Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC): The First Reported Case in Brazil Using Standardized Technique with the Capnopen® Nebulizer Device.

BACKGROUND Peritoneal metastasis is a common progression of abdominal-pelvic cancers, and it is associated with poorer oncological prognosis when compared to other metastasis sites. Its treatment has limited results, mainly because of poor bioavailability of chemotherapy within the abdominal cavity after systemic administration. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has been proposed as a novel method to deliver chemotherapy directly into the peritoneal surface; it combines the effectiveness and response of an intraperitoneal therapy with benefits of a minimally invasive approach. The laparoscopic capnoperitoneum is used to instill chemotherapy particles in a more efficient way for distribution and penetration when compared to peritoneal lavage. In the present study, we describe the first PIPAC performed in Brazil, according to the standard technique previously described with the Capnopen® nebulizer device, as well as technique details based on our literature review. CASE REPORT A 67-year-old man with pancreatic adenocarcinoma metastatic to the liver at first diagnosis underwent systemic treatment with the FOLFIRINOX protocol. After a major clinical response due to systemic treatment, pancreaticoduodenectomy was performed with resection and radiofrequency ablation of hepatic nodules. After 7 months of follow-up, the patient's condition evolved with symptomatic relapse in the peritoneum. Aiming at better control of this site, multiple PIPAC procedures were performed, showing excellent control of the peritoneal cavity disease. The patient had a sustained response in the peritoneal cavity and showed systemic disease progression 6 months after the first PIPAC procedure, which deceased at 20 months after the first PIPAC procedure and 42 months after the primary diagnosis. CONCLUSIONS This report shows that the PIPAC procedure is reproducible elsewhere, with safety and good functional results.

Inadequate Functioning of Nebulizer System Compressors Used by Individuals With Cystic Fibrosis.

BACKGROUND: The treatment of cystic fibrosis involves the use of drugs delivered by nebulizer systems, and adequate functioning of the compressors and nebulizers is essential. We hypothesized that compressors of nebulizer systems used by individuals with cystic fibrosis would not work properly. Therefore, we aimed to assess the performance of the compressors from nebulizer systems used by individuals with cystic fibrosis. METHODS: This is a cross-sectional study to assess the performance of compressors from nebulizer systems used by subjects with cystic fibrosis registered at the Cystic Fibrosis Patient Association in Minas Gerais, Brazil. Compressors (Proneb Ultra II) brought by the individuals were tested with new nebulizer parts (Pari LC plus) to assess the variables of nebulization efficiency, including residual volume, solution output, and aerosol output rate. Compression performance was assessed by measuring the operating pressure using a PARI PG101 manometer. RESULTS: The performance of 146 compressors was analyzed. Fifty-seven (39%) of the compressors were ineffective, with operating pressure values well below the manufacturer's technical reference and the compressor time used for a median time of 36 (15 days to 156 months). The systems with low pressure values demonstrated significantly worse results for nebulization efficiency variables, and a significant correlation was found between residual volume (r = -0.5, P < .001), solution output (r = +0.5, P < .001), and aerosol output rate (r = +0.5, P < .001), and operating pressure values. CONCLUSIONS: A significant number of compressors generate low operating pressure values. These systems showed a compromised efficiency of nebulization, indicating that the pressure generated by the compressor is a critical aspect of treatment efficiency.

A prototype single-port device for pressurized intraperitoneal aerosol chemotherapy. Technical feasibility and local drug distribution

Purpose: To evaluate the technical feasibility and homogeneity of drug distribution of pressurized intraperitoneal aerosol chemotherapy (PIPAC) based on a novel process of intraperitoneal drug application (multidirectional aerosolization). Methods: This was an in vivo experimental study in pigs. A single-port device was manufactured at the smallest diameter possible for multidirectional aerosolization of the chemotherapeutic drug under positive intraperitoneal pressure. Four domestic pigs were used in the study, one control animal that received multidirectional microjets of 9 mL/sec for 30 min and three animals that received multidirectional aerosolization (pig 02: 9 mL/sec for 30 min; pigs 03 and 04: 3 mL/sec for 15 min). Aerosolized silver nitrate solution was applied for anatomopathological evaluation of intraperitoneal drug distribution. Results: Injection time was able to maintain the pneumoperitoneum pressure below 20 mmHg. The rate of moderate silver nitrate staining was 45.4% for pig 01, 36.3% for pig 02, 36.3% for pig 03, and 72.7% for pig 04. Conclusions: Intra-abdominal drug distribution had a broad pattern, especially in animals exposed to the drug for 30 min. Our sample of only four animals was not large enough to demonstrate an association between aerosolization and a higher silver nitrate concentration in the stained abdominal regions.(AU)

