Nursing care management in substitutive renal therapy in patients with COVID-19: integrative review / Gestión de Cuidados de Enfermería en Terapia Renal Sustitutiva en Pacientes con COVID-19: Revisión Integradora

Introducción: Among the systems most affected by COVID-19, the renal system stands out, which leads to challenges in the management of nursing care for these patients. Objetives: To describe the scientific evidence on nursing care management in patients diagnosed with COVID-19 undergoing Renal Replacement Therapy. Methodology: Articles were searched in PubMed, SCOPUS, Web of Science, LILACS, BDENF, EMBASE, IBECS, CINAHL, COCHRANE LIBRARY, and Scielo databases, using the following cross-references: “renal therapy” AND “nursing care” AND “covid-19”. To systematize the searches, the Boolean operator “AND” was used. Initially, 167 primary references were identified in the selected databases/virtual library, and as a final sample, 14 articles were included. Results: It was found that among the contributions to nursing care management in hemodialysis patient care in the context of the COVID-19 pandemic, the use of health technologies (examples: use of telehealth and the development of new protocols), development of new methods in nursing care management and continuing education are described in the literature. These tools were essential for the continuity of nursing care. Conclusion: Among the tools used for nursing care management in the context of the pandemic of COVID-19 in hemodialysis patients, health technologies and continuing education in health are included, enabling qualified care management. (AU)

Introducción: Entre los sistemas más afectados por la pandemia COVID-19, destaca el sistema renal, circunstancia que conlleva desafíos en la gestión de cuidados de enfermería en los pacientes. Objetivo: Describir la evidencia científica sobre la gestión de cuidados de enfermería en pacientes diagnosticados con COVID-19 sometidos a terapia renal sustitutiva. Metodología: Se buscaron artículos en las bases de datos PubMed, SCOPUS, Web Of Science, LILACS, BDENF, EMBASE, IBECS, CINAHL, COCHRANE LIBRARY y Scielo, utilizando las siguientes palabras clave cruzadas: “renal therapy” AND “nursing care” AND “covid-19”. Para sistematizar las búsquedas, se utilizó el operador booleano “AND”. Inicialmente, se identificaron 167 referencias primarias en las bases de datos seleccionadas, y como muestra final, se incluyeron 14 artículos. Resultados: Se encontró que entre las contribuciones a la gestión de cuidados de enfermería en la atención de pacientes en hemodiálisis en el contexto de la pandemia de COVID-19, se describen el uso de tecnologías de la salud (ejemplos: el uso de telemedicina y el desarrollo de nuevos protocolos), el desarrollo de nuevos métodos en la gestión de cuidados de enfermería y la educación continua. Estas herramientas fueron esenciales para la continuidad de los cuidados de enfermería. Conclusión: Entre las herramientas utilizadas para la gestión de cuidados de enfermería en el contexto de la pandemia de COVID-19 en pacientes en hemodiálisis, se incluyen las tecnologías de la salud y la educación continua en salud, lo que permite una gestión de cuidados calificada. (AU)

Antiretroviral therapy use in selected countries in Latin America during 2013-2017: results from the Latin American Workshop in HIV Study Group.

OBJECTIVE: To document antiretroviral use in Latin America during the last decade. METHODS: We collected indicators from 79 HIV health care centres in 14 Latin American Spanish-speaking countries for 2013-2017. Indicators were analysed by age, sex and other characteristics and weighted by the estimated people under care (PUC) population in each country. RESULTS: We gathered information on 116 299 PUC. One-third belonged to centres reporting a shortage of at least one antiretroviral therapy (ART) drug for >30 days during 2017. At end 2017, 95.1% of PUC were receiving ART. During 2013-2017, 45 329 people living with HIV were admitted to 39 centres. ART initiated during the first year after admission increased from 76.7% in 2013 to 83.8% in 2017. In 35 centres across the study period, 71.7% of PUC started ART with tenofovir disoproxil fumarate and lamivudine, and zidovudine use decreased. The third most common ART drug, EFV, reached 64.8%. Raltegravir and other alternatives increased annually to almost 10% of total use in 2017. CONCLUSIONS: Initial ART in Latin America is not based on the most recent scientific evidence and recommendations; use of drugs with higher efficacy and safety profiles and guarantee of ART availability continues to be a public health challenge.

