Anesthetic and surgical considerations for staged bilateral nephrectomies in a pediatric patient: A case report / Consideraciones anestésicas y quirúrgicas en nefrectomía bilateral en dos tiempos en un paciente pediátrico: Reporte de caso

Abstract We present a 9-year-old patient with end-stage renal disease, on peritoneal dialysis, who underwent a staged prone retroperitoneoscopic bilateral nephrectomy. Bilateral nephrectomy was indicated in preparation for renal transplant in the context of genetic predisposition malignancy when immunosuppressed. The two mirror-image surgeries enable the comparison of the anesthetic management and outcomes in a single patient. Features of interest to anesthesiologists include approach to a child with chronic kidney disease, different requirements for intraoperative antihypertensives; pain management strategies, including a comparison of erector spinae plane block with and without adjunct dexmedetomidine; anesthetic management of retroperitoneoscopic pediatric surgery and the first description of using a Foley bag attached to a peritoneal dialysis catheter to aid in diagnosis and repair of posterior peritoneal cavity entry.

Resumen Se presenta un paciente de 9 años de edad con enfermedad renal terminal, en diálisis peritoneal, quien se sometió a nefrectomía bilateral retroperitoneoscópica estadificada en posición prona. Se indicó la nefrectomía bilateral en preparación para trasplante renal en el contexto de predisposición genética hacia desarrollar una patología maligna al estar inmunosuprimido. Las dos cirugías en espejo permiten hacer una comparación del manejo anestésico y de los desenlaces en un mismo paciente. Las características de interés para los anestesiólogos incluyen el abordaje de un niño con enfermedad renal crónica, con requisitos diferentes de antihipertensivos intraoperatorios; estrategias para el manejo del dolor, incluyendo una comparación de bloqueo del plano del erector espinal con y sin dexmedetomidina adyuvante; manejo anestésico de cirugía pediátrica retroperitoneoscópica y la primera descripción del uso de una bolsa Foley conectada a un catéter de diálisis peritoneal para ayudar en el diagnóstico y la reparación de la entrada de la cavidad peritoneal posterior.

First report of fibropapillomatosis (FP) and Chelonid alphaherpesvirus 5 (ChHV5) in a green sea turtle (Chelonia mydas) from the historically fibropapillomatosis-free Fernando de Noronha Archipelago, Northeastern Brazil / Primeiro caso de fibropapilomatose (FP) e de Chelonid alphaherpesvirus 5 (ChHV5) em tartaruga-verde (Chelonia mydas) no Arquipélago de Fernando de Noronha, Nordeste do Brasil

Fibropapillomatosis (FP) is an infectious disease caused by Chelonid alphaherpesvirus 5 (ChHV5). Nevertheless, its clinical manifestations are considered multifactorial. Due to its relevance, FP is currently monitored in sea turtle populations in the United States, Australia, Caribbean, and Brazil. Between 2000 and 2020, the TAMAR Project/ TAMAR Project Foundation analyzed the prevalence of FP in nine states and oceanic islands along the Brazilian coast, including Fernando de Noronha Archipelago (FNA), a historically FP-free area. A total of 4,435 green sea turtles (Chelonia mydas) were monitored from 2010 to 2016. Additionally, in 2012 and 2014, 43 FP-free skin samples were analyzed for ChHV5 using a qualitative PCR for the UL30 polymerase (pol) sequence. In 2015, a bilateral ocular nodule characterized as an FP tumor was reported in one of the monitored individuals undergoing rehabilitation. Tissue samples were collected following surgical removal of the tumor. Characterization of a 454 bp UL30 polymerase gene revealed a ChHV5 sequence previously reported in other areas of the Atlantic Brazilian coast. In the years following this finding from January 2017 to March 2020, a total of 360 C. mydas were monitored in the same area and no FP tumors were detected. This is the first report of FP and the first detection of ChHV5 in FNA, a finding of great concern considering this site's historical absence of FP occurrence. This study highlights the importance of monitoring this disease in historically FP-free areas of the Brazilian Atlantic coast.(AU)

A fibropapilomatose (FP) é uma doença infecciosa causada pelo Chelonid alphaherpesvirus 5 (ChHV5). No entanto, as manifestações clínicas da doença são consideradas multifatoriais. Esta doença é monitorada atualmente em populações de tartarugas marinhas nos EUA, Austrália, Caribe e Brasil. Desde 2000, o Projeto TAMAR/Fundação Projeto TAMAR analisa a presença de FP em nove estados da costa brasileira e ilhas oceânicas, incluindo o arquipélago de Fernando de Noronha, uma área historicamente livre de FP. Um total de 4.435 indivíduos de Chelonia mydas foram monitorados de 2010 a 2016 e 43 amostras de pele foram analisadas para detectar ChHV5 em 2012 e 2014 com o objetivo de avaliar a presença do vírus em tecidos sem FP, usando uma PCR qualitativa para detecção de sequências do gene da UL30 polimerase. Em 2015, uma tartaruga verde (C. mydas) foi relatada com um nódulo ocular bilateral caracterizado como FP. Amostras de tecido foram coletadas durante sua reabilitação e procedimento cirúrgico para remover o tumor. A caracterização parcial de uma sequência de 454 bp do gene UL30 polimerase detectou ChHV5 anteriormente relatado em outras áreas da costa atlântica brasileira. Após estes achados, de janeiro de 2017 a março de 2020, um total de 360 indivíduos de C. mydas foram monitorados e nenhum caso de FP foi registrado. Este é o primeiro relato de FP e a primeira caracterização de ChHV5 no arquipélago de Fernando de Noronha, uma questão preocupante e que ressalta a importância do monitoramento desta doença em áreas historicamente livres de FP na costa atlântica brasileira.(AU)

