Sex-Related Differences in Post-Stroke Anxiety, Depression and Quality of Life in a Cohort of Smokers.

BACKGROUND: We aimed to study anxiety, depression and quality of life in smokers after stroke by sex. METHODS: A longitudinal prospective study with a 24-month follow-up of acute stroke patients who were previously active smokers. Anxiety and depression were evaluated with the Hospital Anxiety and Depression scale, and quality of life was evaluated with the EQ-5D questionnaire. RESULTS: One hundred and eighty patients participated (79.4% men); their mean age was 57.6 years. Anxiety was most prevalent at 3 months (18.9% in men and 40.5% in women) and depression at 12 months (17.9% in men and 27% in women). The worst perceived health occurred at 24 months (EQ-VAS 67.5 in men and 65.1 in women), which was associated with depression (p < 0.001) and Rankin Scale was worse in men (p < 0.001) and depression in women (p < 0.001). Continued tobacco use was associated with worse perceived health at 3 months in men (p = 0.034) and at 12 months in both sexes. Predictor variables of worse perceived health at 24 months remaining at 3 and 12 months were tobacco use in men and neurological damage in women. CONCLUSION: Differences by sex are observed in the prevalence of anxiety and depression and associated factors and in the predictive factors of perceived health.

Influence of Hospital Type on Outcomes of Patients With Acute Spontaneous Intracerebral Hemorrhage: A Population-Based Study.

BACKGROUND AND OBJECTIVES: Whether the outcome of patients with spontaneous intracerebral hemorrhage (ICH) differs depending on the type of hospital where they are admitted is uncertain. The objective of this study was to determine influence of hospital type at admission (telestroke center [TSC], primary stroke center [PSC], or comprehensive stroke center [CSC]) on outcome for patients with ICH. We hypothesized that outcomes may be better for patients admitted to a CSC. METHODS: This is a multicenter prospective observational and population-based study of a cohort of consecutively recruited patients with ICH (March 2020-March 2022). We included all patients with spontaneous ICH in Catalonia (Spain) who had a pre-ICH modified Rankin scale (mRS) score of 0-3 and who were admitted to the hospital within 24 hours of onset. We compared patients admitted to a TSC/PSC (n = 641) or a CSC (n = 1,320) and also analyzed the subgroup of patients transferred (n = 331) or not transferred (n = 310) from a TSC/PSC to a CSC. The main outcome was the 3-month mRS score obtained by blinded investigators. Outcomes were compared using adjusted ordinal logistic regression to estimate the common odds ratio (OR) and 95% CI for a shift in mRS scores. A propensity score matching (PSM) analysis was performed for the subgroup of transferred patients. RESULTS: Relevant data were obtained from 1961 of a total of 2,230 patients, with the mean (SD) age of 70 (14.1) years, and 713 (38%) patients were women. After adjusting for confounders (age, NIH Stroke Scale score, intraventricular hemorrhage, hematoma volume, and pre-ICH mRS score), type of hospital of initial admission (CSC vs TSC/PSC) was not associated with outcome (adjusted common OR 1.13, 95% CI 0.93-1.38). A PSM analysis indicated that transfer to a CSC was not associated with more favorable outcomes (OR 0.77, 95% CI 0.55-1.10; p = 0.16). DISCUSSION: In this population-based study, we found that, after adjusting for confounders, hospital types were not associated with functional outcomes. In addition, for patients who were transferred from a TSC/PSC to a CSC, PSM indicated that outcomes were similar to nontransferred patients. Our findings suggest that patient characteristics are more important than hospital characteristics in determining outcome after ICH. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov Identifier: NCT03956485.

Effects of Achieving Rapid, Intensive, and Sustained Blood Pressure Reduction in Intracerebral Hemorrhage Expansion and Functional Outcome.

