Carga de trabalho de enfermagem: perfil da assistência em neonatologia / Nursing workload: care profile in neonathology / Carga de trabajo de enfermería: perfil de la atención en neonatología

Objetivo: identificar o perfil assistencial, com base na carga de trabalho evidenciada pelo Nursing Activities Score (NAS), em Unidade de Terapia Intensiva Neonatal (UTIN). Método: trata-se de um estudo descritivo, transversal, de abordagem quantitativa, realizado na UTI Neonatal de um hospital escola. Resultados: identificou-se o perfil assistencial por meio da frequência dos itens do NAS cujo valor médio global encontrado foi de 56,1%. Os itens do NAS mais pontuados mostram o predomínio de atividades de registro de sinais vitais, horários, cálculo e registro regular do balanço hídrico; administração de medicações não vasoativas independentemente da via, procedimentos de higiene e suporte aos pacientes e familiares que requerem dedicação exclusiva, por cerca de uma hora, em algum plantão. Encontraram-se diferenças na carga de trabalho entre os dias da semana, o menor escore pontuado foi de 55,7 no domingo e o maior de 57,8 na sexta-feira. Conclusão: o NAS identificou o perfil assistencial em UTI neonatal e pode auxiliar o enfermeiro na adequação do quantitativo de pessoal, além de identificar as maiores demandas no cuidado da sua unidade. Descritores: Enfermagem; Carga de trabalho; Unidades de Terapia Intensiva Neonatal; Cuidados de enfermagem; Equipe de enfermagem; Neonatologia.(AU)

Objective: to identify the care profile, based on the workload shown by the Nursing Activities Score (NAS), in a Neonatal Intensive Care Unit (NICU). Method: this is a descriptive and cross-sectional study, with a quantitative approach, performed in the Neonatal ICU of a teaching hospital. Results: the care profile was identified through the frequency of the NAS items, whose global mean value found was 56.1%. The most scored NAS items show the predominance of vital signs recording activities, schedules, calculation and regular notes of water balance; administration of non-vasoactive medications regardless of the route, hygiene procedures and support for patients and their relatives who require exclusive dedication, for about an hour, on a shift. Differences were found in the workload among the days of the week, the lowest score being 55.7 on Sunday and the highest 57.8 on Friday. Conclusion: the NAS identified the care profile in the neonatal ICU and can help nurses to adjust the sizing of staff, in addition to identifying the greatest demands in the care of their unit.(AU)

Objetivo: identificar el perfil de atención, a partir de la carga de trabajo evidenciada por el Nursing Activities Score (NAS), en una Unidad de Cuidados Intensivos Neonatales (UCIN). Método: se trata de un estudio descriptivo y transversal, con enfoque cuantitativo, realizado en la UCI Neonatal de un hospital escuela. Resultados: el perfil de atención se identificó mediante la frecuencia de los ítems del NAS cuyo valor promedio global encontrado fue del 56,1%. Los ítems del NAS más puntuados muestran el predominio de actividades de registro de signos vitales, horarios, cálculo y re anotación regular del balance hídrico; administración de medicamentos no vasoactivos independientemente de la vía, procedimientos de higiene y apoyo a pacientes y parientes que requieran dedicación exclusiva, durante aproximadamente una hora, en un turno. Se encontraron diferencias en la carga de trabajo entre los días de la semana, donde la puntuación más baja obtenida fue de 55,7 el domingo y la más alta de 57,8 el viernes. Conclusión: el NAS identificó el perfil de atención en la UCI neonatal y puede ayudar a los enfermeros a ajustar el número de personal, además de identificar las mayores demandas en la atención de su unidad.(AU)

In vivo and in vitro Digestibility of an Extruded Complete Dog Food Containing Black Soldier Fly (Hermetia illucens) Larvae Meal as Protein Source.