Infertility diagnosis in jaguar (Panthera onca): case report / Diagnóstico de infertilidade em onça pintada (Panthera onca): relato de caso

This work reports one case of infertility in a male jaguar (Panthera onca) aged 21 years and weighing 125 kg. Changes in sperm due to chronic stress, inadequate food handling and reproductive senescence are emphasized.(AU)

O presente trabalho relata um caso de infertilidade em uma onça-pintada (Panthera onca), macho, de 21 anos e 125 kg. São ressaltadas as alterações ocorridas nos espermatozoides, devido a estresse crônico, manejo alimentar inadequado e senescência reprodutiva.(AU)

Spray Freeze-Drying as an Alternative to the Ionic Gelation Method to Produce Chitosan and Alginate Nano-Particles Targeted to the Colon.

Chitosan and alginate nano-composite (NP) carriers intended for colonic delivery containing prednisolone and inulin were obtained by two processes. Spray freeze-drying using chitosan (SFDC) or alginate (SFDA) was proposed as an alternative to the traditional chitosan-tripolyphosphate platform (CTPP). NPs were fully characterised and assessed for their yield of particles; level of prednisolone and inulin release in phosphate and Krebs buffers; and sensitivity to degradation by lysozyme, bacteria and faecal slurry. NPs based on chitosan showed similar properties (size, structure, viscoelastic behaviour), but those based on SFDC showed a higher mean release of both active ingredients, with similar efficiency of encapsulation and loading capacity for prednisolone but lower for inulin. SFDC was less degraded in the presence of lysozyme and E. coli and was degraded by B. thetaiotaomicron but not by faecal slurry. The results obtained with SFDA were promising because this NP showed good encapsulation parameters for both active ingredients and biological degradability by E. coli and faecal slurry. However, it will be necessary to use alginate derivatives to reduce its solubility and improve its mechanical behaviour.

Release of prednisolone and inulin from a new calcium-alginate chitosan-coated matrix system for colonic delivery.

Putative colonic release formulations of calcium (Ca)-alginate coated with chitosan containing two different actives, prednisolone and inulin, were prepared in three different sizes, beads (D50 = 2104 µm) and microparticles (D50 = 354 and 136 µm). The formulations were tested in standard phosphate buffer and biorelevant Krebs bicarbonate buffer at pH 7.4, and were further evaluated in the presence of the bacterium E. coli. Product yield and encapsulation were higher with prednisolone than with inulin. In Krebs bicarbonate buffer, a clear relationship between particle size and prednisolone release was observed. In contrast, release of inulin was independent of the particle size. In phosphate buffer, the particles eroded quickly, whereas in Krebs buffer, the particles swelled slowly. The difference in behavior can be attributed to the formation of calcium phosphate in the phosphate buffer medium, which in turn weakens the Ca-alginate matrix core. In the presence of E. coli, the formulations were fermented and the release of prednisolone was accelerated. In conclusion, the buffer media affects formulation behavior and drug release, with the bicarbonate media providing a better simulation of in vivo behavior. Moreover, the susceptibility of the formulations to bacterial action indicates their suitability as carriers for colonic drug delivery.

[Evaluation of microbial growth on single-use vitrectomy probes reprocessed in healthcare practice]. / Avaliação do crescimento microbiano em sondas de uso único para vitrectomia reprocessadas na prática assistencial.

The aim of this study was to evaluate the microbial growth on single-use vitrectomy probes reprocessed in healthcare practice. We investigated nine vitrectomy probes that had been reused and reprocessed using different methods. The samples were sectioned, individually, in portions of 3.5 cm, totaling 979 sampling units (extensions, connectors and vitrectomy cutters), which were inoculated in culture medium and incubated at 37º C for 14 days. The results showed microbial growth on 57 (5.8%) sample units, 25 of which had been sterilized using ethylene oxide, 16 by hydrogen peroxide plasma, and 16 by low-temperature steam and formaldehyde. Seventeen microbial species were identified. The most prevalent were: Micrococcus spp., coagulase-negative Staphylococcus, Pseudomonas spp., and Bacillus subtilis. The reuse of single-use vitrectomy probes was shown to be unsafe, therefore this practice is not recommended.