BACKGROUND AND OBJECTIVES: The time taken to achieve blood pressure (BP) control could be pivotal in the benefits of reducing BP in acute intracerebral hemorrhage (ICH). We aimed to assess the relationship between the rapid achievement and sustained maintenance of an intensive systolic BP (SBP) target with radiologic, clinical, and functional outcomes. METHODS: Rapid, Intensive, and Sustained BP lowering in Acute ICH (RAINS) was a multicenter, prospective, observational cohort study of adult patients with ICH <6 hours and SBP ≥150 mm Hg at 4 Comprehensive Stroke Centers during a 4.5-year period. Patients underwent baseline and 24-hour CT scans and 24-hour noninvasive BP monitoring. BP was managed under a rapid (target achievement ≤60 minutes), intensive (target SBP <140 mm Hg), and sustained (target stability for 24 hours) BP protocol. SBP target achievement ≤60 minutes and 24-hour SBP variability were recorded. Outcomes included hematoma expansion (>6 mL or >33%) at 24 hours (primary outcome), early neurologic deterioration (END, 24-hour increase in NIH Stroke Scale score ≥4), and 90-day ordinal modified Rankin scale (mRS) score. Analyses were adjusted by age, sex, anticoagulation, onset-to-imaging time, ICH volume, and intraventricular extension. RESULTS: We included 312 patients (mean age 70.2 ± 13.3 years, 202 [64.7%] male). Hematoma expansion occurred in 70/274 (25.6%) patients, END in 58/291 (19.9%), and the median 90-day mRS score was 4 (interquartile range, 2-5). SBP target achievement ≤60 minutes (178/312 [57.1%]) associated with a lower risk of hematoma expansion (adjusted odds ratio [aOR] 0.43, 95% confidence interval [CI] 0.23-0.77), lower END rate (aOR 0.43, 95% CI 0.23-0.80), and lower 90-day mRS scores (aOR 0.48, 95% CI 0.32-0.74). The mean 24-hour SBP variability was 21.0 ± 7.6 mm Hg. Higher 24-hour SBP variability was not related to expansion (aOR 0.99, 95% CI 0.95-1.04) but associated with higher END rate (aOR 1.15, 95% CI 1.09-1.21) and 90-day mRS scores (aOR 1.06, 95% CI 1.04-1.10). DISCUSSION: Among patients with acute ICH, achieving an intensive SBP target within 60 minutes was associated with lower hematoma expansion risk. Rapid SBP reduction and stable sustention within 24 hours were related to improved clinical and functional outcomes. These findings warrant the design of randomized clinical trials examining the impact of effectively achieving rapid, intensive, and sustained BP control on hematoma expansion. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that in adults with spontaneous ICH and initial SBP ≥150 mm Hg, lowering SBP to <140 mm Hg within the first hour and maintaining this for 24 hours is associated with decreased hematoma expansion.

Utilidad del índice de comorbilidad de Charlson en personas ancianas. Concordancia con otros índices de comorbilidad / Utility of the Charlson Comorbidity Index in older people and concordance with other comorbidity indices

Objetivo: El objetivo principal de nuestro estudio fue evaluar la utilidad actual del índice de comorbilidad de Charlson (CCI) para predecir la mortalidad en personas mayores y la concordancia entre varios índices. Diseño: Estudio observacional, cohorte concurrente. Emplazamiento: Servicio de Medicina Interna de un hospital terciario, pacientes ambulatorios de un centro de salud y residentes de cuatro hogares de ancianos. Participantes: 375 individuos ≥ 65 años, con supervivencia esperada ≥ 6 meses, sin deterioro cognitivo. Mediciones principales: Se realizaron tres índices: CCI, el índice geriátrico de comorbilidad (GIC) y el índice de Kaplan-Feinstein (KF). A los 12 meses, se registró mortalidad. Los datos se analizaron con IBM SPSS Statistics® versión 23.0. Resultados: Edad media: 81,4 años. El CCI mostró comorbilidad baja-media en el grupo ambulatorio de 65-75 años (43 [75,4%]); moderada-alta más común en hospitalizados (19 [61,3%]) y en hogares de ancianos (5 [62,5%]). Al año fallecieron 59 (16,1%) individuos: con CCI: 10 (6,4%) comorbilidad baja-media y 49 (23,3%) moderada-alta, odds ratio (OR) 3,63 (intervalo de confianza [IC] 95% 1,76-7,51); con KF: 27 (13,3%) baja-media y 32 (19,5%) moderada-alta, OR 1,38 (IC 95% 0,78-2,44), y con GIC: 45 (14,1%) baja-media y 14 (29,2%) moderada-alta, OR 2,47 (IC 95% 1,21-5,06). La concordancia entre CCI-KF fue: 65-75 años: K = 0,62, 76-85 años: K = 0,396, y ≥ 86 años: K = 0,255. La concordancia entre CCI-GIC: 65-75 años: K = 0,202, 76-85 años: K = 0,069, y ≥ 86 años: K = 0,118. Conclusión: El CCI es el mejor predictor de mortalidad después de 1 año de seguimiento. Concordancia considerable entre CCI y KF en los individuos de 65-75 años, en el resto de las franjas etarias la correlación con GIC fue insignificante.(AU)