A arte no ensino da gerontologia: o envelhecimento na visão dos pintores renascentistas / Art in the teaching of gerontology: aging in view of renaissance painters

Ao usar a arte no ensino da gerontologia, foram pesquisadas obras de pintores renascentistas que abordassem a temática velhice e envelhecimento. Utilizou-se o enfoque qualitativo descritivo, realizando-se busca nas bases de dados Europeana, Britannica Academic, Scholarpedia, Yale Arts database, Web Gallery of Art e Art Source ­ Ebsco, e em livros de texto sobre arte. Foram utilizados os seguintes termos na pesquisa em português, francês e inglês: as três idades; as três idades na arte; as idades da vida; as idades na pintura; as idades do homem na pintura; a arte da velhice; alegoria do tempo; velhos na pintura renascentista; velhice na pintura renascentista. Encontraram-se cinco obras que destacavam os contrastes de beleza entre corpos jovens e idosos: A Velha (1505), de Giorgione; As Três Idades do Homem (1512), de Ticiano; As Três Idades do Homem (1515), de Dosso Dossi; Três Idades da Mulher e a Morte (1510) e As idades e a morte (1539), de Hans Baldung Grien. Estas figuras, em alguns casos, eram realçadas por pinceladas que tornaram mais evidente a diferença entre as idades do ser humano. Os pintores renascentistas reproduziam em suas obras a visão de que o envelhecimento era o último estágio da vida humana, portanto, época de decadência física e, muitas vezes, de solidão.(AU)

The present article researched works of Renaissance painters that approached the thematic of old age and aging. A qualitative descriptive approach was used, searching the databases Europeana, Britannica Academic, Scholarpedia, Yale Arts database, Web Gallery of Art and Art Source ­ Ebsco, as well as art textbooks. The following terms were used to search in the Portuguese, French and English languages: the three ages; the three ages in art; the ages of life; the ages in painting; the ages of man in painting; the art of old age; allegory of time; the older person in Renaissance painting; old age in Renaissance painting. There were five works that emphasized the contrasts of beauty between young and old bodies: The Old Woman (1505), by Giorgione; The Three Ages of Man (1512), by Titian; The Three Ages of Man (1515), by Dosso Dossi; Three Ages of the Woman and the Death (1510), and The Ages and the Death (1539), by Hans Baldung Grien. These figures, in some cases, were highlighted by brushstrokes that made the difference between the ages of the human being more evident. Renaissance painters reproduced in their works the view that aging was the last stage of human life, therefore, a time of physical decay and, often, loneliness. It was conclude that one way of teaching gerontology is by using art, when the gaze is not only observer, but see beyond, understanding what they are seeing.(AU)

Acciones educativas de la familia con el escolar durante el confinamiento por la COVID-19 / Family educational actions with schoolers during COVID-19 confinement

Introducción: El confinamiento por la COVID-19 ha generado un desafío en la crianza de los escolares. Objetivo: Examinar el desempeño de acciones educativas de la familia con el escolar durante el confinamiento por la COVID-19. Métodos: Investigación descriptiva, muestreo no probabilístico,112 familias. que cumplían aislamiento social en la comunidad Ramón López Peña, San Cristóbal, Artemisa en 2020. Instrumento utilizado: Escala de acciones educativas de la familia con el escolar durante el confinamiento por la COVID-19, construida y validada por los investigadores con alfa de Cronbach= 0,970). Resultados: Las acciones educativas: cumplir los horarios de alimentación y sueño (70,6 por ciento), distribuir los roles en el cuidado del menor (70,6 por ciento), apoyo emocional (70,6 por ciento), apoyar con las teleclases (70,6 por ciento), siempre se realizaron por las familias con desempeño favorable. Las acciones: ayudar a recuperarse de una emoción negativa (72,7 por ciento), alejar al escolar de las preocupaciones y tensiones del hogar (72,7 por ciento), explicar si no entiende los contenidos o buscar ayuda (72,7 por ciento), casi nunca fueron realizadas por las familias con desempeño desfavorable. Conclusiones: La mayoría de las familias presentaron desempeño favorable de acciones educativas. La dimensión Cuidados del menor fue la mejor expresada. Enseñar al escolar las medidas higiénicas de protección; brindar información a los escolares sobre cómo protegerse; enseñar y practicar formas de saludar y de mantenerse conectados con seres queridos y amigos, fueron las acciones educativas más realizadas por ambos grupos de familia. La complejidad del aprendizaje en casa y el manejo afectivo del niño requieren especial atención(AU)