Growing attention is being directed toward insects as a novel and sustainable source of protein for pet food. The aim of the study was to evaluate nutrient digestibility of a diet containing black soldier fly larvae as its main protein source. Moreover, the purpose of the study was to compare the traditional in vivo total collection method with the in vivo marker method and in vitro digestibility method. Two isonitrogenous and isoenergetic dry diets containing either venison meal (CTRL diet) or black soldier fly larvae meal (BSF diet) as their primary sources of proteins were fed to six adult dogs, according to a Latin square design. The digestibility of nutrients was determined using both in vivo ("total collection" and "internal marker" approaches) and in vitro methods. The two diets showed similar nutrient digestibility values for dry matter, organic matter, ether extract, ash, and phosphorus. However, a statistical trend (p = 0.066) was observed indicating greater protein digestibility in the BSF diet compared with the CTRL diet. Calcium digestibility was higher in the BSF diet compared with the CTRL diet (p = 0.018). On the contrary, fiber digestibility was lower in the insect-based diet compared with the venison diet (p < 0.001). There was no difference between total collection and internal marker methods in the assessment of in vivo digestibility for any of the nutrients considered. The in vitro digestibility values for dry matter, organic matter, and crude protein, as well as the estimated in vivo digestibility of organic matter and crude protein by the means of the predictive equation, were aligned with the in vivo results, although in vitro estimations were consistently higher compared with those obtained by in vivo analysis. Digestibility analysis of a dog food containing insect meal as the sole source of protein (36.5% inclusion) showed promising results in terms of it presenting similar values as a meat-based diet, indicating its suitability as a sustainable protein source for pet food. Moreover, the study showed that both the in vivo marker method and the in vitro method could be possible alternatives to the traditional total collection method in digestibility trials.

Effects of "fresh mechanically deboned meat" inclusion on nutritional value, palatability, shelf-life microbiological risk and digestibility in dry dog food.

Fresh mechanically deboned meat (MDM) is usually claimed as high-quality ingredient on dry pet food recipes and this aspect may positively influence consumer choice. It is important to determine the scientifically sustainability of this claim and to assess the microbiological safety of MDM inclusion in dry pet food. Objectives were: 1) to evaluate the effect of inclusion of MDM in dry dog food on fatty acid profile and in vivo and in vitro digestibility, proposing a new system (DaisyII Incubator) to measure the in vitro digestibility for dogs; 2) to compare palatability of dry dog food containing MDM with dry dog food in which meat by-products (MBP) are the only animal protein sources; 3) to determine, whether or not, the inclusion of that ingredient changes the microbiology and the storage quality. Results indicated that MDM product was characterized by significant higher nutritional value in terms of fatty acids profile, in vitro digestibility (HV-IVD method) and lower palatability than the MBP product. Microbiological risk assessment showed no microbiological hazards for either product. After 6-months storage, the total mesophilic bacterial count ranged between 1.77 and 2.09 log CFU/g feed, while polyamine values were higher in the MDM (0.37 g/kg) than in the MBP (0.27 g/kg). The DaisyII Incubator was found to be a valid instrument for studying in vitro digestibility also for dogs, providing data simply, quickly, with less variability and costs than in vivo trials. In conclusion, MDM inclusion in dry dog food is microbiologically safe and it can improve its nutritional quality, at the expense of a reduced palatability. The higher polyamine levels fount in MDM-enriched petfood after 6-months storage, however, may represent a possible hazard, and further studies are still warranted.

Small Pilot Survey on Parents' Perception of the Relationship between Children and Pets.

Since companion animals are taking on more important roles in family life, the aim of this study was to evaluate the perception of parents about the relationship between their children and pets. A number of parents were asked to fill in a questionnaire; the principal topics were: pet ownership, pet care, relationship between pets and children, and sources of information about pet management. Eighty-two parents completed the survey; 71.4% of them already had pets before having children; pet care and health has emerged to be rather important, since 96.4% of the pets are taken to the veterinarian at least once a year; moreover, the great majority of the parents (97.2%) were not worried about the possible risks, linked to pets, pertaining to their child's health. The present survey confirms that pets are mostly considered as members of the family, and not only as a benefit for the children. Moreover, the relationship between children and pets is basically seen as a positive experience for children.

Medico-legal aspects of congenital heart diseases in buying and selling of pets.

AIM: The veterinarian should be able to assess congenital and inherited malformations such as heart defects because they may be object of legal disputes. In this study, the authors report some cases of congenital heart defects in pets (dogs and cats) to clarify whether or not they may be considered a redhibitory defect. MATERIALS AND METHODS: A total of 28 medical records of pets referred with suspected congenital heart disease were examined. All patients aged between 3 and 24 months underwent clinical examination, chest X-ray examination, electrocardiogram, and echocardiography and angiocardiography when necessary. RESULTS: Congenital heart diseases or associated cardiac malformations were confirmed. Considering the above congenital diseases as redhibitory defect and the rights of the owners from a strictly legal viewpoint, 9 owners demanded an estimatory action and 11 a redhibitory action; 1 owner decided to demand the reimbursement of veterinary expenses because the animal died; 7 owners took no legal action but requested surgical intervention. CONCLUSIONS: Until more appropriate and detailed legislation on the buying and selling of pet animals is put in place; the authors propose to include in the contract a temporal extension of the guarantee relating to congenital heart disease, which can often become evident later.

