Experimental model of nephropathy associated with diabetes mellitus in mice.

PURPOSE: Nontransmissible chronic diseases, such as diabetes mellitus (DM) and nephropathy, affect a significant portion of the population, often treated due to injuries that require healing and regeneration. To create an experimental model of associated comorbidities, for healing and regeneration studies, protocols for induction of nephropathy by ischemia and reperfusion (I/R) and induction of DM by injection of streptozotocin (STZ) were associated. METHODS: Sixty-four mice (Mus musculus), female, adult, Swiss strain, weighing approximately 20 g, were divided into four groups: G1: control (n = 24), G2: nephropathy group (N) (n = 7), G3, DM (n = 9), and G4: N+DM (n = 24). Arteriovenous stenosis (I/R) of the left kidney was performed as the first protocol. The animals received a hyperlipidemic diet for 7 days after the injection of STZ (150 mg/kg, via i.p.) and an aqueous glucose solution (10%) for 24 h. The animals in the G3 and G4 groups were observed for 14 days before receiving the diet and STZ. The evolution of nephropathy was observed using a urine test strip and the DM, through the analysis of blood glucose with a reagent strip on a digital monitor. RESULTS: The ischemic induction protocols of nephropathy and DM with STZ, associated, were sustainable, low-cost, and without deaths. There were alterations compatible with initial renal alterations, in the first 14 days, such as increased urinary density, pH alteration, presence of glucose, proteins and leukocytes, when compared to the control group. DM was confirmed by the presence of hyperglycemia 7 days after induction and its evolution after 14 days. The animals in the G4 group showed constant weight loss when compared to the other groups. It was possible to observe morphological alterations in the kidneys submitted to I/R, regarding coloration, during surgery and after the end of the observation period, in the volume and size of the left kidney, when compared to the contralateral kidney. CONCLUSIONS: It was possible to induce nephropathy and DM associated in the same animal, in a simple way, confirmed with rapid tests, without losses, providing a basis for future studies.

Experimental model of nephropathy associated with diabetes mellitus in mice

Purpose: Nontransmissible chronic diseases, such as diabetes mellitus (DM) and nephropathy, affect a significant portion of the population, often treated due to injuries that require healing and regeneration. To create an experimental model of associated comorbidities, for healing and regeneration studies, protocols for induction of nephropathy by ischemia and reperfusion (I/R) and induction of DM by injection of streptozotocin (STZ) were associated. Methods: Sixty-four mice (Mus musculus), female, adult, Swiss strain, weighing approximately 20 g, were divided into four groups: G1: control (n = 24), G2: nephropathy group (N) (n = 7), G3, DM (n = 9), and G4: N+DM (n = 24). Arteriovenous stenosis (I/R) of the left kidney was performed as the first protocol. The animals received a hyperlipidemic diet for 7 days after the injection of STZ (150 mg/kg, via i.p.) and an aqueous glucose solution (10%) for 24 h. The animals in the G3 and G4 groups were observed for 14 days before receiving the diet and STZ. The evolution of nephropathy was observed using a urine test strip and the DM, through the analysis of blood glucose with a reagent strip on a digital monitor. Results: The ischemic induction protocols of nephropathy and DM with STZ, associated, were sustainable, low-cost, and without deaths. There were alterations compatible with initial renal alterations, in the first 14 days, such as increased urinary density, pH alteration, presence of glucose, proteins and leukocytes, when compared to the control group. DM was confirmed by the presence of hyperglycemia 7 days after induction and its evolution after 14 days. The animals in the G4 group showed constant weight loss when compared to the other groups. It was possible to observe morphological alterations in the kidneys submitted to I/R, regarding coloration, during surgery and after the end of the observation period, in the volume and size of the left kidney, when compared to the contralateral kidney. Conclusion: It was possible to induce nephropathy and DM associated in the same animal, in a simple way, confirmed with rapid tests, without losses, providing a basis for future studies.

Effect of electrophysical resources on healing of neurotendinous injury in an experimental model of type I diabetes and kidney disease.

PURPOSE: To evaluate and describe the effect of electrophysical resources laser therapy (LLLT), intravascular laser blood irradiation (ILIB), and cryotherapy on the healing process of neurotendinous injury, as well as possible systemic changes, in the experimental model of type 1 diabetes associated with kidney injury. METHODS: The animals were randomized into four groups: G1) healthy control with untreated injury; G2) healthy control with injury and treatment; G3) disease control with untreated lesion; G4) disease with injury and treatment. Furthermore, the treated groups were divided into three, according to the type of treatment. All animals were induced to neurotendinous injury and treated according to the therapeutic protocols. Healing and inflammation were analyzed by semiquantitative histopathological study. RESULTS: It was observed in sick animals treated with cryotherapy and ILIB reduction of inflammatory exudate, presence of fibroblasts and organization of collagen, when compared to the effects of LLLT. Moreover, there was reduction in glycemic levels in the group treated with ILIB. CONCLUSIONS: Cryotherapy promoted reduction in inflammatory exudate and organization of collagen fibers, in addition to the absence of signs of tissue necrosis, in the groups treated with and without the disease. ILIB therapy showed the same findings associated with significant reduction in glycemic levels in the group of diseased animals. The application of LLLT showed increased inflammatory exudate, low organization of collagen fibers and low sign of tissue degeneration and necrosis. This study in a model of associated diseases (diabetes and kidney disease) whose effects of electrophysical resources studied after neurotendinous injury allows us to verify histopathological variables suggestive of patients with the same comorbidities.

