Paciente com câncer colorretal em quimioterapia adjuvante: evidências para os cuidados com estoma e equipamentos coletores / Patient with colorectal cancer in adjuvant chemotherapy: evidence for the stoma care and collectors equipment

A Quimioterapia antineoplásica (QtA) adjuvante para câncer colorretal (CCR) traz consequências fisiológicas e psicossociais como os eventos adversos (EA) gastrintestinais e dermatológicos, que podem trazer dificuldades na utilização de equipamentos para os pacientes com estomia intestinal. Este estudo teve por objetivos analisar a produção científica nacional e internacional sobre os EA gastrintestinais e dermatológicos para pacientes com CCR em QtA adjuvante; e estabelecer as recomendações em relação à indicação de equipamentos coletores e adjuvantes para os pacientes com estomia intestinal por CCR, assim como para os cuidados com a estomia intestinal e o manejo destes equipamentos durante a QtA, com base nas evidências científicas. Trata-se de uma Revisão Integrativa, fundamentada na Prática Baseada em Evidências, cuja pergunta formulada foi: Quais os EA gastrintestinal e dermatológico decorrentes da quimioterapia adjuvante em pacientes com câncer colorretal? Os descritores utilizados para as buscas foram Neoplasias Colorretais, Quimioterapia, Toxicidade, Efeitos adversos, nas bases de indexação eletrônica PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Cumulative Index to Nursing and Allied Health (CINAHL), e Excerpta Médica (EMBASE), mediante os critérios de inclusão: estudos que abordassem a ocorrência e o tratamento de EA gastrintestinais ou dermatológicos em pacientes com CCR em QtA adjuvante; e estudos publicados em inglês, português ou espanhol, sem corte temporal de publicação; obtidos na íntegra via Biblioteca Central do Campus de Ribeirão Preto da Universidade de São Paulo; e os critérios de exclusão que foram estudos em modelo animal e modelo in vitro; estudos sobre metástases associadas ao tumor primário colorretal. Do total de 4.021 artigos científicos, resultantes das buscas, foram selecionados mediante os critérios de inclusão e exclusão, 20 estudos que constituíram a amostra final, sendo que todos foram publicados em inglês, com níveis de evidência pouco fortes em 65% (IV e VI) e cujos aspectos abordados foram categorizados em quatro temáticas: Diarreia e demais EA gastrintestinais; Diarreia e EA Gastrodermatológicos; EA Gastrintestinais; e EA Dermatológicos. No tema Diarreia e demais EA gastrintestinais evidenciou-se diarreia, náusea, perda de apetite e constipação, vinculados à QtA adjuvante com 5-FU, capecitabina e irinotecano. No tema Diarreia e EA Gastrodermatológicos evidenciou-se síndrome palmar-plantar, outras afecções cutâneas (eritema, úlcera, descamação, prurido, eritema, bolha), estomatite, edema das mãos/face/boca, e hipersensibilidade por capecitabina e oxaliplatina. No tema EA Gastrintestinais verificamos que náusea e vômito foram mais frequentes e relacionados à oxaliplatina. No tema EA Dermatológicos, evidenciou-se rash cutâneo, rubor, prurido, reações alérgicas, síndrome palmar-plantar nos esquemas com 5-FU, capecitabina, oxaliplatina e irinotecano. Considerando estas evidências e a necessidade de utilização de equipamentos coletores do paciente com estomia intestinal por CCR em QtA adjuvante, a assistência de enfermagem especializada deve assegurar a demarcação de estoma, ensino do autocuidado sobre EA e seu manejo, indicação e fornecimento de equipamentos coletores e adjuvantes, que atendam as suas necessidades, assim como o desenvolvimento de protocolos para avaliação dos EA gastrintestinais e dermatológicos durante a QtA adjuvante