Evaluación del conocimiento de los padres de la técnica de aerosolterapia con aerocámara / Evaluation of parental knowledge of the aerosol technique with holding chamber

Introducción. Los episodios de tos, disnea y sibilancias son causa frecuente de consulta pediátrica. Su tratamiento de elección es la administración de fármacos a través de la aerosolterapia. El éxito de esta estrategia depende de la correcta aplicación de la técnica inhalatoria. Objetivo. Evaluar el conocimiento de padres de niños con patología obstructiva recurrente de la vía aérea en el uso de la aerosolterapia con aerocámara. Población y métodos. Estudio transversal, observacional, descriptivo. Se incluyeron aleatoriamente padres de niños menores de 6 años con tos, disnea y/o sibilancias con antecedentes de uso de aerocámara en la consulta al Servicio de Pediatría y/o de Alergia e Inmunología. Se evaluó el conocimiento en el empleo del inhalador mediante observación de la técnica. Resultados. Se incluyeron 114 niños, 51% masculino, con una edad promedio de 29,23 meses (DE=18,30). La persona a cargo de realizar la aerosolterapia tenía una media de edad de 32,28 años (DE=5,29); la mayoría de los responsables evaluados fueron madres (92,98%), con nivel de educación superior (71,05%). La forma de aprendizaje de la técnica fue demostrativa visual en 62 casos (54,4%), y el principal instructor de la misma fue el pediatra. Se demostró que 68 (72%) padres no realizaban en forma correcta la técnica y se encontró asociación entre edad del paciente y la correcta realización de la aerosolterapia (r=0,21; p=0,03). Conclusión. La mayoría de los padres realizan la aerosolterapia de forma incorrecta y la edad del niño influye en la técnica de la terapia inhalatoria.(AU)

Introduction. Symptoms of cough, dyspnea and wheezing are common cause for medical consultation. Their treatment is the administration of drugs through the aerosol. The success of this strategy depends on the correct application of inhalation technique. Objective. To evaluate the knowledge of parents of children with recurrent obstructive airway disease in the use of aerosol therapy with valved holding chamber. Population and Methods. Cross-sectional, observational, descriptive study. Randomly included parents of children under six years with cough, dyspnea and / or wheezing with a background of use in the office holding chamber of Pediatric and / or of Allergy and Immunology section of an Hospital. We evaluated the knowledge about the inhaler technique by medical observation. Results. We included 114 children, 51% male, with an average age of 29.23 months (SD=18.30). The median age o the caregiver responsible for conducting the aerosol therapy was 32.28 years (SD=5.29); the majority of evaluated makers were mothers (92.98%) with higher education level (71.05%). The most frequent way for learning was the visual demonstration technique in 62 cases (54.4%), and the main instructor was the pediatrician. Sixty-eight (72%) of parents did not perform properly the inhalation technique and a positive association was found between patient age and the proper realization of the aerosol (r=0.21; P=0.03). Conclusion. Most parents perform incorrectly aerosol therapy with valved holding chamber and the child's age influences the inhalation technique.(AU)

Methods of assessing adherence to inhaled corticosteroid therapy in children and adolescents: adherence rates and their implications for clinical practice.