Electroacupuncture reduces weight, skinfold thickness and waist circumference and increases skin temperature of the abdominal region in women: a randomized controlled trial.

BACKGROUND: Acupuncture, as a complementary and alternative medical treatment, has shown some promise as a therapeutic option for obesity and weight control. The aim of the current study was to investigate the effects of electroacupuncture (EA) on body weight, body mass index (BMI), skin fold thickness, waist circumference and skin temperature of the abdominal region in non-obese women with excessive abdominal subcutaneous fat. METHODS: A total of 50 women with excessive abdominal subcutaneous fat (and average BMI of 22) were randomly assigned to one of two groups: an EA group (n = 25) receiving 10 EA sessions (insertion of needles connected to an electrical stimulator at a frequency of 40 Hz for 40 min) and a control group (n = 25) that received no treatment. Outcome measures evaluated included waist circumference, supra-iliac and abdominal skinfolds, body composition and superficial skin temperature (measured by cutaneous thermography) before and after treatment. RESULTS: Compared with the untreated group, women in the EA group exhibited decreased supra-iliac and abdominal skin folds (p < 0.001), waist circumference (p < 0.001), percentage body fat (p = 0.001) and percentage abdominal fat (p < 0.001). In addition, the EA group showed an elevated skin temperature at the site of the treatment. However, EA did not significantly impact body weight (p = 0.01) or BMI (p = 0.2). CONCLUSION: EA promoted a reduction in abdominal waist circumference, supra-iliac and abdominal skin folds, and percentage body and abdominal fat in women of normal BMI with excessive abdominal subcutaneous fat, as well as an increase in the superficial skin temperature of the abdominal region. TRIAL REGISTRATION NUMBER: RBR-9tsmpp (Brazilian Registry of Clinical Trials).

Cuidados generales en el manejo del traumatismo craneoencefálico grave: consenso latinoamericano / General care in the management of severe traumatic brain injury: Latin American consensus

El traumatismo craneoencefálico grave (TCEg) continúa siendo prevalente en la población adulta joven. Lejos de descender, su incidencia se mantiene elevada. Uno de los pilares en los que se asienta su tratamiento es evitar, detectar y corregir complicaciones secundarias de origen sistémico que agravan la lesión primaria. Gran parte de este objetivo se logra manteniendo un microambiente fisiológico adecuado que permita la recuperación del tejido cerebral lesionado. Las medidas de cuidados generales son acciones inespecíficas destinadas a cumplir dicho objetivo. Las guías disponibles de manejo del TCEg no han incluido la mayoría de los tópicos motivo de este consenso. Para ello, hemos reunido un grupo de profesionales miembros del Consorcio latinoamericano de Injuria Cerebral (LABIC), involucrados en los diferentes aspectos del manejo agudo del TCEg (neurocirujanos, intensivistas, anestesiólogos, neurólogos, enfermeros, fisioterapeutas). Se efectuó una búsqueda bibliográfica en las bases de datos LILACS, PubMed, Embasse, Scopus, Cochrane Controlled Register of Trials y Web of Science de los tópicos seleccionados. Para establecer recomendaciones o sugerencias con su respectiva fortaleza o debilidad, fue aplicada la metodología Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Adicionalmente, ciertas recomendaciones (incluidas en material complementario) no fueron valoradas por GRADE, por ser las mismas un conjunto de acciones terapéuticas de cumplimento efectivo, en las que no fue posible aplicar dicha metodología. Fueron establecidas 32 recomendaciones; 16 fuertes y 16 débiles, con su respectivo nivel de evidencia. El presente consenso intenta homogeneizar y establecer medidas de cuidados generales básicas en esta población de individuos

Severe traumatic brain injury (sTBI) remains prevalent in the young adult population. Indeed, far from descending, the incidence of sTBI remains high. One of the key bases of treatment is to avoid, detect and correct secondary injuries of systemic origin, which aggravate the primary lesion. Much of this can be achieved by maintaining an adequate physiological microenvironment allowing recovery of the damaged brain tissue. General care measures are nonspecific actions designed to meet that objective. The available guidelines on the management of sTBI have not included the topics contemplated in this consensus. In this regard, a group of members of the Latin American Brain Injury Consortium (LABIC), involved in the different aspects of the acute management of sTBI (neurosurgeons, intensivists, anesthesiologists, neurologists, nurses and physiotherapists) were gathered. An exhaustive literature search was made of selected topics in the LILACS, PubMed, Embase, Scopus, Cochrane Controlled Register of Trials and Web of Science databases. To establish recommendations or suggestions with their respective strength or weakness, the GRADE methodology (Grading of Recommendations, Assessment, Development and Evaluation) was applied. Additionally, certain recommendations (included in complementary material) were not assessed by GRADE, because they constitute a set of therapeutic actions of effective compliance, in which it was not possible to apply the said methodology. Thirty-two recommendations were established, 16 strong and 16 weak, with their respective levels of evidence. This consensus attempts to standardize and establish basic general care measures in this particular patient population