Background: The main aim of our study was to evaluate the current usefulness of the CCI in predicting mortality in older people and the concordance between various comorbidity indices. Design: An observational, concurrent cohort study was performed. Location: Internal Medicine Service of a tertiary hospital, outpatients in a health centre and residents in four nursing homes. Participants: 375 individuals ≥65 years and with expected survival ≥6 months, without cognitive impairment. Main measurements: Three indices, the CCI, the Geriatric Index of comorbidity (GIC), and the Kaplan-Feinstein index (KFI), were administered in all participants. At 12 months, mortality was evaluated. The data were analyzed using the SPSS 23.0 statistical programme. Results: Average age 81.4 years. The CCI revealed low-medium comorbidity in the outpatient group aged 65-75: 43 (75.4%), moderate-high morbidity and more common in hospitalized patients: 19 (61.3%) and nursing homes: 5 (62.5%). At one year follow-up 59 (16.1%) individuals died: CCI: 10 (6.4%) low-medium and 49 (23.3%) moderate-high comorbidity, OR 3.63 (95% CI 1.76-7.51); KF: 27 (13.3%) low-medium and 32 (19.5%) moderate-high comorbidity, OR 1.38 (95% CI 0.78-2.44) and GIC: 45 (14.1%) low-medium and 14 (29.2%) moderate-high comorbidity, OR 2.47 (95% CI 1.21-5.06). The concordance between CCI-KF: 65-75 years K=0.62, 76-85 years: K=0.396 and ≥86 years: K=0.255. Concordance between CCI-GIC was: 65-75 years K=0.202, 76-85 years: K=0.069 and ≥86 years: K=0.118. Conclusion: CCI was found to be the best predictor of mortality after one year of follow up. There was considerable concordance between CCI and KF in the 65-75 years and remaining age groups. Correlation with GIC was low.(AU)

Características y evolución de los pacientes COVID-19 en un centro de salud urbano al inicio de la pandemia / Characteristics and evolution of COVID-19 in an urban Health Center at the pandemic beginning

OBJETIVO: Evaluar las características de los pacientes con SARS-CoV-2 y analizar diferencias entre los que requirieron asistencia hospitalaria y los seguidos ambulatoriamente. DISEÑO: Estudio observacional, descriptivo, retrospectivo. EMPLAZAMIENTO: 2 unidades básicas asistenciales de un centro de salud urbano en Salamanca (España). PARTICIPANTES: Pacientes ≥ 18 años diagnosticados de SARS-CoV-2 entre el 11 de marzo y el 20 de abril. MEDICIONES PRINCIPALES: Características clínico-epidemiológicas, diagnóstico, tratamiento y desenlace a fecha fin de estudio. RESULTADOS: Ciento veintidós pacientes (63,9% mujeres), 19,7% trabajadores sociosanitarios y 4,9% institucionalizados. Franja etaria predominante: 46-60 años, edad media: 52,1(DE 17,85). El 67,2% sin comorbilidad. Síntomas más prevalentes: febrícula (73,5%), tos (65,2%) y fiebre (43%). La edad media de los que requieren atención hospitalaria es mayor a los seguidos ambulatoriamente: 59,85 años (DE 16,22) vs. 50,78 (DE 17,88); p = 0,013. El 63,6% del total seguidos por Atención Primaria no presentó disnea, frente a 17 (14,1%) de los que acudieron a Urgencias; p = 0,001. No se realizaron pruebas confirmatorias al 2,5% de los que visitaron el hospital, frente al 61,5% de los seguidos ambulatoriamente; p = 0,0001; 26 acuden a Urgencias: 11 (9%) ingresaron y 2 (1,6%) fallecieron. El 52,5% no necesitó antibioterapia y el 70.5% no requirió inhaladores. El antipirético más empleado fue paracetamol (78.7%). CONCLUSIONES: Prevalencia en mujeres, personas sin comorbilidad y en la franja de edad de 46-60 años. Las pruebas complementarias y confirmatorias se realizaron mayoritariamente en asistencia hospitalaria. Predominancia de sintomatología leve y evolución favorable. Destacamos el papel de Atención Primaria en la detección, la intervención temprana y el seguimiento en casos graves

OBJETIVE: To evaluate SAR-COV-2 pacients' features. To analyse de diferences between those who required hospital care and those who didn't. DESIGN: Observational, descriptive and retrospective study. SETTING: Two medical practices of an urban health center in Salamanca (Spain). PARTICIPANTS: ≥ 18 years diagnosed with SAR-CoV-2 between March 11 th and April 20 th. MAIN MEASUREMENTS: clinical-epidemiological chatacteristics, diagnosis, treatment and outcome at the end of study RESULTS: 122 patients (63.9% female), 19.7% social and health care workers y 4.9% from nursing homes. Predominant age group: 46-60 years. 67.2% without comorbility. Predomint symptoms: low-grade fever (73.5%), cough (65.2%) y fever (43%). Average age of the patients requiring hospital care was higher: 59.85 (DE16.22) versus 50.78 (DE17.88) P = .013. 63.6% of all the patients monitored by Primary Health Care and 14.1% of patients that required assistance did not present dyspnea P = .001. Only 2.5% of the hospital-assisted patients, compared to 61.5% of Primary Health Care, were not tested P = .0001. 26 patients were attendedn at an emergency room: 11(9%) stayed and 2 (1.6%) passed away. No antibiotic or inhaler treatment for 52.5% and 70.5% respectively. The most used antipyretic treatment was paracetamol (78.7%). CONCLUSIONS: Prevalence in females, comorbility-free patients and in age range: 46-60 years. Complementary and confirmatory test were performed mainly in hospital care. Predominance of mild symptoms and favourable evolution. Highliting the role played by Primary Health Care in detection, early intervention and monitoring of severe cases