Introduction: COVID-19 confinement has created a challenge in raising schoolers. Objective: Examine the performance of educational actions of the family with the school during the confinement by COVID-19. Methods: Descriptive research, non-probabilistic sampling, 112 families who complied with social isolation in Ramón López Peña community, San Cristobal, Artemisa province in 2020. Instrument used: Scale of educational actions of the family with school children during confinement by COVID-19, built and validated by researchers with Cronbach´s alpha = 0.970. Results: Educational actions as meeting food and sleep schedules (70.6 percent), distributing roles in child care (70.6 percent), emotional support (70.6 percent), supporting with teleclasses (70.6 percent) were always carried out by families with favorable performance. Actions like helping to recover from negative emotions (72.7 percent), keeping the schooler away from household concerns and tensions (72.7 percent), explaining whether they don't understand the contents or looking for help (72.7 percent) were almost never made by families with unfavorable performance. Conclusions: Most families had a favorable performance in educational actions. The Child Care dimension was the best performed one. Teaching the schoolchildren the hygienic protective measures, provide information to schoolchildren on how to protect themselves, teaching and practicing ways to greet and stay connected with loved ones and friends were the most performed educational actions by both family groups. The complexity of home learning and the child's affective management require special attention(AU)

El reto de una UCI en un recinto ferial / The challenge of an ICU in a fairground

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Vulnerabilidad al estrés en pacientes adultos hipertensos / Vulnerability to the stress in hypertensive adult patients

RESUMEN Introducción: En la hipertensión, el estrés constituye un factor sicosocial de riesgo. Objetivo: establecer la relación entre vulnerabilidad al estrés con variables sociodemográficas y clínicas en pacientes hipertensos adultos del Policlínico Santa Cruz. Métodos: Estudio descriptivo, transversal. El universo lo conformaron 65 hipertensos, diagnosticados de enero a junio del 2019. La muestra intencional fue de 58 hipertensos. Para la recogida de información se emplearon: la Historia Clínica Individual y familiar y el Test de Vulnerabilidad al Estrés. Resultados: Predominio del 70,7 % de hipertensos en la tercera subetapa de la adultez, supremacía femenina (69,0 %); la mayoría con secundaria básica terminada (36,2 %); casados (44,8 %) y trabajadores estatales (51,7 %); predominaron los fumadores (81 %); prevaleció la hipertensión arterial grado II (69 %) y dieron cumplimiento al tratamiento el 53,4 %. La mayoría presentó vulnerabilidad al estrés (65,5%); mejor representado en la tercera subetapa de la adultez (81,6 %), mujeres (63,2 %), con secundaria básica terminada (39,5 %), casados (42,1 %), trabajador estatal (55,3 %), fumadores (76,3 %), con hipertensión arterial grado II el 76,3 %; cumplieron el tratamiento siempre el 55,3 %; presentaron nivel vulnerable al estrés el 68,4 % de los hipertensos. Existió asociación entre el nivel seriamente vulnerable al estrés y la escolaridad primaria (p= 0,007). La mayoría de los hipertensos presentaron vulnerabilidad al estrés. El nivel vulnerable al estrés predominó; mejor representado en la tercera subetapa de la adultez, en las mujeres, los fumadores, los hipertensos grado II y los que siempre cumplían con el tratamiento. Existió asociación entre el nivel seriamente vulnerable al estrés y la escolaridad primaria.

ABSTRACT Introduction: In the hypertension, the stress constitutes a psychosocial risk factor. Objective: To establish the relation between vulnerability to the stress with socio-demographics and clinical variables in adult hypertensive patients of the General hospital Santa Cruz. Methods: Descriptive, transverse study. The universe was constituted of 65 hypertensive patients, diagnosed from January until June, 2019. The intentional sample was 58 hypertensive patients. For the information collection, it was used: the Individual and familiar Case history and the Test of Vulnerability to the Stress. Results: Predominance 70.7 % of hypertensive patients in the third sub-stage of the adulthood, feminine supremacy (69.0 %); the majority with secondary school finished (36.2 %); married (44.8 %) and state workpeople (51.7 %); there prevailed the smokers (81 %); the arterial hypertension grade II prevailed (69 %) and they fulfilled the treatment 53.4 %. The majority presented vulnerability to the stress (65.5 %); better represented in the third sub-stage of the adulthood (81.6 %), women (63.2 %), with secondary school finished (39.5 %), married (42.1 %), state worker (55.3 %), smokers (76.3 %), with arterial hypertension grade II 76.3 %; they always fulfilled the treatment 55.3 %; they presented vulnerable level to the stress 68.4 % of the hypertensive patients. Association existed between the level seriously vulnerably to the stress and the primary schooling (p = 0.007). Discussion: Most of the hypertensive patients presented vulnerability to the stress. The vulnerable level to the stress prevailed; better represented in the third sub-stage of the adulthood, in the women, the smokers, hypertensive grade II and those who were always fulfilled with the treatment. Association existed between the level seriously vulnerably to the stress and the primary schooling.