Nonadherence to inhaled corticosteroid therapy is common and has a negative effect on clinical control, as well as increasing morbidity rates, mortality rates and health care costs. This review was conducted using direct searches, together with the following sources: Medline; HighWire; and the Latin American and Caribbean Health Sciences Literature database. Searches included articles published between 1992 and 2008. The following methods of assessing adherence, listed in ascending order by degree of objectivity, were identified: patient or family reports; clinical judgment; weighing/dispensing of medication, electronic medication monitoring; and (rarely) biochemical analysis. Adherence rates ranged from 30 to 70%. It is recognized that the degree of adherence determined by patient/family reports or by clinical judgment is exaggerated in comparison with that obtained using electronic medication monitors. Physicians should bear in mind that true adherence rates are lower than those reported by patients, and this should be considered in cases of poor clinical control. Weighing the spray quantifies the medication and infers adherence. However, there can be deliberate emptying of inhalers and medication sharing. Pharmacies provide the dates on which the medication was dispensed and refilled. This strategy is valid and should be used in Brazil. The use of electronic medication monitors, which provide the date and time of each triggering of the medication device, although costly, is the most accurate method of assessing adherence. The results obtained with such monitors demonstrate that adherence was lower than expected. Physicians should improve their knowledge on patient adherence and use accurate methods of assessing such adherence.

Métodos empregados na verificação da adesão à corticoterapia inalatória em crianças e adolescentes: taxas encontradas e suas implicações para a prática clínica: [revisão] / Methods of assessing adherence to inhaled corticosteroid therapy in children and adolescents: adherence rates and their implications for clinical practice: [review]

Adesão inadequada à corticoterapia inalatória é comum e contribui para um controle clínico insatisfatório, aumento da morbidade, mortalidade e dos custos do setor. Este artigo de revisão foi conduzido utilizando-se bancos de dados Medline, HighWire, Literatura Latino-Americana e do Caribe em Ciências da Saúde e pesquisa direta, entre 1992 e 2008. Os métodos para avaliar a adesão, citados em ordem crescente de sua objetividade, são: relato do paciente ou seus familiares, julgamento clínico, pesagem da medicação, dispensação de medicação, dosadores eletrônicos e análise bioquímica (pouco utilizada). As taxas de adesão variaram de 30 a 70 por cento. A adesão determinada pelo relato do paciente/familiares e julgamento clínico é reconhecidamente exagerada quando comparada à obtida através do dosador eletrônico. O clínico deve sempre lembrar que as taxas reais de adesão são menores do que as relatadas pelo paciente e isso deve ser considerado, se não houver bom controle da doença. A pesagem do spray quantifica a medicação e infere adesão, porém pode ocorrer esvaziamento deliberado e compartilhamento da medicação. A farmácia fornece datas de dispensação e recarga da medicação. Esta estratégia é válida e deveria ser utilizada em nosso meio. O uso de dosador eletrônico é o método mais acurado para avaliar adesão, ele fornece a data e horário de cada disparo na utilização da medicação, porém é oneroso. Os resultados obtidos com dosadores demonstraram que a adesão foi menor que a esperada. Melhorar o conhecimento do médico sobre a adesão do seu paciente e utilizar métodos acurados para acessá-la é um caminho a seguir.

Nonadherence to inhaled corticosteroid therapy is common and has a negative effect on clinical control, as well as increasing morbidity rates, mortality rates and health care costs. This review was conducted using direct searches, together with the following sources: Medline; HighWire; and the Latin American and Caribbean Health Sciences Literature database. Searches included articles published between 1992 and 2008. The following methods of assessing adherence, listed in ascending order by degree of objectivity, were identified: patient or family reports; clinical judgment; weighing/dispensing of medication, electronic medication monitoring; and (rarely) biochemical analysis. Adherence rates ranged from 30 to 70 percent. It is recognized that the degree of adherence determined by patient/family reports or by clinical judgment is exaggerated in comparison with that obtained using electronic medication monitors. Physicians should bear in mind that true adherence rates are lower than those reported by patients, and this should be considered in cases of poor clinical control. Weighing the spray quantifies the medication and infers adherence. However, there can be deliberate emptying of inhalers and medication sharing. Pharmacies provide the dates on which the medication was dispensed and refilled. This strategy is valid and should be used in Brazil. The use of electronic medication monitors, which provide the date and time of each triggering of the medication device, although costly, is the most accurate method of assessing adherence. The results obtained with such monitors demonstrate that adherence was lower than expected. Physicians should improve their knowledge on patient adherence and use accurate methods of assessing such adherence.

