The Availability and Price of Healthy Food in Seattle by Neighborhood Sociodemographic Characteristics.

INTRODUCTION: Unequal access to healthy food in the local food retail environment contributes to diet quality disparities. We assessed whether in-store availability and prices of healthy foods differ by neighborhood-level income and racial and ethnic composition in a representative sample of food stores in Seattle, Washington. METHODS: We developed and validated an in-store survey tool and surveyed 134 stores. We measured availability and prices of 19 items. For each store, we calculated a healthy food availability score (range, 0-25), and mean prices within each category. Using census tract data, we identified the median household income and proportions of Black and Hispanic residents for each store's neighborhood and grouped them by tertiles of these neighborhood characteristics across Seattle census tracts. We used Wald tests to compare mean availability scores and prices between tertiles and applied postestimation weights to reflect store-type distributions within each tertile. RESULTS: Neighborhoods with lower income and a larger proportion of Black residents had lower healthy food availability scores compared with neighborhoods with higher income (8.06 [95% CI, 7.04-9.07] vs 12.40 [95% CI, 10.63-14.17], P < .001) and fewer Black residents (8.88 [95% CI, 7.79-9.98] vs 12.32 [95% CI, 10.51-14.14], P = .003). Availability did not differ by Hispanic population proportions. Mean prices of grains, eggs, and meat were lower in neighborhoods with larger proportions of Black residents. CONCLUSION: We found systematic differences in healthy food availability based on neighborhood-level income and racial composition. In-store assessments of the food retail environment can inform local, tailored strategies to improve healthy food access.

School Lunch Entrées Before and After Implementation of the Healthy, Hunger-Free Kids Act of 2010.

BACKGROUND: The Healthy, Hunger-Free Kids Act (HHFKA) 2010 updated standards to increase the nutritional quality of school meals. Studies of HHFKA outcomes have focused primarily on fruit and vegetables, nutrient quality of whole meals, and plate waste. OBJECTIVE: To examine changes in school lunch entrée nutrient quality and student selections after HHFKA implementation. DESIGN: Descriptive, longitudinal study analyzing 1.7 million student-selected lunch entrées in eight entrée categories. PARTICIPANTS/SETTING: Three middle schools and three high schools in an urban school district in Washington State, from January 2011 to January 2014 (16 months before and 15 months after HHFKA implementation). MAIN OUTCOME MEASURES: Nutritional quality of each entrée category was assessed by analyzing mean adequacy ratio, energy density, and energy per serving. Selection was determined by analyzing number of entrées in each category selected by students. STATISTICAL ANALYSES PERFORMED: Comparison of indices of pre- and postimplementation nutritional quality using a combination of Wilcoxon two-sample test with t approximation and a two-sided alternative t test assuming equal variances and t test assuming unequal variances using Satterthwaite approximation. Quantity of entrée categories selected was also determined by Satterthwaite approximation. RESULTS: After implementation, there was significant improvement in mean adequacy ratio and energy per serving overall for all entrées combined. There were significant improvements in both mean adequacy ratio and energy per serving for salads, burritos, and pizza in middle schools and for hot sandwiches and burritos in high schools. For energy density, middle schools also had significant decreases for casseroles and salads, with no significant changes found in high schools. The variety of entrées decreased by 44%, and there were significant changes in the proportions of entrées selected from specific food categories. CONCLUSION: Nutritional quality of lunch entrées, variety of entrées available, and student entrée selections changed after implementation of HHFKA policy in one urban school district in Washington State.

An Evaluation of Washington State SNAP-Ed Farmers' Market Initiatives and SNAP Participant Behaviors.

OBJECTIVE: To describe Supplemental Nutrition Assistance Program-Education (SNAP-Ed)-supported farmers' market (FM) access activities in Washington State communities and identify associations between participation in these activities and SNAP participants' FM shopping and fruit and vegetable consumption. DESIGN: Descriptive study; data included stakeholder interviews and surveys with FM managers and a stratified clustered random sample of SNAP participants. SETTING: Washington State. PARTICIPANTS: A total of 51 SNAP-Ed stakeholders, 400 SNAP participants, and 94 FM managers participated. MAIN OUTCOME MEASURE(S): Partnership measures and SNAP-Ed FM access activities; SNAP participants' participation in FM access activities, FM shopping frequency, and fruit and vegetable consumption. ANALYSIS: Thematic content analysis, descriptive statistics, and 0-inflated Poisson and ordinary least-squares regression models. RESULTS: A total of 343 FM access activities and strong multi-sector partnerships were identified. Fifty percent of SNAP participants shopped at an FM in the past year, and 30% at least monthly. The SNAP participants participating in FM access activities shopped at FMs more frequently (P=.005). The SNAP participants shopping at FMs ate fruit and vegetables more frequently than did non-FM shoppers (P<.001). CONCLUSIONS AND IMPLICATIONS: Through nutrition education and systems and environmental changes, Washington SNAP-Ed developed effective programming and multi-sector partnerships. These efforts are associated with SNAP participants' FM shopping and fruit and vegetable consumption.

Multiple Disadvantage and Discrimination: Implications for Adolescent Health and Education.

