What is the best score for predicting difficult laparoscopic cholecystectomy? A diagnostic trial study.

BACKGROUND: Multiple scores have been created in order to predict difficult cholecystectomy, nonetheless there is not a consensuated standard on which to use. The importance of a predictive score to be able to establish a difficult cholecystectomy would be a relevant instrument in order to better inform the patient, properly call for help when needed, choose the correct staff, and schedule and plan the surgical procedure accordingly. METHODS: A diagnostic trial study was performed. All different predictive scores for difficult cholecystectomy were calculated for each patient. The correlation between the preoperative score and cholecystectomies considered as "difficult" were measured estimating the preoperative score's predictive value using a receiver operating characteristics curve in order to predict findings for difficult cholecystectomy. RESULTS: A total of 635 patients between 2014 and 2021 were selected. Selected patients had a mean age of 55.0 (interquartile range: 28.00) and were mostly female (64.25%). Surgical outcomes of patients with difficult cholecystectomy had statistically significant higher rates of subtotal cholecystectomies, drain usage, complications and reinterventions, prolonged surgical times, and longer hospital stay. When analyzing the predictive value on each of the different scores applied, score 4 had the highest performance for predicting difficult cholecystectomy with an area under the curve=0.783 (CI 95% 0.745-0.822). CONCLUSIONS: Difficult cholecystectomies are associated with worse surgical outcomes. The standardization and use of predictive scores for difficult cholecystectomy must be implemented in order to improve surgical outcomes as a result of more meticulous planning when scheduling the procedure.

Bilateral Acute Iris Transillumination Syndrome after Topical Moxifloxacin/Dexamethasone Initially Misdiagnosed as Uveitis: Case Report.

Bilateral acute iris transillumination (BAIT) syndrome is a rare condition of unknown etiology, characterized by acute onset of pigment dispersion in the anterior chamber, depigmentation of the iris, and heavy pigment deposition in the anterior chamber angle, with bilateral involvement in most cases. We present a case of a 46-year-old healthy woman, who developed BAIT in both eyes, following the use of topical moxifloxacin/dexamethasone for bilateral bacterial conjunctivitis, followed by a nonarteritic anterior ischemic optic neuropathy in the left eye.

Mudança no perfil do aleitamento materno exclusivo em um território vulnerável do município de Fortaleza ­ Ce durante a pandemia do novo coronavírus / Change in the profile of exclusive breastfeeding in a vulnerable territory in the city of Fortaleza - Ce during the pandemic of the new coronavirus / Cambio en el perfil de lactancia materna exclusiva en un territorio vulnerable de la ciudad de Fortaleza - Ce durante la pandemia del nuevo coronavirus

Introdução: A prevalência do aleitamento materno exclusivo (AME) no Brasil permanece aquém do recomendado pela Organização Mundial da Saúde, principalmente no Nordeste. Destaca-se o papel da Atenção Primária à Saúde (APS), imprescindível para a manutenção do AME. Em 2020, entretanto, a APS de Fortaleza deixou de realizar parte de suas funções devido à pandemia do novo coronavírus (COVID-19), o que pode ter causado prejuízos ainda não identificados para o AME. Objetivo: Avaliar se houve mudanças na duração do AME durante a pandemia de COVID-19 em um território adscrito a uma Equipe de Saúde da Família (ESF) em Fortaleza. Métodos: Estudo observacional, transversal e quantitativo, pela revisão de prontuários das crianças assistidas pela equipe da ESF Lagamar 1, nascidas de setembro de 2018 a junho de 2019 (grupo pré-pandêmico) e de setembro de 2019 a junho de 2020 (grupo pandêmico). Os prontuários permitiram estabelecer a mediana das variáveis: duração do AME, número de consultas de puericultura até os seis meses de idade e de pré-natal durante a gestação, idade e paridade maternas e realizar a comparação entre os grupos. Resultados: Foram analisados 39 prontuários, sendo dois retirados do estudo por critérios de exclusão. Dos remanescentes, 15 (40,54%) pertenciam ao grupo pré- pandêmico e 22 (59,46%) ao pandêmico. A mediana do tempo de duração do AME foi de 2 meses e 1,5 mês, respectivamente. Houve redução ainda da mediana da idade materna (de 25 para 21 anos) e da paridade da nutriz (de dois para 1,5) entre os grupos. Além disso, durante o período pandêmico, 12 crianças já não estavam em AME no primeiro contato com a ESF. Conclusões: Houve redução na duração mediana do AME na ESF do Lagamar durante a pandemia de COVID-19. Contudo, o presente estudo teve limitações, como o pequeno tamanho da amostra. É necessária, portanto, a realização de outros estudos para fornecer evidências robustas e explicações acerca dos resultados encontrados para as variáveis.