Morbilidad y mortalidad por neumonía nosocomial en pacientes tratados con aerosoles de eucalipto durante la ventilación artificia / Morbidity and mortality for nosocomial pneumonia in patients treated with eucalyptus aerosols during the artificial ventilation

Se efectuó un estudio longitudinal y prospectivo sobre 26 pacientes tratados con ventilación mecánica artificial en el Servicio de Terapia Intensiva del Hospital Provincial Docente “Dr. Joaquín Castillo Duany” de Santiago de Cuba, en los meses de septiembre a diciembre del 2006. El empleo de aerosoles con eucalipto persiguió disminuir la incidencia de neumonía asociada a ventilación, la colonización del árbol bronquial por gérmenes intrahospitalarios, los efectos de la infección y la letalidad, la cual resultó ser de 37,5 % en la casuística, causada fundamentalmente por microorganismos gramnegativos como Acinetobacter y Pseudomonas. La utilización de dichos aerosoles en los pacientes con ventilación mecánica artificial puede constituir un tratamiento eficaz para aminorar la incidencia, gravedad y letalidad de la neumonía en estos casos(AU)

A longitudinal and prospective study was carried on 26 patients treated with artificial mechanical ventilation in the Service of Intensive Therapy of "Dr. Joaquín Castillo Duany" Teaching Provincial Hospital in Santiago de Cuba, in the months of September to December, 2006. The use of aerosols with eucalyptus was aimed at diminishing the pneumonia incidence associated with ventilation, the colonization of the bronchial tree by nosocomial pathogens and the effects of infection and lethality, which turned out to be of 37,5% in the case material, mainly caused by gram-negative microorganisms such as Acinetobacter and Pseudomonas. The use of these aerosols in the patients with artificial mechanical ventilation can constitute an effective treatment to reduce the incidence, severity and lethality of pneumonia in these cases.

Morbilidad y mortalidad por neumonía nosocomial en pacientes tratados con aerosoles de eucalipto durante la ventilación artificia / Morbidity and mortality for nosocomial pneumonia in patients treated with eucalyptus aerosols during the artificial ventilation

Se efectuó un estudio longitudinal y prospectivo sobre 26 pacientes tratados con ventilación mecánica artificial en el Servicio de Terapia Intensiva del Hospital Provincial Docente “Dr. Joaquín Castillo Duany” de Santiago de Cuba, en los meses de septiembre a diciembre del 2006. El empleo de aerosoles con eucalipto persiguió disminuir la incidencia de neumonía asociada a ventilación, la colonización del árbol bronquial por gérmenes intrahospitalarios, los efectos de la infección y la letalidad, la cual resultó ser de 37,5 % en la casuística, causada fundamentalmente por microorganismos gramnegativos como Acinetobacter y Pseudomonas. La utilización de dichos aerosoles en los pacientes con ventilación mecánica artificial puede constituir un tratamiento eficaz para aminorar la incidencia, gravedad y letalidad de la neumonía en estos casos.

A longitudinal and prospective study was carried on 26 patients treated with artificial mechanical ventilation in the Service of Intensive Therapy of "Dr. Joaquín Castillo Duany" Teaching Provincial Hospital in Santiago de Cuba, in the months of September to December, 2006. The use of aerosols with eucalyptus was aimed at diminishing the pneumonia incidence associated with ventilation, the colonization of the bronchial tree by nosocomial pathogens and the effects of infection and lethality, which turned out to be of 37,5% in the case material, mainly caused by gram-negative microorganisms such as Acinetobacter and Pseudomonas. The use of these aerosols in the patients with artificial mechanical ventilation can constitute an effective treatment to reduce the incidence, severity and lethality of pneumonia in these cases.