Afectación clínica y sintomatológica en pacientes mayores de 65 años por COVID-19 / Clinical involvement and symptoms of patients older than 65 years with COVID-19

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A relevância da extensão acadêmica sobre a prática racional de medicamentos: relato de experiência / The relevance of the academic extension on the rational practice of medicines: experience report / La relevancia de la extensión académica sobre la práctica racional de medicamentos: relato de experiencia

Objetivos:Apresentar a experiência da extensão acadêmica vivenciada por estudantes do curso de enfermagem, durante um Projeto de Extensão Comunitária pela Faculdade CESMAC do Sertão. Descrição de experiência:Trata-se de um relato de experiência baseado em ações educativas realizadas em escolas da rede pública e privada no Município de Palmeira dos índios-AL, acerca do uso racional de medicamentos. Relato: As atividades foram desenvolvidas com escolares do ensino fundamental e médio, beneficiando aproximadamente 1200 escolares entre os meses de fevereiro a dezembro do ano de 2017. Os temas foram abordados de acordo com a Política Nacional de Medicamentos e Manuais do Ministério da Saúde. Conclusão: As atividades desenvolvidas conseguiramcontribuir de forma significativa para a ampliação da educação em saúde, proporcionando aos beneficiadosestratégias simples que garantemo conhecimento sobre o Uso Racional de Medicamentos, além de promover a integração da faculdade coma sociedade (AU).

137Rev Enferm Health Care [Online]. Jan/Jul 2020; 9(1):136-143ISSN 2317-1154ABSTRACTObjectives:To present the experience of the academic extension undergone by students of the nursing course, during a Community Extension Project by CESMAC do Sertão Faculty. Description of experience:This is an experience report based on educational actions carriedout in public and private schools in the municipality of Palmeira dos Indios-AL, about the rational use of medicines. Report:The activities were carried out with elementary and middle school students, benefiting approximately 1200 students between February and December of the year 2017. The subjects were approached according to the National Policy of Medications and Manuals of the Ministry of Health. Conclusions:The activities developed can contribute significantly to the expansion of health education, providing beneficiaries with simple strategies that guarantee knowledge about the Rational Use of Medicines and promote the integration of the faculty withand society (AU).

Objetivos:Presentar la experiencia de la extensión académica vivenciada por estudiantes del curso de enfermería, durante un Proyecto de Extensión Comunitaria por la Facultad CESMAC del Sertão. Descripción de experiencia:Se trata de un relato de experiencia basado en acciones educativas realizadas en escuelas de la red pública y privada en el Municipio de Palmeira de los indios-AL, acerca del uso racional de medicamentos. Relato:En el presente trabajo se analizaron los resultados obtenidos en el análisis de los resultados obtenidos en el estudio de los resultados obtenidos en el estudio. Conclusión:Las actividades desarrolladas logran contribuir de forma significativa a la ampliación de la educación en salud, proporcionando a los beneficiados estrategias simples que garanticen el conocimiento sobre el Uso Racional de Medicamentos, además de promover laintegración de la universidad conla sociedad (AU).

Evaluación y uso de un péptido sintético para la detección de anticuerpos específicos contra Plasmodium falciparum / Development and use of a synthetic peptide for the detection of specific antibodies against Plasmodium falciparum

Resumen Introducción. La malaria continúa siendo una de las enfermedades que causa mayor morbi-mortalidad a nivel mundial. Por esta razón es importante desarrollar herramientas diagnósticas eficaces que se implementen como estrategias para el control de la enfermedad. Objetivos. Estandarizar las condiciones del inmunoensayo enzimático (ELISA), para la detección de IgG específica contra Plasmodium falciparum en sueros de pacientes diagnosticados por gota gruesa con malaria no complicada por P. falciparum, empleando como antígeno un extracto proteico obtenido a partir de cultivo de P. falciparum o un péptido sintético derivado de la proteína de superficie de merozoito GLURP (del inglés: glutamate rich protein). Materiales y métodos. Para la estandarización de la técnica, se utilizaron 22 sueros de pacientes positivos para malaria por P. falciparum y 11 diagnosticados positivos para malaria por P. vivax utilizando la técnica de gota gruesa. Como controles negativos se utilizaron 44 sueros de individuos sanos. Los sueros fueron probados contra extracto de proteínas del parásito y el péptido sintético IMT 94 derivado de la proteína GLURP, para evaluar las concentraciones y las diluciones óptimas de cada componente del sistema. Para la validación de la técnica se utilizaron 251 sueros de pacientes positivos para P. falciparum y 44 sueros de individuos sanos, diagnosticados utilizando la técnica de gota gruesa. Resultados. La técnica estandarizada con el péptido sintético permitió observar diferencia significativa en el reconocimiento de sueros de pacientes, controles positivos y negativos por los antígenos (extracto de proteínas y péptidos sintéticos). Conclusiones. La metodología usada permite identificar la respuestas inmune específica contra P. falciparum.