Introduction: The prevalence of exclusive breastfeeding (EBF) in Brazil remains below that recommended by the World Health Organization, especially in the Northeast. The role of Primary Health Care (PHC) is highlighted, essential for maintaining EBF. In 2020, however, the PHC in Fortaleza ceased to carry out its functions due to the new coronavirus (COVID-19) pandemic, which may have caused unidentified damage to the EBF. Objective: Assess whether there were changes in the duration of EBF during the COVID-19 pandemic in a territory assigned to a Family Health Team (FHT) in Fortaleza. Methods: Observational, cross-sectional and quantitative study, by reviewing the medical records of children assisted by the FHT Lagamar 1 team, born from September 2018 to June 2019 (pre-pandemic group) and from September 2019 to June 2020 (pandemic group). The medical records allowed establishing the median of the variables: duration of EBF, number of childcare consultations up to six months of age and prenatal care during pregnancy, maternal age and parity, and comparison between groups. Results: A total of 39 medical records were analyzed, two of which were removed from the study due to exclusion criteria. Of the remainder, 15 (40.54%) belonged to the pre- pandemic group and 22 (59.46%) to the pandemic. The median duration of EBF was 2 months and 1.5 months, respectively. There was also a reduction in the median maternal age (from 25 to 21 years) and the mother's parity (from two to 1.5) between groups. In addition, during the pandemic period, 12 children were no longer on EBF at the first contact with the FHT. Conclusions: There was a reduction in the median duration of EBF at the Lagamar FHT during the COVID-19 pandemic. However, the present study had limitations, such as the small sample size. It is therefore necessary to carry out other studies to provide robust evidence and explanations about the results found for the variables.

Introducción: La prevalencia de lactancia materna exclusiva (LME) en Brasil se mantiene por debajo de lo recomendado por la Organización Mundial de la Salud, especialmente en el Nordeste. Se destaca el papel de la Atención Primaria de Salud (APS), esencial para el mantenimiento de la LME. Sin embargo, en 2020, la APS de Fortaleza dejó de ejercer sus funciones debido a la nueva pandemia de coronavirus (COVID-19), que puede haber causado daños no identificados a la LME. Objetivo: Evaluar si hubo cambios en la duración de la FEB durante la pandemia de COVID-19 en un territorio asignado a un Equipo de Salud de la Familia (ESF) en Fortaleza. Método: Estudio observacional, transversal y cuantitativo, mediante la revisión de las historias clínicas de los niños atendidos por el equipo FHT Lagamar 1, nacidos de septiembre de 2018 a junio de 2019 (grupo prepandémico) y de septiembre de 2019 a junio de 2020 (grupo pandémico). Las historias clínicas permitieron establecer la mediana de las variables: duración de la FEB, número de consultas de puericultura hasta los seis meses de edad y cuidados prenatales durante el embarazo, edad materna y paridad, y comparación entre grupos. Resultados: Se analizaron 39 historias clínicas, dos de las cuales fueron eliminadas del estudio por criterios de exclusión. Del resto, 15 (40,54%) pertenecían al grupo prepandémico y 22 (59,46%) al pandémico. La duración media de la FEB fue de 2 meses y 1,5 meses, respectivamente. También hubo una reducción de la mediana de la edad materna (de 25 a 21 años) y de la paridad de la madre (de 2 a 1,5) entre los grupos. Además, durante el periodo pandémico, 12 niños dejaron de recibir LME en el primer contacto con el FHT. Conclusiones: Durante la pandemia de COVID-19 se produjo una reducción de la mediana de duración de la LME en el FHT de Lagamar. Sin embargo, el presente estudio tuvo limitaciones, como el pequeño tamaño de la muestra. Por lo tanto, es necesario llevar a cabo otros estudios para proporcionar pruebas sólidas y explicaciones sobre los resultados encontrados para las variables.