O ABC da asma / Asthma's ABC

A asma afeta parcela significativa da população global, representando um importante problema de Saúde Pública em muitos países. Resultado da interação entre fatores genéticos e ambientais, a asma tem complexos e imbricados mecanismos patogênicos, desenvolvidos em conseqüência do comportamento anormal da maior parte das células constituintes do aparelho respiratório. Doença crônica, de caráter inflamatório, não pode ser curada. Os sintomas e as disfunções por ela causados interferem no cotidiano de seus portadores. Entretanto, o tratamento adequado, se instituído precocemente, pode controlá-la e permitir ao asmático ter uma vida normal. Dado ser causa freqüente de atendimento médico em consultórios e em unidades de emergência, bem como razão de elevado número de hospitalizações, é importante que o médico, independentemente de sua especialidade, esteja capacitado para identificá-la e orientar o seu tratamento.

[Different inhaler devices in acute asthma attacks: a randomized, double-blind, placebo-controlled study]. / Diferentes dispositivos inalatórios na crise aguda de asma: um estudo randomizado, duplo-cego e controlado com placebo.

OBJECTIVE: To verify the efficacy, side effects, and cost of treatment of acute asthma attacks, using different inhaler devices. METHODS: This is a randomized, double-blind, placebo-controlled study. Salbutamol was administered via a nebulizer, a metered-dose inhaler (attached to a commercially available spacer device), a homemade non-valved spacer device, or a dry powder inhaler. Assessments were made at zero, 20, 40 and 60 minutes, followed by the application of salbutamol and placebo with another device. Forty children (mean age of 11+/-3.5 years) with acute asthma attacks, were evaluated. Clinical score, forced expiratory volume in one second and side effects were analyzed. The costs for medication and spacer devices were calculated. RESULTS: There is no difference between groups regarding clinical score and variation of forced expiratory volume in one second. There was a major variation in the heart rate response to the nebulizer (35%) compared to the commercially available spacer and dry powder inhaler (15 and 17%) and between the homemade spacer and the commercially available spacer (28 and 15%) (p = 0.004). The nebulizer and homemade spacer caused more tremor (p = 0.02). The cost of treatment was higher for the nebulizer and commercially available spacer (p = 0.0001). CONCLUSIONS: The nebulizer was more expensive and used more medicine, showing the same efficiency. The homemade spacer was cheaper, but presented more side effects. The commercially available spacer was as expensive as the nebulizer, although safer. The dry powder inhaler was cheaper, but, just as the homemade spacer, it also caused tachycardia.

Diferentes dispositivos inalatórios na crise aguda de asma: um estudo randomizado, duplo-cego e controlado com placebo / Different inhaler devices in acute asthma attacks: a randomized, double-blind, placebo-controlled study

OBJETIVO: Verificar a eficácia, eventos adversos e custo do tratamento da crise aguda de asma, utilizando diferentes dispositivos inalatórios. MÉTODOS: Estudo randomizado, duplo-cego e controlado com placebo. Foi utilizado salbutamol em nebulizador, inalador dosimetrado com espaçadores industrial e artesanal e inalador em pó. As avaliações foram feitas em 0, 20, 40 e 60 minutos, seguidas da aplicação de salbutamol e placebo em outro dispositivo. Foram avaliadas 40 crianças em crise aguda de asma, com média de idade = 11±3,5 anos. Utilizou-se escore clínico e função pulmonar, e foram verificados eventos adversos. Foram calculados gastos com o medicamento e o dispositivo inalatório. RESULTADOS: O escore clínico e a variação no volume expiratório forçado no primeiro segundo foram semelhantes entre os grupos ao final do estudo. Foi encontrada uma variação maior na freqüência cardíaca com o uso de nebulizador (35 por cento) do que nos grupos que fizeram uso do espaçador industrial (15 por cento) e do inalador em pó (17 por cento), e também entre os espaçadores artesanal e industrial, 28 e 15 por cento, respectivamente (p = 0,004). O nebulizador e o espaçador artesanal provocaram mais tremores (p = 0,02). O custo do tratamento por paciente foi maior nos grupos nebulizador e espaçador industrial, R$ 22,31 e R$ 16,58, respectivamente (p = 0,0001). CONCLUSÕES: O nebulizador foi o mais caro e consumiu mais droga para apresentar a mesma eficácia. O espaçador artesanal foi o mais barato. No entanto, apresentou mais eventos adversos do que o espaçador industrial e o inalador em pó. O espaçador industrial foi tão caro quanto o nebulizador, porém mais seguro. O inalador em pó foi mais barato e apresentou menos tremores, mas taquicardia semelhante ao espaçador artesanal.