Abstract Introduction. Malaria continues being one of the diseases causing the greatest morbi-mortality around the world. For that reason, effective diagnostic tools must thus be developed which can be used in strategies for controlling the disease. Objectives. To standardise enzyme- linked immunosorbent assay (ELISA) conditions for detecting Plasmodium falciparum specific IgG in sera from patients diagnosed by thick smear as suffering non-complicated malaria caused by P. falciparum. A protein extract obtained from P. falciparum culture or a synthetic peptide derived from glutamate rich protein (GLURP) merozoite surface protein would be used as antigen. Materials and Methods. 22 serum samples from patients diagnosed as suffering from P. falciparum malaria, 11 serum samples from patients diagnosed as suffering from P. vivax and 44 from healthy donors, diagnosed by using the thick smear tecnique were used for standarising the technique. Serum samples were tested against parasite protein extract and GLURP- derived IMT 94 synthetic peptide for standardisign optimum dilutions and concentrations for each component in the system. 251 serum samples from patients diagnosed as suffering from P. falciparum malaria and 44 from healthy donors diagnosed by using the thick smear tecnique were used to validate the technique. Results. The technique led to significant differences being observed in antigens (protein extract and synthetic peptides) recognising serum from positive and negative patients and controls. Conclusions. The methodology used led to identifying specific immune response against P. falciparum.

Saúde e qualidade de vida: discursos de docentes no cotidiano de uma escola pública de Santa Catarina / Health and quality of life: teachers' speeches in daily life of a public school in Santa Catarina / Salud y calidad de vida: discursos de docentes en el cotidiano de una escuela pública de Santa Catarina

Resumo A pesquisa teve por objetivo conhecer as concepções sobre saúde, doença, qualidade de vida e temas afins de docentes de uma escola pública de Florianópolis, Santa Catarina, Brasil, 2013. Estudo qualitativo, descritivo, com dados coletados por meio de grupo focal e entrevistas semiestruturadas. A estratégia de grupo focal adotada foi orientada segundo a abordagem do ‘círculo de cultura’, no qual os participantes expressaram suas concepções sobre os temas estudados e refletiram sobre como contribuir com estratégias de promoção da saúde no contexto escolar por meio da educação em saúde. O universo da pesquisa foi formado por 16 docentes da rede estadual de ensino; oito docentes confirmaram a participação no grupo focal e, desses, apenas seis compareceram do primeiro ao último encontro. Ao final os dados revelaram que os docentes percebem uma estreita relação entre saúde e qualidade de vida e que uma vida saudável é possível na presença de enfermidade. Enfatizaram a necessidade de maior participação dos pais e profissionais da saúde no processo de educação em saúde e, também, de um preparo sistemático e permanente sobre as questões que envolvam saúde no contexto escolar. As concepções dos docentes reafirmam que a dimensão social sobressai à biológica e que o conhecimento e a valorização desses aspectos, na prática docente, podem ampliar as ações em saúde.

Abstract The research aimed to know the conceptions of health, disease, quality of life and other topics in teachers of a public school in Florianópolis, Santa Catarina, Brazil, 2013. A qualitative and descriptive study was carried out with data collected in focus group and semi-structured interviews. The focal group strategy was oriented on the approach of the ‘circle of culture’, in which the participants expressed their concepts on the studied themes and reflected on how to contribute to health promotion strategies in the school context through education on health. The research universe included 16 teachers from state schools; eight teachers confirmed their participation in the focus group and, of these, only six attended the first to the last meeting. At the end, the data revealed that teachers perceive a close relationship between health and quality of life and that a healthy life is possible in the presence of disease. They emphasized the need for greater participation of parents and health professionals in the health education process and also a systematic and continuing preparation on issues involving health in the school context. Conceptions of teachers reaffirm that the social dimension exceeds the biological one and that knowledge and appreciation of these aspects, in teaching practice, can broaden health actions.

Resumen La investigación tuvo por objetivo conocer las concepciones sobre salud, enfermedad, calidad de vida y temas afines de docentes de una escuela pública de Florianópolis, Santa Catarina, Brasil, 2013. Estudio cualitativo, de naturaleza descriptiva, con datos colectados por medio de grupo focal y entrevistas semiestructuradas. La estrategia de grupo focal adoptada fue orientada según el abordaje del ‘círculo de cultura’, en el cual los participantes expresaron sus concepciones sobre los temas estudiados y reflejan sobre como contribuir con estrategias de promoción de la salud en el contexto escolar por medio de educación en salud. El universo de la investigación fue formado por 16 docentes de la red estadual de enseño; ocho docentes confirmaron la participación en el grupo focal y, de esos, apenas seis comparecieron del primero al último encuentro. Al final los datos revelaron que los docentes perciben una estrecha relación entre salud y calidad de vida y que una vida saludable es posible en la presencia de enfermedad. Enfatizaron la necesidad de mayor participación de los padres y profesionales de la salud en el proceso de educación en salud y, también, de un preparo sistemático y permanente sobre las cuestiones que envuelven salud en el contexto escolar. Las concepciones de los docentes reafirman que la dimensión social sobresale a la biológica y que el conocimiento y la valorización de esos aspectos, en la práctica docente, pueden ampliar las acciones en salud.

