Alcohol Sniff Test (AST): An Important Tool for Screening Post-Viral Olfactory Loss in Acute Flu-Like Dysfunction.

Olfactory disorders have a significant impact on patients' quality of life but are often underestimated in clinical practice. Upper respiratory tract infections (URTIs) are a common cause of olfactory loss. While most cases of olfactory loss due to URTIs are conductive and reversible, post-viral olfactory dysfunction (PVOD) persists despite symptom improvement. PVOD is attributed to damage to the olfactory epithelium and nerves or central olfactory pathway lesions. The Alcohol Sniff Test (AST) has been proposed as a tool to assess olfactory function in the acute phase and aid in differentiating PVOD from conductive disorders. This study aims to evaluate the effectiveness of the AST as a predictor of post-viral olfactory loss in patients with flu-like syndrome. An observational cross-sectional study was conducted among employees with flu-like syndrome at a tertiary hospital. Three groups were formed: flu-like syndrome with conductive disorder without COVID-19 (PVOD-), flu-like syndrome with neurosensory and/or central disorder due to COVID-19 (PVOD +), and an asymptomatic control group. The Alcohol Sniff Test was performed to assess olfactory function. Statistical analysis was conducted to evaluate the AST's performance. For a cut off of 10 cm, 88.57% of PVOD + patients and 60.53% of PVOD - patients showed AST alteration, respectively (p = 0.013, OR = 5.05, 95% CI [1.48-17.25]). There was a statistically significant difference in the mean distance between the PVOD + group (4.35 ± 4.1 cm) and the control group (20 ± 4.33 cm) (p < 0.05). This relationship was also observed between the PVOD + and PVOD- groups (9 cm ± 7.5) (p < 0.05) and between the PVOD- and control groups (p < 0.05). For a cut off of 10 cm, the AST showed a sensitivity of 88% and specificity of 41%, resulting in an Odds Ratio of 9.7 (95% CI 3.3-28.1) (p < 0.001) and a Positive Predictive Value of 69.4% for PVOD. PVOD, including cases associated with COVID-19, is a prevalent cause of olfactory loss. The Alcohol Sniff Test demonstrated promising results in identifying PVOD in patients with flu-like syndrome. The test's simplicity and accessibility make it a valuable tool for early screening and identifying individuals who may benefit from prompt treatment. The Alcohol Sniff Test (AST) shows potential as an effective tool for screening post-viral olfactory loss in patients with flu-like syndrome. It can aid in early identification of PVOD cases and facilitate timely interventions to reduce the likelihood of persistent hyposmia.

Olfactory dysfunction in COVID-19: a marker of good prognosis? / Disfunção de olfato na Covid-19: marcador de bom prognóstico?

Abstract Introduction In May 2020, the World Health Organization recognized olfactory dysfunction as a COVID-19 symptom. The presence of hyposmia/anosmia may be a marker of good prognosis in COVID-19. Objective To associate the presence of olfaction disorder to the clinical condition severity in patients with COVID-19. Methods Individuals with the flu syndrome caused by SARS-CoV-2, diagnosed from March to June 2020, were recruited. They were divided into three groups: mild flu syndrome, severe flu syndrome (admitted to hospital wards) and critical illness (admitted to the ICU). Inpatients were interviewed by telephone contact after hospital discharge and their medical records were also evaluated regarding complementary test results. Outpatients answered an electronic questionnaire containing only clinical information. Results A total of 261 patients participated in the study: 23.75% with mild flu syndrome, 57.85% with severe flu syndrome and 18.40% with critical illness. A total of 66.28% patients with COVID-19 had olfaction disorders. In approximately 56.58% of the individuals the smell alterations lasted between 9 days and 2 months. There was a significantly higher proportion of individuals with olfactory dysfunction in the group with mild flu syndrome than in the severe flu syndrome group (mild × severe - p< 0.001; Odds Ratio = 4.63; 95% CI [1.87-10.86]). This relationship was also maintained between patients with mild flu syndrome and critically-ill patients (mild × critical - p< 0.001; Odds Ratio = 9.28; 95% CI [3.52-25.53]). Conclusion Olfaction dysfunction was significantly more prevalent in patients with mild flu syndrome in COVID-19. It may be a predictor of a good prognosis for this infection. New population-based studies must be carried out to corroborate these findings.