The antineoplastic chemotherapy for adjuvant colorectal cancer (ACC) brings physiological and psychosocial consequences such as gastrointestinal and dermatologic adverse events (AE), which can cause difficulties in using equipment for patients with ostomy. This study aimed to analyze the national and international scientific literature on the gastrointestinal and dermatological EA for patients with CRC in adjuvant chemotherapy; and establish recommendations regarding the indication of equipment supplies and also aid for patients with ostomy by CRC, as well as for ostomy care and management of this equipment during the chemotherapy, based on scientific evidence. This is an integrative review, based on the evidence-based practice, whose question was: What are the gastrointestinal and dermatological EA resulting from adjuvant chemotherapy in patients with colorectal cancer? The descriptors used for the search were Colorectal neoplasms, Drug therapy, Toxicity, and Adverse effects, in electronics PubMed indexing bases, Latin American and Caribbean Health Sciences (LILACS), Cumulative Index to Nursing and Allied Health (CINAHL) and Excerpta Medical (EMBASE) by the inclusion criteria: studies that addressed the occurrence and treatment of gastrointestinal or dermatological EA in patients with CRC in adjuvant chemotherapy; and studies published in English, Portuguese or Spanish, without temporal cutting time publication; obtained in entirety at Ribeirão Preto Campus Central Library of the University of São Paulo; and the exclusion criteria were studies in animal models and in vitro model; studies on colorectal metastases associated with primary tumor. Of the total of 4,021 scientific articles resulting from the searches, they were selected by the inclusion and exclusion criteria, 20 studies which formed the final sample, all of which have been published in English, with little strong evidence levels 65% (IV and VI) and whose addressed aspects were categorized into four themes: Diarrhea and other gastrointestinal EA; Diarrhea and gastrointestinal and dermatologic EA; Gastrointestinal EA; Dermatologic EA. In the subject Diarrhea and other gastrointestinal EA became evident diarrhea, nausea, loss of appetite and constipation linked with adjuvant 5-FU, capecitabine, and irinotecan. On the topic diarrhea and Gastrointestinal and dermatologic EA showed up hand-foot syndrome, other skin disorders (erythema, ulcers, peeling, itching, erythema, and bubble), and stomatitis, swelling of the hands / face / mouth, and hypersensitivity oxaliplatin and capecitabine. On the topic Gastrointestinal EA were found that nausea and vomiting were more frequent and related to oxaliplatin. On the topic of Dermatological EA, evidence of skin rash, redness, itching, allergic reactions and palmar-plantar syndrome in the schemes with 5-FU, capecitabine, oxaliplatin and irinotecan. Considering this evidence and the need for equipment supplies in patients with ostomy by CRC in chemotherapy, specialized nursing care to ensure the demarcation of stoma, self-care education on EA and its management, display and supply collectors equipment and adjuvants that meet their needs, as well as the development of protocols for evaluation of gastrointestinal and dermatological EA during adjuvant chemotherapy

Impacto colateral del COVID-19 en la salud ambiental derivado de la disposición inadecuada de mascarillas / Collateral impact of COVID-19 on environmental health derived from improper disposition of masks

El uso de mascarillas por parte de la población general como elemento de protección personal frente al COVID-19 se mantuvo en ascenso durante la primera mitad del 2020, en medio de constantes actualizaciones de la OMS acerca del público objetivo, su correcto uso y posibles beneficios, pero donde no se definieron protocolos para el manejo del desecho resultante. Durante el segundo semestre del 2020 la población mundial usaba diariamente 4.300 millones de mascarillas, de las cuales el 78,5% se descartaban de forma incorrecta, llegando a generar un volumen de 2,61 (2,26-2,94; IC=95%) millones de toneladas de desecho diseminadas en el medio ambiente. Los componentes plásticos incorporados en la fabricación de mascarillas como PP, PE y PET pueden tardar 400 años en degradarse en condiciones ambientales, fragmentándose paulatinamente en microplásticos, que afectan a la flora, fauna, agua y suelos de su entorno. Adicionalmente, algunos aditivos sintéticos antioxidantes (AO) usados en la fabricación de plásticos pueden retardar aún más las reacciones de degradación de las mascarillas descartadas hacia el ambiente, aumentando su daño potencial. Se calculó que 216,9 (188,5-245,3; IC=95%) toneladas de AO168, 190 (165,2-214,9; IC=96%) toneladas de AO168O y 442,7 (384,8-500,6; IC=95%) toneladas de AO1010 fueron expuestas al medio ambiente debido a la disposición incorrecta de mascarillas en la segunda mitad de 2020. Aunque la masa conjunta de estos componentes sintéticos sólo representa el 0,017% de las mascarillas desechadas en el mismo lapso, su concentración resulta suficiente para acrecentar el riesgo de daño al ambiente(AU)

The use of masks by the general population as an element of personal protection against COVID-19 continued to rise during the first half of 2020, amid constant updates from the WHO about the target audience, their correct use and possible benefits, but where no protocols were defined for the management of the resulting waste. During the second half of 2020, the world population used 4.3 billion masks daily, of which 78.5% were discarded incorrectly, generating a volume of 2.61 (2.26-2.94; IC = 95%) million tons of waste disseminated in the environment. The plastic components incorporated in the manufacture of masks such as PP, PE and PET can take 400 years to degrade under environmental conditions, gradually fragmenting into microplastics, which affect the flora, fauna, water and soils of their environment. Additionally, some synthetic antioxidant additives (OA) used in the manufacture of plastics can further delay the degradation reactions of discarded masks into the environment, increasing their potential damage. It was calculated that 216.9 (188.5-245.3; IC = 95%) tons of AO168, 190 (165.2-214.9; IC = 96%) tons of AO168O and 442.7 (384.8 -500.6; IC = 95%) tons of AO1010 were exposed to the environment due to the incorrect disposal of masks in the second half of 2020. Although the combined mass of these synthetic components only represents 0.017% of the masks discarded in the same period, its concentration is sufficient to increase the risk of damage to the environment(AU)