Multiply disadvantaged youths exhibit worse health and academic success than their less disadvantaged peers, possibly due to greater exposure to social status-based discrimination. Models that capture the additive burden of disadvantage in tandem with multiple forms of discrimination are needed to explicate the unique and combined impact of these factors on adolescent health and academic outcomes. In addition, protective factors like positive family and peer relationships may attenuate these relationships. This study used data from the Beyond High School Study (N = 9,658), which looked at the transition to adulthood among senior class cohorts from 12 high schools in western Washington state, to investigate the influence of multiple disadvantage, four types of discrimination, and protective resources on student physical and mental health and school grades. Results show that both increased multiple disadvantage statuses and experienced discrimination are associated with decrements across outcomes; however, effects are attenuated when protective resources are considered. Yet, as disadvantages mount, the buffering effect of peer and family resources are dampened. No interaction was found between experienced discrimination and protective resources on outcomes.

Effect of the Healthy Hunger-Free Kids Act on the Nutritional Quality of Meals Selected by Students and School Lunch Participation Rates.

IMPORTANCE: Effective policies have potential to improve diet and reduce obesity. School food policies reach most children in the United States. OBJECTIVE: To assess the nutritional quality of foods chosen by students and meal participation rates before and after the implementation of new school meal standards authorized through the Healthy Hunger-Free Kids Act. DESIGN, SETTING, AND PARTICIPANTS: This descriptive, longitudinal study examined changes in the nutritional quality of 1,741,630 school meals at 3 middle schools and 3 high schools in an urban school district in Washington state. Seventy two hundred students are enrolled in the district; 54% are eligible for free and reduced-price meals. Student food selection data were collected daily from January 2011 through January 2014 during the 16 months prior to and the 15 months after implementation of the Healthy Hunger-Free Kids Act. EXPOSURE: The Healthy Hunger-Free Kids Act. MAIN OUTCOMES AND MEASURES: Nutritional quality was assessed by calculating monthly mean adequacy ratio and energy density of the foods selected by students each day. Six nutrients were included in the mean adequacy ratio calculations: calcium, vitamin C, vitamin A, iron, fiber, and protein. Monthly school meal participation was calculated as the mean number of daily meals served divided by student enrollment. Mean monthly values of mean adequacy ratio, energy density, and participation were compared before and after policy implementation. RESULTS: After implementation of the Healthy Hunger-Free Kids Act, change was associated with significant improvement in the nutritional quality of foods chosen by students, as measured by increased mean adequacy ratio from a mean of 58.7 (range, 49.6-63.1) prior to policy implementation to 75.6 (range, 68.7-81.8) after policy implementation and decreased energy density from a mean of 1.65 (range, 1.53-1.82) to 1.44 (range, 1.29-1.61), respectively. There was negligible difference in student meal participation following implementation of the new meal standards with 47% meal participation (range, 40.4%-49.5%) meal participation prior to the implemented policy and 46% participation (range, 39.1%-48.2%) afterward. CONCLUSIONS AND RELEVANCE: Food policy in the form of improved nutrition standards was associated with the selection of foods that are higher in nutrients that are of importance in adolescence and lower in energy density. Implementation of the new meal standards was not associated with a negative effect on student meal participation. In this district, meal standards effectively changed the quality of foods selected by children.

Cumulative Disadvantage and Youth Well-Being: A Multi-Domain Examination with Life Course Implications.

PURPOSE: The accumulation of disadvantage has been shown to increase psychosocial stressors that impact life course well-being. This study tests for significant differences, based on disadvantage exposure, on youths' emotional and physical health, as well as family supports, peer assets, and academic success, which hold potential for resilience and amelioration of negative health outcomes. METHODS: A 12 item cumulative disadvantage summed index derived from surveys of a racially and socioeconomically diverse sample of urban high school seniors (n=9,658) was used to distinguish youth at low, moderate, and high levels. RESULTS: Findings supported hypothesized stepped patterns such that as multiple disadvantages accumulate, a concomitant decline is evident across the assessed outcome variables (except positive academic identity). Post-hoc tests indicated a pattern of groups being significantly different from one another. DISCUSSION: Overall, results lend support for an additive stress load associated with stacked disadvantage, with implications for continuing trends into adulthood as well as preventive interventions.

Predictors of recovery-oriented competencies among mental health professionals in one community mental health system.

A survey of 813 mental health professionals serving adults with severe mental illness clustered in 25 community mental health centers assessed the extent to which mental health professionals possess clinical competencies that support recovery and the predictors of these competencies. The results suggest there is room for improvement in recovery-oriented competencies. In-depth professional training in recovery, greater job variety, more years practicing in mental health, participation on an intensive case management team, and perceptions of workplace recovery culture were predictors of recovery-oriented competencies. Prioritization of on-going professional, worker retention, and management strategies that incorporate a team approach to treatment and improvements in workplace recovery culture may potentially increase recovery-oriented clinical practice.

Conceptions of mental illness: attitudes of mental health professionals and the general public.

