Assistência de enfermagem na depressão pós-parto: Revisão Integrativa / Nursing care in postpartum depression ­ Integrative Review / Cuidados de enfermería en la depresión posparto: Revisión integrativa

Objetivo: Objetivo: Diante da necessidade do aprofundamento da temática para a enfermagem, o objetivo do presente estudo foi revisar produções científicas que investigaram como é realizada a assistência de enfermagem na depressão pós-parto e sua importância para a saúde da puérpera. Método: O estudo trata-se de uma Revisão Integrativa da Literatura. As bases de dados consultadas foram BVS, SciELO, LILACS, Ministério da Saúde e OMS. Resultados: De acordo com o texto foram encontrados durante a pesquisa 58 artigos, os quais sofreram seleção e 11 compõem a amostra final. Os estudos foram publicados num intervalo de tempo de cinco anos, no entanto, não existem estudos suficientes que padronizem uma ferramenta para o diagnóstico e nem que mostrem como têm sido realizados esses diagnósticos nas unidades de saúde. Sendo notória a necessidade de realização de mais estudos sobre o assunto, esclarecendo as principais dúvidas, solucionando os problemas encontrados e possibilitando a agregação de conhecimento dos profissionais de saúde neste processo. Conclusão: Os profissionais da saúde devem buscar mais conhecimento se habilitando para um atendimento cada vez melhor, proporcionando tratamento precoce, favorecendo uma rápida e surpreendente recuperação da puérpera

Objective: Given the need to deepen the theme for nursing, the aim of this study was to review scientific productions that investigated how nursing care is performed in postpartum depression and its importance for the health of the puerperal. Method: The study is an Integrative Literature Review. The databases consulted were VHL, SciELO, LILACS, Ministry of Health and WHO. Results: According to the text, 58 articles were found during the study, which were selected and 11 compose the final sample. The studies were published within five years, however, there are not enough studies to standardize a diagnostic tool or show how these diagnoses have been made in health units. The need to conduct more studies on the subject is notorious, clarifying the main doubts, solving the problems encountered and enabling the aggregation of knowledge of health professionals in this process. Conclusion: Health professionals should seek more knowledge by enabling themselves to better care, providing early treatment, favoring a rapid and surprising recovery of the puerperal woman.

Objetivo: Dada la necesidad de profundizar el tema de enfermería, el objetivo de este estudio fue revisar las producciones científicas que investigaron cómo se realiza el cuidado de enfermería en la depresión posparto y su importancia para la salud del puerperal. Método: El estudio es una Revisión Integrativa de la Literatura. Las bases de datos consultadas fueron BVS, SciELO, LILACS, Ministerio de Salud y OMS. Resultados: Según el texto, durante el estudio se encontraron 58 artículos, los cuales fueron seleccionados y 11 componen la muestra final. Los estudios fueron publicados dentro de los cinco años, sin embargo, no hay suficientes estudios para estandarizar una herramienta diagnóstica o mostrar cómo se han realizado estos diagnósticos en las unidades de salud. La necesidad de realizar más estudios sobre el tema es notoria, aclarando las principales dudas, resolviendo los problemas encontrados y posibilitando la agregación de conocimientos de los profesionales de la salud en este proceso. Conclusión: Los profesionales de la salud deben buscar más conocimientos permitiéndose una mejor atención, proporcionando un tratamiento temprano, favoreciendo una recuperación rápida y sorprendente de la mujer en el posparto

Trinucleotide repeats in 202 families with ataxia: a small expanded (CAG)n allele at the SCA17 locus.

BACKGROUND: Ten neurodegenerative disorders characterized by spinocerebellar ataxia (SCA) are known to be caused by trinucleotide repeat (TNR) expansions. However, in some instances the molecular diagnosis is considered indeterminate because of the overlap between normal and affected allele ranges. In addition, the mechanism that generates expanded alleles is not completely understood. OBJECTIVE: To examine the clinical and molecular characteristics of a large group of Portuguese and Brazilian families with ataxia to improve knowledge of the molecular diagnosis of SCA. PATIENTS AND METHODS: We have (1) assessed repeat sizes at all known TNR loci implicated in SCA; (2) determined frequency distributions of normal alleles and expansions; and (3) looked at genotype-phenotype correlations in 202 unrelated Portuguese and Brazilian patients with SCA. Molecular analysis of TNR expansions was performed using polymerase chain reaction amplification. RESULTS: Patients from 110 unrelated families with SCA showed TNR expansions at 1 of the loci studied. Dominantly transmitted cases had (CAG)(n) expansions at the Machado-Joseph disease gene (MJD1) (63%), at SCA2 (3%), the gene for dentatorubropallidoluysian atrophy (DRPLA) (2%), SCA6 (1%), or SCA7 (1%) loci, or (CTG)(n) expansions at the SCA8 (2%) gene, whereas (GAA)(n) expansions in the Freidreich ataxia gene (FRDA) were found in 64% of families with recessive ataxia. Isolated patients also had TNR expansions at the MJD1 (6%), SCA8 (6%), or FRDA (8%) genes; in addition, an expanded allele at the TATA-binding protein gene (TBP), with 43 CAGs, was present in a patient with ataxia and mental deterioration. Associations between frequencies of SCA2 and SCA6 and a frequency of large normal alleles were found in Portuguese and Brazilian individuals, respectively. Interestingly, no association between the frequencies of DRPLA and large normal alleles was found in the Portuguese group. CONCLUSIONS: Our results show that (1) a significant number of isolated cases of ataxia are due to TNR expansions; (2) expanded DRPLA alleles in Portuguese families may have evolved from an ancestral haplotype; and (3) small (CAG)(n) expansions at the TBP gene may cause SCA17.