Causas institucionais para cancelamento de cirurgias eletivas / Institutional causes for elective surgery cancellation / Causas institucionales para la cancelación de cirugías electivas

Objetivo: Analisar as produções científicas sobre cancelamento de cirurgias eletivas pelas causas institucionais. Método: Revisão integrativa da literatura, sistematizada pelo acrônimo Participante, Interesse e Contexto (PICo), de acordo com a estratégia PICo e procedimentos definidos pelo Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A busca bibliográfica foi realizada em setembro de 2018 e atualizada em maio de 2020, nas bases de dados Sistema Online de Busca e Análise de Literatura Médica (MEDLINE)/PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) e Base de Dados em Enfermagem (BDEnf ) da Biblioteca Virtual em Saúde (BVS), Scopus (Elsevier) do Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) e Biblioteca Eletrônica Científica Online (SciELO). Foram consideradas publicações de 2008 até 2020, nos idiomas português, inglês e espanhol. Resultados: Foram identificados, na busca bibliográfica, 920 estudos, sendo 263 duplicados, restando 657 para seleção. Ao final, foram incluídos 15 estudos na síntese. Conclusão: As causas institucionais identificadas foram o avanço de horário da cirurgia anterior, gerando a indisponibilidade de salas cirúrgicas, problemas estruturais, falta ou defeitos em equipamentos e recursos humanos insuficientes.

Objective: To analyze scientific productions about elective surgery cancellation due to institutional causes. Method: Integrative literature review, systematized by the acronym Problem, Interest, and Context (PICo), according to PICo strategy and procedures defined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Bibliographic search was carried out in September 2018 and updated in May 2020 in the following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE)/PubMed, Latin American and Caribbean Health Sciences Literature (Lilacs), Nursing Database (BDEnf ) of the Virtual Health Library (VHL), Scopus (Elsevier) of the Periodical Portal of the Coordination for the Improvement of Higher Education Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior ­ CAPES), and Scientific Electronic Library Online (SciELO). Publications from 2008 to 2020 in Portuguese, English, and Spanish were retrieved. Results: We found 920 studies in the bibliographic search, 263 of them were duplicates, and 657 remained for selection. In the end, 15 studies were included in the review. Conclusion: The institutional causes identified were delay in the previous surgery, leading to unavailability of operating rooms, structural problems, lack of or defects in equipment, and insufficient human resources.

Objetivo: Analizar producciones científicas sobre la cancelación de cirugías electivas por causas institucionales. Método: Revisión bibliográfica integral, sistematizada por el acrónimo Participante, Interés y Contexto (PICo), de acuerdo con la estrategia y los procedimientos PICo definidos por el Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). La búsqueda bibliográfica se realizó en septiembre de 2018 y se actualizó en mayo de 2020, en las bases de datos MEDLINE/Pubmed, LILACS y BDEnf de la Biblioteca Virtual en Salud, SCOPUS (Elsevier) del Portal de revistas Capes y SciELO. Consideró publicaciones de 2008 a 2020, en portugués, inglés y español. Resultados: En la búsqueda bibliográfica, se identificaron 920 estudios, 263 de los cuales se duplicaron, dejando 657 para la selección. Al final, se incluyeron 15 estudios en la síntesis. Conclusión: Las causas institucionales identificadas fueron el tiempo de avance de la cirugía previa, generando la falta de disponibilidad de quirófanos, problemas estructurales, falta o defectos en los equipos y recursos humanos insuficientes.

Monitorización electroencefalográfica en el paciente crítico: ¿qué información útil puede aportar? / Electroencephalographic monitoring in the critically ill patient: What useful information can it contribute?

La monitorización es crucial en el cuidado del paciente crítico. Detecta disfunciones orgánicas y provee orientación en el abordaje terapéutico. Los intensivistas monitorizan habitualmente la función de varios sistemas orgánicos y el cerebro no es la excepción. La monitorización EEG continuo es una vía no invasiva e ininterrumpida para valorar la actividad eléctrica cortical con aceptable resolución espacial y excelente resolución temporal. La efectividad diagnóstica del estado epiléptico no convulsivo como causa de compromiso de la consciencia no explicable por otras causas se ha incrementado con el empleo del EEG continuo; sin embargo, no es la única indicación para valorar la actividad eléctrica cortical cerebral. Este manuscrito intenta resumir las indicaciones, modos de empleo y metodología para el empleo del monitoreo electroencefalográfico continuo en la unidad de cuidados intensivos con la finalidad que el intensivista se familiarice con el mismo

Monitoring is a crucial part of the care of the critically ill patient. It detects organ dysfunction and provides guidance on the therapeutic approach. Intensivists closely monitor the function of various organ systems, and the brain is no exception. Continuous EEG monitoring is a noninvasive and uninterrupted way of assessing cerebral cortical activity with good spatial and excellent temporal resolution. The diagnostic effectiveness of non-convulsive status epilepticus as a cause of unexplained consciousness disorder has increased the use of continuous EEG monitoring in the neurocritical care setting. However, non-convulsive status epilepticus is not the only indication for the assessment of cerebral cortical activity. This study summarizes the indications, usage and methodology of continuous EEG monitoring in the intensive care unit, with the aim of allowing practitioners to become familiarized the technique

Indicadores gerenciais do mapa cirúrgico de um hospital universitário / Management indicators of the surgical schedule in a university hospital / Indicadores de gestión del mapa quirúrgico de un hospital universitario