Tratamiento inhalatorio en la crisis asmática severa / Inhalation treatment in acute asthma

Se realiza una revisión sobre el tratamiento inhalatorio de la crisis asmática. La inhaloterapia está ampliamente difundida en la práctica médica habitual, implicando importantes costos económicos. Sin embargo, se estima a nivel mundial que hay una administración inadecuada en un procentaje importante, lo que resulta en fracasos terapéuticos y gastos innecesarios. Esto adquiere relevancia cuando se conoce el aumento de la mortalidad por asma en las últimas décadas y se detecta que tanto los pacientes como los médicos y paramédicos carecen mayoritariamente de los conocimientos básicos y habilidades para su adecuado manejo. Se establece los objetivos de la inhaloterapia y se consideran los aspectos fundamentales (físicos, generadores de aerosoles, farmacología). Se estudian y comparan los distintos sistemas de generación de aerosoles y también se analizan los diferentes fármacos inhalados. Se exponen con detalle los beta agonistas, anticolinérgicos y corticoides en sus formas inhaladas. También se presentan otros tratamientos inhalatorios no tradicionales como el sulfato de magnesio y una mezcla gaseosa heliox. En los distintos tópicos se recurre en lo posible a revisiones sistemáticas o metaanálisis para establecer preferencias o elegir tratamientos. Los autores proponen algunas estrategias terapéuticas avaladas en su experiencia, documentada en la bibliografía aportada. (AU)

Aerossolterapia na asma da criança / Aerosol therapy in childhood asthma

Objetivos: Os objetivos dessa revisäo säo apresentar resultados de pesquisas em aerossolterapia e discutir a otimizaçäo dessa forma de administraçäo de medicamentos. Método: Foram revistos alguns dos principais trabalhos publicados sobre aerosslterapia, sobre aparelhos geradores de aerossol, e sobre farmacocinética e farmacodinâmica das drogas inaladas. Resultados: Säo apresentados os fatores que interferem sobre o padräo de deposiçäo das drogas inaladas, sua farmacocinética e a influência da deposiçäo e da farmacocinética sobre os efeitos do tratamento. Os aparelhos geradores de aerossol säo comparados, em seus aspectos positivos e negativos, e procura-se estabelecer equivalência entre doses com diferentes dispositivos inalatórios. Conclusöes: Os aparelhos geradores de aerossol e as técnicas inalatórias determinam o padräo de deposiçäo e os efeitos clínicos das drogas. Esses fatores devem ser bem conhecidos, afim de se alcançarem os melhores resultados possíveis no tratamento por via inalatória...

Conceptos y actualidades sobre el uso de la aerosolterapia en pediatría / Concepts and state of the art about the use of aerosols therapy in pediatrics

En los últimos años hemos observado dos hechos singulares: un acelerado aumento de los cuadros asmáticos y bronquiales obstructivos en general en la población infantil y por otra parte el advenimiento de diversas modalidades terapéuticas para la administración de los broncodilatadores. De allí la importancia de actualizar nuestros conceptos sobre la aerosolterapia en pediatría. Revisamos las condiciones físicas que los aerosoles deben tener para lograr un efecto terapéutico, los factores clínicos que pueden modífícar tanto la penetración como el depósito de las partículas, y los tipos de aparatos usados en la aerosolterapía: nebulizadores, inhaladores de dosís medida (MDI) y los inhaladores de polvo seco. Se dan algunas pautas para la correcta administración de los nebulizadores y los MDI, señalando las ventajas y desventajas de cada uno de ellos. Por último se enfatiza la superioridad de los MDI más aerocámara con mascarilla facial, para la inmensa mayoría de niños con obstrucción bronquial

Verificaçao da dispersao de respingos durante o trabalho do cirurgiao-dentista / Confirmation of spatter dispersion during dental work

