste artigo são abordadas as recomendações atuais do tratamento das exacerbações graves de asma brônquica nos setores de emergência e terapia intensiva...

The natural history of status asthmaticus is, most of the time, sorted out with overall mortality less than 1%. About 80% of patients with exacerbation of asthma emergency are released within the first two hours of treatment. However, in patients requiring mechanical ventilation mortality can reach 8%. The rapid and effective treatment is essential for the success of the treatment and the prevention of complications. This paper addresses the current recommendations the treatment of severe exacerbations of asthma in the emergency department and intensive care...

Pasteurização do leite-do-amapá in natura para controle do escurecimento enzimático / Pasteurization of the milk-of-amapá for control of enzymatic browning

O extrato do amapazeiro (Brosimum parinarioides Ducke), conhecido como leite-do-amapá, é utilizado pelas populações amazônicas como fonte alimentar e medicinal. A rápida alteração de cor do látex após extração representa a presença de enzimas como polifenoloxidase (PPO) e peroxidase (POD), escurecendo o produto in natura e desqualificando-o para comercialização. Desse modo, este trabalho objetivou a avaliação da atividade das enzimas PPO e POD em três amostras de leite-do-amapá resfriadas a 8°C, coletadas em amapazeiros em Moju (PA), e onze amostras de leite-do-amapá após o processo de pasteurização em diversos binômios tempo/temperatura e posteriormente resfriadas a 8°C, visando à otimização da conservação do produto in natura. Após resfriamento a 8°C, as amostras de leite-do-amapá in natura apresentaram diferença significativa entre os valores de atividade da enzima POD e, posteriormente observou-se elevação dessa atividade durante os períodos de tempo analisados. Como também se observou atividade da enzima PPO nas mesmas amostras, constata-se que esse tipo de conservação não foi eficiente para as enzimas POD e PPO para leite-do-amapá. As amostras pasteurizadas de leite-do-amapá, e posteriormente resfriadas, apresentaram atividades das enzimas POD e PPO significativamente diferenciadas da respectiva amostra controle (sem pasteurização), concluindo que a pasteurização nos binômios estudados, aliada ao resfriamento, foi eficaz na diminuição da atividade das enzimas peroxidase e polifenoloxidase, alcançando-se a inativação destas, podendo ser um processo potencial para conservação desse produto.

The extract of amapazeiro (Brosimum parinarioides Ducke), known as milk-of-amapá, is used by Amazonian populations as food and medicinal sources. The rapid change in color of the latex after extraction indicates the presence of enzymes such as polyphenoloxidase (PPO) and peroxidase (POD), darkening the fresh product and disqualifying it for trading. Thus, this study aimed at evaluating the activity of enzymes PPO and POD from three milk-of-amapá samples collected in amapazeiros in Moju (PA) cooled to 8°C and eleven samples of milk-of-amapá after the pasteurization process in different binomials time / temperature and then cooled to 8°C in order to optimize the storage of the fresh product. After cooling to 8°C, samples from the fresh milk-of-amapá showed significant difference between the values of PER enzyme activity POD, and later there was an increase of activity during the periods analyzed. As it was also observed PPO enzyme activity in the same samples, it appears that this type of conservation was not effective for the POD and PPO enzymes from milk-of-amapá. The samples of pasteurized milk-of-Amapá, and then cooled, showed enzyme activities of PPO and POD significantly different from respective control sample (without pasteurization), what leads to a conclusion that pasteurization in binomials studied, together with the cooling, was effective in reducing the activity of peroxidase and polyphenoloxidase enzymes, reaching to the inactivation of them, being a potencial process for conservation of this product.

Transfusão consciente de hemoderivados. Revisão sistemática dos fatores indicativos do gatilho para a infusão dos componentes sanguíneos / Consciously transfusion of blood products. Systematic review of indicative factors for blood components infusion's trigger / Transfusión consciente de hemoderivados. Revisión sistemática del los factores indicativos del gatillo para la infusión de los componentes sanguíneos

JUSTIFICATIVA E OBJETIVOS: Com o avanço da tecnologia cirúrgica e anestésica, expandem-se as indicações de intervenção, assim como, em muitos casos, a necessidade de transfusão de hemoderivados. Com grande valor científico, o tema a ser exposto é alvo de infindáveis discussões que fornecem diferentes diretrizes nos diversos aspectos clínicos e laboratoriais. O objetivo dessa revisão é determinar os sinais clínicos, laboratoriais e de monitoração que devem guiar o início da hemotransfusão, evitando-se qualquer risco e o uso desnecessário de recursos, além da demora no início da terapia, determinando hipóxia tecidual e suas consequências. CONTEÚDO: Foram utilizados artigos científicos de ensaios clínicos e revisões sobre vários assuntos abordados no presente conteúdo. Estes foram divididos em orientações segundo aspectos clínicos e laboratoriais. Após a aplicação da estratégia de busca acima relatada, foram identificados 2.608 artigos científicos do gênero, porém somente 17 referências originais foram selecionadas pelos critérios de inclusão. CONCLUSÕES: A literatura é incerta sobre os critérios clínicos que devem guiar o ponto ideal de início da terapia transfusional, de maneira a se otimizar as relações risco/custo/benefício. Estudos revelam que não existe diferença significativa da oferta de oxigênio (O2) quando se comparam níveis de hemoglobina (Hb) entre 6 e 10 g.dL-1, principalmente pela redução da viscosidade sanguínea, facilitando o fluxo vascular aos tecidos. Existe, no entanto, uma tendência de se recomendar o gatilho da transfusão (GT) sempre que ela atinja valores tão baixos quanto 6-7 g.dL-1. Essa mesma tendência indica que hemácias nunca devem ser administradas com Hb em níveis maiores do que 10 g.dL-1, exceto em situações especiais.