Resumo Introdução Em maio de 2020, a Organização Mundial da Saúde reconheceu a disfunção do olfato como um sintoma da C-19. A presença de hiposmia/anosmia pode ser um marcador de bom prognóstico na Covid-19. Objetivos Relacionar a presença do transtorno do olfato à gravidade do quadro clínico nos pacientes com Covid-19. Método Foram recrutados indivíduos com síndrome gripal causada pelo SARS-CoV-2, diagnosticados de março a junho de 2020. Eles foram divididos em três grupos: síndrome gripal leve; síndrome gripal grave (internados em enfermarias) e doença crítica (internados em UTI). Os doentes internados foram entrevistados por ligação telefônica após alta hospitalar e também tiveram seus prontuários avaliados para registro de exames complementares; os ambulatoriais responderam a um questionário eletrônico com somente informações clínicas. Resultados Participaram do estudo 261 pacientes: 23,75% com síndrome gripal leve, 57,85% com síndrome gripal grave e 18,40% com doença crítica. Ocorreu alteração do olfato em 66,28% doentes com Covid-19. Dos indivíduos, 56,58% apresentaram duração da alteração do olfato entre 9 dias e 2 meses. Houve significativamente maior proporção de indivíduos com disfunção olfatória no grupo com síndrome gripal leve do que nos graves (leves × graves - p < 0,001; odds ratio = 4,63; 95% IC [1,87-10,86]). Essa relação também se manteve entre os doentes leves e críticos (leves × críticos - p < 0,001; odds ratio = 9,28; 95% IC [3,52-25,53]). Conclusão A disfunção do olfato foi significantemente mais prevalente nos doentes com síndrome gripal leve na Covid-19. Pode ser um preditor de bom prognóstico dessa infecção. Novos estudos populacionais devem ser feitos para corroborar esses achados.

CD133, a Progenitor Cell Marker, is Reduced in Nasal Polyposis and Showed Significant Correlations with TGF-β1 and IL-8

Abstract Introduction Combination of chronic inflammation and an altered tissue remodeling process are involved in the development of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). Studies demonstrated that mesenchymal stem cells expressing the progenitor gene CD133 were involved in a significant reduction of the chronic inflammatory process in the polypoid tissue. Objective To evaluate the levels of CD133 (Prominin-1) in nasal polypoid tissue and its correlation with interleukin-8 (IL-8) and transforming growth factor β1 (TGF-β1). Methods A total of 74 subjects were divided in the following groups: control group (n = 35); chronic rhinosinusitis with nasal polyps nonpresenting comorbid asthma and aspirin intolerance (CRSwNPnonAI) group (n = 27); and chronic rhinosinusitis with nasal polyps presenting comorbid asthma and aspirin intolerance (CRSwNPAI) group (n = 12). Histologic analysis and also evaluation of the concentration of CD133, IL-8, and TGF-β1 by enzyme-linked immunosorbent assay (ELISA) kits were performed in nasal tissue obtained from nasal polypectomy or from middle turbinate tissue. Results Higher eosinophilic infiltration was found in both CRSwNP groups by histologic analysis. Lower levels of TGF-β1 and IL-8 were observed in both CRSwNP groups when compared with the control group, whereas the CD133 levels were significantly reduced only in the CRSwNPnonAI group compared with the control group. Conclusion It was demonstrated that the nasal mucosa presenting polyposis showed a significant reduction of CD133 levels, and also that this reduction was significantly correlated with the reduction of TGF-β1 levels, but not with IL-8 levels. Therefore, these findings may be involved in the altered inflammatory and remodeling processes observed in the nasal polyposis.

Olfactory dysfunction in COVID-19: a marker of good prognosis?

INTRODUCTION: In May 2020, the World Health Organization recognized olfactory dysfunction as a COVID-19 symptom. The presence of hyposmia/anosmia may be a marker of good prognosis in COVID-19. OBJECTIVE: To associate the presence of olfaction disorder to the clinical condition severity in patients with COVID-19. METHODS: Individuals with the flu syndrome caused by SARS-CoV-2, diagnosed from March to June 2020, were recruited. They were divided into three groups: mild flu syndrome, severe flu syndrome (admitted to hospital wards) and critical illness (admitted to the ICU). Inpatients were interviewed by telephone contact after hospital discharge and their medical records were also evaluated regarding complementary test results. Outpatients answered an electronic questionnaire containing only clinical information. RESULTS: A total of 261 patients participated in the study: 23.75% with mild flu syndrome, 57.85% with severe flu syndrome and 18.40% with critical illness. A total of 66.28% patients with COVID-19 had olfaction disorders. In approximately 56.58% of the individuals the smell alterations lasted between 9 days and 2 months. There was a significantly higher proportion of individuals with olfactory dysfunction in the group with mild flu syndrome than in the severe flu syndrome group (mild × severe - p < 0.001; Odds Ratio = 4.63; 95% CI [1.87-10.86]). This relationship was also maintained between patients with mild flu syndrome and critically-ill patients (mild × critical - p <  0.001; Odds Ratio = 9.28; 95% CI [3.52-25.53]). CONCLUSION: Olfaction dysfunction was significantly more prevalent in patients with mild flu syndrome in COVID-19. It may be a predictor of a good prognosis for this infection. New population-based studies must be carried out to corroborate these findings.