OBJECTIVES: The authors compared attitudes of the U.S. general public and of mental health professionals about the competence and perceived dangerousness of people with mental health problems and the desire for social distance from them. Factors related to negative attitudes and the desire for social distance also were examined. METHODS: Vignettes describing individuals meeting DSM-IV criteria for major depression and schizophrenia were included in the 2006 General Social Survey (GSS) and a 2009 study of mental health professionals, and responses were descriptively compared (GSS, N=397 responses to depression vignette, N=373 responses to schizophrenia vignette; 731 mental health professionals responded to both vignettes). Regression analyses examined whether demographic and provider characteristics were associated with perceptions of less competence and perceived dangerousness of the vignette character and with respondents' desire for social distance. RESULTS: Compared with the American public, mental health professionals had significantly more positive attitudes toward people with mental health problems. However, some providers' conceptions about the dangerousness of people with schizophrenia and provider desire for social distance from clients in work and personal situations were concerning. Younger age, self-identifying as non-Hispanic white, being female, having at least a four-year college degree, being familiar with mental illness, and certain job titles and more years of experience in the mental health field were predictive of more positive conceptions. CONCLUSIONS: Although mental health professionals held more positive attitudes than the general public about people with mental health problems, strong stereotypes persisted in both groups, especially concerning schizophrenia. This study identified several demographic and provider characteristics that can inform intervention strategies in both groups.

Sedação com sufentanil e clonidina em pacientes submetidos a cateterismo cardíaco / Sedation with sufentanil and clonidine in patients undergoing heart catheterization / Sedación con sufentanil y clonidina en pacientes sometidos a cateterismo cardíaco

FUNDAMENTO: A sedação para a realização de cateterismo cardíaco tem sido alvo de preocupação. Benzodiazepínicos, agonistas alfa-2 adrenérgicos e opioides são utilizados para esse fim, entretanto, cada um destes medicamentos possui vantagens e desvantagens. OBJETIVO: Avaliar a eficácia do sufentanil e da clonidina como sedativos em pacientes submetidos a cateterismo cardíaco, observando o impacto dos mesmos sobre os parâmetros hemodinâmicos e respiratórios, a presença de efeitos colaterais, além da satisfação do paciente e do hemodinamicista com o exame. MÉTODOS: Trata-se de um ensaio clínico prospectivo, duplo-cego, randomizado e controlado, que envolveu 60 pacientes que receberam 0,1 µg/kg de sufentanil ou 0,5 µg/kg de clonidina antes da realização do cateterismo cardíaco. O escore de sedação segundo a escala de Ramsay, a necessidade de utilização de midazolam, os efeitos colaterais, os parâmetros hemodinâmicos e respiratórios foram registrados, sendo os dados analisados em 06 diferentes momentos. RESULTADOS: O comportamento da pressão arterial, da frequência cardíaca e da frequência respiratória foi semelhante nos dois grupos, entretanto, no momento 2, os pacientes do grupo sufentanil (Grupo S) apresentaram menor escore de sedação segundo a escala de Ramsay, e a saturação periférica da oxihemoglobina foi menor que o grupo clonidina (Grupo C) no momento 6. Os pacientes do Grupo S apresentaram maior incidência de náusea e vômito pós-operatório que os pacientes do Grupo C. A satisfação dos pacientes foi maior no grupo clonidina. Os hemodinamicistas mostraram-se satisfeitos nos dois grupos. CONCLUSÃO: O sufentanil e a clonidina foram efetivos como sedativos em pacientes submetidos a cateterismo cardíaco.

BACKGROUND: Sedation for heart catheterization has been a cause for concern. Benzodiazepines, alpha-2 adrenergic agonists and opioids are used for this purpose. However, each drug has advantages and disadvantages. OBJECTIVE: To evaluate the efficacy of sufentanil and clonidine as sedative in patients undergoing heart catheterization, observing their impact on hemodynamic and respiratory parameters, the presence of side effects and satisfaction of the patient and interventional cardiologist with the examination. METHODS: This is a prospective, double-blind, randomized and controlled clinical trial involving 60 patients who received 0.1 µg/kg of sufentanil or 0.5 µg/kg of clonidine before heart catheterization. The score of sedation according to the Ramsay scale, the need for use of midazolam, side effects and hemodynamic and respiratory parameters were recorded, with the data being analyzed at 06 different moments. RESULTS: The behavior of blood pressure, heart rate and respiratory rate was similar in both groups, but, at moment 2, the patients in the sufentanil group (Group S) had a lower sedation score on the Ramsay scale, and the peripheral oxyhemoglobin saturation was lower than in the clonidine group (Group C) at time 6. Patients in Group S had higher incidence of nausea and vomiting after surgery than patients in Group C. Patient satisfaction was higher in the clonidine group. The interventional cardiologists were satisfied in both groups. CONCLUSION: Sufentanil and clonidine were effective as sedative in patients undergoing heart catheterization.