Avaliação do crescimento microbiano em sondas de uso único para vitrectomia reprocessadas na prática assistencial / Evaluation of microbial growth on single-use vitrectomy probes reprocessed in healthcare practice / Evaluación de crecimiento microbiano en sondas de uso único para vitrectomía recicladas en la práctica asistencial

O objetivo deste estudo foi avaliar o crescimento microbiano em sondas para vitrectomia de uso único, reprocessadas na prática assistencial. Foram investigadas nove sondas reusadas e reprocessadas por diferentes métodos. As sondas foram segmentadas, individualmente, em porções de 3,5 cm, totalizando em 979 unidades amostrais (extensões, conectores e ponteiras) inoculadas em meio de cultura e incubadas a 37ºC, por 14 dias. Os resultados mostraram crescimento microbiano em 57 (5,8%) unidades amostrais, das quais, 25 foram esterilizadas por Óxido de Etileno, 16 por Plasma de Peróxido de Hidrogênio e 16 por Vapor à Baixa Temperatura e Formaldeído. Foram identificadas 17 espécies microbianas, sendo as mais prevalentes o Micrococcus spp., Staphylococcus coagulase negativa, Pseudomonas spp. e Bacillus subtilis. O reuso de sondas de uso único para vitrectomia não se mostrou seguro, portanto tal prática não é recomendada.

The aim of this study was to evaluate the microbial growth on single-use vitrectomy probes reprocessed in healthcare practice. We investigated nine vitrectomy probes that had been reused and reprocessed using different methods. The samples were sectioned, individually, in portions of 3.5 cm, totaling 979 sampling units (extensions, connectors and vitrectomy cutters), which were inoculated in culture medium and incubated at 37ºC for 14 days. The results showed microbial growth on 57 (5.8%) sample units, 25 of which had been sterilized using ethylene oxide, 16 by hydrogen peroxide plasma, and 16 by low-temperature steam and formaldehyde. Seventeen microbial species were identified. The most prevalent were: Micrococcus spp., coagulase-negative Staphylococcus, Pseudomonas spp., and Bacillus subtilis. The reuse of single-use vitrectomy probes was shown to be unsafe, therefore this practice is not recommended.

Este estudio objetivó evaluar el crecimiento microbiano en sondas para vitrectomía de uso único recicladas en la práctica asistencial. Se investigaron nueve sondas reutilizadas y recicladas mediante diferentes métodos. Las sondas fueron segmentadas individualmente en porciones de 3,5 cm, totalizándose 979 unidades de muestra (extensiones, conectores y punteras), inoculadas en medio de cultivo e incubadas a 37ºC por 14 días. Los resultados demostraron crecimiento microbiano en 57 (5,8%) unidades de muestra, 25 de las cuales habían sido esterilizadas con óxido de etileno, 16 con plasma de peróxido de hidrógeno y 16 por vapor a baja temperatura y formaldehido. Se identificaron 17 especies microbianas, prevaleciendo el Micrococcus spp, Staphylococcus couagulasa negativo, Pseudomonas spp y Bacillus subtilis. La reutilización de sondas de uso único para vitrectomía no demostró seguridad, por lo que la práctica no es recomendable.

Implicações da sexualidade e reprodução no adolescer saudável / Sexuality and reproduction: implications in the process of healthy adolescence

Este estudo objetivou compreender a percepção de adolescentes acerca de seu processo de adolescer saudável, no que se refere à sexualidade e reprodução. Trata de uma pesquisa qualitativa do tipo exploratória, realizada com 10 adolescentes, em uma escola estadual no sul do Rio Grande do Sul, entre agosto e outubro de 2007. Para a coleta dos dados, foram utilizadas entrevistas semiestruturadas, cujo conteúdo foi submetido à análise temática, surgindo o tema: Sexualidade e reprodução na adolescência. Diante dos dados, percebeu-se que é preciso proporcionar mais orientações para um adolescer saudável, no sentido de fortalecer e favorecer a segurança necessária ao adolescente no exercício da sua sexualidade e reprodução. Evidenciou-se também a necessidade de preparo do adolescente, seja por profissionais da saúde, da educação ou familiares, para o enfrentamento de algumas situações, tais como: gravidez indesejada, primeira relação sexual, automedicação, receio de conversar com os pais sobre sexualidade, dentre outras.