Objetivos: Analisar a produtividade cirúrgica de um hospital universitário relacionando os indicadores gerenciais do mapa cirúrgico com os aspectos do planejamento e propor estratégias para elaboração do mapa e agendamento cirúrgico. Método: Trata-se de uma pesquisa quantiqualitativa, descritiva, documental, transversal, realizada no centro cirúrgico de um hospital universitário, de abril a junho de 2018, por meio da análise dos mapas cirúrgicos. Resultados: Analisou-se no trimestre uma média de 400 cirurgias mensais. Identificou-se que as cirurgias de porte II (55,9%) foram as mais frequentes, sendo a urologia (18,7%) a especialidade mais recorrente. A taxa de cancelamento avaliou o índice de desempenho do planejamento, que foi de 16,9%. Conclusões: A produtividade cirúrgica e a taxa de cancelamento encontrada aproximam-se da realidade de outros hospitais universitários do país, e as fragilidades apontadas são pertinentes às falhas no planejamento, gerando custos institucionais. Recomenda-se, como estratégia de planejamento, a realização do bate-mapa, a visita pré-operatória de enfermagem e a confirmação do paciente

Objectives: To analyze the surgical productivity in a university hospital, correlating the management indicators of the surgery schedule with planning aspects, and propose strategies for developing the surgery schedule. Method: This is a quantitative and qualitative study of descriptive, documentary, and cross-sectional nature, performed at the surgical center of a university hospital, from April to June 2018, based on the analysis of surgery schedules. Results: In the quarter, an average of 400 monthly surgeries were assessed. We identified that magnitude II (55.9%) surgeries were the most frequent, and urology (18.7%) was the predominant specialty. The cancellation rate evaluated the planning performance index, which was 16.9%. Conclusions: The surgical productivity and the cancellation rate found were close to those of other university hospitals in the country, and the weaknesses detected are related to planning failures, leading to institutional costs. We recommend the implementation of a schedule review, a preoperative nursing visit, and patient confirmation as a planning strategy

Objetivos: Analizar la productividad quirúrgica de un hospital universitario contra los indicadores de gestión del mapa quirúrgico con los aspectos de planificación y proponer estrategias para la elaboración del mapa y el calendario quirúrgico. Método: Esta es una investigación cuantitativa, cualitativa, descriptiva, documental, transversal, realizada en el quirófano de un hospital universitario, de abril a junio de 2018, a través del análisis de mapas quirúrgicos. Resultados: Se analizó un promedio de 400 cirugías mensuales durante el trimestre. Se encontró que las cirugías de tamaño II (55.9%) fueron las más frecuentes, siendo la urología (18.7%) la especialidad más recurrente. La tasa de cancelación evaluó el índice de desempeño de planificación, que fue de 16.9%. Conclusiones: la productividad quirúrgica y la tasa de cancelación están cerca de la realidad de otros hospitales universitarios en el país y las debilidades identificadas son pertinentes a las fallas de planificación, generando costos institucionales. Como estrategia de planificación, se recomienda realizar el toque de mapa, la visita de enfermería preoperatoria y la confirmación del paciente.

Planejamento do principal recurso material utilizado em sala operatória / Planning of the main material resource used in the operating room

Objetivo: analisar o fluxo do principal recurso material utilizado em sala operatória de um hospital universitário. Método: trata-se de um estudo qualitativo, descritivo, documental e observacional realizado em um hospital universitário. Executaram-se duas etapas: análise documental dos recursos materiais utilizados em sala operatória; e construção e análise descritiva do fluxograma do material elencado. Catalogaram-se, posteriormente, esses recursos, armazenando-os em um banco de dados no Microsoft® Excel, versão 2016, para a realização da análise descritiva. Resultados: revelou-se que os materiais mais utilizados foram gaze e compressa com 3.415 e 3.325 unidades, respectivamente. Evidenciaram-se, pelo fluxograma, 44 etapas, 10 departamentos envolvidos e 15 processos documentais mapeados. Conclusão: observou-se que a falta de compressa resultou em compras emergenciais para garantir o funcionamento do setor e o fluxo institucional. A aquisição de materiais é complexa, burocrática e morosa. Pode-se minimizar a falta dos recursos materiais com uma inserção mais evidente do enfermeiro no planejamento em sala operatória.(AU)

Objective: to analyze the flow of the main material resource used in an operating room of a university hospital. Method: this is a qualitative, descriptive, documentary and observational study carried out in a university hospital. The two initial phases were: documentary analysis of the material resources used in the operating room; and construction and descriptive analysis of the flowchart with the material listed. These resources were subsequently cataloged and stored in a database using Microsoft® Excel, version 2016, in order to perform the descriptive analysis. Results: it was found that the most used materials were gauzes and compresses, with 3,415 and 3,325 units, respectively. The flowchart indicated 44 phases, 10 departments involved, and 15 mapped processes. Conclusion: it was observed that the lack of compresses resulted in emergency purchases aimed at maintaining the operation of the sector and the institutional flow. The acquisition of materials is complex, bureaucratic, and time-consuming. The lack of material resources can be minimized with a more evident insertion of nurses in operating room planning.(AU)