FUNDAMENTO: La sedación para la realización de cateterismo cardíaco ha sido blanco de preocupación. Benzodiazepínicos, agonistas alfa-2 adrenérgicos y opioides son utilizados para ese fin, entre tanto, cada uno de estos medicamentos posee ventajas y desventajas. OBJETIVO: Evaluar la eficacia del sufentanil y de la clonidina como sedativos en pacientes sometidos a cateterismo cardíaco, observando el impacto de los mismos sobre los parámetros hemodinámicos y respiratorios, la presencia de efectos colaterales, además de la satisfacción del paciente y del hemodinamista con el examen. MÉTODOS: Se trata de un ensayo clínico prospectivo, doble ciego, randomizado y controlado, que incluyó 60 pacientes que recibieron 0,1 µg/kg de sufentanil o 0,5 µg/kg de clonidina antes de la realización del cateterismo cardíaco. El escore de sedación según la escala de Ramsay, la necesidad de utilización de midazolam, los efectos colaterales, los parámetros hemodinámicos y respiratorios fueron registrados, siendo los datos analizados en 6 diferentes momentos. RESULTADOS: El comportamiento de la presión arterial, de la frecuencia cardíaca y de la frecuencia respiratoria fue semejante en los dos grupos, entre tanto, en el momento 2, los pacientes del grupo sufentanil (Grupo S) presentaron menor escore de sedación según la escala de Ramsay, y la saturación periférica de la oxihemoglobina fue menor que el grupo clonidina (Grupo C) en el momento 6. Los pacientes del Grupo S presentaron mayor incidencia de náusea y vomito post operatorio que los pacientes del Grupo C. La satisfacción de los pacientes fue mayor en el grupo clonidina. Los hemodinamistas se mostraron satisfechos en los dos grupos. CONCLUSIÓN: El sufentanil y la clonidina fueron efectivos como sedativos en pacientes sometidos a cateterismo cardíaco.

Sedation with sufentanil and clonidine in patients undergoing heart catheterization.

BACKGROUND: Sedation for heart catheterization has been a cause for concern. Benzodiazepines, alpha-2 adrenergic agonists and opioids are used for this purpose. However, each drug has advantages and disadvantages. OBJECTIVE: To evaluate the efficacy of sufentanil and clonidine as sedative in patients undergoing heart catheterization, observing their impact on hemodynamic and respiratory parameters, the presence of side effects and satisfaction of the patient and interventional cardiologist with the examination. METHODS: This is a prospective, double-blind, randomized and controlled clinical trial involving 60 patients who received 0.1 µg/kg of sufentanil or 0.5 µg/kg of clonidine before heart catheterization. The score of sedation according to the Ramsay scale, the need for use of midazolam, side effects and hemodynamic and respiratory parameters were recorded, with the data being analyzed at 06 different moments. RESULTS: The behavior of blood pressure, heart rate and respiratory rate was similar in both groups, but, at moment 2, the patients in the sufentanil group (Group S) had a lower sedation score on the Ramsay scale, and the peripheral oxyhemoglobin saturation was lower than in the clonidine group (Group C) at time 6. Patients in Group S had higher incidence of nausea and vomiting after surgery than patients in Group C. Patient satisfaction was higher in the clonidine group. The interventional cardiologists were satisfied in both groups. CONCLUSION: Sufentanil and clonidine were effective as sedative in patients undergoing heart catheterization.

Comparação dos efeitos do sufentanil e da clonidina administrados por via endovenosa para sedação em pacientes submetidos a cateterismo cardíaco / Comparison of sufentanil and clonidine effects administered endovenously in patients submitted to cardiac catheterization

A sedação para a realização de cateterismo cardíaco, apesar de pouco estudada, tem sido alvo de preocupação de alguns anestesiologistas. Os benzodiazepínicos, os agonistas alfa-2 adrenérgicos e os opióides são comumente utilizados para este fim, entretanto, cada um destes medicamentos possui vantagens e desvantagens. O objetivo deste trabalho é avaliar a eficácia do sufentanil e da clonidina como medicação sedativa em pacientes submetidos a cateterismo cardíaco, comparando o impacto dos mesmos sobre os parâmetros hemodinâmicos e respiratórios apresentados, observando a presença de efeitos colaterais, além da satisfação do paciente e do hemodinamicista durante o exame. Trata-se de um ensaio clínico prospectivo, duplo-cego, randomizado e controlado, que envolveu sessenta pacientes divididos igualmente em dois grupos: GS e GC que receberam respectivamente, 0,1 mcg/kg de sufentanil e 0,5 mcg/kg de clonidina. Estes fármacos foram administrados antes da realização do cateterismo cardíaco. O escore de sedação segundo a escala de Ramsay, a necessidade de utilização de midazolam, os efeitos colaterais, a PAS, a PAD, a FC, a FR e a SpO2 foram registrados a cada cinco minutos, sendo os dados analisados em 06 diferentes momentos. Os grupos foram homogêneos em relação aos dados demográficos e avaliação clínica inicial. O comportamento da PAS, da PAD, da FC e da FR foi semelhante nos dois grupos, entretanto os pacientes do GS apresentaram menor escore de sedação segundo a escala de Ramsay no momento 2 e SpO2 menor que o GC no momento 6. Os pacientes do GS apresentaram maior incidência de NVPO que os pacientes do GC. A satisfação dos pacientes foi maior no GC. Os hemodinamicistas mostraram-se igualmente satisfeitos nos dois grupos. O sufentanil e a clonidina se mostraram efetivos como fármacos sedativos em pacientes submetidos a cateterismo cardíaco.

Assessment of the relative dose-response test based on serum retinol-binding protein instead of serum retinol in determining low hepatic vitamin A stores.