Risk of breast implant-associated anaplastic large cell lymphoma in patients submitted to breast implantation: A systematic review.

Although breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare disease, its incidence has been increasing. The aim of this study was to assess the risk of BIA-ALCL in women with breast implants. A systematic search was carried out in Pubmed, Scopus, ScienceDirect, LIVIVO, Cochrane Library, Google Scholar, and OpenGrey databases. The risk assessment of bias was based on the Newcastle-Ottawa Scale. The rarity of BIA-ALCL was a major limitation. Although we have found evidence of an increased risk of BIA-ALCL, further studies are needed to understand why some large samples did not present any case of the disease.

Effects of Ghrelin on the Oxidative Stress and Healing of the Colonic Anastomosis in Rats.

BACKGROUND: Anastomotic leakage is the deadliest complication of colonic procedures. Ghrelin is an orexigenic hormone with potent actions on growth hormone release and functions in the processes of growth, tissue inflammation, repair, and oxidative stress. We evaluated the hypothesis that the exogenous administration of ghrelin causes beneficial effects on the healing of colonic anastomosis. MATERIALS AND METHODS: Sixty-four male Wistar rats were randomly assigned to eight subgroups receiving postoperative intraperitoneal administration of ghrelin (23 µg/kg/d) or saline after a colonic anastomosis. The anastomotic tissue was evaluated on the third, seventh, and 14th postoperative days. Anastomotic bursting pressure, histological parameters, hydroxyproline content, and tissue oxidative stress markers were compared. RESULTS: There was a significant increase in the mean anastomotic bursting pressure in the ghrelin subgroup on the seventh postoperative day (P = 0.035). Histological evaluation demonstrated a significant difference in the neutrophilic infiltrate (P = 0.035) on the third and 14th d and in apoptosis (P = 0.004), granulation tissue (P = 0.011) and peritoneal inflammation (P = 0.014) on the 14th postoperative day. There was a statistically significant increase in the hydroxyproline content in the ghrelin subgroup on the 14th postoperative day (P = 0.043). There were significant differences in the nitrite tissue levels (P = 0.021) on day 3 and in reactive oxygen species (P = 0.012) on day 14. CONCLUSIONS: The administration of ghrelin had beneficial anti-inflammatory and antioxidant effects, increasing the resistance of the anastomosis and the hydroxyproline tissue content in the postoperative period.

EFECTOS DEL CAMBIO CLIMÁTICO EN LA ETNIA DE LOS QUILLACINGAS / EFFECTS OF CLIMATE CHANGE ON THE QUILLACINGAS ETHNIC GROUP

El presente artículo de investigación tiene como objetivo realizar una lectura etnográfica de las estrategias comunitarias que los cabildos indígenas quillacingas del municipio de Pasto han implementado para adaptarse y mitigar los efectos nocivos generados por el cambio climático sobre el paisaje cultural (geografía sagrada). El texto se enfoca en los efectos de este fenómeno sobre el buen vivir y el etnodesarrollo. La investigación adelantada corresponde al enfoque cualitativo de carácter hermenéutico, en donde se aplicó el método etnográfico, utilizándose las siguientes técnicas de recolección de la información: la entrevista, el taller y la observación participante. La unidad de trabajo estuvo conformada por doce integrantes de los cuatro cabildos quillacingas, para un total de cuarenta y ocho participantes entre miembros, líderes y personas mayores de 40 años que por su conocimiento del medio ambiente local se consideraron como informantes clave. El estudio permitió establecer que el cambio climático está generando efectos adversos sobre el buen vivir en la etnia de los quillacingas, especialmente debido a las alteraciones en la concepción del tiempo y en el manejo del territorio respecto a los ciclos de producción agrícola, los ritos estacionales, las labores tradicionales y las prácticas comunitarias, así como el consecuente desplazamiento de algunos miembros de la familia hacia las ciudades en búsqueda de oportunidades de vida que son esquivas para ellos. Todo esto ha contribuido a aumentar la pobreza y la miseria, la desprotección, la inseguridad y la violencia, el desarraigo hacia sus territorios y la pérdida de identidad cultural.

The objective of this research paper is to make an ethnographic reading of the community strategies that the Quillacingas ethnic group councils of the Municipality of Pasto have implemented to adapt and mitigate the harmful effects generated by climate change on the cultural landscape (sacred geography). The text focuses on the effects of this phenomenon on good living and ethno-development. The research carried out corresponds to the qualitative approach of hermeneutical nature, where the ethnographic method was applied using the following techniques of information gathering: the interview, the workshop and the participant observation. The work unit consisted of twelve members of the four Quillacingas councils, for a total of forty-eight participants among members, leaders and people over 40 years of age who, because of their knowledge of the local environment, were considered as key informants. The results allowed establishing that climate change is generating adverse effects on the good living in the Quillacingas ethnic group, specially due to the alterations in the conception of time and in the management of the territory regarding the cycles of agricultural production, seasonal rites, traditional tasks and Community practices, as well as the consequent displacement of some family members to the cities in search of life opportunities that are elusive for them. All this has contributed to increasing poverty and misery, lack of protection, insecurity and violence, uprooting towards their territories and the loss of cultural identity.