Crisis epiléptica complicada con un síndrome de takotsubo / Epileptic seizures complicated by Takotsubo syndrome

Introducción. El síndrome de takotsubo es un trastorno caracterizado por disfunción ventricular reversible, dolor precordial de tipo anginoso y cambios electrocardiográficos sin evidencia de obstrucción coronaria en coronariografía. Se desencadena por estrés, y es frecuente tras crisis epilépticas. Presentamos el caso de una paciente que inicia esta miocardiopatía tras una crisis epiléptica al finalizar su sesión de hemodiálisis. Caso clínico. Mujer de 55 años en hemodiálisis por insuficiencia renal crónica, con epilepsia secundaria a lesión residual frontoparietal derecha por un hematoma que precisó evacuación quirúrgica. Tras una sesión de hemodiálisis experimenta una crisis epiléptica focal con generalización secundaria y, horas después de ésta, dolor centrotorácico. En seriación enzimática se objetiva elevación de troponina I y, electrocardiográficamente, ondas T negativas en derivaciones precordiales (V2-V6). Se realiza coronariografía, cuyo resultado es normal, y se demuestran alteraciones de la contractilidad, confirmadas como de carácter transitorio en un estudio ecocardiográfico seriado. Todos los datos anteriores hacen sospechar el diagnóstico de síndrome de takotsubo. Conclusión. Las complicaciones cardíacas son una de las causas de morbimortalidad en la epilepsia, y entre ellas se encuentra el síndrome de takotsubo. La incidencia real de dicho síndrome se desconoce, pero dada su implicación en la mortalidad de causa cardíaca en la epilepsia es importante sospecharlo ante la presencia de disfunción cardíaca tras una crisis epiléptica (AU)

Introduction. Takotsubo syndrome is a disorder characterised by a reversible ventricular dysfunction, angina-like precordial pain and electromyographic changes with no evidence of coronary obstruction in examinations performed by coronary catheterisation. It is triggered by stress and is frequent following bouts of epileptic seizures. We report the case of a patient who began with this cardiomyopathy following epileptic seizures suffered after one of her aemodialysis sessions. Case report. We report the case of a 55-year-old female on haemodialysis due to chronic renal failure, with epilepsy secondary to a residual lesion in the right frontoparietal area due to a haematoma that required surgical evacuation. After her haemodialysis session she suffered an attack of focal epilepsy with secondary generalisation and, some hours later, pain in the middle of her chest. Serial enzymes revealed increased levels of troponin I and, electrocardiographically, negative T waves were observed in precordial derivations (V2-V6). Coronary catheterisation was performed, with normal results, and alterations were noted in contractility, which were confirmed as being transient in a serial echocardiography study. All the previous data lead us to a suspected diagnosis of Takotsubo syndrome. Conclusions. Cardiac complications are one of the causes of morbidity and mortality in epilepsy, and Takotsubo syndrome is an example of them. The real incidence of this syndrome is unknown, but given its involvement in mortality caused by heart problems in epilepsy it is important to suspect it in the presence of cardiac dysfunction following epileptic seizures (AU)

O uso da aromaterapia no combate ao estresse / Use of aromatherapy in the fight against stress

O modelo biomédico tradicional, muitas vezes, realiza o atendimento fragmentado, não dá ênfase ao ser humano em sua totalidade. A correria do dia a dia faz com que o homem fique mais vulnerável aos agentes estressores, desestabilizando seu organismo. Por isso, há necessidade do atendimento acolhedor e humanitário por meio do cuidado integral, promovendo o bem-estar e qualidade de vida. As terapias complementares como a aromaterapia vem ganhando grande destaque nas áreas da estética e saúde. Essas terapias, segundo referenciais como os de Helman (2004), conseguem muitas vezes proporcionar para as pessoas que utilizam a sensação de equilíbrio corpóreo e bem-estar entre outros aspectos pessoais / individuais. Vários óleos essenciais são utilizados para o tratamento do estresse e devem ser manipulados por um profissional com conhecimento científico sobre os efeitos que proporciona. O objetivo do presente trabalho, consiste em uma levantamento bibliográfico da utilização dos óleos essenciais no tratamento do estresse, bem como em suas consequências a para a saúde. Conclui-se que a aromaterapia possui um papel significativo nos efeitos do estresse, pois proporciona momentos de satisfação e bem estar ao paciente.