Avaliação do ensino prático desenvolvido em um hospital universitário na perspectiva de graduandos em Enfermagem / Assessment of practical teaching in a university hospital according the view of nursing undergraduate students / Evaluación de la enseñanza práctica en hospital universitario desarrollado en la perspectiva de estudiantes de enfermería

Buscando condições apropriadas para formação de enfermeiros críticos e reflexivos, este estudo objetivou avaliar, na perspectiva dos graduandos da Escola de Enfermagem da Universidade de São Paulo (USP), o ensino prático desenvolvido no Hospital Universitário. Trata-se de estudo quantitativo descritivo com população de 77 graduandos de enfermagem, que cursavam 8º período em 2007 e 2008. A coleta de dados ocorreu por meio de escala psicométrica testada e validada previamente. Os resultados mostraram que os enfermeiros dispensaram atenção aos graduandos e oportunidades de aprendizagem na dinâmica de trabalho e forneceram orientações objetivas e seguras; estimularam o raciocínio clínico visando à tomada de decisão e planejamento da assistência de enfermagem, discutindo a dimensão ética. Os graduandos sentiram-se respeitados e integrados à equipe. As atividades práticas desenvolvidas no Hospital da USP atenderam aos objetivos das diversas disciplinas, estabelecendo relação teoria e prática e colaborando na construção da identidade profissional dos futuros enfermeiros. Este estudo permitirá o aprimoramento do campo em consonância com o projeto político pedagógico da Escola...

In order to seeking proper conditions fortrainingcriticaland reflective nurses, this study aims to evaluate according the perspective of students of the 8th semester of the School of Nursing, University of Sao Paulo, the practice developed at the Hospital of the University. It is a quantitative, exploratory and descriptive study. The population consisted of 77 students that were studying at the 8th period of the course in 2007 and 2008. Data collection occurred through psychometric scale previously tested and validated. The results showed that nurses have spent attention to the students and offered opportunities for their learning concerning the work dynamics of the units. Also, they provided objective and safe advices, discussing the ethical aspects of the care. Furthermore they stimulated the development of clinical reasoning for decision-making, and for planning the nursing care. , The students fell respected and integrated into the team. The practical activities developed in the USP Hospitals provided to establish the relationship between theory and practice and contributed to the construction of professional identity of future nurses. This study will contribute to improving the training field according to the political pedagogical project...

Con finalidad de buscar condiciones adecuadas a enseñanza de enfermeros críticos y reflexivos, este estudio objetivó evaluar la enseñanza practica desarrollada en hospital escuela, según estudiantes de Escuela de Enfermería - Universidad de São Paulo (USP). Estudio cuantitativo descriptivo con 77 estudiantes de enfermería del 8º período, en 2007 y 2008. Datos fueron recogidos por escala psicométrica probada y validada previamente. Los resultados mostraron que enfermeros ofrecen oportunidad de aprendizaje dinámica del trabajo, orientaciones objetivas y confiables, estimularon el razonamiento clínico objetivando la tomada de decisiones y planeamiento de asistencia de enfermería según dimensión ética. Los estudiantes se cayeron respeto y integrados con el equipo. Actividades practicas desarrolladas en el hospital proporcionaron alcance de objetivos de disciplinas, estableciéndose relaciones entre teoría-practica, y colaborando en la construcción de la identidad profesional con futuros enfermeros. Este estudio contribuirá con el campo de entrenamiento basándose en Proyecto Político Pedagógico de la Escuela...

Prevalence of alveolar bone loss in healthy children treated at private pediatric dentistry clinics.

OBJECTIVES: The purpose of this study was to evaluate the prevalence of alveolar bone loss (BL) in healthy children treated at private pediatric dentistry clinics in Brasília, Brazil. MATERIAL AND METHODS: The research included 7,436 sites present in 885 radiographs from 450 children. The BL prevalence was estimated by measuring the distance from the cementoenamel junction (CEJ) to alveolar bone crest (ABC). Data were divided in groups: (I) No BL: distance from CEJ to ABC is <2 mm; (II) questionable BL (QBL): distance from CEJ to ABC is >2 and <3 mm; (III) definite BL (DBL): distance from CEJ to ABC >3 mm. Data were treated by the chi-square nonparametric test and Fisher's exact test (p<0.05). RESULTS: Among males, 89.31% were classified in group I, 9.82% were classified in group II and 0.85% in group III. Among females, 93.05%, 6.48% and 0.46% patients were classified in Group I, II and III, respectively. The differences between genders were not statistically significant (Chi-square test, p = 0.375). Group composition according to patients' age showed that 91.11% of individuals were classified as group I, 8.22% in group II and 0.67% in group III. The differences among the age ranges were not statistically significant (Chi-square test, p = 0.418). The mesial and distal sites showed a higher prevalence of BL in the jaw, QBL (89.80%) and DBL (79.40%), and no significant difference was observed in the distribution of QBL (Fisher's exact test p = 0.311) and DBL (Fisher's exact test p = 0.672) in the dental arches. The distal sites exhibited higher prevalence of both QBL (77.56%) and DBL (58.82%). CONCLUSIONS: The periodontal status of children should never be underestimated because BL occurs even in healthy populations, although in a lower frequency.