Caracterização de mães e recém-nascidos pré-termo em uma unidade de terapia intensiva neonatal / Characterization of mothers and preterm newborns in a neonatal intensive care unit / Caracterización de madres y recién nacidos pretérminos en una unidad de cuidado intensivo neona-tal

Objetivo: Objetivou-se caracterizar o perfil sociodemográfico e clínico dos recém-nascidos pré-termo de uma Unidade de Terapia Intensiva Neonatal. Método: Trata-se de um estudo observacional, descritivo e quantitativo realizado em uma UTIN em Fortaleza-CE, de janeiro a novembro de 2017. A amostra foi composta por 70 recém-nascidos pré-termo. A coleta de dados foi feita por meio de um formulário, contendo as características demográficas e clínicas das mães e dos recém-nascidos. Resultados: Dentre os principais resultados, destacam-se: 69,6% das mães tinham idade entre 20-34 anos, 22,1% fizeram cinco consultas de pré-natal, 29,4% apresentaram doença hipertensiva específica da gestação. Concernente aos recém-nascidos, quanto à idade gestacional, a maioria era pré-termo extremo (85,3%), extremamente baixo peso (50%) e estavam sob ventilação mecânica (78,6%). Conclusão: Por meio do conhecimento das características dos recém-nascidos internados, deve-se visar à melhor assistência pré-natal, prever recursos e treinar os profissionais, no intuito de melhorar a assistência à saúde na Unidade de Terapia Intensiva Neonatal (AU).

Objective: The objective was to characterize the sociodemographic and clinical profile of preterm newborns in a Neonatal Intensive Care Unit. Method: This is an observational, descriptive and quantitative study performed in a Neonatal Intensive Care Unit in Fortaleza-CE, from January to November 2017. The sample was composed of 70 preterm newborns. Data collection took place using a form, containing the demographic and clinical characteristics of mothers and newborns. Results: Among the main results, one highlights: 69.6% of the mothers were aged between 20 and 34 years, 22.1% underwent five prenatal consultations, 29.4% presented hypertensive diseases specific to pregnancy. With regard to newborns, as for gestational age, most were extremely preterm (85.3%), extremely underweight (50%) and were undergoing mechanical ventilation (78.6%). Conclusion: Through knowledge of the characteristics of hospitalized newborns, we should aim at achieving better prenatal care, providing resources and training professionals, in order to enhance health care in the Neonatal Intensive Care Unit (AU).

Objetivo: El objetivo fue caracterizar el perfil sociodemográfico y clínico de los recién nacidos prematuros en una Unidad de Cuidado Intensivo Neonatal. Método: Estudio observacional, descriptivo y cuantitativo llevado a cabo en una Unidad de Cuidado Intensivo Neonatal en Fortaleza-CE, de Ene. hasta Nov. 2017. La muestra se compuso de 70 recién nacidos prematuros. La recolección de datos tuvo lugar mediante un formulario que contiene las características demográficas y clínicas de las madres y los recién nacidos. Resultados: Entre los principales resultados, se señalan: el 69,6% de las madres tenían entre 20 y 34 años, el 22,1% hicieron cinco consultas prenatales, el 29,4% presentaron una enfermedad hipertensiva específica del embarazo. Con respecto a los recién nacidos, acerca de la edad gestacional, la mayoría eran extremadamente pretérminos (85,3%), con un peso extremadamente bajo al nacer (50%) y estaban bajo ventilacion mecanica (78,6%). Conclusión: A través del conocimiento de las características de los recién nacidos hospitalizados, se debe buscar una mejor atención prenatal, predecir recursos y capacitar a profesionales, con miras a mejorar la atención de salud en la Unidad de Cuidado Intensivo Neonatal (AU).

Left diaphragmatic hernia following thoracoabdominal aortic repair: A case report.

INTRODUCTION: Diaphragmatic hernias are somewhat rare complications of thoracoabdominal interventions. Given their late clinical manifestations and misdiagnosis, their incidence is unknown. These hernias have a high mortality risk when an emergency intervention is warranted due to complications from visceral strangulation. CASE PRESENTATION: We present the case of a 67-year-old male with prior history of thoracoabdominal aortic repair, who reconsults due to upper gastrointestinal bleeding. Upon arrival, imaging shows a left diaphragmatic herniation with migration of the stomach, omentum and spleen to the thoracic cavity. Through laparoscopic approach, a left diaphragmatic hernial defect is identified with protrusion of half the stomach, omentum and the posterior aspect of the spleen with a sub capsular tear. Additionally, a severe adhesion syndrome on the chest wall and diaphragm were also evident, with entrapment of the inferior lobe of the left lung. The contents were successfully reduced, however pulmonary decortication and extensive adhesiolysis through thoracoscopy was required for complete extraction, enabling a primary repair without tension. CONCLUSIONS: We present an infrequent pathology without an established incidence, which has relevant clinical and surgical implications at any level of care, in this case requiring interdisciplinary management. The suspicion of diaphragmatic hernia in a patient with past medical history of thoracoabdominal aortic repair with non-specific gastrointestinal symptoms is essential. We emphasize the importance of clinical suspicion of this complication once the surgical precedent has been identified.