Tratamiento laparoscópico de la hidatidosis hepática: experiencia inicial / Laparoscopic approach to liver hydatidosis: Initial experience

INTRODUCCIÓN: La hidatidosis hepática es una enfermedad que se presenta frecuentemente en algunas provincias de Argentina. El tratamiento quirúrgico sigue siendo aún el que ofrece los mejores resultados. El tratamiento laparoscópico es controvertido debido a la poca experiencia con esta técnica. OBJETIVO: Evaluar la factibilidad y eficacia del tratamiento laparoscópico de esta enfermedad y presentar la experiencia obtenida en un centro de Argentina. Material y métodos Se evaluó de manera prospectiva a los pacientes con hidatidosis hepática no complicada mayores de 15 años cuyos quistes tenían las siguientes características: quiste único, menor de 5 cm, situado en segmentos anteriores o de fácil exposición. Fueron evaluados los siguientes datos: sexo, edad, localización del quiste, tratamiento, tiempo operatorio, morbimortalidad y recurrencia. RESULTADOS: Nueve pacientes fueron operados por laparoscopia, los quistes estuvieron localizados en los segmentos III, IV anterior, V y VI. Seis pacientes fueron operados con neumoperitoneo y 3 con un sistema de tracción parietal, en todos ellos el primer gesto fue realizar un PAIR laparoscópico. Se efectuaron 7 procedimientos de Mabit-Lagrot y 2 periquistectomías. El tiempo operatorio medio fue de 89,7 min y la estancia hospitalaria de 52 h. La morbilidad fue de 22,2% y la mortalidad de 0%. La media de seguimiento fue de 19 meses sin recidivas. CONCLUSIÓN: Un mayor número de casos y un seguimiento más prolongado son necesarios para evaluar mejor su eficacia; el abordaje laparoscópico parece ser seguro. Nuestros resultados coinciden con la mayoría de los publicados

INTRODUCTION: Hepatic hydatidosis is a pathology that has a worldwide distribution, and is frequent in some rural areas in Argentina. Surgical treatment still offers the best results. The laparoscopic approach is controversial because of lack of experience with this technique. OBJECTIVE: To evaluate the feasibility and efficacy of the laparoscopic approach in this pathology and to present the experience obtained in a medical center in Argentina. MATERIAL AND METHODS: We prospectively evaluated patients with a diagnosis of non complicated hydatidosis, over 15 years of age whose cyst had the following characteristics: unique cyst, size less than 5 centimeters, located in the anterior segments or easy access. Analyzed data were: sex, age, cyst localization, treatment, operating time, morbidity and mortality and recurrence. RESULTS: Nine patients were operated using a laparoscopic approach. The cysts were localized in the segments III, IV, V and VI. Six patients were operated with pneumoperitoneum and 3 with a parietal traction device, in all the patients the first approach was a laparoscopic PAIR (punction, aspiration, injection and reaspiration). Seven Mabit-Lagrot procedures were performed and 2pericystectomies. The operative time was a mean of 89.7 min and a hospital stay of 52 h. The morbidity was 22.2% and the mortality was 0%. Mean follow-up of 19 months showed no recurrences. CONCLUSION: A higher number of patients and a longer follow-up are necessary to evaluate the efficacy of approach; the laparoscopic approach seems to be safe. Our results coincide with the majority of other publications

Laparoscopic approach to liver hydatidosis: initial experience.