Prevalence of alveolar bone loss in healthy children treated at private pediatric dentistry clinics

OBJECTIVES: The purpose of this study was to evaluate the prevalence of alveolar bone loss (BL) in healthy children treated at private pediatric dentistry clinics in Brasília, Brazil. MATERIAL AND METHODS: The research included 7,436 sites present in 885 radiographs from 450 children. The BL prevalence was estimated by measuring the distance from the cementoenamel junction (CEJ) to alveolar bone crest (ABC). Data were divided in groups: (I) No BL: distance from CEJ to ABC is <2 mm; (II) questionable BL (QBL): distance from CEJ to ABC is >2 and <3 mm; (III) definite BL (DBL): distance from CEJ to ABC >3 mm. Data were treated by the chi-square nonparametric test and Fisher's exact test (p<0.05). RESULTS: Among males, 89.31 percent were classified in group I, 9.82 percent were classified in group II and 0.85 percent in group III. Among females, 93.05 percent, 6.48 percent and 0.46 percent patients were classified in Group I, II and III, respectively. The differences between genders were not statistically significant (Chi-square test, p = 0.375). Group composition according to patients' age showed that 91.11 percent of individuals were classified as group I, 8.22 percent in group II and 0.67 percent in group III. The differences among the age ranges were not statistically significant (Chi-square test, p = 0.418). The mesial and distal sites showed a higher prevalence of BL in the jaw, QBL (89.80 percent) and DBL (79.40 percent), and no significant difference was observed in the distribution of QBL (Fisher's exact test p = 0.311) and DBL (Fisher's exact test p = 0.672) in the dental arches. The distal sites exhibited higher prevalence of both QBL (77.56 percent) and DBL (58.82 percent). CONCLUSIONS: The periodontal status of children should never be underestimated because BL occurs even in healthy populations, although in a lower frequency.

Transmissão de bactérias periodontais: [revisão] / Transmission of periodontal bacteria: [review]

Periodontite corresponde a uma diversidade de doenças clinicamente diferentes, associadas com uma microbiota subgengival variável entre os diferentes grupos de pacientes. A maioria das espécies bacterianas subgengivais é indígena à cavidade bucal. Aggregatibacter actinomycetemcomitans e Porphyromonas gingivalis são considerados patógenos periodontais importantes que apresentam características de patógenos exógenos e não são frequentemente detectados em indivíduos com periodonto sadio. A transmissão de microrganismos entre pais e filhos (transmissão vertical) é particularmente evidente. Técnicas de genética molecular têm demonstrado que se uma criança é colonizada por uma espécie potencialmente patogênica, então um dos pais comumente abriga a bactéria idêntica genotipicamente. Os dados também indicam que transferência de bactéria entre cônjuges (transmissão horizontal) ocorre, embora não frequentemente. Todavia, a transferência de microrganismos não resulta necessariamente em colonização ou infecção do hospedeiro. Além disso, há indivíduos que abrigam periodonto patógenos e não manifestam qualquer sinal de doença periodontal. O propósito deste artigo é apresentar uma revisão da literatura sobre a transferência de bactérias associadas com as doenças periodontais entre membros da família.

Periodontitis corresponds to a variety of clinically different diseases associated with a variable subgingival microbiotaamong different patient groups. The majority of subgingival bacterial species are indigenous to the oral cavity.Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis are adjudged as important periodontais pathogen that presents characteristicsof exogenous pathogens and are infrequently detected in subjects with healthy periodontium. The transmission of microorganisms between parentsand children (ver tical transmission) is particularly evident. Molecular genetic techniques have demonstrated that if a child is colonized by a potentially pathogenic species, then one of the parents usually harbor genotypically identical bacteria. The data also indicate that transfer of bacteria between spouses (horizontal transmission) occurs, although infrequently. However, the transfer of microorganisms does not necessarily result in colonization or infection of the host. Furthermore, there are individuals who harbor periodontopathogens and do notmanifest any signs of periodontal disease. The purpose of this article is to present a review of the literature about the intra-familial transfer of bacteria associated with periodontal diseases.