Efectos adversos a nivel cardiovascular y neurológico asociados al consumo de modafinilo / Adverse effects at the cardiovascular and neurological level associated with the consumption of modafinil

Resumen Introducción: el modafinilo es un fármaco neuroestimulante utilizado principalmente para promover estados de vigilia atención y disminuir la fatiga ante ciertos comportamientos que propician la somnolencia diurna excesiva. Objetivo: identificar en la literatura científica los efectos adversos neurológicos y cardiovasculares causados por el consumo del modafinilo. Materiales y Métodos: revisión bibliográfica de los artículos encontrados entre los meses de abril y julio de 2019 en las bases de datos PUBMED, SCOPUS, DIALNET. 51 artículos superaron la evaluación de calidad metodológica y se incluyeron en la revisión. Resultados: se identificaron que los principales efectos adversos a nivel cardiovascular son la cardiomiopatía Tako-Tsubo y la taquicardia ventricular polimórfica, mientras que a nivel neurológico puede generar insomnio y distonías. Conclusiones: El consumo del modafinilo genera repercusiones en las funciones cognitivas y cardiovasculares por lo cual no es aconsejable su uso a largo plazo en personas sanas. MÉD. UIS.2020;33(1):31-8.

Abstract Introduction: modafinil is a neurostimulant drug used mainly to promote wakefulness, attention and decrease fatigue in certain behaviors that cause excessive daytime sleepiness. Objective: identify in the scientific literature the neurological and cardiovascular adverse effects caused by the consumption of modafinil. Materials and Methods: bibliographic review of the articles found between the months of April and July of 2019 in the PUBMED, SCOPUS, DIALNET databases. 51 articles passed the methodological quality assessment and were included in the review. Results: the main adverse effects at the cardiovascular level were identified as Tako-Tsubo cardiomyopathy and polymorphic ventricular tachycardia, while at the neurological level it can generate insomnia and dystonia. Conclusions: the consumption of modafinil generates repercussions on cognitive and cardiovascular functions, so its long-term use in healthy people is not advisable. MÉD.UIS.2020;33(1):31-8.

Conceptions of health education practices in the context of Nursing Education / Concepções das práticas de educação em saúde no contexto da formação em Enfermagem

Objective: to understand health education practices in the context of nursing education. Methods: a qualitative study held in a private Higher Education Institution. The participants were 22 subjects who answered a semi-structured interview, whose information was organized and analyzed by the content analysis method. Results: three categories were identified: health education and the nurse as an educator; health education in primary care; and comparison of educational practices in levels of care. Conclusion: the students understood the importance of health education in their training, and felt the need to expand these practices to all health care levels.

Compreender as práticas de educação em saúde no contexto da formação em enfermagem. Métodos:estudo qualitativo, realizado em Instituição de Ensino Superior da rede privada. Participaram 22 sujeitos, queresponderam a uma entrevista semiestruturada, cujas informações foram organizadas e analisadas pelo métodode Análise Conteúdo. Resultados: identificaram-se três categorias: educação em saúde e o enfermeiro comoeducador; educação em saúde na atenção primária; e comparativo das práticas educativas nos níveis de atenção.Conclusão: os acadêmicos compreenderam a importância da educação em saúde em sua formação, e sentiam anecessidade de expandir essas práticas para todos os níveis de atenção em saúde.

Initiation or maintenance of beta-blocker therapy in patients hospitalized for acute heart failure.