The traditional biomedical model often provides a fragmented care, not emphasizing the human being in its entirety. The everyday rush makes humans become more vulnerable to stressors, destabilizing their body. Thus, there is the need for warm and humanitarian assistance through comprehensive care, promoting well-being and quality of life. Complementary therapies such as aromatherapy have gained great prominence in the s of aesthetics and health. These therapies, according to references such as Helman (2004), can often provide the sensation of balance and well-being, among other personal/individual aspects. Various essential oils are used for treating stress and should be handled by a professional with scientific knowledge on the effects they provide. The aim of this work consists in a literature review on the use of essential oils in the treatment of stress and its consequences in terms of health. It can be concluded that aromatherapy has a significant role in the effects of stress as it provides moments of satisfaction and well-being to the patient.

Antinociceptive effects of an extract, fraction and an isolated compound of the stem bark of Maytenus rigida

The antinociceptive activity of the Maytenus rigida Mart. (Celastraceae) ethanol extract and its ethyl acetate fraction as well as of (-)-4'-methylepigallocatechin (1), a previously isolated compound, was demonstrated in vivo. ED50 for 1 in the writhing test was 14.14 mg/kg. The acetic acid-induced writhing was inhibited by 98.4, 84.4, and 58.3%, respectively, when mice were treated with the ethanol extract, ethyl acetate fraction, and 1. In the hot plate test, mice pretreated with 1 showed significantly increased reaction times (60-89%). Oral administration of 1 significantly inhibited first and second phases of the formalin-induced pain (50 and 26.5%, respectively), whereas indomethacin inhibited only the second phase of the test (41.2%). Ethanol extract and its fraction showed effects on inflammatory pain, while neurogenic and inflammatory pain suppression by 1 is a strong indication of the presence of both central and peripheral effects and suggests its analgesic and anti-inflammatory potential.

Trabalho em saúde e a implantação do acolhimento na atenção primária à saúde: afeto, empatia ou alteridade? / Trabajo en salud y la implantación de la acogida en la atención primaria a la salud: ¿afecto, empatía o alteridad? / Health work and the implementation of user embracement in primary healthcare: affection, empathy or alterity?

Desenvolvemos uma reflexão teórica sobre o trabalho na Atenção Primária à Saúde (APS) na diretriz do acolhimento, buscando possibilidades de superar a alienação em seu processo produtivo, a partir de relatos de experiência da implantação do acolhimento em serviços de APS. Identificamos as seguintes perspectivas teóricas nas relações interpessoais nos serviços, com indicadores de avanços na humanização do trabalho em saúde e de uma aproximação com a subjetividade: afeto, empatia e alteridade. Ainda que todas sejam adequadas e mesmo complementares entre si, fazemos nossa opção pela alteridade como perspectiva teórica capaz de instrumentalizar o trabalhador da saúde para desenvolver o acolhimento, sem deixar de garantir sua própria humanização. Esta abre possibilidades de enfrentamento das situações do cotidiano dos serviços de saúde, oferecendo aos profissionais condições de construírem seu trabalho sem limitá-lo à perspectiva biomédica e preservando sua própria saúde.

We conducted a theoretical reflection on the work of primary healthcare professionals in the scope of user embracement, searching for possibilities to overcome alienation in their production process, based on experience reports regarding user embracement implementation in primary healthcare services. We identified the following theoretical perspectives which we consider useful in order to enhance humanization in the work in the health area and also to foster subjectivity in interpersonal relationships: affection, empathy and alterity. Although they are closely related to each other, we believe alterity is the theoretical perspective that is able to give the health worker conditions to develop user embracement while ensuring his/her own humanization. Alterity opens possibilities to cope with everyday situations in the healthcare services, providing health professionals with the conditions to work without restricting themselves to a biomedical point of view and, at the same time, preserving their own health.

Desarrollamos una reflexión teórica sabre el trabajo en la Atención Primaria a la Salud (APS) en la directriz de la acogida, buscando posibilidades de superar la alienación en su proceso productivo a partir de relatos de experiencia de la implantación de la acogida en servicios de APS. Identificamos las siguientes perspectivas teóricas en las relaciones interpersonales en los servicios, con indicadores de avances en la humanización del trabajo en salud y de una aproximación con la subjetividad: afecto, empatía y alteridad. Aunque todas sean adecuadas y basta complementarias entre sí, hacemos nuestra opción par la alteridad como perspectiva teórica capaz de instrumentalizar al trabajador de la salud para desarrollar la acogida sin dejar de garantizar su propia humanización. De este modo se abren posibilidades de afrontar las situaciones cotidianas de los servicios de salud, ofreciendo a los profesionales condiciones de construir su trabajo sin limitarlo a la perspectiva biomédica y de preservar su propia salud.