BACKGROUND: The relative dose-response (RDR) test, which measures the percentage of change in serum retinol concentration in response to an oral vitamin A (VA) dose, is a functional reference method to assess low hepatic VA stores. However, problems due to the relative instability of retinol, which is measured in the traditional RDR test, could be circumvented if retinol-binding protein (RBP), a more stable marker of VA, could be measured instead of retinol to provide the RDR value. OBJECTIVE: The objective was to compare classification of VA status assessed by retinol-RDR with that assessed by using RBP-RDR. DESIGN: With the use of serum samples from 57 lactating women in northern Kenya collected in August-September 2006, we assessed the accuracy of RBP-RDR in predicting low hepatic VA stores through receiver operator characteristic (ROC) analysis using retinol-RDR values as the gold standard. By using regression analysis, we explored the effects of 1) body mass index (BMI) on RBP-RDR performance and 2) the oral VA dose on the retinol-RBP molar ratio. RESULTS: The classificatory accuracy of RBP-RDR was low to moderate (n = 50; ROC area: 0.56-0.72) depending on the cutoffs used. RBP-RDR systematically overestimated VA deficiency with higher BMI, although it was superior to a single measurement of serum retinol. The discrepancy between RBP-RDR and retinol-RDR appears to originate in a retinol concentration-dependent alteration of the retinol-RBP molar ratio triggered by the oral dose. CONCLUSIONS: RBP-RDR has the potential to serve as a moderately accurate surrogate measure of retinol-RDR if the variation associated with BMI is understood and adjusted. Further studies should clarify the dynamics of the retinol-RBP molar ratio and its link to RBP-RDR performance.

Disfunção temporária do nervo lingual após uso de máscara laríngea: relato de caso / Temporary lingual nerve dysfunction following the use of the laryngeal mask airway: report

JUSTIFICATIVA E OBJETIVOS: A máscara laríngea tem sido utilizada com freqüência em Anestesiologia. O emprego dessa técnica, embora esteja relacionado com um menor número de complicações quando comparado com a cânula traqueal, não é isento de morbidade, principalmente, nos casos de via aérea difícil. O objetivo desse relato foi apresentar um caso de lesão unilateral de nervo lingual após o uso da máscara laríngea. RELATO DO CASO: Paciente do sexo feminino foi submetida à intervenção cirúrgica para troca de prótese mamária bilateral, sob anestesia geral balanceada, com máscara laríngea de tamanho 3. O volume aplicado para insuflação do balonete foi de 30 mL de ar. Após a primeira hora do pós-operatório, iniciou quadro de dormência e dor na garganta e nos dois terços posteriores da língua que evoluiu em 24 horas com perda da percepção do sabor dos alimentos. A suspeita diagnóstica foi de neuropraxia do nervo lingual pelo uso de máscara laríngea. Esse quadro se manteve por três semanas, período em que se obteve resolução dos sintomas. CONCLUSÃO: Complicações após o uso de máscara laríngea, apesar de raras, podem ocorrer. A neuropraxia do nervo lingual é uma delas. O seu diagnóstico é clínico, e a sua evolução, favorável, com resolução dos sintomas em semanas ou meses.

BACKGROUND AND OBJECTIVES: The laryngeal mask has been frequently used in Anesthesiology. Although the rate of complications with this technique is smaller than that of the endotracheal tube, it is not devoid of risks, especially in cases of difficult airways. The objective of this study was to report a case of unilateral lingual nerve damage after the use of the laryngeal mask airway. CASE REPORT: A female patient underwent a surgical procedure for removal of bilateral breast prosthesis under general, balanced anesthesia, with a size three laryngeal mask. The balloon was inflated with 30 mL of air. After the first postoperative hour, she developed decreased sensation and pain in the oropharynx and posterior two thirds of the tongue, which evolved for loss of taste in the next 24 hours. A tentative diagnosis of lingual nerve neuropraxis secondary to the use of the laryngeal mask was made. After three weeks, her symptoms subsided. CONCLUSION: Although complications after the use of the laryngeal mask airway are rare, they do occur, and neuropraxis of the lingual nerve is one of them. The diagnosis is clinical and it has a good outcome, with resolution of the symptoms within a few weeks or months.

JUSTIFICATIVA Y OBJETIVOS: La máscara laríngea ha sido utilizada con frecuencia en Anestesiología. El empleo de esa técnica, aunque esté relacionada a un menor número de complicaciones cuando se le compara a la cánula traqueal, no está exento de morbidez, principalmente en los casos de vía aérea difícil. El objetivo de este relato fue presentar un caso de lesión unilateral de nervio lingual trás del uso de la máscara laríngea. RELATO DEL CASO: Paciente del sexo femenino, sometida a intervención quirúrgica para cambio de prótesis mamaria bilateral, bajo anestesia general balanceada, con máscara laríngea de tamaño tres. El volumen aplicado para insuflación del globo fue de 30 mL de aire. Después de la primera hora del postoperatorio, se inició el cuadro de adormecimiento y dolor en la garganta y en los dos tercios posteriores de la lengua que evolucionó en 24 horas con pérdida de la percepción del sabor de los alimentos. La sospecha diagnóstica fue de neuropraxia del nervio lingual por el uso de máscara laríngea. Este cuadro se mantuvo por tres semanas, período en que se obtuvo una resolución de los síntomas. CONCLUSION: Complicaciones después del uso de máscara laríngea, a pesar de no frecuentes, pueden ocurrir. La neuropraxia del nervio lingual es una de ellas. Su diagnóstico es clínico y su evolución es favorable con resolución de los síntomas en semanas o meses.