Background Beta-blockers have been recommended for patients with heart failure and reduced ejection fraction for their long-term benefits. However, the tolerance to betablockers in patients hospitalized with acute heart failure should be evaluated. Objective To estimate the proportion of patients hospitalized with acute heart failure who can tolerate these agents in clinical practice and compare the clinical outcomes of patients who can and cannot tolerate treatment with beta-blockers. Setting Two reference hospitals in cardiology. Methods Retrospective cohort study of consecutive patients hospitalized for acute heart failure between September 2008 and May 2012. Population-based sample. During the study period, 325 patients were admitted consecutively, including 194 individuals with an acute heart failure diagnosis and systolic left ventricular dysfunction and ejection fraction ≤45 %, who were candidates for the initiation or continuation of beta-blockers. Main outcome measure The percentage of patients intolerant to beta-blockers and the clinical characteristics of patients. Results On admission, 61.8 % of patients were already using beta-blockers, and 73.2 % were using beta-blockers on discharge. During hospitalization, 85 % of patients used these agents for some period. The main reasons for not using betablockers were low cardiac output syndrome (24.4 %), bradycardia (24.4 %), severe hypotension or shock (17.8 %), and chronic obstructive pulmonary disease (13.3 %). Patients who were intolerant or did not use a beta-blocker had a longer hospital stay (18.3 vs. 11.0 days; p < .001), greater use of vasoactive drugs (41.5 vs. 16.3 %; p < .001, CI 1.80-7.35), sepsis and septic shock (RR = 3.02; CI 95 % 1.59-5.75), and higher mortality rate during hospitalization (22.6 vs. 2.9 %; p < .001; CI 3.05-32.26). Conclusion Beta-blockers could be used in 73.2 % of patients hospitalized for acute heart failure. Patients who can not tolerate BB presented a higher frequency of adverse clinical outcomes including frequency of sepsis, use of vasoactive drugs, average length of hospitalization, and death.

A interdisciplinaridade vivenciada em um grupo de idosos de uma unidade de saúde da família do Recife / The interdisciplinarity experienced in a group of elderly from a family health unit in Recife

O crescimento da população idosa associado às doenças crônicas constitui-se em desafio à saúde pública por aumentar o risco de incapacidades. Assim, o atendimento à saúde engloba uma equipe com objetivo não de prolongar a vida, mas manter a capacidade funcional, para que o indivíduo permaneça autônomo e independente. O trabalho em equipe interdisciplinar possibilita troca de saberes entre o campo da saúde e núcleos profissionais, inovando a assistência. A Estratégia Saúde da Família prioriza a promoção da saúde e os grupos transformam-se em uma prática da equipe. Este estudo tem como objetivo relatar experiência interdisciplinar vivenciada em uma Unidade de Saúde da Família (USF) com um Grupo de Idosos, por meio do Programa de Educação pelo Trabalho para a Saúde (PET-Saúde) desenvolvido na Universidade Federal de Pernambuco (UFPE). A participação dos estudantes no Grupo de Idoso contribuiu para incrementar as ações da equipe de saúde da USF, uma vez que auxiliaram e dinamizaram as atividades voltadas para a educação e promoção em saúde com os idosos participantes.

The growth of the elderly population Associated with chronic diseases such as diabetes, cancer, cardiovascular and mental diseases, is a major challenge to public health for increasing the risk of disability and severe disabilities. Thus, the health care encompasses a team and the goal is not only to prolong life, but maintaining functional ability for the individual to remain autonomous and independent as long as possible. The work of an interdisciplinary team allows the exchange of specific and general knowledge among the field of occupational health and nuclei, innovating assistance to users. From this perspective, the Education Program for Health at Work (PET-Health) offered the possibility of interdisciplinary learning by placing students in the daily work of the staff of Primary Health. Considering that Family Health is a strategy for reorienting the health care model that prioritizes health promotion activities with user groups, by health status or life cycle, have become a necessary practice to work family health team. The objective of this study is to report the interdisciplinary experiences in a Family Health Unit (FHU) with the Elderly Group, through the PET-Health, from the Federal University of Pernambuco (UFPE). The participation of caregivers in the Elderly Group contributed to increasing the team's actions, since they helped and boosted the activities aimed at education and health promotion in the Elderly Group.