Objetivo: analizar el flujo del principal recurso material utilizado en el quirófano de un hospital universitario. Método: se trata de un estudio cualitativo, descriptivo, documental y observacional realizado en un hospital universitario. Se llevaron a cabo dos etapas: análisis documental de los recursos materiales utilizados en el quirófano; y la construcción y el análisis descriptivo del diagrama de flujo del material enumerado. Esos recursos fueron posteriormente catalogados y almacenados en una base de datos usando Microsoft® Excel, versión 2016, para la realización del análisis descriptivo. Resultados: se encontró que los materiales más utilizados fueron gasa y compresa con 3.415 y 3.325 unidades, respectivamente. El diagrama de flujo mostró 44 etapas, 10 departamentos involucrados y 15 procesos documentales mapeados. Conclusión: se observó que la falta de compresas resultó en compras de emergencia para asegurar el funcionamiento del sector y el flujo institucional. La adquisición de materiales es compleja, burocrática y morosa. Se puede minimizar la falta de recursos materiales con una inserción más evidente del enfermero en la planificación en el quirófano.(AU)

Fatores intervenientes na implantação do checklist de cirurgia segura em um hospital universitário / Intervening factors in the implantation of the safe surgery check list in a university hospital

Objetivo: identificar os fatores intervenientes na implantação do checklist de cirurgia segura em um hospital universitário. Metodologia: Estudo descritivo, exploratório, com abordagem qualitativa e análise de conteúdo de Bardin. Coleta de dados realizada no período de março a maio de 2017, por meio de entrevistas posteriormente transcritas na íntegra. População: três enfermeiros, quatro residentes de enfermagem, sete residentes de medicina e nove técnicos de enfermagem. Resultados: foram agrupados em dois eixos - os fatores que dificultam a implantação do checklist, sendo estes, modificar a cultura, déficit de material, resistência da equipe e a burocracia; e os fatores que favorecem, como o fato de ser hospital universitário e a qualificação profissional. Conclusão: A mudança cultural destacou-se como dificultador no processo de implantação do checklist de cirurgia segura, em contrapartida, o principal fator que favorece esse processo é a instituição ser unidade de ensino tendo o corpo acadêmico inserido na assistência (AU)

Objective: to identify the factors involved in implanting the safe surgery checklist in a university hospital. Methodology: Descriptive, exploratory study with a qualitative approach. Data collection was carried out from March to May 2017, through interviews later transcribed in full. Three nurses, four nursing residents, seven medical residents and nine nursing technicians participated in the study. For the data treatment, Bardin content analysis was used. Results: were grouped into two axes - the factors that make it difficult to implement the checklist, being these, modify the culture, material deficit, team resistance and bureaucracy; and the factors that favor it, such as being a university hospital and professional qualification. Conclusion: The cultural change was highlighted as a difficult factor in the implementation process of the safe surgery checklist, in contrast, the main factor that favors this process is the institution being a teaching unit having the academic body inserted in the care. (AU)

Objetivo: identificar los factores intervinientes en la implantación del checklist de cirugía segura en un hospital universitario. Metodología: Estudio descriptivo, exploratorio, con abordaje cualitativo. La recolección de datos realizada en el período de marzo a mayo de 2017, por medio de entrevistas posteriormente transcritas en su totalidad. Participaron del estudio tres enfermeros, cuatro residentes de enfermería, siete residentes de medicina y nueve técnicos de enfermería. Para el tratamiento de los datos se utilizó el análisis de contenido de Bardin. Resultados: fueron agrupados en dos ejes - los factores que dificultan la implantación del checklist, siendo éstos, modificar la cultura, déficit de material, resistencia del equipo y la burocracia; y los factores que favorecen, como el hecho de ser hospital universitario y la calificación profesional. Conclusión: El cambio cultural se destacó como dificultador en el proceso de implantación del checklist de cirugía segura, en contrapartida, el principal factor que favorece ese proceso es la institución ser unidad de enseñanza teniendo el cuerpo académico insertado en la asistencia. (AU)

Hiperactividad simpática paroxística: una entidad que no debería pasar desapercibida / Paroxysmal sympathetic hyperactivity: An entity to keep in mind

La hiperactividad simpática paroxística es una urgencia neurológica potencialmente letal secundaria a múltiples lesiones cerebrales agudas adquiridas. Se caracteriza por rasgos clínicos de aparición cíclica y simultánea, consecuencia de una descarga simpática exacerbada. El diagnóstico es clínico, requiriendo elevados índices de alerta. Actualmente no existen criterios diagnósticos homogéneos que estén ampliamente difundidos y validados. El consenso reciente intenta arrojar luz sobre este oscuro panorama. Su fisiopatología es compleja y aún no ha sido elucidada con certeza; sin embargo, la teoría basada en el modelo excitación-inhibición es la que mejor explica los distintos aspectos de esta entidad, incluyendo la respuesta a la terapia con los fármacos disponibles. Los pilares terapéuticos se asientan sobre el reconocimiento precoz, evitar insultos secundarios y el desencadenamiento de los paroxismos. De ocurrir crisis simpáticas, es que estas se aborten de forma perentoria y que se prevengan. Cuanto más tarde en reconocerse el síndrome, peores serán los resultados