PERITONEAL ADHESIONS TYPE I, III AND TOTAL COLLAGEN ON POLYPROPYLENE AND COATED POLYPROPYLENE MESHES: EXPERIMENTAL STUDY IN RATS.

BACKGROUND: Hernia correction is a routinely performed treatment in surgical practice. The improvement of the operative technique and available materials certainly has been a great benefit to the quality of surgical results. The insertion of prostheses for hernia correction is well-founded in the literature, and has become the standard of treatment when this type of disease is discussed. AIM: To evaluate two available prostheses: the polypropylene and polypropylene coated ones in an experimental model. METHODS: Seven prostheses of each kind were inserted into Wistar rats (Ratus norvegicus albinus) in the anterior abdominal wall of the animal in direct contact with the viscera. After 90 days follow-up were analyzed the intra-abdominal adhesions, and also performed immunohistochemical evaluation and videomorphometry of the total, type I and type III collagen. Histological analysis was also performed with hematoxylin-eosin to evaluate cell types present in each mesh. RESULTS: At 90 days the adhesions were not different among the groups (p=0.335). Total collagen likewise was not statistically different (p=0.810). Statistically there was more type III collagen in the coated polypropylene group (p=0.039) while type I was not different among the prostheses (p=0.050). The lymphocytes were statistically more present in the polypropylene group (p=0.041). CONCLUSION: The coated prosthesis was not different from the polypropylene one regarding the adhesion. Total and type I collagen were not different among the groups, while type III collagen was more present on the coated mesh. There was a greater number of lymphocytes on the polypropylene mesh.

EXPERIÊNCIA DE AÇÃO INTEGRADA EM EMERGÊNCIA FITOSSANITÁRIA NA REGIÃO OESTE DA BAHIA / EXPERIENCE OF INTEGRATED ACTION IN PHYTOSANITARY EMERGENCY IN THE WEST OF BAHIA / EXPERIENCIA DE ACCIÓN INTEGRADA EN EMERGENCIA FITOSANITARIA EN EL OESTE DE BAHÍA

Entre os anos de 2000 e 2012, ocorreu um aumento considerável do uso de agrotóxicos no Brasil e a Bahia ocupa o 7º lugar no ranking do Brasil nesse uso, o que implica a ocorrência de exposição e de casos de intoxicação severos. O texto relata uma experiência integrada de vigilância e atenção em saúde de populações expostas a agrotóxicos, com base na situação de emergência fitossanitária e da intoxicação em humanos e óbito de animais devido à aplicação de agrotóxicos por meio de pulverização aérea numa fazenda na Região Oeste do estado da Bahia, no município de Luiz Eduardo Magalhães, ocorridas entre os anos de 2013 e 2014. Para enfrentamento das duas situações, optou-se por uma metodologia de ação que teve como objetivo fortalecer a atuação integrada na área da vigilância e atenção à população exposta a agrotóxicos. Considerando a complexidade dos agrotóxicos, em particular do produto autorizado pelo Estado para aplicação, o Benzoato de Emamectina, foi adotada uma abordagem interdisciplinar e integrada para a execução de todas as ações desenvolvidas na Região. A adoção de estratégias e metodologias integradas possibilitou o aprendizado e a replicação das experiências com perspectiva de construção de modelo de atuação integrada voltada para proteção da saúde dos trabalhadores e da população em geral para diagnóstico e manejo das intoxicações por agrotóxicos e de vigilância de ambientes.

Between 2000 and 2012 there was a meaningful increase to the use of pesticide in Brazil and Bahia occupies the 7th place in the consumption of pesticides in Brazil, which implies the occurrence of exposure and severe intoxication cases. The text presents an integrated experience of surveillance and attention to the health of populations exposed to pesticides, based on phytosanitary emergency situation and humans intoxication and death of animals, caused by pesticide air pulverization application on a farm in the West of Bahia State, at Luiz Eduardo Magalhães municipality, between 2013 and 2014. In order to address both situations a methodology of action with the intent of strengthening the integrated action in the surveillance and attention to the health of populations exposed to pesticides was chosen. Considering the complexity of pesticides, in particular of the product authorized by the State, the Emamectin Benzoate, an interdisciplinary and integrated approach to the execution of all actions developed within the region was adopted. The adoption of strategies and methodologies enabled the learning and the replication of experiences with perspective of construction of an integrated action model to the protection of workers's and the general population's health.

Entre 2000 y 2012 ocurrió el incremento del uso de plaguicidas en en Brasil y Bahía ocupa el séptimo lugar en el consumo de plaguicidas en Brasil, lo que implica en la ocurrencia de exposición y de casos de intoxicación graves. El texto relata una experiencia integrada de vigilancia y atención a la salud de las poblaciones expuestas a los plaguicidas, basada en la situación de emergencia fitosanitaria y de la intoxicación en humanos y la muerte de animales debido a la aplicación de plaguicidas por medio de pulverización aérea de plaguicidas en una hacienda en la región Oeste de Bahía, en el municipio de Luiz Eduardo Magalhães, ocurridas entre 2013 y 2014. Para enfrentamiento de las dos situaciones se escogió una metodología de acción que tuvo como objetivo fortalecer la actuación integrada en el área de la vigilancia y atención a la población expuesta a los plaguicidas. Considerando la complejidad de los plaguicidas, en particular del producto autorizado por el Estado para aplicación, el Benzoato de Emamectina, fue adoptado un abordaje interdisciplinario e integrado para la ejecución de todas las acciones desarrolladas en la Región. La adopción de estrategias y metodologías integradas posibilitó el aprendizaje y la replicación de las experiencias con perspectiva de construcción de un modelo de actuación integrada dirigida para la protección de la salud de los trabajadores y de la población en general.