Antinociceptive activities of crude methanolic extract and phases, n-butanolic, chloroformic and ethyl acetate from Caulerpa racemosa (Caulerpaceae) / Atividade antinociceptiva do extrato metanólico bruto e das fases n-butanólica, clorofórmica e acetato de etila de Caulerpa recemosa (Caulerpaceae)

In this study, we attempted to identify the possible antinociceptive actions of n-butanolic phase, chloroformic phase, ethyl acetate phase and crude methanolic extract obtained from Caulerpa racemosa. This seaweed is cosmopolitan in world, mainly in tropical regions. The n-butanolic, chloroformic, ethyl acetate phases and crude methanolic extract, all administered orally in the concentration of 100 mg/kg, reduced the nociception produced by acetic acid by 47.39 percent, 70.51 percent, 76.11 percent and 72.24 percent, respectively. In the hotplate test the chloroformic and ethyl acetate phase were activite in this models. In the neurogenic phase on formalin test, were observed that crude methanolic extract (51.77 percent), n-butanolic phase (35.12 percent), chloroformic phase (32.70 percent) and indomethacin (32.06 percent) were effective in inhibit the nociceptive response. In the inflammatory phase, only the ethyl acetate phase (75.43 percent) and indomethacin (47.83 percent) inhibited significantly the nociceptive response. Based on these data, we can infer that the ethyl acetate phase shows a significant anti-inflammatory profile, whose power has not yet been determined. However, pharmacological and chemical studies are continuing in order to characterize the mechanism(s) responsible for the antinociceptive action and also to identify other active principles present in Caulerpa racemosa.

Neste estudo, tentamos identificar a atividade antinociceptiva do extrato metanólico bruto e das fases n-butanólica, clorofórmica e acetato de etila provenientes da alga Caulerpa racemosa. Esta alga é cosmopolita no mundo, principalmente em regiões tropicais. O extrato metanólico bruto e as fases n-butanólica, clorofórmica e acetato de etila foram administrados por via oral, na concentração de 100 mg/kg. Estes foram capazes de reduzir a nocicepção produzida pelo ácido acético, sendo 47,39 por cento, 70,51 por cento, 76,11 por cento e 72,24 por cento, respectivamente. No ensaio da placa quente as fases clorofórmica e acetato de etila foram ativas neste modelo. Na fase neurogênica do teste de formalina, foi observado que o extrato metanólico bruto (51,77 por cento), fase n-butanólica (35,12 por cento), fase clorofórmica (32,70 por cento) e indometacina (32,06 por cento) foram eficazes em inibir a resposta nociceptiva. Na fase inflamatória, apenas a fase acetato de etila (75,43 por cento) e indometacina (47,83 por cento) foram capazes de inibir significativamente a resposta nociceptiva. Com base nestes dados, podemos sugerir que o a fase acetato de etila apresenta um significativo efeito anti-inflamatório, cuja potência ainda não foi determinada. No entanto, estudos farmacológicos e químicos serão necessários, a fim de caracterizar o mecanismo responsável pela ação antinociceptiva e também para identificar outros princípios ativos presentes na alga Caulerpa racemosa.

Reverse smokers’s and changes in oral mucosa. Department of Sucre, Colombia

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Objectives: This work is intended to establish the prevalence of reverse smokers at the villages of Hato Nuevo, San Francisco and Cayo de Palma, Department of Sucre, Colombia, characterizing their socio-culture conditions, clinical and histological changes in the oral mucosa.Design of study: A descriptive study was done through a home to home inquiry to select the people with inclusion criteria for a posterior clinical test and a biopsy of the affected oral mucosa.Results and conclusions: Reverse smokers’s prevalence was from the 15%, mainly women (p<0.001) with an ageaverage of 59.3 years. The lesions were classified clinically in mild, moderate and severe changes. Tongue moderate lesions presented the higher frequency (80%), followed by severe lesions on palate (74%). Oral cancer prevalence was 10.8% in the San Francisco village and 18.2% in Cayo de Palma village, no new cases were reported in Hato Nuevo village. This was the highest prevalence reported in comparison with other studies with similar population. The clinical and histological findings agree with the reported in literature, no relation was found between the degree of clinical severity and the dysplasia itself. Cases of oral submucous fibrosis-like lesions were found, which had never been reported in Latin America. Further studies are required in order to decrease the morbidity for this habit and to identify other related risk factors (AU)

Riscos potenciais à saúde em itinerários de cura e cuidado / Potential risks for health on routes of healing and care

Neste estudo buscou-se caracterizar os riscos potenciais à saúde identificados em itinerários de cura e cuidado de famílias, observados e descritos por agentes comunitários de saúde que atuavam na Barra do Rio em Balneário Camboriú - Santa Catarina. Utilizamos uma abordagem qualitativa com o uso de estratégias adaptadas da etnografia e do estudo de caso. Verificamos a ocorrência de vários itinerários de cura e cuidado possíveis, envolvendo sistema de saúde diversos, cada um com riscos potenciais à Saúde específicos. Assim, esse estudo trouxe informações que podem ser utilizadas pelos profissionais de saúde tanto no sentido de estimular a autonomia e o autocuidado dos pacientes quanto permitindo prevenir os pacientes sobre riscos potenciais nos itinerários que estes podem desenvolver, mesmo que não incluam o sistema de saúde formal