Vibration associated with cryotherapy to relieve pain in children / Vibração associada à crioterapia no alívio da dor em crianças

ABSTRACT BACKGROUND AND OBJECTIVES: The administration of intramuscular drugs and peripheral venous puncture are procedures that use needles cause pain, especially in children. This painful experience generates distress, phobia, tachycardia, refusal to further treatments, anxiety, and sadness in parents. The use of non-pharmacological methods such as vibration and cold for pain relief in children has become a reliable alternative. The objective of this study was to evaluate the association between vibration and cryotherapy as a strategy for the relief of pain in children undergoing procedures with the use of needles. CONTENTS: This is an integrative review, in which articles were searched in the Pubmed, Medline, BDENF and LILACS databases, using the descriptors: "Child", "Vibration", "Cryotherapy" and "Pain" associated with the Boolean operator "and". After the selection and reading of the articles in full, they were systematically synthesized and classified with a level of scientific evidence 2. Studies have shown that the association between vibration and cryotherapy is effective in reducing pain in children with or without cognitive alterations, also reducing their and parents' anxiety during procedures performed with needles. CONCLUSION: The implementation of vibration associated with cryotherapy during the administration of injectable drugs and the installation of a peripheral venous device can reduce the fear, anguish, and anxiety in children, calming the parents and benefiting health professionals.

RESUMO JUSTIFICATIVA E OBJETIVOS: A administração de fármacos por via muscular e a punção venosa periférica são procedimentos que utilizam agulhas e causam dor, especialmente em crianças. Essa experiência dolorosa gera angústia, fobia, taquicardia, recusa em tratamentos posteriores, além da ansiedade e desconforto na família. A utilização de métodos não farmacológicos, como a vibração e a crioterapia para o alívio da dor em crianças tem se tornado uma forte alternativa. O objetivo deste estudo foi avaliar a utilização da associação entre a vibração e a crioterapia como estratégia para o alívio da dor em crianças submetidas a procedimentos com a utilização de agulhas. CONTEÚDO: Trata-se de uma revisão integrativa, na qual, buscou-se artigos nas bases de dados: Pubmed, Medline, BDENF e LILACS, com a utilização dos descritores: "Criança", "Vibração", "Crioterapia" e "Dor" associados entre si com o operador booleano "and". Após a seleção e leitura dos artigos na íntegra, os mesmos foram sistematicamente sintetizados e classificados com nível de evidência científica 2. Os estudos demonstraram que a associação entre a vibração e a crioterapia apresentou eficácia na redução da dor em crianças com ou sem alterações cognitivas, além de reduzir a ansiedade das crianças e dos pais durante os procedimentos executados com agulhas. CONCLUSÃO: A implementação da vibração associada à crioterapia na administração de fármacos injetáveis ou na instalação de dispositivo venoso periférico, pode reduzir o medo, a angústia e a ansiedade nas crianças, tranquilizando os pais e beneficiando os profissionais de saúde.

Formação dos discentes de enfermagem acerca da avaliação da dor / Nursing students' training on pain assessment

Objetivo: avaliar a formação dos discentes do último período do curso de Enfermagem quanto à avaliação da dor. Método: trata-se de um estudo quantitativo, descritivo, transversal, desenvolvido em uma instituição de ensino privada. Compôs-se a amostra por 169 graduandos do décimo período. Utilizou-se um formulário com questões objetivas. Realizou-se a análise descritiva univariada a partir de tabelas. Resultados: constata-se que a dor foi ensinada pelos docentes como o quinto sinal vital para 52,1% dos participantes; 76% afirmaram que, no estágio curricular obrigatório, não observaram o registro da dor nos prontuários; 68% não foram estimulados a utilizar as escalas para a avaliação da dor e 62,1% nunca utilizaram as escalas para a avaliação da dor. Entende-se que muitos acadêmicos de Enfermagem, no último semestre da graduação, não se sentem aptos a realizar a avaliação da dor. Conclusão: encontram-se falhas no conhecimento dos graduandos de Enfermagem no tocante à avaliação da dor, e é preocupante a formação desses enfermeiros, considerando que a avaliação da dor e o seu controle são princípios básicos para uma assistência de qualidade.(AU)

Objective: to evaluate the training of students from the last semester of the Nursing undergraduate course regarding pain assessment. Method: this is a quantitative, descriptive, cross-sectional study, developed in a private educational institution. The sample consisted of 169 students from the last semester, who answered a form with objective questions. The univariate descriptive analysis was performed from tables. Results: professors teah pain as the fifth vital sign for 52.1% of the participants; 76% stated not observing pain record on medical charts in the curricular mandatory internship; 68% were not encouraged to use the scales for pain assessment and 62.1% have never used the scales for pain assessment. Many Nursing undergraduate students, in the last semester, do not feel able to carry out pain assessment. Conclusion: Nursing graduates' knowledge present gaps in relation to pain assessment, whose training is worrying, considering pain assessment and control as basic principles for quality assistance.(AU)