Estudos clínicos sobre processo e diagnóstico de enfermagem em um hospital universitário: relato de experiência / Clinical studies on nursing process and diagnosis at a university hospital: experience report

O presente relato de experiência tem como objetivo apresentar a trajetória do Grupo de Trabalho do Diagnóstico de Enfermagem do Hospital de Clínicas de Porto Alegre na realização de estudos clínicos. Essa atividade vem ocorrendo desde dezembro de 2001 e visa a propiciar conhecimentos e discussões sobre a aplicação do processo de enfermagem, mais recentemente denominado sistematização da assistência de enfermagem, com foco na etapa dos diagnósticos. Até o momento, foram apresentados 46 estudos clínicos por enfermeiros dos diferentes serviços de enfermagem do hospital. A avaliação dos participantes tem sido positiva e permite constatar o envolvimento crescente dos profissionais, com aprofundamento da temática e autocrítica sobre o cuidado que vem sendo prestado aos pacientes e documentado. São apontadas sugestões de melhoria para o sistema de prescrição informatizada aos pacientes hospitalizados

The present experience report aims at presenting the course of the Nursing Diagnosis Work Group at Hospital de Clínicas de Porto Alegre in performing clinical studies. This activity has been developed since December 2001 and attempts to provide knowledge and discussions about the application of the nursing process, more recently called nursing assistance systematization, focusing on the diagnostic stage. So far, 46 clinical studies have been presented by nurses from different nursing services of the hospital. Evaluation of participants has been positive so far and allows us to notice the growing involvement of professionals, with better understanding of this theme and self-criticism about the care being provided to patients and registered. Some suggestions to improve the computerized prescription system to hospitalized patients are provided

Recobrimento radicular: retalho posicionado coronalmente x enxerto de tecido conjuntivo associado ao retalho posicionado coronalmente / Root coverage: coronally positioned flap x connective tissue graft associated with coronally positioned flap

O sucesso do tratamento das recessões gengivais baseia-se no conhecimento de sua etiologia e na avaliação da previsibilidade do recobrimento radicular. Diversas técnicas têm sido propostas para o tratamento das recessões gengivais. Entre estas, encontra-se o reposicionamento coronal do retalho com ou sem a colocação de enxerto subepitelial de tecido conjunti-vo. Ambas as modalidades têm grande aplicabilidade e são utilizadas freqüentemente pelo clínico. O trabalho propõe uma revisão da literatura sobre recobrimento radicular comparando as técnicas de reposicionamento coronal do retalho com ou sem a colocação de enxerto subepitelial de tecido conjuntivo, assunto este já bem explorado na literatura. Ainda assim, os autores conseguiram coletar referências importantes relacio-nadas ao tema.

Utilização do laser em bolsas periodontais revisão de literatura / Laser Utilization in Periodontal Pockets

O uso do laser tem sido avaliado tanto durante a raspagem e alisamento radicular, quanto como substituto de antimicrobianos sistêmicos na desinfecção de bolsas periodontais. Os estudos a respeito deste assunto são recentes, datando a partir da década de 90. Os lasers de baixa intensidade atuam como coadjuvantes à terapia periodontal. e trazem benefícios valiosos à mesma, como diminuição da hiperestesia dentinária e cura mais rápida dos teddos após raspagem. Quanto aos lasers de alta intensidade, é questionável sua eficácia no debridamento radicular sem que cause possíveis efeitos térmicos danosos à estrutura dentária. Este trabalho aborda a utilização do laser em bolsas periodontais e suas possíveis conseqüências

Experimental therapy of epilepsy with transcranial magnetic stimulation: lack of additional benefit with prolonged treatment.