Endoscopy mitigation strategy with telemedicine and low-cost device use for COVID-19 prevention: A fourth-level Colombian center experience.

BACKGROUND AND STUDY AIMS: The COVID-19 outbreak has reorganized surgical team conditions regarding endoscopy. The number of interventions has been reduced, the number of healthcare professionals must be limited, and both the patients and physicians are more protected than ever. PATIENTS AND METHODS: In the highest peak of contagion in Colombia, endoscopy, colonoscopy, and esophagogastroduodenoscopy were performed using a low-cost disposable device. A total of 1388 procedures were performed. Every patient was assessed for symptoms via a telephone call, at the health center, and after the procedure, following specific attention routes. RESULTS: After procedure follow-up, no positive cases of COVID-19 were noted. CONCLUSION: The methodology reduced the risk of infection during the COVID-19 pandemic.

Escovas de limpeza em centrais de materiais e esterilização: características e cuidados / Cleaning brushes in Central Materials and Sterilization

A limpeza é a primeira e mais essencial etapa antes que qualquer processo de desinfecção ou esterilização possa ocorrer. Nesta etapa ocorre a fricção manual dos materiais com escovas apropriadas a fim de eliminar sujidades. A depender das características, estas escovas podem ter um custeio elevado para os serviços de saúde, especialmente em países com recursos limitados como o Brasil. Elucidar, em tempo oportuno, o que traz a literatura sobre as características necessárias às escovas de limpeza em Centrais de Materiais e Esterilização (CME), especialmente sobre a necessidade de serem autoclavadas.

Qualidade e segurança no uso da insulinoterapia pela população idosa / Calidad y seguridad en el uso de la insulinoterapia por parte de la población de edad avanzada / Quality and safety in the use of insulin therapy by the aged population

Objetivo: avaliar a qualidade e segurança individual e coletiva no uso de insulina pela população idosa em um município de grande porte do sul do Brasil. Método: estudo transversal de base populacional realizado em 2016-2017 com idosos de 68 anos ou mais. As entrevistas foram realizadas nos domicílios dos idosos. O desfecho foi medido pela forma de utilização e descarte das seringas e agulhas. Realizou-se análise descritiva mediante cálculo das proporções e projeções dos dados para os idosos do município. Resultados: foram entrevistados 735 idosos. A prevalência de diabetes foi de 20,0%, e 13,8% faziam uso de insulina injetável. A reutilização das seringas e agulhas foi relatada por 55,0% e 65,0% referiram descartar o material direto no lixo comum. Conclusões: a qualidade e a segurança dos idosos em insulinoterapia estão comprometidas, sendo necessário implementar estratégias de educação em saúde que visem melhorar o conhecimento e acesso as orientações adequadas.

Objective: to evaluate individual and collective quality and safety in the use of insulin by the aged population in a large city of southern Brazil. Method: a cross-sectional population-based study conducted in 2016-2017 with older adults aged 68 and over. The interviews were conducted in the older adults' homes. The outcome was measured by the way in which syringes and needles were used and disposed of. Descriptive analysis was performed by calculating the data proportions and projections for the older adults in the municipality. Results: 735 older adults were interviewed. The prevalence of diabetes was 20.0%, and 13.8% made use of injectable insulin. Syringes and needle reuse was reported by 55.0%, and 65.0% mentioned discarding the material directly in regular garbage. Conclusions: the quality and safety of the older adults in insulin therapy are compromised, and it is necessary to implement health education strategies aimed at improving knowledge and access to the appropriate guidelines.