BACKGROUND AND OBJECTIVES: With the surgical and anesthetic technology advance the indications for intervention are expanding, as well as the need for blood transfusions. Because of its great scientific value, the content to be exposed is subject for endless discussions that provide different guidelines in various clinical and laboratory aspects. The objective of this review is to determine the clinical, laboratorial, and monitoring signs that should guide blood transfusion initiation, avoiding any risk and unnecessary use of resources, as well as the delay on starting therapy, determining tissue hypoxia and its corollaries. CONTENT: Scientific articles of clinical trials and reviews were used to range various subjects approached in the present content. These subjects were divided according to clinical and laboratorial aspects. Once the described search finished, 2,608 papers were identified, but only 17 original references were selected by inclusion criteria. CONCLUSIONS: Literature is unclear about clinical criteria on the ideal moment to begin the transfusion therapy in order to optimize the relations risk/ and cost/benefit. Studies show that there is no significant difference of oxygen supply (O2) in a comparison of hemoglobin (Hb) levels between 6 and 10 g.dL-1, mainly by reduced blood viscosity, facilitating the vascular flow to tissues. However, there is a tendency to recommend the transfusion trigger (TT) when it reaches low values as 6-7 g.dL-1. This same tendency indicates that red blood cells should never be administered with Hb levels > 10 g.dL-1, except in special situations.

JUSTIFICATIVA Y OBJETIVOS: Con el avance de la tecnología quirúrgica y anestésica se han extendido las indicaciones de intervención y en muchos casos, la necesidad de transfusión de hemoderivados. Con un gran valor científico, el tema que se expone es objeto de infinitas discusiones que acaban suministrando diferentes directrices en los diversos aspectos clínicos y laboratoriales. El objetivo de esta revisión, es determinar los signos clínicos, laboratoriales y de monitorización que deben guiar el inicio de la hemotransfusión, evitando el riesgo y el uso innecesario de recursos y la demora en el inicio de la terapia, determinando la hipoxia tisular y sus consecuencias. CONTENIDO: Se usaron artículos científicos de ensayos clínicos y revisiones sobre varios asuntos abordados en el texto que se presentará a continuación, dividido en orientaciones según los aspectos clínicos y laboratoriales. Después de la aplicación de la estrategia de búsqueda anteriormente relatada, se identificaron 2.608 artículos científicos del género, pero solamente 17 referencias originales se seleccionaron por los criterios de inclusión. CONCLUSIONES: La literatura no es muy exacta sobre los criterios clínicos que deben guiar el punto ideal de inicio de la terapia transfusional, optimizando las relaciones riesgo/ y coste/beneficio. Los estudios arrojan que no hay diferencia significativa de la oferta de oxígeno (O2) cuando se compara con los niveles de hemoglobina (Hb) entre 6 y 10 g.dL-1, principalmente por la reducción de la viscosidad sanguínea, facilitando el flujo vascular a los tejidos. Existe, sin embargo, una tendencia de recomendar el gatillo de la transfusión (GT) siempre que esa tendencia alcance valores tan bajos como 6 a 7 g.dL-1, y los hematíes nunca deben ser administradas con Hb en niveles mayores que 10 g.dL-1, con excepción de las situaciones especiales.

Toxicological studies on hydroalcohol extract of Calendula officinalis L.

The hydroalcohol extract (HAE) of Calendula officinalis L. was evaluated for its acute toxicity by the oral route in rats and mice and for the subacute effect on hematological, biochemical and morphologic parameters in rats. In the acute toxicity test, HAE failed to cause death in the animals after administration of oral doses up to 5.0 g/kg. Oral treatment with HAE at 0.025, 0.25, 0.5 and 1.0 g/kg did not induce hematological alterations when compared with the control group. In the biochemical parameters, there was an increase in blood urea nitrogen (BUN) and in alanine transaminase (ALT) levels. Morphological examination of the brain, kidney and heart did not show any alteration. However, inflammatory sites were found in the lung and liver, which were associated, respectively, with oral gavage and a possible hepatotoxic effect. HAE was non-toxic in rats, although there was evidence of renal and liver overload.