OBJECTIVE: To investigate the effect of three months of low-frequency repetitive transcranial magnetic stimulation (rTMS) treatment in intractable epilepsy. METHODS: Five patients (four males, one female; ages 6 to 50 years), were enrolled in the study; their epilepsy could not be controlled by medical treatment and surgery was not indicated. rTMS was performed twice a week for three months; patients kept records of seizure frequency for an equal period of time before, during, and after rTMS sessions. rTMS was delivered to the vertex with a round coil, at an intensity 5% below motor threshold. During rTMS sessions, 100 stimuli (five series of 20 stimuli, with one-minute intervals between series) were delivered at a frequency of 0.3 Hz. RESULTS: Mean daily number of seizures (MDNS) decreased in three patients and increased in two during rTMS--one of these was treated for only one month; the best result was achieved in a patient with focal cortical dysplasia (reduction of 43.09% in MDNS). In the whole patient group, there was a significant (p<0.01) decrease in MDNS of 22.8%. CONCLUSION: Although prolonged rTMS treatment is safe and moderately decreases MDNS in a group of patients with intractable epilepsy, individual patient responses were mostly subtle and clinical relevance of this method is probably low. Our data suggest, however, that patients with focal cortical lesions may indeed benefit from this novel treatment. Further studies should concentrate on that patient subgroup.

Experimental therapy of epilepsy with transcranial magnetic stimulation: lack of additional benefit with prolonged treatment

OBJETIVO: investigar o efeito de três meses de estimulação magnética transcraniana repetitiva (EMTr) de baixa freqüência, na epilepsia de difícil controle. MÉTODO: Cinco pacientes (quatro homens, uma mulher, idades entre 6 e 50 anos), participaram do estudo; suas crises epilépticas não puderam ser controlados por tratamento medicamentoso e não tinham indicação cirúrgica; a EMTr foi realizada duas vezes por semana durante três meses, sendo que os pacientes anotaram o número diário de crises neste período, assim como nos três meses anteriores e posteriores ao tratamento. A aplicação da EMTr foi feita no vértex com bobina circular, com intensidade 5 por cento abaixo do limiar motor. Durante as sessões de EMTr, 100 estímulos (5 séries de 20 estímulos, com um minuto de intervalo entre as séries) foram realizadas na freqüência de 0,3 Hz. RESULTADOS: A média diária de crises (MDC) decresceu em três pacientes e aumentou em dois durante o uso da EMTr; um destes casos foi tratado somente por um mês; o melhor resultado foi encontrado em um paciente com displasia cortical focal (redução de 43,09 por cento na MDC). Em todo o grupo de pacientes, houve decréscimo significativo na MDC de 22,8 por cento (p<0,01). CONCLUSAO: Embora o tratamento prolongado com a EMTr seja seguro e tenha sido registrado decréscimo moderado da MDC em um grupo de pacientes com epilepsia de difícil controle, respostas individuais de pacientes foram imprevisíveis e a relevância clínica deste método é provavelmente baixa. Nossos dados sugerem, contudo, que pacientes com lesões corticais focais podem ser beneficiar deste novo tipo de tratamento. Estudos futuros devem se concentrar neste grupo de pacientes.

Revisão técnica de livros sobre diagnósticos de enfermagem: percepções de enfermeiras do sul do Brasil / Technical proofreading of books about nursing diagnosis: perceptions of nurses from the south of Brazil

A temática desenvolvida no presente estudo aborda o relato de experiência de enfermeiras do sul do Brasil como revisoras técnicas de livros sobre diagnóstico de enfermagem. Busca-se contribuir com colegas que venham realizar tarefa semelhante lançando alguns aspectos para discussão. É situado o desenvolvimento do diagnóstico de enfermagem no Brasil. São identificadas as principais etapas de produção de livros traduzidos e citadas as atribuições de revisores técnicos. Comentam-se os pontos positivos e as dificuldades encontradas na atividade de revisão técnica. Sugerem-se alternativas para manter a qualidade final da obra e ampliar a oferta de textos especializados o mais fiel possível aos seus originais.

[Technical proofreading of nursing diagnosis books: perceptions of nurses from the south of Brazil]. / Revisão técnica de livros sobre diagnósticos de enfermagem: percepções de enfermeiras do sul do Brasil.

The present study is a report of an experience of nurses from the South of Brazil as technical proofreaders of books about nursing diagnosis. It aims at contributing with colleagues who might do similar task arousing some aspects for discussion. The development of nursing diagnosis in Brazil is presented. The main steps of a translated book production are identified and the attributions of technical proofreaders are cited. The positive aspects and the difficulties found in this activity are commented. Alternatives are given in order to maintain the final quality of the work and to enlarge the availability of specialized texts as faithful to the original as possible.