Abscesso do músculo psoas em paciente submetida à analgesia por via peridural: relato de caso / Psoas muscle abscess after epidural analgesia: case report

JUSTIFICATIVA E OBJETIVOS: O abscesso do músculo psoas é uma complicação rara da analgesia peridural. O manuseio adequado dessa intercorrência é fundamental para uma boa resolução do quadro clínico. O objetivo deste relato foi discutir o diagnóstico e o tratamento do abscesso do músculo psoas. RELATO DO CASO: Paciente do sexo feminino, 65 anos, com dor neuropática nos membros inferiores de difícil controle com medicamentos por via sistêmica. Optou-se pela administração de opióide e anestésico local por via peridural como alternativa analgésica. Vinte dias após o uso contínuo da via peridural, a paciente começou a apresentar dor na região lombar, cefaléia e febre. A tomografia computadorizada da pelve revelou abscesso do músculo psoas, sendo indicada drenagem fechada e antibioticoterapia. CONCLUSÕES: A supervisão minuciosa do paciente é necessária e deve ser contínua quando um cateter peridural for colocado. Essa vigilância deve ser mantida após a sua retirada.

BACKGROUND AND OBJECTIVES: Psoas muscle abscess is a rare complication of epidural analgesia. The adequate approach to this complication is fundamental for a good resolution. The objective of this report was to discuss the diagnosis and treatment of psoas muscle abscess. CASE REPORT: A female patient, 65 years old, with neuropathic pain in the lower limbs, difficult to control with systemic drugs. The patient was treated with epidural opioid and local anesthetic as an alternate treatment. Twenty days after the continuous epidural administration, the patient complained of lumbar pain, headache, and fever. A CT scan of the pelvis showed an abscess of the psoas muscle, thus, closed drainage and antibiotics were indicated. CONCLUSIONS: An adequate, continuous supervision of the patient is necessary when an epidural catheter is placed, and it should continue after its removal.

JUSTIFICATIVA Y OBJETIVOS: El absceso del músculo psoas es una complicación rara de la analgesia peridural. El manoseo adecuado de esa situación intercurrente es fundamental para una buena resolución del cuadro clínico. El objetivo de este relato fue discutir el diagnóstico y el tratamiento del absceso del músculo psoas. RELATO DEL CASO: Paciente del sexo femenino, 65 años, con dolor neuropático en los miembros inferiores de difícil control con medicamentos por vía sistémica. Se optó por la administración de opioide y anestésico local por vía peridural como alternativa analgésica. Veinte días después del uso continuo de la vía peridural, la paciente empezó a presentar dolor en la región lumbar, cefalea y fiebre. La tomografía computadorizada de la pelvis reveló absceso del músculo psoas, siendo indicado el drenado cerrado y antibioticoterapia. CONCLUSIONES: La supervisión minuciosa del paciente es necesaria y debe ser continua cuando un catéter peridural se pone, y esa vigilancia debe mantenerse después de su retirada.

Dor: aspectos atuais da sensibilização periférica e central / Dolor: aspectos actuales de la sensibilización periférica y central / Pain: current aspects on peripheral and central sensitization

JUSTIFICATIVA E OBJETIVOS: As pesquisas recentes têm focalizado a plasticidade bioquímica e estrutural do sistema nervoso decorrente da lesão tissular. Os mecanismos envolvidos na transição da dor aguda para crônica são complexos e envolvem a interação de sistemas receptores e o fluxo de íons intracelulares, sistemas de segundo mensageiro e novas conexões sinápticas. O objetivo deste artigo foi discutir os novos mecanismos que envolvem a sensibilização periférica e central. CONTEUDO: A lesão tissular provoca aumento na resposta dos nociceptores, chamada de sensibilização ou facilitação. Esses fenômenos iniciam-se após a liberação local de mediadores inflamatórios e a ativação de células do sistema imune ou de receptores específicos no sistema nervoso periférico e central. CONCLUSÕES: As lesões do tecido e dos neurônios resultam em sensibilização de nociceptores e facilitação da condução nervosa central e periférica.

BACKGROUND AND OBJECTIVES: Current research has focused on the biochemical and structural plasticity of the nervous system secondary to tissue injury. The mechanisms involved in the transition from acute to chronic pain are complex and involve the interaction of receptor systems and the flow of intracellular ions, second messenger systems, and new synaptic connections. The aim of this article was to discuss the new mechanisms concerning peripheral and central sensitization. CONTENTS: Tissue injury increases the response of nociceptors, known as sensitization or facilitation. These phenomena begin after the local release of inflammatory mediators and the activation of the cells of the immune system or specific receptors in the peripheral and central nervous system. CONCLUSIONS: Tissue and neuronal lesions result in sensitization of the nociceptors and facilitation of the central and peripheral nervous conduction.

JUSTIFICATIVA Y OBJETIVOS: Las recientes investigaciones se han centrado en la plasticidad bioquímica y estructural del sistema nervioso proveniente de la lesión tisular. Los mecanismos involucrados en transición del dolor agudo para crónico son complejos e involucran la interacción de sistemas receptores y el flujo de iones intracelulares, sistemas de segundo mensajero y nuevas conexiones sinápticas. El objetivo de este artículo fue discutir los nuevos mecanismos que envuelven la sensibilización periférica y central. CONCLUSION: La lesión tisular provoca un aumento en la respuesta de los nociceptores, llamada sensibilización o facilitación. Esos fenómenos empiezan después de la liberación local de mediadores inflamatorios y de la activación de células del sistema inmune o de receptores específicos en el sistema nervioso periférico y central. CONCLUSIONES: Las lesiones del tejido y de las neuronas resultan en una sensibilización de nociceptores y en la facilitación de la conducción nerviosa central y periférica.