Todas as pessoas envolvidas em um atendimento odontológico estao sujeitas a contaminaçao por bactérias, vírus e fungos que podem causar diversas enfermidades, dentre as quais se destacam a hepatite, a tuberculose, o herpes e a AIDS. Sabe-se, que durante um atendimento, há possibilidade de ocorrer dispersao de respingos e aerossóis contendo microrganismos patogênicos. No entanto, algumas clínicas odontológicas sao projetadas com vários consultórios no mesmo ambiente, sem divisórias entre eles. O objetivo deste trabalho foi verificar qual o alcance dos respingos provenientes da utilizaçao de seringa tríplice e turbina de alta rotaçao em cinco atendimentos clínicos simulados em uma clínica de atendimento coletivo, considerando que estes respingos podem conter saliva e sangue do paciente. Para isso, anilina de diferentes cores (rosa, azul, amarela, verde e marrom) foi adicionada a agua do reservatório de cada um dos cinco equipamentos. Todo o ambiente físico, assim como a roupa do operador e do paciente, foram cobertos com papel crepom branco. Constatou-se grande concentraçao de respingos sobre as cadeiras, osbre o operador, sobre o piso, cadeiras vizinhas e bandejas clínicas das unidades vizinhas. A distancia máxima atingida pelos respingos foi de 1,82 m, medindo-se a partir do ponto correspondente a boca do paciente. Durante um atendimento real, coletivo e simultaneo nesta clínica, as cadeiras vizinhas e seus respectivos pacientes e operadores, bem como a bandejas clínicas contendo instrumental esterilizado situam-se dentro da área de abrangência dos respingos. Portanto, existe uma possibilidade real de ocorrer contaminaçao cruzada, havendo necessidade de colocaçao de barreiras físicas entre os equipamentos. O estudo evidenciou também a necessidade de proteçao de toda a face, o corpo, o cabelo e os braços do operador, uma vez que estas foram regioes muito atingidas pelos respingos

The professionals and patients involved in dental examinations are at risk for infection by various disease-causing bacteria, viruses, and fungi, such as those responsible for hepatitis, tuberculosis, herpes, and AIDS. It is known that aerosols and spatter containing pathogenic microorganisms can spread during an examination. Nevertheless, some dental clinics are designed to have multiple examination areas in the same room, with no physical barriers between them. The objective of this study was to verify the reach of spatter resulting from the use of a triple syringe and high-rotation turbine during five simulated exams in a collective clinic, bearing in mind that spatter can contain the patient's saliva and blood. To facilitate tracking of the spatter, aniline dye (pink, blue, yellow, green, and brown) was added to the water in the appropriate receptacle in each of the five units. The room, the equipment, and the patient's and operator's clothing were covered with white paper. A high concentration of spatter was observed on the chair, the operator, and the floor of each unit, and it also appeared on the chairs and trays of the surrounding units. The maximum distance reached by spatter was 1.82 m from a point on the chair corresponding to the position of the patient's mouth. During real simultaneous examinations, the surrounding chairs and their patients and operators, as well as the trays containing sterilized instruments, are within spatter range. Therefore, there is a real possibility of crossinfection, and physical barriers should be placed between the units. This study also confirmed the need for protection of the operator's face, body, hair, and arms, since these regions were heavily affected by spatter.

Terapêutica inalatória na asma / Inhalation therapy for asthma

A via inalatória utilizada no tratamento da asma representa uma verdadeira revolução no controle e prevenção desta doença. Neste artigo é feita uma revisão na literatura, abordando as características das partículas para que sejam eficientemente depositadas nos pulmões, a utilização da via inalatória no tratamento da asma através de nebulizadores, aerossol dosificado e de inaladores de pó seco. Ressalta a importância do uso do espaçador e da aerocâmara para o melhor aproveitamento do aerossol dosificado. Aponta, ainda, as principais falhas no tratamento da via inalatória e como evitá-los.

The use of inhalation therapy represents a real revolution towards the control and prophylaxis of asthma. This review discusses several aspects of this therapeutic approach in infants and children, regarding the utilization of nebulizers (air compressor and oxygen-driven) and inhalers (metered-dose and dry powder). It stresses the importance of the commercially available spacers for a better performance of medicine administered from metered-dose inhalers. This review also highlights the major drawbacks on the inhalation treatment and how to avoid them.