Objetivo: evaluar la calidad y la seguridad individual y colectiva en el uso de insulina por parte de la población de edad avanzada en un importante municipio del sur de Brasil. Método: estudio transversal de base poblacional realizado en 2016-2017 con ancianos de al menos 68 años de edad. Las entrevistas se realizaron en los domicilios de las personas de edad avanzada. El resultado se midió considerando la forma de utilización y descarte de las jeringas y agujas. Se realizó un análisis descriptivo mediante el cálculo de las proporciones y proyecciones de los datos para los ancianos del municipio. Resultados: se entrevistó a un total de 735 personas de edad avanzada. La prevalencia de diabetes fue del 20,0%, y el 13,8% utilizaba insulina inyectable. El 55,0% indicó que reutilizaba las jeringas y agujas y el 65,0% mencionó que desechaba el material directamente en la basura común. Conclusiones: la calidad y la seguridad de las personas de edad avanzada sometidas a insulinoterapia están en riesgo, por lo que resulta necesario implementar estrategias de educación en salud que tengan por objetivo mejorar el conocimiento y el acceso a las pautas adecuadas.

Reúso de dispositivos médicos de uso único e implicações para a segurança do paciente / Reuse of single use medical devices and implications for patienty safety / Reutilización de dispositivos médicos de uso individual e implicaciones para la seguridad del paciente

Objetivo: Descrever aspectos do reúso dos dispositivos médicos de uso único e as implicações dessa prática para a segurança do paciente. Método: Ensaio acadêmico, utilizando dados de revisão integrativa e expertise da autora. Resultados: O reúso de produtos de uso único é realidade mundial e ocasiona debates regulatórios, técnicos, econômicos, éticos e de segurança do paciente, denotando diversos interesses dos distintos atores envolvidos: Estado, fabricantes, serviços de saúde, academia, profissionais e usuários. Embora haja risco teórico, dados não identificam relação causal entre evento adverso e reúso desses produtos. Existem argumentos a favor e contra que compreendem riscos e benefícios e justiça distributiva e social. O rótulo desses produtos representa nó crítico e elemento fomentador dos dilemas que permeiam essa prática. Conclusão: Há consenso de que o reúso de um produto médico deve ter o mesmo padrão de segurança, independentemente se rotulado como de uso único ou de multiuso. Alguns produtos ditos de uso único podem ser seguramente reusados, mas essa prática requer condições organoestruturais dos serviços de saúde, além de expertise, adoção de protocolos e supervisão dessas atividades.

Objective: to describe aspects of the reuse of single-use medical devices and implications for patient safety. Method: academic essay, using integrative review data and author's expertise. Results: the reuse of single-use products is a worldwide reality and causes regulatory, technical, economic, ethical and patient safety debates, denoting several interests of the different actors involved: State, manufacturers, health services, academia, professionals and users. Although there is a theoretical risk, data do not identify a causal relationship between adverse events and reuse of these products. There are arguments for and against and are involved: risks and benefits, distributive and social justice. The label of these products represents a critical node and fomenting element of the dilemmas that permeate this practice. Conclusion: There is consensus that the reuse of a medical product should have the same safety standard, regardless of whether labeled as single-use or multipurpose. Some so-called single-use products can be safely reused, but this practice requires organo-structural conditions of health services, as well as expertise, adoption of protocols and supervision of these activities.

Objetivo: Describir aspectos de la reutilización de dispositivos médicos de un solo uso e implicaciones para la seguridad del paciente. Método: ensayo académico, utilizando datos de revisión integradores y la experiencia del autor. Resultados: La reutilización de productos de un solo uso es una realidad mundial y provoca debates regulatorios, técnicos, económicos, éticos y de seguridad del paciente, que denotan diversos intereses de los diferentes actores involucrados: Estado, fabricantes, servicios de salud, academia, profesionales y usuarios. Aunque existe un riesgo teórico, los datos no identifican una relación causal entre el evento adverso y la reutilización de estos productos. Hay argumentos a favor y en contra y están involucrados: riesgos y beneficios, justicia distributiva y social. La etiqueta de estos productos representa un nodo crítico y un elemento que fomenta los dilemas que impregnan esta práctica. Conclusión: Existe un consenso de que la reutilización de un producto médico debe tener el mismo estándar de seguridad, independientemente de si está etiquetado como de uso único o multipropósito. Algunos de los llamados productos de un solo uso pueden reutilizarse de manera segura, pero esta práctica requiere condiciones organoestructurales para los servicios de salud, además de experiencia, adopción de protocolos y supervisión de estas actividades.

Cotton-Tipped Plastic Swabs for SARS-CoV-2 RT-qPCR Diagnosis to Prevent Supply Shortages.

CDC and WHO guidelines for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis only recommend synthetic fiber swabs for nasopharyngeal (NP) sampling. We show that cotton-tipped plastic swabs do not inhibit PCR and have equivalent performance to rayon swabs. Cotton-tipped plastic swabs are massively produced worldwide and would prevent swab supply shortages under the current high SARS-CoV-2 testing demands, particularly in developing countries.