VIGILÂNCIA E ATENÇÃO À SAÚDE DE POPULAÇÕES EXPOSTAS A AGROTÓXICOS: METODOLOGIAS E PRÁTICAS INTEGRADAS / SURVEILLANCE AND ATTENTION TO THE HEALTH OF POPULATIONS EXPOSED TO PESTICIDES: METHODOLOGIES AND INTEGRATED PRACTICES / VIGILANCIA Y ATENCIÓN A LA SALUD DE POBLACIONES EXPUESTAS A LOS PLAGUICIDAS: METODOLOGÍAS Y PRÁCTICAS INTEGRADAS

O alto consumo de agrotóxicos na Bahia e o impacto do uso de agrotóxicos na saúde e no ambiente exigem a aplicação de metodologias integradoras de vigilância e atenção à saúde das populações expostas. O texto relata uma experiência de educação em saúde voltada para a construção de metodologias e práticas integradas de vigilância e atenção à saúde de populações expostas a agrotóxicos, por meio da capacitação de técnicos das secretarias estadual e municipais de saúde, dos âmbitos central, regional e municipal. Nessa experiência, adotou-se a metodologia dialógica, valorizando as experiências individuais. Utilizaram-se instrumentos e mecanismos que permitiram a construção coletiva com base em uma determinada temática, potencializando a reflexão crítica da realidade. A abordagem teve como princípio a articulação intra e interinstitucional, a gestão da informação para a ação e a qualificação das equipes de saúde para atuarem em situações de rotina e em eventos inusitados. O Grupo de Trabalho de Agrotóxicos da Secretaria da Saúde do Estado da Bahia elaborou o plano de ação estadual, identificando estratégias para sua operacionalização, dentre elas o curso para técnicos de municípios definidos como prioritários, das áreas de Vigilância em Saúde e Centro de Referência Regional em Saúde do Trabalhador, bem como das respectivas Diretorias Regionais de Saúde. A experiência vivenciada pelos participantes durante o processo de concepção e realização do curso foi transformadora enquanto metodologia participativa e aprendizado coletivo, possibilitando a reflexão sobre a prática e o agir dos sujeitos.

The high consumption of pesticides in Bahia and the impact of pesticide use on human health and the environment and require the application of integrative methodologies of surveillance and attention to the health of the exposed population. This text reports on a health education experience focused on building methodologies and integrated surveillance and health care practices for populations exposed to pesticides through the capacitation of technicians from state and municipal departments of health, central, regional and municipal areas. For this experience the dialogic methodology was adopted, valuing individual experiences. Tools and mechanisms that allowed the collective construction based on a particular subject, potentiate the critical reflection on reality. The approach has had as principle the articulation intra and inter institutional, the management of information for the action and the qualification of health teams to work in routine situations and in unusual events. The Pesticide Working Group of the Department of Health of the State of Bahia elaborated the state action plan, identifying strategies for its operation, including the course for technicians of the municir municipalities defined as priority areas of Public Health Surveillance and Occupational Health´s Reference Center as well as the respective Regional Health Board. The experience experimented by the participants during the process of conception and execution of the course was exceptional as participative methodology and collective learning, allowing the reflectio on the practice and action of the subjects.

El alto consumo de plaguicidas en Bahia y el impacto del uso de plaguicidas en la salud y el medio ambiente exigen la aplicación de metodologías integradoras de vigilancia y atención a la salud de las poblaciones expuestas. El texto presenta la experiencia de educación para la salud dirigida a la construcción de metodologías y prácticas integradas de vigilancia y atención a la salud de las poblaciones expuestas a los plaguicidas, a través de la capacitación técnica de las secretarías de salud estatal y municipal, de los niveles central, regional y municipal. Por lo tanto, se ha adoptado la metodología dialógica, para valorar las experiencias individuales. Se han utilizado instrumentos y mecanismos que permitieron la construcción colectiva basada en una temática específica, potenciando la reflexión crítica de la realidad. El abordaje tuvo como principio la articulación intrainstitucional e interinstitucional, el manejo de la información para la acción y la calificación de los equipos de salud para actuar en situaciones de rutina y eventos inusuales. El Grupo de Trabajo de Plaguicidas del Departamento de Salud de Bahia ha elaborado el plan de acción estatal identificando estrategias para su operacionalización, entre ellas el curso para técnicos de municipalidades definidas como prioritarias, de las áreas de vigilancia de la salud y de los centros de referencia de salud de los trabajadores, así como de las respectivas Juntas Directivas Regionales de Salud.