Objetivo: evaluar la formación de los estudiantes del último período del curso de enfermería en la evaluación del dolor. Método: se trata de un estudio cuantitativo, descriptivo, transversal, desarrollado en una institución de enseñanza privada. La muestra estuvo compuesta por 169 estudiantes del 10º período. Se utilizó un formulario con preguntas objetivas. El análisis descriptivo univariado de tablas. Resultados: se observó que el dolor era enseñada por los profesores como el quinto signo vital para 52,1% de los participantes; 76% afirmaron que, en la práctica laboral curricular obligatoria, no observaron el registro del dolor en los cuadros; 68% no fueron estimulados a usar las escalas de evaluación del dolor y 62,1% nunca han utilizado las escalas para la evaluación del dolor. Se entiende que muchos universitarios de enfermería, en el último semestre de graduación, no se sienten capaces de llevar a cabo la evaluación del dolor. Conclusión: existen lagunas en el conocimiento de los graduados de enfermería en relación con la evaluación del dolor, y es preocupante la formación de estos enfermeros, mientras que la evaluación del dolor y su control son los principios básicos para la calidad de la asistencia.(AU)

Nasal Polyposis: More than a Chronic Inflammatory Disorder-A Disease of Mechanical Dysfunction-The São Paulo Position.

Introduction The importance of our study lies in the fact that we have demonstrated the occurrence of mechanical dysfunction within polypoid tissues, which promotes the development of polyps in the nasal cavity. Objective To change the paradigm of nasal polyposis (NP). In this new conception, the chronic nasal inflammatory process that occurs in response to allergies, to pollution, to changes in the epithelial barrier, or to other factors is merely the trigger of the development of the disease in individuals with a genetic predisposition to an abnormal tissue remodeling process, which leads to a derangement of the mechanical properties of the nasal mucosa and, consequently, allows it to grow unchecked. Data Synthesis We propose a fundamentally new approach to intervening in the pathological process of NP, addressing biomechanical properties, fluid dynamics, and the concept of surface tension. Conclusion The incorporation of biomechanical knowledge into our understanding of NP provides a new perspective to help elucidate the physiology and the pathology of nasal polyps, and new avenues for the treatment and cure of NP.

Pain management in children undergoing surgical procedures / Manejo da dor em crianças submetidas a procedimentos cirúrgicos

In view of the relevance of adequate pain management in the evolution of the clinical picture of children, this study aimsto emphasize, for health professionals, the importance of using the Analgesic Ladder and pain assessment scale andtheir recording. The objective of this study was to evaluate the therapeutic suitability of the analgesic used accordingto the Pain Management Index, to the intensity and to pain reported by children submitted to a surgical procedure.An exploratory and quantitative study was carried out in which the sample consisted of 31 children from 5 to 12years of age in the immediate postoperative period. The data collection instrument was composed of questions aboutsociodemographic and clinical data. Pain assessment occurred for 3 consecutive days. The univariate descriptiveanalysis was performed and the results were presented in the form of graphs and tables. A high prevalence of pain wasfound in the first (48%) and third (45%) postoperative days, with a greater pain intensity on the first day (moderate tointense - 49%). On the first day the children presented greater analgesic inadequacies and the registration of pain inthe medical records did not correspond to the amount of reports. These inadequacies constitute an important challengefor children’s postoperative success. This study serves as a subsidy for improvements in the quality of the postoperative care of children

Diante da relevância do manejo adequado da dor na evolução do quadro clínico da criança, este estudo visa ressaltarpara os profissionais da saúde a importância da utilização da escada analgésica, escala de avaliação da dor e deseu registro. O objetivo deste estudo foi avaliar a adequação terapêutica do analgésico de acordo com o Índice deManejo da Dor, a intensidade e o registro de dor em crianças submetidas a procedimento cirúrgico. Foi realizadoum estudo exploratório e quantitativo, cuja amostra foi constituída por 31 crianças de 5 a 12 anos em pós-operatóriomediato. O instrumento de coleta de dados foi composto por questões sobre dados sociodemográficos e clínicos. Aavaliação de dor ocorreu durante 3 dias consecutivos. Realizou-se a análise descritiva univariada e os resultados foramapresentados na forma de gráfico e tabelas. Constatou-se alta prevalência de dor no primeiro (48%) e terceiro (45%)dia de pós-operatório, com maior intensidade de dor no primeiro dia (moderada à intensa - 49%). No primeiro diaas crianças apresentaram maiores inadequações analgésicas e os registros de dor no prontuário não condiziam coma quantidade de relatos. Essas inadequações, constituindo um importante desafio para o sucesso no pós-operatórioinfantil. Este estudo serve de subsídio para melhorias na qualidade do cuidado pós-operatório de crianças

Dor no pós-operatório em crianças submetidas a procedimentos cirúrgicos / Post-surgery pain in children submitted to surgical procedures