[Temporary lingual nerve dysfunction following the use of the laryngeal mask airway: report]. / Disfunção temporária do nervo lingual após uso de máscara laríngea: relato de caso.

BACKGROUND AND OBJECTIVES: The laryngeal mask has been frequently used in Anesthesiology. Although the rate of complications with this technique is smaller than that of the endotracheal tube, it is not devoid of risks, especially in cases of difficult airways. The objective of this study was to report a case of unilateral lingual nerve damage after the use of the laryngeal mask airway. CASE REPORT: A female patient underwent a surgical procedure for removal of bilateral breast prosthesis under general, balanced anesthesia, with a size three laryngeal mask. The balloon was inflated with 30 mL of air. After the first postoperative hour, she developed decreased sensation and pain in the oropharynx and posterior two thirds of the tongue, which evolved for loss of taste in the next 24 hours. A tentative diagnosis of lingual nerve neuropraxis secondary to the use of the laryngeal mask was made. After three weeks, her symptoms subsided. CONCLUSION: Although complications after the use of the laryngeal mask airway are rare, they do occur, and neuropraxis of the lingual nerve is one of them. The diagnosis is clinical and it has a good outcome, with resolution of the symptoms within a few weeks or months.

[Psoas muscle abscess after epidural analgesia: case report.]. / Abscesso do músculo psoas em paciente submetida à analgesia por via peridural: relato de caso.

BACKGROUND AND OBJECTIVES: Psoas muscle abscess is a rare complication of epidural analgesia. The adequate approach to this complication is fundamental for a good resolution. The objective of this report was to discuss the diagnosis and treatment of psoas muscle abscess. CASE REPORT: A female patient, 65 years old, with neuropathic pain in the lower limbs, difficult to control with systemic drugs. The patient was treated with epidural opioid and local anesthetic as an alternate treatment. Twenty days after the continuous epidural administration, the patient complained of lumbar pain, headache, and fever. A CT scan of the pelvis showed an abscess of the psoas muscle, thus, closed drainage and antibiotics were indicated. CONCLUSIONS: An adequate, continuous supervision of the patient is necessary when an epidural catheter is placed, and it should continue after its removal.

Pain: current aspects on peripheral and central sensitization.

BACKGROUND AND OBJECTIVES: Current research has focused on the biochemical and structural plasticity of the nervous system secondary to tissue injury. The mechanisms involved in the transition from acute to chronic pain are complex and involve the interaction of receptor systems and the flow of intracellular ions, second messenger systems, and new synaptic connections. The aim of this article was to discuss the new mechanisms concerning peripheral and central sensitization. CONTENTS: Tissue injury increases the response of nociceptors, known as sensitization or facilitation. These phenomena begin after the local release of inflammatory mediators and the activation of the cells of the immune system or specific receptors in the peripheral and central nervous system. CONCLUSIONS: Tissue and neuronal lesions result in sensitization of the nociceptors and facilitation of the central and peripheral nervous conduction.

Pneumoencéfalo intraventricular após perfuração acidental de dura-máter: relato de caso / Intraventricular pneumocephalus after accidental perforation of the dura mater: case report

JUSTIFICATIVA E OBJETIVOS: O uso de ar para a realização do teste da perda da resistência com a finalidade de identificar o espaço peridural é extremamente difundido no mundo inteiro, porém uma das complicações possíveis é a perfuração acidental de dura-máter que apresenta incidência estimada entre 1 por cento e 2 por cento. O objetivo deste relato foi descrever um caso de paciente com pneumoencéfalo intraventricular após perfuração acidental de dura-máter usando a técnica da perda da resistência com ar. RELATO DO CASO: Paciente do sexo feminino, 26 anos, 75 kg, 1,67 m, estado físico ASA I, com 38 semanas de gestação foi encaminhada ao centro obstétrico para realização de cesariana. Após monitorização foi realizada punção venosa. A paciente foi posicionada na posição sentada para realização de anestesia peridural. Durante a realização da identificação do espaço peridural com a técnica da perda da resistência usando-se ar, foi diagnosticada perfuração acidental da dura-máter por meio da observação de fluxo livre de líquor pela agulha. Foi modificada a técnica para raquianestesia e administradas medicações anestésicas através da agulha que já estava posicionada no espaço subaracnóideo. Nas primeiras 24 horas a paciente evoluiu com cefaléia que foi tratada com cafeína, dipirona, hidratação, hidrocortisona e repouso; mesmo assim, houve piora do quadro, passando a apresentar cefaléia até na posição de decúbito. Foi realizada tomografia computadorizada de crânio que evidenciou presença de pneumoencéfalo. Após consulta com especialista foi adotada conduta expectante com melhora progressiva do sintoma, com alta hospitalar no quinto dia de evolução, sem seqüelas. CONCLUSÕES: O pneumoencéfalo após perfuração acidental da dura-máter apresentou um quadro de cefaléia com características semelhantes àquela produzida pela perda liquórica, porém com resolução espontânea após absorção do ar, dispensando medidas mais invasivas como a realização do tampão...