Laser-induced Damage to Disposable Single-mirror Trabeculoplasty Lens During Selective Laser Trabeculoplasty.

PURPOSE: To demonstrate disposable trabeculoplasty lens damage after routine selective laser trabeculoplasty (SLT) for primary open-angle glaucoma. METHODS: Disposable single-mirror laser lenses were used to perform SLT in 2 patients with primary open-angle glaucoma. Images of the single-use mirrors were taken before and after treatment. RESULTS: One lens showed heavy focal loss of reflectivity of its mirror with SLT settings of 0.8 to 0.9 mJ × 97 shots on a patient with a lightly pigmented angle. Aiming beam splashing or loss was noted after most shots. The second lens showed much less damage with 0.6 mJ × 90 shots in a heavily pigmented angle. CONCLUSION: Although single-use Gonio lenses have gained popularity for their role in infection control and elimination of wear and tear of reusable lenses, our cases show that damage occurs to the silver mirror because of high laser fluence, interfering with proper aiming and possibly diminishing delivered energy and treatment efficacy.

A novel disposable sensor for measure intra-abdominal pressure.

BACKGROUND: Measurement of intra-abdominal pressure (IAP) is realized with the Kron's method. However, this technique has drawbacks like an infusion of water into the bladder of the patient. OBJECTIVE: The prove a new novel disposable sensor in the way to measure the IAP (DSIAP) this one addresses some limitations of the Kron method. MATERIALS AND METHODS: The DSIAP was tested in vitro and clinical settings. The proposed technique was compared with Kron's method through Pearson correlation and Bland-Altman analysis. For in vitro tests, 159 measurements were taken performed by simulating the IAP in the bladder. For the clinical test, 20 pairs of measurements were made in patients with routine IAP monitoring in the intensive care unit. RESULTS: In vitro measurements showed a strong correlation between the DSIAP and the reference (r = 0.99, p-value < 2.2 × 10-16). The bias and 95% confidence intervals were 0.135 and -0.821-1.091 cmH2O, respectively. Measurements in patients with DSIAP versus Kron's method shown a very good correlation (r = 0.973, p-value < 5.46 × 10-13), while the bias and confidence intervals were 0.018 and -3.461-3.496 mmHg, respectively. CONCLUSIONS: The results suggest that the proposed DSIAP showed a profile similar to pressure transducers already in clinical use while overcoming some limitations of the former.

ANTECEDENTES: La medición de la presión intraabdominal (PIA) generalmente se realiza con el método de Kron, a pesar de presentar inconvenientes como la infusión de agua en la vejiga del paciente. OBJETIVO: Introducir un nuevo sensor desechable para medir la PIA (SDPIA) que aborda algunas limitaciones del método de Kron. MÉTODO: Se probó el SDPIA en pruebas in vitro y clínicas. La técnica se contrastó con el método de Kron empleando la correlación de Pearson y el análisis de Bland-Altman. Para las pruebas in vitro se realizaron 159 mediciones simulando la PIA en la vejiga. Para las pruebas clínicas se realizaron 20 mediciones en pacientes con monitorización rutinaria de la PIA en la unidad de cuidados intensivos. RESULTADOS: En las mediciones in vitro se encontró una alta correlación (r = 0.99; p < 2.2 × 10−16). El sesgo para la diferencia entre los dos métodos de medición fue de 0.135 cmH2O, con un intervalo de confianza del 95% de −0.821 a 1.091 cmH2O. En las mediciones clínicas también se encontró una alta correlación (r = 0.973; p < 5.46 × 10−13) para la diferencia entre los dos métodos de medición de 0.18, con un intervalo de confianza del 95% de −3.302 a 3.650 mmHg. CONCLUSIONES: Los resultados sugieren que el SDPIA propuesto muestra un desempeño similar al de los transductores de presión actualmente en uso clínico, mientras sobrelleva algunas limitaciones de estos últimos.

Design of novel, simple, and inexpensive 3D printing-based miniaturized electrochemical platform containing embedded disposable detector for analytical applications.

This paper describes the development of a novel, simple, and inexpensive electrochemical device containing an integrated and disposable three-electrode system for detection. The base of this platform consists on a PDMS structure containing microchannels which were prototyped using 3D-printed molds. Pencil graphite leads were inserted into these microchannels and utilized as working, counter and reference electrodes in a novel design. Morphological analysis and electrochemical experiments with benchmark redox probes were carried out in order to evaluate the performance and characterize the miniaturized device proposed. Even using inexpensive materials and a simple fabrication protocol, the electrochemical platform developed provided good repeatability and reproducibility over a low cost (ca. $2 per device), acceptable lifetime (ca. 250 voltammetric runs) and extremely reduced consumption of samples and reagents (order of µL). As proof of concept, the analytical feasibility of the platform was investigated through the simultaneous determination of dopamine (DOPA) and acetaminophen (AC). The two analytes showed linear dependence on the concentration range from 1 to 15 µM and the LODs achieved were 0.21 µM for DOPA and 0.29 µM for AC. Moreover, the platform was successfully applied on the determination of DOPA and AC in spiked blood serum and urine samples. The results obtained with the device described here were better than some reports in literature that use more costly electrodic materials and complex modification steps for the detection of the same analytes.