O objetivo deste estudo foi avaliar os fatores sociodemográficos, clínicos e cirúrgicos relacionados com a intensidade da dor no pós-operatório de crianças. Estudo descritivo e exploratório com abordagem quantitativa, realizado com 31 crianças de cinco a 12 anos nas primeiras 72 horas de pós-operatório utilizou-se um questionário com perguntas clínicas, sociodemográficas e as escalas de faces e numérica de dor. Foram realizados os testes Qui-quadrado e Exato de Fisher para a análise dos resultados. Evidenciou-se que o tipo de cirurgia realizada influencia significativamente (p-valor= 0,036) na presença de dor nas 24h, após a cirurgia. A intensidade da dor com o tipo de cirurgia nos dois primeiros dias de pós-operatório apresentou valor significativo (p-valor=0,044) no primeiro dia e (p-valor=0,021) no segundo. No 2º dia de internação, a variável sexo (feminino) mostrou diferença significativa com relação à média de intensidade de dor (p-valor=0,032) e no 3º dia, a característica clínica que se fez significativa foram os antecedentes patológicos (p-valor=0,031) quando relacionado à intensidade da dor. Conclui-se que as variáveis sociodemográficas, clínica e cirúrgica interferem na presença e intensidade de dor em crianças no pós-operatório, principalmente tipo de cirurgia, sexo e antecedentes patológicos

The aim of this study is evaluating the socio-demographic, clinical and surgical factors related to the pain intensity in the children´s post-surgery. Descriptive and exploratory study with a quantitative approach conducted with 31 five to twelve-year-old children in the first 72 hours of the post-surgery, where it was applied a questionnaire with clinical and socio- demographic questions, and the face and numerical scales of pain. The Chi-square and the Fischer Exact tests were used for the analysis of the results. It was observed that the kind of surgery performed influences significantly (p-value= 0.036) in the presence of pain in the first 24 hours, after the surgery. The intensity of pain with the kind of surgery in the first two post-surgery days presented a significant value (p-value=0.044) in the first day and (p-value=0.021) in the second day. In the 2nd day of admission the variable sex (female) showed a significant difference in relation to the intensity of pain average (p-value=0.032), and in the 3rd day the significant characteristic was the pathological background (p-value=0.031) when related to the intensity of pain. It is concluded that socio-demographic, clinical and surgical variables interfere in the presence and intensity of pain in children in post-surgery, especially kind of surgery and pathological background

Nasal polyposis: more than a chronic inflammatory disorder-a disease of mechanical dysfunction - the São paulo position

Introduction: The importance of our study lies in the fact that we have demonstrated the occurrence ofmechanical dysfunction within polypoid tissues, which promotes the development of polyps in the nasal cavity. Objective: To change the paradigm of nasal polyposis (NP). In this new conception, the chronic nasal inflammatory process that occurs in response to allergies, to pollution, to changes in the epithelial barrier, or to other factors is merely the trigger of the development of the disease in individuals with a genetic predisposition to an abnormal tissue remodeling process, which leads to a derangement of the mechanical properties of the nasal mucosa and, consequently, allows it to grow unchecked. Data: Synthesis We propose a fundamentally new approach to intervening in the pathological process of NP, addressing biomechanical properties, fluid dynamics, and the concept of surface tension. Conclusion: The incorporation of biomechanical knowledge into our understanding of NP provides a new perspective to help elucidate the physiology and the pathology of nasal polyps, and new avenues for the treatment and cure of NP (AU)

Efeito antioxidante da diosmina: revisão integrativa / The diosmin antioxidant effect: an integrative review

O estresse oxidativo está relacionado ao desenvolvimento de muitas enfermidades e atualmente tem-se utilizado a Diosmina visando reduzi-lo. O objetivo deste estudo é identificar através da literatura o efeito antioxidante da Diosmina. Trata-se de um estudo descritivo bibliográfico de revisão integrativa, realizada a partir artigos que abordassem o tema pesquisado publicados entre 2013 a 2017 oriundos das bases de dados eletrônicas PubMed e Bireme. Foram analisados 9 artigos. Os estudos avaliados evidenciam que com a utilização da Diosmina há uma elevação da quantidade no organismo de enzimas que combatem o estresse oxidativo como, catalase e outras. E também que ocorreu a redução do Malondialdeído. Conclui-se com esse estudo que a Diosmina contribui para o combate das lesões desencadeadas pelo desequilíbio no status redox que estimula o aumento de antioxidantes enzimáticos e inibe a formação de malondialdeído, assim colaborando para a diminuição de danos aos tecidos.