Representação artística das consequências neurológicas do Acidente Vascular Encefálico, nas obras de Otto Dix (1891-1969), a partir de seus 76 anos / Artistic representation of the neurological consequences of stroke in the works of Otto Dix (1891-1969), from the age of 76 / Representación artística de las consecuencias neurológicas del Accidente Vascular Encefálico en las obras de Otto Dix (1891-1969), a partir de sus 76 años

As doenças cerebrovasculares atingem cerca de 17 milhões de indivíduos por ano mundialmente, encontrando-se, entre elas, o Acidente Vascular Encefálico (AVE), que se caracteriza por déficit neurológico súbito decorrente de alteração vascular focal. No presente estudo, reporta-se o caso do pintor alemão Otto Dix, acometido por AVE no hemisfério direito, aos 76 anos. Em decorrência do episódio, desenvolveu heminegligência e hemiparesia à esquerda, hemianopsia, distúrbio de construção visuoespacial moderado, e apraxia associada ao déficit de propriocepção do membro superior esquerdo. Descrevem-se as mudanças na representação visual nas obras produzidas por ele, após a doença, a fim de correlacionar as consequências neurológicas através da expressão gráfica.

Cerebrovascular diseases reach about 17 million individuals per year worldwide, including Stroke, which is characterized by sudden neurological deficit due to focal vascular alteration. In the present study, the case of the German painter Otto Dix, affected by stroke in the right hemisphere, at 76 years of age, is reported. As a result of the episode, he developed left hemielegiation and hemiparesis, hemianopsia, moderate visuo-spatial construction disorder, and apraxia associated with proprioception deficit of the left upper limb. The changes in the visual representation in the works produced by him, after the illness, are described in order to correlate the neurological consequences through graphic expression.

Las enfermedades cerebrovasculares alcanzan a cerca de 17 millones de individuos por año en todo el mundo, encontrándose entre ellas el Accidente Vascular Encefálico (AVE), que se caracteriza por déficit neurológico súbito resultante de alteración vascular focal. En el presente estudio, se reporta el caso del pintor alemán Otto Dix, acometido por AVE en el hemisferio derecho, a los 76 años. En consecuencia del episodio, desarrolló heminexia y hemiparesia a la izquierda, hemianopsia, disturbio de construcción visuoespacial moderado, y apraxia asociada al déficit de propriocepción del miembro superior izquierdo. Se describen los cambios en la representación visual en las obras producidas por él, después de la enfermedad, a fin de correlacionar las consecuencias neurológicas a través de la expresión gráfica.

Relação médico-paciente idoso no cinema: visões de atendimento / The doctor-elderly patient relationship in cinema: visions of care / Relación entre el médico y los pacientes ancianos en el cine: visiones de atención

Resumo Este artigo objetiva descrever diferentes visões de atendimento da relação médico-paciente idoso abordada em filmes de ficção. Pesquisou-se filmografia nacional e internacional, buscando filmes de longa-metragem que exibissem cenas em que a relação médico-paciente idoso fosse retratada de diferentes formas. Foi possível identificar nos dez filmes analisados expectativas referentes ao atendimento do paciente idoso, tanto na visão do paciente quanto na de seus familiares, evidenciando sentimentos e valores socioculturais presentes na inter-relação estabelecida durante o exercício profissional da medicina. Concluiu-se que a linguagem cinematográfica é útil para a formação do médico, que deve se preocupar com o sentido humano de seu trabalho, bem como para interpretar elementos que envolvem a complexa relação médico-paciente, particularmente com o idoso.

Abstract This article aims to describe different views of care through the doctor-elderly patient relationship as addressed in feature films. Research was carried out based on national and international filmography, seeking films containing scenes in which the doctor-elderly patient relationship was portrayed in different ways. In the ten films analyzed, it was possible to identify expectations regarding the care of the elderly patient, both from the patient's and their family's view, describing the feelings and socio-cultural values present in the interrelationship established during the professional practice of medicine. It was concluded that cinematographic language is useful for the training of physicians, who should be concerned with the human aspect of their work, as well as for the interpretation of elements involving the complex doctor-patient relationship, particularly among the elderly.

Resumen El objetivo de este artículo es describir las diferentes visiones de atención, abordadas en películas de ficción, sobre la relación entre el médico y los pacientes ancianos. Se investigó la filmografía nacional e internacional, buscando películas de larga duración que exhibieran escenas en las que la relación entre el médico y el paciente anciano se retratara de diferentes formas. En las diez películas analizadas, fue posible identificar expectativas referentes a la atención del paciente anciano, tanto en la visión del paciente como en la de sus familiares, evidenciando sentimientos y valores socioculturales presentes en la interrelación establecida en el ejercicio profesional de la medicina. Se concluyó que el lenguaje cinematográfico es útil para la formación del médico, quien debe preocuparse del sentido humano de su trabajo, para interpretar elementos que involucran la relación compleja entre el médico y el paciente, particularmente el anciano.