Can cover sheath model influence semen retention in AI-gun trials and pregnancy rates of cows inseminated at a fixed-time? / A bainha utilizada na inseminação artificial (IA) pode influenciar a retenção residual de sêmen e as taxas de concepção de vacas inseminadas em tempo fixo?

The achievement of satisfactory results in fixed-time artificial insemination (FTAI) protocols depends on several factors, such as the quality of the materials used to perform the artificial insemination (AI). In this context, three experiments were conducted to evaluate the effect of the cover sheath model on the residual retention of semen during AI and the pregnancy rates of cows submitted to FTAI. In Experiment 1, 400 straws of cryopreserved bovine semen were thawed and repacked in samples with similar weight and volume characteristics. Each new dose of semen (n = 300) was mounted using one of three AI cover sheath models (n = 100 semen/sheath doses): the main brand in the global market (G1), the main model in the Brazilian market (G2), and a model marketed as having a low residual semen retention rate (G3), to determine the percentages of seminal elimination (PSEs) during AI. In Experiment 2, 464 Nelore cows were synchronized through intravaginal progesterone implants and inseminated using the same cover sheaths as those tested in Experiment 1, which were grouped into classes (conventional: G1 and G2 [n = 225]; and low reflux: G3 [n = 239]). In Experiment 3, 859 Nelore cows were synchronized and inseminated as described above, using the same cover sheaths previously tested. After each AI, cover sheaths were visually inspected for the presence of residual semen and pregnancy diagnosis was performed 35 days after FTAI (Experiments 2 and 3). The PSEs in Experiment 1 were 91.7%, 90.6% and 96.5% for groups G1, G2 and G3, respectively (P = 0.05). The pregnancy rates in Experiment 2 were 53.33% and 58.16% for the conventional and low reflux model, respectively (P > 0.05), but there were differences (P = 0.05) among the cover sheath models employed for AI (G1 - 57.72% [71/123]; G2 - 48.04% [49/102]; G3 - 58.16% [139/239]). Additionally, a lower semen reflux incidence (P < 0.05) was observed in the low residual sperm retention model (0.72%) in Experiment 3, compared to the main international (10.42%) and national (22.99%) market models. In conclusion, residual semen retention occurs regardless of the cover sheath model used for AI. However, the PSE is influenced by the model and quality of cover sheath used. According to the results, the cover sheath represents a factor that may compromise the pregnancy rates of synchronized cows for FTAI.(AU)

Diversos fatores podem influenciar os resultados de concepção dos programas de inseminação artificial em tempo-fixo (IATF), como por exemplo a qualidade dos materiais utilizados para a inseminação artificial (IA). Nesse contexto, três experimentos foram conduzidos para testar o efeito da bainha sobre o percentual de retenção residual de sêmen nos aplicadores de IA e nas taxas de concepção de vacas submetidas à IATF. No Experimento 1 foram descongeladas 400 palhetas de sêmen bovino criopreservado, que foram re-envasadas para compor amostras com características de peso e volume semelhantes. Cada nova dose de sêmen (n=300) foi montada em um dos três modelos de bainhas de inseminação artificial em teste (n=100 doses de sêmen/ bainha): marca líder no mercado global (G1), modelo líder no mercado brasileiro (G2), modelo comercializado como de baixa taxa de retenção residual de sêmen (G3), para determinação do percentual de eliminação seminal (PES). No Experimento-2 foram selecionadas 464 vacas Nelore, sincronizadas através de implantes intravaginais de progesterona e inseminadas empregando as mesmas bainhas do experimento anterior, porém agrupadas em classes (convencional: G1 e G2 [n = 225]; ou baixo refluxo: G3 [n = 239]). No Experimento-3 859 vacas Nelore foram sincronizadas e inseminadas com sêmen previamente selecionado, utilizando os mesmos modelos de bainhas testadas nos experimentos anteriores. Após cada IATF as bainhas foram inspecionadas visualmente para detecção de presença residual de sêmen e o diagnóstico de gestação foi realizado a partir de 35 dias após a IATF (Experimentos 2 e 3). O PES foi de 91,7%, 90,6% e 96,5%, respectivamente para os grupos G1, G2 e G3 (P = 0,05). As taxas de concepção no Experimento-2 foram de 53,33% e 58,16%, respectivamente para o modelo convencional e de baixo refluxo (P > 0,05), porém havendo diferenças (P = 0,05) de acordo com o modelo da bainha empregada para a IA (57,72% [71/123], 48,04% [49/102] e 58,16% [139/239], respectivamente para os grupos G1, G2 e G3). Menor incidência de refluxo de sêmen (P < 0,05) foi observado para o modelo de baixa retenção residual de espermatozoides (0,72%), frente aos modelos líderes do mercado internacional (10,42%) e nacional (22,99%; Experimento-3). Conclui-se que ocorre retenção residual de sêmen, independente do modelo de bainha utilizada para a IA. No entanto, a PES é influenciada pelo modelo e qualidade da bainha utilizada para inseminação artificial, fator que pode comprometer os índices de concepção de vacas sincronizadas para IATF.(AU)