INTRODUCTION: Hepatic hydatidosis is a pathology that has a worldwide distribution, and is frequent in some rural areas in Argentina. Surgical treatment still offers the best results. The laparoscopic approach is controversial because of lack of experience with this technique. OBJECTIVE: To evaluate the feasibility and efficacy of the laparoscopic approach in this pathology and to present the experience obtained in a medical center in Argentina. MATERIAL AND METHODS: We prospectively evaluated patients with a diagnosis of non complicatedhydatidosis, over 15 years of age whose cyst had the following characteristics: unique cyst, size less than 5 centimeters, located in the anterior segments or easy access. Analyzed data were: sex, age, cyst localization, treatment, operating time, morbidity and mortality and recurrence. RESULTS: Nine patients were operated using a laparoscopic approach. The cysts were localized in the segments iii, iv, v and vi. Six patients were operated with pneumoperitoneum and 3 with a parietal traction device, in all the patients the first approach was a laparoscopic PAIR (punction, aspiration, injection and reaspiration). Seven Mabit-Lagrot procedures were performed and 2pericystectomies. The operative time was a mean of 89.7min and a hospital stay of 52h. The morbidity was 22.2% and the mortality was 0%.Mean follow-up of 19 months showed no recurrences. CONCLUSION: A higher number of patients and a longer follow-up are necessary to evaluate the efficacy of approach; the laparoscopic approach seems to be safe. Our results coincide with the majority of other publications.

[Liver resections as radical surgery for hepatic hydatidosis: results in 50 patients]. / Resultados de las resecciones hepáticas como tratamiento radical de la hidatidosis hepatica en 50 pacientes.

INTRODUCTION: Among several regions in the world hepatic hydatidosis can be considered endemic. Currently there are many available treatments for this disease, been surgery the most effective one. Surgical procedures can be divided in two main groups, radical and non-radical procedures. The goal of this work is to evaluate the morbidity, mortality and percentage of recurrence in patients treated with hepatectomies, comparing them with other publications. MATERIAL AND METHODS: This retrospective study was carried out in a series from Spain and Argentina. We analyzed the following data: sex, age, type of resection, associated surgical gestures, presence of liver disease, operative time, blood transfusion, morbidity, mortality, hospital stay, re-hospitalization, recurrence and follow up. Dindo--Clavien classification was used for complications, and International Hepato-Pancreato-Biliary Association (IHPBA) Brisbane classification for hepatectomies. Mortality was considered until 90 days after surgery. To evaluate the recurence we only included patients followed over 6 months. RESULTS: Indications for liver resections were performed in patients with cysts larger than 5 centimeters, multiple cysts, large cysts, with bile duct communicated or suspicion of this communication. Five patients required blood transfusions (10%) with a median for these 5 patients of 740 ml and 74 ml for the complete series. The median operative time was 186 minutes (range 45 to 1,050 minutes). Median hospital stay was 7.7 days. Monitoring more than 6 months was conducted in 38 patients. CONCLUSIONS: We believe that hepatic hydatid disease is a multifaceted disease and requires more than one therapeutic approach. Hepatectomy with complete resection of the parasite offers the possibility of doing so in a controlled and safe way by experienced hands, ensuring good results in the treatment of this disease.

Resultados de las resecciones hepáticas como tratamiento radical de la hidatidosis hepatica en 50 pacientes. / [Liver resections as radical surgery for hepatic hydatidosis: results in 50 patients].

INTRODUCTION: Among several regions in the world hepatic hydatidosis can be considered endemic. Currently there are many available treatments for this disease, been surgery the most effective one. Surgical procedures can be divided in two main groups, radical and non-radical procedures. The goal of this work is to evaluate the morbidity, mortality and percentage of recurrence in patients treated with hepatectomies, comparing them with other publications. MATERIAL AND METHODS: This retrospective study was carried out in a series from Spain and Argentina. We analyzed the following data: sex, age, type of resection, associated surgical gestures, presence of liver disease, operative time, blood transfusion, morbidity, mortality, hospital stay, re-hospitalization, recurrence and follow up. Dindo--Clavien classification was used for complications, and International Hepato-Pancreato-Biliary Association (IHPBA) Brisbane classification for hepatectomies. Mortality was considered until 90 days after surgery. To evaluate the recurence we only included patients followed over 6 months. RESULTS: Indications for liver resections were performed in patients with cysts larger than 5 centimeters, multiple cysts, large cysts, with bile duct communicated or suspicion of this communication. Five patients required blood transfusions (10

) with a median for these 5 patients of 740 ml and 74 ml for the complete series. The median operative time was 186 minutes (range 45 to 1,050 minutes). Median hospital stay was 7.7 days. Monitoring more than 6 months was conducted in 38 patients. CONCLUSIONS: We believe that hepatic hydatid disease is a multifaceted disease and requires more than one therapeutic approach. Hepatectomy with complete resection of the parasite offers the possibility of doing so in a controlled and safe way by experienced hands, ensuring good results in the treatment of this disease.