Paroxysmal sympathetic hyperactivity (PSH) is a potentially life-threatening neurological emergency secondary to multiple acute acquired brain injuries. It is clinically characterized by the cyclic and simultaneous appearance of signs and symptoms secondary to exacerbated sympathetic discharge. The diagnosis is based on the clinical findings, and high alert rates are required. No widely available and validated homogeneous diagnostic criteria have been established to date. There have been recent consensus attempts to shed light on this obscure phenomenon. Its physiopathology is complex and has not been fully clarified. However, the excitation-inhibition model is the theory that best explains the different aspects of this condition, including the response to treatment with the available drugs. The key therapeutic references are the early recognition of the disorder, avoiding secondary injuries and the triggering of paroxysms. Once sympathetic crises occur, they must peremptorily aborted and prevented. of the later the syndrome is recognized, the poorer the patient outcome

Condições de temperatura e umidade na sala de distribuição e armazenamento dos produtos para saúde / Temperature and humidity conditions in the distribution and storage room for health products

Objetivos: identificar as condições ambientais, de temperatura e umidade, na área de armazenamento e distribuição de produtos para saúde esterilizados como possível fonte de contaminação dos produtos para saúde esterilizados; e, analisar tais condições ambientais como possível fonte de contaminação dos produtos para saúde esterilizados em relação aos padrões nacionais e internacionais. Método: Estudo retrospectivo documental, com abordagem quantitativa, realizado a partir de análise do formulário de registro da temperatura e de umidade do ar. Os dados coletados foram organizados em planilhas, de acordo com as duas variáveis, sumarizados por meio da distribuição dos dados brutos, as variáveis contínuas foram tratadas por meio da análise quantitativa descritiva, com medidas de tendência central e de dispersão. Resultados: apesar das referências apresentadas para o parâmetro de temperatura e de umidade do ar serem amplamente reconhecidas nacional e internacionalmente, encontra-se fragilidade nos resultados que demonstram a importância do controle de temperatura e de umidade do ar. Conclusão: mostra-se a necessidade de desenvolvimentos de pesquisas que determinem a relevância mediante evidências científicas do controle de temperatura e de umidade do ar na área de armazenamento e distribuição de produtos para saúde esterilizados

Objectives: To identify the environmental conditions of temperature and humidity in the area of storage and distribution of sterilized health products as a possible source of contamination of sterilized health products; and to analyze such environmental conditions as a possible source of contamination of health products sterilized in relation to national and international standards. Method: Retrospective documentary study, with quantitative approach, based on the analysis of the temperature and air humidity record form. The collected data were organized in spreadsheets, according to the two variables, summarized by means of the distribution of the raw data, the continuous variables were treated through quantitative descriptive analysis, with measures of central tendency and dispersion. Results: Although the references presented for the parameters of temperature and air humidity are widely recognized nationally and internationally, there is a fragility in the results that demonstrate the importance of air temperature and humidity control. Conclusion: it is necessary to develop researches that determine the relevance of scientific evidence of temperature and humidity control in the area of storage and distribution of sterilized health products

Controversias en la retirada de la ventilación mecánica y extubación en el paciente neurocrítico / Controversies in weaning from mechanical ventilation and extubation in the neurocritical patient

No disponible

Craniectomía descompresiva secundaria para el manejo de la hipertensión endocraneanal refractaria en el traumatismo craneoencefálico grave. Luces y sombras de los estudios recientes / Secondary decompressive craniectomy for the management of refractory endocraneal hypertension in severe traumatic brain injury. Lights and shadows from recent studies

No disponible

Sedación cooperativa: opción para el manejo de la agitación en el traumatismo craneoencefálico moderado / Cooperative sedation: An option for the management of agitation in moderate traumatic brain injury

No disponible

Predictores de mortalidad y mal resultado funcional en la hemorragia intraparenquimatosa espontánea grave: estudio prospectivo observacional / Predictors of mortality and poor functional outcome in severe spontaneous intracerebral hemorrhage: A prospective observational study

OBJETIVO: Evaluar la mortalidad y el resultado funcional final de los pacientes con hemorragia intraparenquimatosa espontánea grave (HIP). Determinar las características clínicas, radiológicas y terapéuticas con mayor poder predictivo sobre la mortalidad en la Unidad de Cuidados Intensivos (UCI) y durante el ingreso hospitalario, así como sobre los malos resultados funcionales a los 6 meses. DISEÑO: Estudio prospectivo, observacional. ÁMBITO: UCI de un hospital universitario. PACIENTES: Durante 23 meses se incluyó a aquellos pacientes con diagnóstico de HIP. VARIABLES DE INTERÉS: Datos demográficos, factores de riesgo cardiovascular, medicación habitual, datos de laboratorio, tomografía craneal (TC), neuromonitorización, manejo terapéutico y evaluación pronóstica. Intervención: Ninguna. RESULTADOS: Se incluyó a un total de 186 pacientes. En el 25,8% se realizó evacuación quirúrgica de la HIP. La mortalidad fue del 46,7%. La mediana del Rankin modificado a los 6 meses fue de 5 (RI: 4;6). El análisis multivariante de regresión de Cox mostró que la presencia de diabetes, tratamiento previo con anticoagulantes, la gravedad según APACHE II y el tipo de hemorragia en la TC de cráneo se comportaron como variables predictoras de mortalidad y malos resultados funcionales, mientras que la realización de procedimientos neuroquirúrgicos y la monitorización de la presión intracraneal (PIC) asociaron una mayor supervivencia y mejores resultados. CONCLUSIÓN: La presencia de comorbilidades, como la diabetes o el tratamiento previo con anticoagulantes, así como los hallazgos de la TC se asociaron a peores resultados. Por contra, el marcador de mayor supervivencia y mejor resultado funcional era la monitorización de la PIC, así como la cirugía precoz