Oxidative stress is related to the development of multiple diseases and some studies objective to identify the effect of natural substances in lesions caused by it. One of these substances is Diosmin, a flavonoid found in citric fruits. The objective of this study was to identify through the literature the anti-oxidative effect of Diosmin. It is a descriptive and bibliographic study of integrative revision, based on articles which discussed the researched topic published between 2013 and 2017 using the electronic database PubMed and Bireme. 9 articles were analyzed. The studies evaluated show that the use of Diosmin rises the activity of enzymes which fight against oxidative stress, as catalase, superoxide dismutase and glutathione. There was reduction of the concentration of malondialdehyde. It was proved with this study that Diosmin contributes to the fight against lesions caused by the unbalance between the redox status, stimulating the rise of activity of enzymatic anti-oxidants and reducing the production of malondialdehyde, collaborating to the reduction of damage to tissues generated by stress oxidative.

Nursing students' knowledge about pain assessment / Conhecimento dos acadêmicos de enfermagem sobre a avaliação da dor

ABSTRACT BACKGROUND AND OBJECTIVES: The difficulty of the nursing staff in assessing pain, the low adherence to the registry of pain and the quality reported in other studies brings the need to assess the related factors and one of them can be the lack of knowledge. The objective of this study was to evaluate the knowledge of nursing students about pain assessment. METHODS: A cross-sectional, descriptive and quantitative study, conducted in a Higher Education School in Aracaju, Brazil. The sample was composed of 169 nursing students over the last period of graduation. The data were obtained through a form that contained sociodemographic information, questions about pain assessment, and knowledge sources used. RESULTS: The scales to assess pain in children and in adults are known by 70 and 66% of the students, respectively. They reported that pain assessment and the incorrect pain treatment may impair the clinical picture and aggravate the disease, both in the child (17.2%) and the adult (15.4%). The rate of correct answers about pain assessment ranged from 26.6 to 87%. Most of them use articles to gain knowledge about pain (56.2%). The fact of having already used a scale to assess the patient's pain (p=0.045) showed significant differences in the average of hits. CONCLUSION: Nursing graduates are aware of the existence of scales to assess pain, but they do not have the ability to perform them. The prior use of scales promotes learning. The lack of knowledge about pain impacts on the patient's health.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dificuldade da equipe de enfermagem em avaliar a dor, a baixa adesão ao registro de dor e a sua qualidade relatada em outros estudos, faz surgir a necessidade de avaliar os fatores relacionados, podendo ser um deles a deficiência de conhecimento. O objetivo deste estudo foi avaliar o conhecimento dos estudantes de enfermagem sobre a avaliação da dor. MÉTODOS: Estudo transversal, descritivo e quantitativo, desenvolvido em uma instituição de ensino superior em Aracaju, SE, Brasil. A amostra foi composta por 169 acadêmicos de enfermagem do último período da graduação. Os dados foram obtidos por meio de formulário que continha questões sociodemográficas, perguntas sobre a avaliação da dor e as fontes de conhecimento utilizadas. RESULTADOS: As escalas para avaliação da dor na criança e no adulto são conhecidas por 70 e 66% dos acadêmicos, respectivamente. Eles relataram que a avaliação e o tratamento inadequado da dor podem prejudicar o quadro clínico e agravar a doença tanto na criança (17,2%) quanto no adulto (15,4%). O índice de acertos sobre a avaliação da dor variou entre 26,6 e 87%. A maioria deles utiliza artigos para adquirir conhecimento sobre a dor (56,2%). Já ter utilizado escala para avaliação da dor do paciente (p=0,045) apresentou diferenças significativas na média de acertos. CONCLUSÃO: Os formandos de enfermagem sabem da existência das escalas para avaliação da dor, porém não possuem habilidade para executá-las. A utilização prévia de escalas favorece o aprendizado. O baixo conhecimento quanto à dor repercute na saúde do paciente.

Topical therapy with high-volume budesonide nasal irrigations in difficult-to-treat chronic rhinosinusitis / Terapia tópica de irrigação nasal de alto volume com solução de budesonida em rinossinusite crônica de difícil tratamento

ABSTRACT INTRODUCTION: Chronic rhinosinusitis (CRS) is termed difficult-to-treat when patients do not reach acceptable level of control despite adequate surgery, intranasal corticosteroid treatment and up to 2 short courses of systemic antibiotics or corticosteroids in the preceding year. Recently, high-volume corticosteroid nasal irrigations have been recommended for CRS treatment. OBJECTIVE: To assess high-volume budesonide nasal irrigations for difficult-to-treat CRS. METHODS: Prospective uncontrolled intervention trial. Participants were assessed before- and 3 months after nasal irrigation with 1 mg of budesonide in 500 mL of saline solution daily for 2 days. Subjective (satisfactory clinical improvement) and objective (SNOT-22 questionnaire and Lund-Kennedy endoscopic scores) assessments were performed. RESULTS: Sixteen patients were included, and 13 (81.3%) described satisfactory clinical improvement. SNOT-22 mean scores (50.2-29.6; p = 0.006) and Lund-Kennedy mean scores (8.8-5.1; p = 0.01) improved significantly. Individually, 75% of patients improved SNOT-22 scores, and 75% improved Lund-Kennedy scores after high volume budesonide nasal irrigations. CONCLUSION: High-volume corticosteroid nasal irrigations are a good option in difficult-to-treat CRS control of disease, reaching 81.3% success control and significant improvement of SNOT-22 and Lund-Kennedy scores.