Zoonosis and veterinary waste disposal in rural practice / Zoonosis y disposición de desperdicios veterinarios en la práctica rural

The objectives of this study were to estimate: (a) the frequency of zoonoses in large animal veterinarians from rural areas of the province of Buenos Aires, Argentina, and (b) to describe the use and disposal of personal protective equipment (PPE) and selective veterinary clinical waste. A cross-sectional study was carried out on large animal veterinary practitioners in the Province of Buenos Aires (n = 106). One third (29.2%) of them had been diagnosed with a zoonosis by laboratory-methods, being brucellosis the most frequent (22.6%). The more years passed since their graduation, the greater the chances of becoming ill (p < 0.001). Gloves were the most adopted PPE; however, other elements had little or no use at all. Older and experienced professionals used PPE less frequently than young inexperienced practitioners. Some PPE was frequently reused and the final disposal of veterinary waste was often inappropriate. A change in behavior is an urgent need to preserve not only the veterinarians' health but also their families' wellbeing and to ensure proper disposal of potentially hazardous waste.

Los objetivos de este trabajo fueron los siguientes: a) estimar la frecuencia de zoonosis en veterinarios de grandes animales que desarrollan su labor en la provincia de Buenos Aires; b) describir el uso y la disposición de los elementos de protección personal (EPP) y otros residuos generados durante el trabajo de estos veterinarios. Para ello se realizó un estudio transversal en una muestra de 106 profesionales. En un tercio de ellos (29,2%) se había sido diagnosticado por métodos de laboratorio alguna zoonosis; la brucelosis fue la más frecuente (22,6%). Se encontró que a mayor tiempo transcurrido desde la graduación, mayor era la probabilidad de enfermarse (p< 0,001). Sobre la base de las respuestas obtenidas en cuestionarios estructurados, se determinó lo siguiente: que los guantes fueron el EPP más adoptado, mientras que otros elementos tuvieron escasa o nula adopción; que los profesionales de mayor edad y experiencia usaron EPP con menos frecuencia que los practicantes más jóvenes e inexpertos; y que algunos EPP se reutilizaban con frecuencia y que la eliminación final de los desechos veterinarios fue a menudo inapropiada. Considerando estos hallazgos, es claro que se requiere un cambio de comportamiento para preservar no solo la salud de los veterinarios, sino también para asegurar el bienestar de sus familias y garantizar la eliminación adecuada de los residuos potencialmente peligrosos.

Cantidad de descarte de materiales endodónticos contenidos en jeringas dispensadoras: un informe técnico / Discarded quantity of endodontic materials contained within dispenser syringes: a technical report

La presente comunicación tiene como objetivo informar sobre la cantidad de material que se pierde junto con las puntas dispensadoras descartables durante el uso de materiales endodónticos contenidos en jeringas y comprobar si esa cantidad es significativa en comparación con el contenido total original (15 g). Se procedió a pesar en una balanza de precisión 12 puntas dispensadoras descartables vacías, pertenecientes a dos materiales de uso endodóntico: 2Seal EasyMix (VDW) y Activa BioActive-Base/Liner (PulpDent Corp.). La sumatoria del peso (masa) en las 12 puntas pertenecientes a cada uno de los materiales ensayados fue considerada como peso total de las puntas vacías. Posteriormente, las puntas se llenaron completamente con los materiales, se almacenaron durante 48 horas para permitir el fraguado y finalmente se las pesó nuevamente. La diferencia entre el peso de las 12 puntas vacías y llenas fue considerada como la cantidad de material remanente que se descarta con ellas. La diferencia entre los totales de masa contenida en las puntas llenas de cada material y el contenido original de las jeringas representó la proporción de material que se descarta sin haber sido utilizado. Cuando el porcentaje de material descartado fue menor o igual al 20%, el resultado se consideró aceptable. Se observó que la proporción de ambos materiales fue mayor al 20% (2Seal EasyMix=44,36%; Activa BioActive-Base/Liner=36,87%). Se concluyó que el empleo de materiales endodónticos contenidos en jeringas dispensadoras produce la pérdida de una importante proporción de material durante los procedimientos operatorios (AU)