OBJECTIVE: To analyze mortality and functional outcome in patients with severe spontaneous intracerebral hemorrhage (ICH), and identify the clinical characteristics, radiological findings and therapeutic procedures predictive of mortality in the Intensive Care Unit (ICU) and during hospitalization, as well as of poor functional results at 6 months. DESIGN: A prospective, observational study was carried out. SETTING: Neurocritical Care Unit of a university hospital. PATIENTS: Patients diagnosed with ICH were included over a period of 23 months. VARIABLES OF INTEREST: Demographic characteristics, cardiovascular risk factors, regular medication, laboratory test parameters, cranial CT findings, therapeutic procedures and outcome data. Intervention: None. RESULTS: A total of 186 patients with ICH met the inclusion criteria. Surgery to evacuate ICH was performed in 25.8% of the patients. The mortality rate was 46.7%. The modified Rankin score at 6 months was 5 (RI: 4.6). Multivariate Cox regression analysis showed the presence of diabetes, prior anticoagulation, as well as APACHE II severity and the type of bleeding on the cranial CT scan to be predictors of mortality and poor functional outcomes. On the other hand, neurosurgical procedures and intracranial pressure (ICP) monitoring were associated with better outcomes. CONCLUSION: The presence of comorbidities such as diabetes, or previous anticoagulation, as well as the CT findings were associated to poorer outcomes. In contrast, ICP monitoring and early neurosurgery were predictive of longer survival and better functional outcomes

Diagramas para interpretar y corregir eventos fisiopatológicos desencadenados tras el traumatismo craneoencefálico grave / Diagrams to interpret and solve physiopathological events triggered after severe traumatic brain injury

No disponible

Understanding the forms of care of nurses in the operating room - a construction based on the grounded theory method / Conociendo las formas de cuidar de enfermeros del servicio de cirugía - una construcción a partir de la teoría fundamentada en los datos / Conhecendo as formas de cuidar dos enfermeiros de centro cirúrgico - uma construção a partir da teoria fundamentada nos dados

The aim of this study was to identify forms of care of nurses in the operating room, and describe how context influences the implementation of this care. This is qualitative study, for which data were obtained by means of five interviews with nurses working in the operating room of a public hospital in the municipality of Duque de Caxias, in the Brazilian state of Rio de Janeiro, conducted between August and September of 2010, using a semistructured script. The methodology followed the Grounded Theory method. The results show that the nurses perform care motivated by professional commitment and satisfaction, with patient health being their primary focus. Professional context influences ways of working, since the relationship of care exists in the interdependence between the beings involved and working conditions. In conclusion, operating room nurses integrate several factors, acting sometimes as agents of indirect care, despite the difficulties of a complex and specific context.

Se objetivó identificar las formas de cuidar del enfermero de Servicio de Cirugía y describir la influencia del contexto para su realización. Investigación cualitativa, con datos obtenidos a través de cinco entrevistas con enfermeros de Servicio de Cirugía del municipio de Duque de Caxias, RJ, Brasil, realizadas entre agosto y setiembre del 2010, mediante un cuestionario semiestructurado. La metodología siguió la Teoría Fundamentada en los Datos. Los resultados muestran que el enfermero realiza el cuidado motivado por el compromiso y la satisfacción profesional, siendo la preservación del paciente su foco principal. El contexto es señalado como capaz de influir en las formas de trabajar, ya que la relación de cuidado se da en la interdependencia entre los entes involucrados y las condiciones de trabajo. Se concluye que los enfermeros de Servicio de Cirugía integran diversos factores, actuando a veces como agentes del cuidado indirecto, a pesar de las dificultades de un contexto complejo y específico.

Os objetivos deste estudo foram identificar as formas de cuidar do enfermeiro de centro cirúrgico e descrever a influência do contexto para sua realização. Trata-se de pesquisa qualitativa, cujos dados foram obtidos através de cinco entrevistas com enfermeiros de centro cirúrgico do município de Duque de Caxias-RJ, realizadas entre agosto e setembro de 2010, através de um roteiro semiestruturado. A metodologia seguiu a Teoria Fundamentada nos Dados. Os resultados mostram que o enfermeiro realiza o cuidado motivado pelo compromisso e satisfação profissional, tendo a preservação do cliente como foco principal. O contexto é apontado como capaz de influenciar as formas de trabalho, já que a relação de cuidado existe na interdependência entre os entes envolvidos e as condições de trabalho. Concluiu-se que os enfermeiros de centro cirúrgico integram diversos fatores, atuando, por vezes, como agentes do cuidado indireto, apesar das dificuldades de um contexto complexo e específico.