Resultados de las resecciones hepáticas como tratamiento radical de la hidatidosis hepatica en 50 pacientes / [Liver resections as radical surgery for hepatic hydatidosis: results in 50 patients].

INTRODUCTION: Among several regions in the world hepatic hydatidosis can be considered endemic. Currently there are many available treatments for this disease, been surgery the most effective one. Surgical procedures can be divided in two main groups, radical and non-radical procedures. The goal of this work is to evaluate the morbidity, mortality and percentage of recurrence in patients treated with hepatectomies, comparing them with other publications. MATERIAL AND METHODS: This retrospective study was carried out in a series from Spain and Argentina. We analyzed the following data: sex, age, type of resection, associated surgical gestures, presence of liver disease, operative time, blood transfusion, morbidity, mortality, hospital stay, re-hospitalization, recurrence and follow up. Dindo--Clavien classification was used for complications, and International Hepato-Pancreato-Biliary Association (IHPBA) Brisbane classification for hepatectomies. Mortality was considered until 90 days after surgery. To evaluate the recurence we only included patients followed over 6 months. RESULTS: Indications for liver resections were performed in patients with cysts larger than 5 centimeters, multiple cysts, large cysts, with bile duct communicated or suspicion of this communication. Five patients required blood transfusions (10

) with a median for these 5 patients of 740 ml and 74 ml for the complete series. The median operative time was 186 minutes (range 45 to 1,050 minutes). Median hospital stay was 7.7 days. Monitoring more than 6 months was conducted in 38 patients. CONCLUSIONS: We believe that hepatic hydatid disease is a multifaceted disease and requires more than one therapeutic approach. Hepatectomy with complete resection of the parasite offers the possibility of doing so in a controlled and safe way by experienced hands, ensuring good results in the treatment of this disease.

Brain-derived neurotrophic factor plasma variation during the different phases of the menstrual cycle in women with premenstrual syndrome.

Premenstrual syndrome (PMS) is characterized by a cluster of psychological and somatic symptoms that begin during the late luteal phase of the menstrual cycle and disappear after the onset of menses. Since PMS might be caused by an alteration in the cyclical hormonal modifications and ovarian steroids are directly involved in the regulation of mood, affective and cognitive functions and influence neurotrophins expression, in particular the brain-derived neurotrophic factor (BDNF), we aimed to evaluate whether plasma BDNF levels in women with PMS differ from those of normally menstruating women without PMS. Sixty-two women were divided into two groups: one group of women (n=35) with PMS and one group (n=27) composed by normally menstruating women. Plasma samples were collected at day 7 (follicular phase) and day 21 (luteal phase) of the menstrual cycle. Plasma BDNF of the control group significantly increased (p<0.001) from the follicular phase (402.90±74.41pg/ml) to the luteal phase (1098.79±146.49pg/ml). On the other hand, in the PMS group plasma BDNF levels significantly decreased (p<0.001) from the follicular phase (412.45±78.35pg/ml) to the luteal phase (233.03±75.46pg/ml) Luteal BDNF levels of the PMS women were significantly lower than those of the control group (p<0.001). In women with PMS, plasma BDNF followed a decreasing trend during the ovarian cycle, in opposition to the increasing trend observed in women without PMS. The lower luteal BDNF levels of the PMS women might be a consequence of an altered hormonal response and might play a role in the onset of the symptoms PMS related.

Neurosteroids in clinical practice: implications for women's health.

The steroidogenic endocrine glands and local synthesis both contribute to the pool of steroids present in the central nervous system (CNS) and peripheral nervous system (PNS). Although the synthesis of neurosteroids in the nervous system is now well established, the spectrum of respective functions in regulating neuronal and glial functions remains to be fully elucidated. From the concept of neurosteroids derives another therapeutical strategy: the use of pharmaceutical agents that increase the synthesis of endogenous neurosteroids within the nervous system. This approach is so far hampered by the lack of knowledge concerning the regulation of the biosynthetic pathways of neurosteroids and their relationship with sex steroids produced by peripheral glands. The present review summarizes some of the available clinical and experimental findings supporting the critical role of neuro-steroids during the fertile life and reproductive aging and their relationship with endogenous and exogenous sex steroids. Brain metabolism of synthethic progestins and the implication of dehydroepiandrosterone (DHEA) treatment in post-menopausal women will be also discussed.