[Relationship between parenteral gangliosides administration and the Guillain-Barré syndrome]. / Relación entre la administración parenteral de gangliósidos y el síndrome de Guillain-Barré.

OBJECTIVE: We carried out a case a case-control study to analyze the relationship between parenteral gangliosides administration and the Guillain-Barré syndrome. PATIENTS AND METHODS: We retrieved 64 patients with the diagnosis of Guillain-Barré syndrome, and 148 controls. In cases and controls the proportion and 95% confidence intervals (CI) of subject receiving gangliosides, was calculated. The number of patients with the Guillain-Barré syndrome who needed ventilation or died was also calculated. RESULTS: Four of 36 patients (95% CI = 81-0.6), over 40 years, received gangliosides prior to Guillain-Barré syndrome. One of these patients was ventilated (95% CI = 25-2) and died. None of the controls less than 40 years old took gangliosides, while from the 108 over 40 (95% CI = 15-4) 9 received gangliosides. None developed signs suggesting Guillain-Barré syndrome. Although gangliosides were more often used in Guillain-Barré syndrome (OR = 1.75), the difference was not significant (95% CI = 4.82-0.69). CONCLUSION: The present work proves that in spite of the association of Guillain-Barré syndrome, with gangliosides intake, there is no statistical difference between this group of patients and control population.

[Cluster headache]. / Cefaleia em salvas.

We present a review of 60 cases of cluster headache. Most patients were males, ranging from 19 to 65 years of age at the time of the first visit. Headaches consisted of short-lasting (from 15 to 210 minutes), intense, unilateral pain attacks, most frequently in the periorbital area, with ipsilateral autonomic signs (rhinorrhea, ptosis, tearing and conjunctival injection). Between attacks, patients were completely free of pain. The attacks occurred in bouts lasting 1 to 6 months, in which patients had daily headaches (one to three times a day). Headaches responded well to oxygen or ergotamine. Prophylactic therapy in most cases consisted of verapamil, also with a good response. We present this review in order to draw attention to this relatively rare form of headache with a specific therapy.

Behavioral response to headache: a comparison between migraine and tension-type headache.

OBJECTIVE: To compare patients with migraine and tension-type headache in their behavior during the attacks and the maneuvers used to relieve the pain. BACKGROUND: Patients with headache often perform nonpharmacological measures to relieve the pain, but it is not known if these behaviors vary with the diagnosis, clinical features, and pathogenesis. METHODS: One hundred consecutive patients with either migraine (n = 72 ) or tension-type headache (n = 28) were questioned (including the use of a checklist) concerning their usual behavior during the attacks and nonpharmacological maneuvers performed to relieve the pain. The results of the two types of headache were compared. RESULTS: Patients with migraine tended to perform more maneuvers than individuals with tension-type headache (mean, 6.2 versus 3). These maneuvers included pressing and applying cold stimuli to the painful site, trying to sleep, changing posture, sitting or reclining in bed (using more pillows than usual to lay down), isolating themselves, using symptomatic medication, inducing vomiting, changing diet, and becoming immobile during the attacks. The only measure predominantly reported by patients with tension-type headache was scalp massage. However, the benefit derived from these measures was not significantly different between the two groups (except for a significantly better response to isolation, local pressure, local cold stimulation, and symptomatic medication in migraineurs). CONCLUSIONS: The behavior of patients during headache attacks varies with the diagnosis. Measures that do not always result in pain relief are performed to prevent its worsening or to improve associated symptoms. These behavioral differences may be due to the different pathogenesis of the attacks or to different styles of dealing with the pain. They can also aid the differential diagnosis between headaches in doubtful cases.

Extratrigeminal ice-pick status.

We describe six patients with an identical type of headache, consisting of short episodes (lasting around 1 week) of daily attacks of ice-pick-like pain, recurring every minute in the same points of the scalp. In all of them, the pain was felt outside the cutaneous area of the trigeminal nerve (retroauricular, parietal, and occipital regions). All patients were examined in the emergency department of a general hospital over a period of 7 years because of these acute headaches. None of them had a history of migraine. Although this pain is identical to idiopathic stabbing headache, it differs from it by its temporal profile (in "status"), its posterior (extratrigeminal) location, and its lack of association with migraine. While the bouts were usually severe and recurred in two patients, all had a self-limited benign course and responded promptly to indomethacin.

EEG monitoring during endovascular embolization of cerebral arteriovenous malformations.

Arteriovenous malformations (AVMs) may have a bad prognosis. Endovascular embolization with cyanocrylate represents nowadays an important initial step in a staged treatment, that later may include surgery or radiotherapy. Embolization may induce significant changes in the dynamics of the cerebral circulation, some of which may provoke neurological sequelae. Therefore assessment of potential complications is usually done by using a superselective amytal test, during which small doses of amytal are injected directly in the pedicle that is going to be embolized. In spite of an extensive use of the EEG during endovascular embolization its evaluation in terms of benefits and limitations is not available. Such evaluation is therefore the aim of this work. EEG monitoring was performed during endovascular embolization of 19 patients; a large majority of patients presented large AVMs, with Spetzler indexes around IV or V. The main results were as follows: (1) EEG changes at baseline were significantly correlated with the AVM size and the Spetzler index but were unable to predict the difficulties in the embolization; (2) during amytal tests EEG positivity reached 35% and consisted mainly in ipsilateral slow focal activity; (3) in some cases embolization was performed in spite of transient EEG changes. It was found that focal or diffuse abnormalities in the lower frequency range, even when slight, could be followed by clinical hazards (3 out of 11 cases); (4) EEG monitoring was important in the prediction, evaluation and prognosis of clinical complications.