Peritoneal adhesions type i, iii and total collagen on polypropylene and coated polypropylene meshes: experimental study in rats / Aderências peritoneais tipo i, iii e colágeno total em telas de polipropileno e revestidas: estudo experimental em ratos

ABSTRACT Background: Hernia correction is a routinely performed treatment in surgical practice. The improvement of the operative technique and available materials certainly has been a great benefit to the quality of surgical results. The insertion of prostheses for hernia correction is well-founded in the literature, and has become the standard of treatment when this type of disease is discussed. Aim: To evaluate two available prostheses: the polypropylene and polypropylene coated ones in an experimental model. Methods: Seven prostheses of each kind were inserted into Wistar rats (Ratus norvegicus albinus) in the anterior abdominal wall of the animal in direct contact with the viscera. After 90 days follow-up were analyzed the intra-abdominal adhesions, and also performed immunohistochemical evaluation and videomorphometry of the total, type I and type III collagen. Histological analysis was also performed with hematoxylin-eosin to evaluate cell types present in each mesh. Results: At 90 days the adhesions were not different among the groups (p=0.335). Total collagen likewise was not statistically different (p=0.810). Statistically there was more type III collagen in the coated polypropylene group (p=0.039) while type I was not different among the prostheses (p=0.050). The lymphocytes were statistically more present in the polypropylene group (p=0.041). Conclusion: The coated prosthesis was not different from the polypropylene one regarding the adhesion. Total and type I collagen were not different among the groups, while type III collagen was more present on the coated mesh. There was a greater number of lymphocytes on the polypropylene mesh.

RESUMO Racional: A correção herniária é tratamento realizado rotineiramente na prática cirúrgica. O aprimoramento da técnica operatória e dos materiais disponíveis trouxe grande benefício na qualidade dos resultados cirúrgicos. A inserção de próteses para correção herniária é bem embasada na literatura e tornou-se o padrão de tratamento. Objetivo: Avaliar em modelo experimental dois tipos de próteses diferentes, de polipropileno e polipropileno revestido. Métodos: Foram inseridas sete próteses de cada tipo em ratos Wistar (Ratus norvegicus albinus) na parede abdominal anterior do animal em contato direto com as vísceras. Após o seguimento de 90 dias analisaram-se as aderências intra-abdominais, bem como avaliação por imunoistoquímica e videomorfometria do colágeno total, tipo I e tipo III. Também, fez-se análise histológica com hematoxylina-eosina para avaliação dos tipos celulares presentes em cada tela. Resultados: Aos 90 dias as aderências não foram diferentes entre os grupos (p=0,335). O colágeno total igualmente não foi estatisticamente diferente (p=0,810). O colágeno tipo III foi estatisticamente maior no grupo polipropileno revestido (p=0,039) enquanto o tipo I não diferiu entre as próteses (p=0,050). Os linfócitos foram estatisticamente mais presentes no grupo polipropileno (p=0,041). Conclusão: A prótese revestida não foi diferente da de polipropileno na variável aderência. O colágeno total e tipo I não foram diferentes entre os grupos enquanto que o colágeno tipo III foi mais presente na tela revestida. O número de linfócitos foi maior na tela de polipropileno.

Gold Nanoparticles Deposited on Surface Modified Carbon Xerogels as Reusable Catalysts for Cyclohexane C-H Activation in the Presence of CO and Water.

The use of gold as a promotor of alkane hydrocarboxylation is reported for the first time. Cyclohexane hydrocarboxylation to cyclohexanecarboxylic acid (up to 55% yield) with CO, water, and peroxodisulfate in a water/acetonitrile medium at circa 50 °C has been achieved in the presence of gold nanoparticles deposited by a colloidal method on a carbon xerogel in its original form (CX), after oxidation with HNO3 (-ox), or after oxidation with HNO3 and subsequent treatment with NaOH (-ox-Na). Au/CX-ox-Na behaves as re-usable catalyst maintaining its initial activity and selectivity for at least seven consecutive cycles. Green metric values of atom economy or carbon efficiency also attest to the improvement brought by this novel catalytic system to the hydrocarboxylation of cyclohexane.

Direct Endonasal Approach with Partial Upper Posterior Septectomy. A "Rescue Flap" Technique Modification.

Objective Report a modification of the "rescue flap" technique using a direct endonasal approach with a partial superior septectomy for approaching pituitary tumors developed in our institution. Design Prospective study. Setting Hospital Universitario "Dr. José Eleuterio González," Universidad Autónoma de Nuevo León. Main Outcome Measures Since April 2015, we have performed 19 cases employing a direct endonasal approach with partial superior septectomy. Results and a technical note are described below. Results Nineteen patients were included in this report. Six patients presented transoperatory cerebrospinal fluid (CSF) leak, so a nasoseptal rescue flap was harvested. No patients developed postoperative CSF leak in this group. Two patients were submitted to a second surgical procedure. Nasoseptal flap was harvested without complications. In both patients, the size of the flap was enough to cover the dural defect and avoid CSF leak. Conclusion Direct endonasal approach with a partial posterior septectomy allows enough exposition of the sphenoidal sinus while preserving the nasoseptal septum with the possibility of a successful rescue flap when needed.