BACKGROUND AND OBJECTIVES: The loss of resistance to air to identify the epidural space is widely used. However, the accidental perforation of the dura mater is one of the possible complications of this procedure, with an estimated incidence between 1 percent and 2 percent. The objective of this report was to describe the case of a patient with intraventricular pneumocephalus after the accidental perforation of the dura mater using the loss of resistance with air technique. CASE REPORT: Female patient, 26 years old, 75 kg, 1.67 m, physical status ASA I, with a 38-week pregnancy, was referred to the obstetric service for a cesarean section. Venipuncture was performed after placement of the monitoring. The patient was placed in a sitting position for administration of the epidural anesthesia. During the identification of the epidural space with the loss of resistance with air technique, an accidental perforation of the dura mater was diagnosed by observing free flow of CSF through the needle. The technique was modified to epidural anesthesia and anesthetics were administered by the needle placed in the subarachnoid space. In the first 24 hours, the patient developed headache and she was treated with caffeine, dypirone, hydration, hydrocortisone, and bed rest; despite those measures, the patient's symptoms worsened and evolved to headache in decubitus. A CT scan of the head showed the presence of pneumocephalus. After evaluation by a specialist, the patient remained under observation, with progressive improvement of the symptoms and was discharged from the hospital in the fifth day, without complications. CONCLUSIONS: Pneumocephalus after accidental perforation of the dura mater presented headache with the characteristics of headache secondary to loss of CSF, but with spontaneous resolution after the air was absorbed. Invasive measures, such as epidural blood patch, were not necessary.

JUSTIFICATIVA Y OBJETIVOS: El uso de aire para la realización de la prueba de la pérdida de la resistencia con la finalidad de identificar el espacio peridural está extremadamente difundido en el mundo entero, pero una de las complicaciones posibles es la perforación accidental de dura-mater que presenta incidencia estimada entre 1 por ciento y 2 por ciento. El objetivo de ese relato fue el describir un caso de paciente con pneumoencéfalo intraventricular después de la perforación accidental de dura-mater usando la técnica de la pérdida de la resistencia con aire. RELATO DEL CASO: Paciente del sexo femenino, 26 años, 75 kg, 1,67 m, estado físico ASA I, con 38 semanas de embarazo, llevada al centro obstétrico para la realización de cesariana. Después de la monitorización se realizó la punción venosa. La paciente fue posicionada en la posición sentada para la realización de anestesia peridural. Durante la realización de la identificación del espacio peridural con la técnica de la pérdida de la resistencia usando aire, fue diagnosticada una perforación accidental da dura-mater a través de la observación de flujo libre de licuor por la aguja. Se modificó entones la técnica para raquianestesia y administradas medicaciones anestésicas a través de la aguja que ya estaba posicionada en el espacio subaracnoideo. En la primeras 24 horas la paciente evolucionó con cefalea que fue tratada con cafeína, dipirona, hidratación, hidrocortisona y reposo, e incluso así, hubo un empeoramiento del cuadro, pasando a presentar cefalea hasta en la posición de decúbito. Fue realizada una tomografía computadorizada de cráneo que evidenció una presencia de pneumoencéfalo. Después de la consulta con especialista fue adoptada una conducta de espera con mejora progresiva del síntoma, con alta hospitalaria al quinto día de evolución, sin observar secuelas. CONCLUSIONES: El pneumoencéfalo después de la perforación accidental de dura-mater presentó un cuadro de cefalea...

[Intraventricular pneumocephalus after accidental perforation of the dura mater: case report.]. / Pneumoencéfalo intraventricular após perfuração acidental de dura-máter: relato de caso.

BACKGROUND AND OBJECTIVES: The loss of resistance to air to identify the epidural space is widely used. However, the accidental perforation of the dura mater is one of the possible complications of this procedure, with an estimated incidence between 1% and 2%. The objective of this report was to describe the case of a patient with intraventricular pneumocephalus after the accidental perforation of the dura mater using the loss of resistance with air technique. CASE REPORT: Female patient, 26 years old, 75 kg, 1.67 m, physical status ASA I, with a 38-week pregnancy, was referred to the obstetric service for a cesarean section. Venipuncture was performed after placement of the monitoring. The patient was placed in a sitting position for administration of the epidural anesthesia. During the identification of the epidural space with the loss of resistance with air technique, an accidental perforation of the dura mater was diagnosed by observing free flow of CSF through the needle. The technique was modified to epidural anesthesia and anesthetics were administered by the needle placed in the subarachnoid space. In the first 24 hours, the patient developed headache and she was treated with caffeine, dypirone, hydration, hydrocortisone, and bed rest; despite those measures, the patient's symptoms worsened and evolved to headache in decubitus. A CT scan of the head showed the presence of pneumocephalus. After evaluation by a specialist, the patient remained under observation, with progressive improvement of the symptoms and was discharged from the hospital in the fifth day, without complications. CONCLUSIONS: Pneumocephalus after accidental perforation of the dura mater presented headache with the characteristics of headache secondary to loss of CSF, but with spontaneous resolution after the air was absorbed. Invasive measures, such as epidural blood patch, were not necessary.