RESUMO INTRODUÇÃO: A rinossinusite crônica (RSC) de difícil tratamento é aquela inadequadamente controlada com cirurgia, corticosteroides tópicos em spray e até dois ciclos de medicação sistêmica em um ano. Atualmente, tem sido preconizado o uso de irrigações nasais de corticosteroides em alto volume para seu tratamento. OBJETIVO: Avaliar o uso da terapia tópica de irrigações nasais com budesonida em alto volume nos pacientes com RSC de difícil tratamento. MÉTODO: Estudo prospectivo de intervenção não controlado em RSC de difícil tratamento com 3 meses de terapia tópica de irrigação (1 mg de budesonida diluído em 500 mL de soro fisiológico para ser utilizado em dois dias). Realizada avaliação subjetiva (melhora clínica satisfatória) e objetiva (questionário SNOT-22 e classificação endoscópica de Lund-Kennedy). RESULTADOS: Foram incluídos 16 pacientes, sendo que 13 (81,3%) consideraram sua melhora clínica satisfatória. Houve melhora significante das médias de SNOT-22 (50,2 a 29,6; p = 0,006) e de Lund-Kennedy (8,8 a 5,1; p = 0,01). Individualmente, 75% dos pacientes apresentaram melhora do SNOT-22 e 75%, do Lund-Kennedy. CONCLUSÃO: A terapia tópica de irrigação de alto volume de corticosteroide é uma boa opção no controle clínico dos pacientes com rinossinusite crônica de difícil tratamento, com controle adequado de 81,3% destes pacientes e melhora significante do SNOT-22 e do Lund-Kennedy.

Topical therapy with high-volume budesonide nasal irrigations in difficult-to-treat chronic rhinosinusitis.

INTRODUCTION: Chronic rhinosinusitis (CRS) is termed difficult-to-treat when patients do not reach acceptable level of control despite adequate surgery, intranasal corticosteroid treatment and up to 2 short courses of systemic antibiotics or corticosteroids in the preceding year. Recently, high-volume corticosteroid nasal irrigations have been recommended for CRS treatment. OBJECTIVE: To assess high-volume budesonide nasal irrigations for difficult-to-treat CRS. METHODS: Prospective uncontrolled intervention trial. Participants were assessed before- and 3 months after nasal irrigation with 1mg of budesonide in 500 mL of saline solution daily for 2 days. Subjective (satisfactory clinical improvement) and objective (SNOT-22 questionnaire and Lund-Kennedy endoscopic scores) assessments were performed. RESULTS: Sixteen patients were included, and 13 (81.3%) described satisfactory clinical improvement. SNOT-22 mean scores (50.2-29.6; p=0.006) and Lund-Kennedy mean scores (8.8-5.1; p=0.01) improved significantly. Individually, 75% of patients improved SNOT-22 scores, and 75% improved Lund-Kennedy scores after high volume budesonide nasal irrigations. CONCLUSION: High-volume corticosteroid nasal irrigations are a good option in difficult-to-treat CRS control of disease, reaching 81.3% success control and significant improvement of SNOT-22 and Lund-Kennedy scores.

Epistaxe: diagnóstico e tratamento / Epistaxis: diagnosis and treatment

A epistaxe é a principal urgência Otorrinolaringológica, com grande incidência e impacto social, porém a grande maioria dos episódios é autolimitada. A característica principal da vascularização nasal é a presença de anastomoses entre os sistemas carotídeos externo e interno, que determinam correlação clínico-anatômica, que devem ser consideradas na investigação diagnóstica e conduta terapêutica da epistaxe. O objetivo deste artigo é revisar os principais pontos do diagnóstico e do tratamento da epistaxe...

The role of maxillary sinus puncture on the diagnosis and treatment of patients with hospital-acquired rhinosinusitis.

UNLABELLED: Rhinosinusitis is one of the most common causes of fever of unknown origin in critically ill patients and should be systematically searched. OBJECTIVE: This study aims to evaluate the diagnostic and therapeutic effect of maxillary sinus puncture performed at the bedside in patients with infective rhinosinusitis hospitalized in an Intensive Care Unit of a high complexity care hospital. MATERIALS AND METHODS: This retrospective study looks into patients on mechanical ventilation with fever of unknown origin and signs of rhinosinusitis on CT images who were submitted to inferior meatus maxillary sinus puncture. RESULTS: The total study sample consisted of 27 patients (70.3% male; mean age 45.3 years). The most common Intensive Care Unit admission diagnoses were head trauma and stroke. CT scans revealed the maxillary (85.2%) and sphenoid (74.1%) sinuses were the most involved paranasal sinuses. Middle meatus purulent drainage was seen in 30.7% of the nasal cavities. Fever was reduced in 70.4% of the patients after puncture (p < 0.001). The most commonly found organisms in sinus aspirates were Pseudomonas aeruginosa and Acinetobacter baumannii. CONCLUSION: Maxillary sinus puncture performed at the bedside of the patients is an important diagnostic and therapeutic tool for critically ill patients.