In order to inform about the amount of material that is lost along with the disposable dispensing tips during the use of endodontic materials contained in deliver syringes and check if that amount is significant compared to the total original content (15 g) of them. 12 empty disposable dispensing tips belonging to two endodontic materials: 2Seal EasyMix (VDW) and ActivaBioactive Base/liner (PulpDent Corp.), were weighed on a precision scale. The sum of the weight (mass) of each of the 12 tips belonging to each of the materials tested was considered as the total weight of the empty tips. Subsequently, the tips were completely filled with the materials, stored for 48 hours to allow them to set and finally weighed again. The difference between the weight of the 12 empty and full tips was considered as the amount of material remaining within them that is discarded. The difference between the total mass contained in 12 filled tips of each material and the original syringe content represented the proportion of material discarded without being used. It was considered that if the % of discarded material was ≤20% this would be considered acceptable. It was observed that the proportion of both materials was >20% (2Seal EasyMix = 44.36%; ActivaBioactive Base/liner = 36.87%). The use of endodontic materials contained in dispensing syringes causes the loss of a significant proportion of material during the operative procedures (AU)

Randomized Clinical Trial Using Sterile Single Use and Reused Polyvinylchloride Catheters for Intermittent Catheterization with a Clean Technique in Spina Bifida Cases: Short-Term Urinary Tract Infection Outcomes.

PURPOSE: Urinary tract infections are common and severe complications in patients with spina bifida. Management includes intermittent bladder catheterization with single use or reused sterile catheters. There is insufficient evidence to set a standard among the different techniques. We determined whether single use polyvinylchloride catheters would reduce urinary tract infections compared to reused polyvinylchloride catheters in patients with neurogenic bladder due to spina bifida. MATERIALS AND METHODS: We performed a 2-arm randomized parallel clinical trial from 2015 to 2016 with an 8-week followup at our center in patients with neurogenic bladder caused by spina bifida. Patients were divided into single use and reused polyvinylchloride catheter groups. Evaluations were done on days 0, 7, 14, 28, 42 and 56. Participants reported symptoms and urine cultures were obtained. The primary outcome was urinary tract infection frequency, defined as positive urine culture plus fever, flank pain, malaise, or cloudy or odorous urine. Study eligibility criteria were age 2 years or greater, spina bifida diagnosis with regular clean intermittent bladder catheterization and no urinary tract infection at initial evaluation. RESULTS: The calculated sample size was 75. Of the patients 135 were screened, 83 were randomized and 75 completed followup. Mean age was 12.7 years (range 2-56) and there were 29 males and 46 females. No statistical difference was found between the single use vs reused catheter groups in the frequency of asymptomatic bacteriuria (32.4% vs 23.7%, p = 0.398) or urinary tract infections (35.2% vs 36.8%, p = 0.877). CONCLUSIONS: Single use polyvinylchloride catheters for intermittent bladder catheterization did not decrease the incidence of urinary tract infections in our patients with neurogenic bladder compared to reused polyvinylchloride catheters. These results are consistent with the 2014 Cochrane Review.

Zoonosis and veterinary waste disposal in rural practice.

The objectives of this study were to estimate: (a) the frequency of zoonoses in large animal veterinarians from rural areas of the province of Buenos Aires, Argentina, and (b) to describe the use and disposal of personal protective equipment (PPE) and selective veterinary clinical waste. A cross-sectional study was carried out on large animal veterinary practitioners in the Province of Buenos Aires (n=106). One third (29.2%) of them had been diagnosed with a zoonosis by laboratory-methods, being brucellosis the most frequent (22.6%). The more years passed since their graduation, the greater the chances of becoming ill (p<0.001). Gloves were the most adopted PPE; however, other elements had little or no use at all. Older and experienced professionals used PPE less frequently than young inexperienced practitioners. Some PPE was frequently reused and the final disposal of veterinary waste was often inappropriate. A change in behavior is an urgent need to preserve not only the veterinarians' health but also their families' wellbeing and to ensure proper disposal of potentially hazardous waste.