Monitorización de la presión intracraneal en el traumatismo craneoencefálico grave: otra visión del Best Trip trial / Intracranial pressure monitoring in severe traumatic brain injury: A different perspective of the BestTrip trial

Se exponen una serie de dudas y reflexiones sobre la reciente publicación de Chesnutet al., en la que, comparando 2 enfoques para el tratamiento de la hipertensión endocraneal(HEC) en el traumatismo craneoencefálico grave, con y sin monitorización de la presión intracraneal(PIC), se concluye que la monitorización de la PIC no mejora el resultado. Las principales dudas se refieren al grado de entrenamiento de los médicos implicados en el ensayo en el manejo de la PIC, en la posible intervariabilidad en la lectura de la TAC, la capacidad de los signos clínicos para guiar el tratamiento de la HEC y en la idoneidad de la aleatorización. Del análisis de este ensayo no se debe colegir la inutilidad de la monitorización de la PIC, sino la necesidad de utilizar correctamente la información que nos aporta la monitorización de la PICy la búsqueda de métodos de monitorización alternativos no invasivos

The present study outlines a series of questions and reflections upon the recent publication of Chesnut et al., who compared 2 approaches to the treatment of intracranial hypertension (ICH) in severe head injuries: one with and the other without intracranial pressure monitoring (ICP). The authors concluded that no improved outcome was observed in the treatment group guided by ICP monitoring. The main concerns relate to the degree of training of the physicians involved in the monitoring and management of ICH in the ICP group, as well as to the possible inter-observer variability in interpreting the CT scans, the capacity of clinical signs to guide the treatment of ICH, and the suitability of randomization. The analysis of this trial should not be taken to suggest the futility of ICP monitoring but rather the need to correctly use the information afforded by ICP monitoring, with emphasis on the importance of the definition of alternative methods for non-invasive monitoring

O trabalhador sem vínculo previdenciário e a vivência cirúrgica: uma contribuição da enfermagem / Workers without social security and surgical experience: a contribution from nursing / Experiencia quirúrgica: una contribución de la enfermería

A vivência cirúrgica gera grandes repercussões na vida do cliente, ainda mais se o mesmo passa por dificuldades, instabilidade e precarização trabalhista. Sendo assim o presente estudo teve como objetivos identificar as repercussões da necessidade de se submeterem à cirurgia eletiva em trabalhadores sem vínculo previdenciário e analisar as facilidades e as dificuldades que esses trabalhadores vivenciam durante o período perioperatório. O estudo teve uma abordagem qualitativa e descritiva, realizado em enfermarias cirúrgicas de um hospital público do Rio de Janeiro. Os sujeitos foram 10 clientes na condição de "sem vinculo previdenciário". O instrumento foi uma entrevista semiestruturada e as informações coletadas foram tratadas pelo método de análise de conteúdo. Assim, com o método escolhido encontraram-se 15 Unidades de Registro (UR) que foram agrupadas em duas categorias: "O significado da experiência cirúrgica e suas repercussões" e "As incertezas da vivência cirúrgica e modos de enfrentamento". Verificou-se que a experiência cirúrgica tem repercussões psicológicas e sociofinanceiras, gerando dificuldades como o afastamento das atividades laborais, logo um prejuízo financeiro. Considerou-se que a situação é complexa e demanda uma conduta que envolve desde a orientação até o encaminhamento a outros profissionais.

Undergoing surgery has great repercussions in patients' lives, particularly if they are experiencing hardships from work instability and worsening conditions. Thus, the objective of the present study was to identify the effects on workers without social security needing to undergo elective surgery, and analyze the conveniences and difficulties those workers experience during the perioperative period. The study took a qualitative and descriptive approach, conducted in surgical wards from a University Hospital in Rio de Janeiro. Subjects were 10 clients under the "without social security" condition. The instrument was a semi-structured interview and the data were treated by means of content analysis. Thus, the method chosen met fifteen (15) Registration Units (RUs), which were grouped into 2 (two) categories: "The meaning of surgical experience and its impact" and "The uncertainties of surgical experience and coping". It was found that surgical experience has psychological and socio-financial repercussions, causing difficulties such as removal from work activities, resulting in financial loss. It was felt that the situation is complex and requires conduct comprising guidance and referral to other professionals.

La vivencia quirúrgica genera grandes repercusiones en la vida del cliente, aun más si éste pasa por dificultades de inestabilidad y precarización laboral. Así siendo, el presente estudio tuvo como objetivos identificar las repercusiones de la necesidad de someterse a la cirugía electiva en trabajadores sin la tarjeta de la seguridad social y analizar las facilidades y las dificultades que estos trabajadores viven durante el período perioperatorio. El estudio tuvo un abordaje cualitativo y descriptivo, realizado en enfermerías quirúrgicas de un hospital público de Rio de Janeiro. Los sujetos fueron 10 clientes en la condición de "sin tarjeta de la seguridad social". El instrumento fue la entrevista semiestructurada y las informaciones recolectadas fueron tratadas por el método de análisis de contenido. Así, con el método elegido se encontraron 15 (quince) Unidades de Registro (UR) que fueron agrupadas en dos categorías: "El significado de la experiencia quirúrgica y sus repercusiones" y "Las incertidumbres de la vivencia quirúrgica y modos de enfrentamiento". Se verificó que la experiencia quirúrgica tiene repercusiones psicológicas y sociofinancieras, generando dificultades como el alejamiento de las actividades laborales, o sea un perjuicio financiero. Se consideró que la situación es complexa y demanda una conducta que involucra desde la orientación hasta el encaminamiento a otros profesionales.