Papel da punção do seio maxilar no diagnóstico e no tratamento de pacientes com rinossinusite hospitalar / The role of maxillary sinus puncture on the diagnosis and treatment of patients with hospital-acquired rhinosinusitis

A rinossinusite é uma das principais causas de febre em pacientes críticos e deve ser sistematicamente pesquisada. OBJETIVO: Avaliar o impacto da punção do seio maxilar à beira leito, no diagnóstico e no tratamento dos pacientes com rinossinusite infecciosa internados em Unidade de Terapia Intensiva de um hospital universitário de alta complexidade. MATERIAIS E MÉTODOS: Estudo retrospectivo que avaliou os pacientes em ventilação mecânica com febre de origem indeterminada e sinais tomográficos de rinossinusite submetidos à punção do seio maxilar pelo meato inferior. RESULTADOS: A amostra total do estudo consistiu de 27 pacientes (70,3% do sexo masculino com média de idade 45,3 anos). Os diagnósticos de admissão mais frequentes na Unidade de Terapia Intensiva foram Trauma Crânio Encefálico e Acidente Vascular Cerebral. No exame tomográfico, os seios paranasais mais acometidos foram o maxilar, em 85,2%, e esfenoidal, em 74,1%. A secreção purulenta foi visualizada no meato médio em 30,7% das fossas nasais. Os microrganismos mais frequentes nos aspirados dos seios foram Pseudomonas aeruginosa e Acinetobacter baumannii. CONCLUSÃO: A punção do seio maxilar à beira leito demonstrou-se uma importante ferramenta diagnóstica e terapêutica nos pacientes de UTI com rinossinusite hospitalar, submetidos à ventilação mecânica invasiva.

Rhinosinusitis is one of the most commom causes of fever of unknown origin in critically ill patients and should be systematically searched. OBJECTIVE: This study aims to evaluate the diagnostic and therapeutic effect of maxillary sinus puncture performed at the bedside in patients with infective rhinosinusitis hospitalized in an Intensive Care Unit of a high complexity care hospital. MATERIALS AND METHODS: This retrospective study looks into patients on mechanical ventilation with fever of unknown origin and signs of rhinosinusitis on CT images who were submitted to inferior meatus maxillary sinus puncture. RESULTS: The total study sample consisted of 27 patients (70.3% male; mean age 45.3 years). The most common Intensive Care Unit admission diagnoses were head trauma and stroke. CT scans revealed the maxillary (85.2%) and sphenoid (74.1%) sinuses were the most involved paranasal sinuses. Middle meatus purulent drainage was seen in 30.7% of the nasal cavities. Fever was reduced in 70.4% of the patients after puncture (p < 0.001). The most commonly found organisms in sinus aspirates were Pseudomonas aeruginosa and Acinetobacter baumannii. CONCLUSION: Maxillary sinus puncture performed at the bedside of the patients is an important diagnostic and theraupetic tool for critically ill patients.

Diagnóstico e tratamento do angiofibroma juvenil em um hospital universitário / Diagnose and treatment of juvenile nasopharyngeal angiofibroma in a university hospital

Introdução: O angiofibroma nasofaríngeo juvenil (ANJ) é o tumorbenigno mais comum na rinofaringe. O tratamento de escolhaé cirúrgico, porém com altas taxas de recidivas. Objetivo:Descrever as características de diagnóstico e tratamento deANJ em um hospital de ensino. Método: Estudo transversalretrospectivo, onde foram revisados prontuários de pacientestratados por ANJ de janeiro/2007 a outubro/2010. Resultados:Encontrados 11 pacientes operados para ANJ neste período.Todos do gênero masculino, com idade média de 15,18 anos.Obstrução nasal foi o principal sintoma inicial (54,55%), seguidode epistaxe (45,45%). O estadio II de Andrews foi o mais comum(54,55%). Embolização pré-operatória realizada em 45,45% dospacientes e a via de acesso mais comum foi o degloving médiofacialassistido por endoscópio em 72,73% dos casos. Transfusãosanguínea intra-operatória em 72,73%, devido à diminuição dehemoglobina em média de 13,18 para 8,54 g/dL. Pós-operatórioem UTI com média de 2,78 dias, sendo a alta hospitalar em médiaapós 8,18 dias de pós-operatório. Houve dois casos de recidiva,totalizando 18,18% de falha. Conclusão: Descrevemos nossaexperiência, e observamos que embolização pré-operatória e usodo endoscópio diminuíram o risco de recidivas.