Alterações nos parâmetros fisiológicos dos recém-nascidos sob oxigenoterapia na coleta de gasometria / Alterations in the physiological parameters of newborns using oxygen therapy in the collection of blood gases

Objetivo: Identificar as alterações que ocorrem nos parâmetros fisiológicos dos recém-nascidos sob oxigenoterapia na coleta de gasometria arterial, comparando os momentos imediatamente antes, imediatamente depois, e cinco minutos depois do procedimento. Métodos: Estudo longitudinal, do tipo antes e depois,. Amostra composta por 67 recém-nascidos sob oxigenoterapia que receberam punção arterial para gasometria. Resultados: O grupo de recém-nascidos em Oxi-Hood sofreu alterações significativas (p<0,05) na frequência cardíaca, pulso e saturação de oxigênio. Os recém-nascidos em ventilação mecânica obtiveram alterações de frequência respiratória e pulso e aqueles sob CPAP nasal não mostraram instabilidade dos parâmetros fisiológicos. Conclusão: O estímulo doloroso causado pela coleta de gasometria nos recém-nascidos mostrou variações de todos os parâmetros fisiológicos, porém, para tal procedimento, as alterações foram diferentes em cada modalidade de oxigenoterapia. .

Objective: To identify the changes that occur in the physiological parameters of newborns under oxygen therapy during the collection of arterial blood gases, comparing the moments immediately before, immediately after, and five minutes after the procedure. Methods: A longitudinal study, of the before and after research design. The sample was composed of 67 newborns under oxygen therapy that had an arterial puncture for blood gas analysis. Results: The group of newborns in an Oxyhood experienced significant alterations (p<0.05) in heart rate, pulse and oxygen saturation. Newborns on mechanical ventilation had alterations in respiratory rate and pulse, while those with nasal CPAP showed no instability in physiological parameters. Conclusion: The painful stimulus caused by the collection of blood gases in newborns showed changes in all physiological parameters, however, for such a procedure, the changes were different for each mode of oxygen therapy. .

Propafenone versus vernakalant for conversion of recent-onset atrial fibrillation.

INTRODUCTION: An oral loading dose of propafenone 600 mg is used in our center as in other places around the world for conversion of recent-onset atrial fibrillation (AF) in patients without structural heart disease. Vernakalant is a novel, safe, and effective drug used intravenously and has proved to be more rapid in converting recent-onset AF to sinus rhythm compared with placebo and amiodarone. There is no study that compares vernakalant with propafenone. The aim of our study is to compare the time taken for conversion of recent-onset AF in patients treated with vernakalant and propafenone. METHODS: Thirty-six hemodynamically stable patients with recent-onset AF without structural heart disease were prospectively included. A single oral dose of propafenone 600 mg was administered to 19 patients and 17 received intravenous vernakalant. Clinical and laboratory variables, conversion rate, and time to conversion were recorded. RESULTS: Baseline characteristics were similar in both groups. Time to conversion to sinus rhythm was of 166 min (120-300) in the propafenone group versus 9 min (6-18) in the vernakalant group (P = 0.0001). Conversion rate was of 78% in the propafenone group at 8 h and of 93% in the vernakalant group at 2 h; yet, this difference was not statistically significant (P = 0.4). Time to conversion had a direct impact in hospital stay, which was 43% shorter in the vernakalant group (P = 0.0001). CONCLUSION: Time to conversion of AF to sinus rhythm was significantly shorter in the vernakalant group compared with the propafenone group and was associated with shorter hospital stay.

Is there evidence favoring the use of beta-blockers and dobutamine in acute heart failure?

Several studies have reported the benefits of beta-blockers (BB) for patients presenting with systolic heart failure. however, many patients hospitalized as a result of acute heart failure are already using BB and require dobutamine for arterial hypotension and low cardiac output. Therefore, a decision must be made regarding whether BB should be maintained or even started in such cases. The aim of this study was to establish whether there is evidence supporting the safety andyeffectiveness of BB together with dobutamine for patients presenting with acute decompensated heart failure (ADHF). We conducted a search of the English-language literature in the databases MEDLINE, ISI Web of Science, Virtual Health Library, Cochrane Library and the CAPES Portal of Scientific Journals to identify related studies. Additional literature was obtained through the review of relevant references in the identified articles. The expected outcomes included information on the prognosis (in-hospital and on follow-up mortality, number of days of hospitalization and readmission),yeffectiveness and safety (worsening of symptoms, shock, intolerance) of the concomitant use of these drugs in hospitalized patients with ADHF and low cardiac output. This review included nine studies. however, no randomized clinical trials on this subject were found. Most studies include a low number of patients, and no studies addressing the safety of the concomitant use of these drugs were found. The resulting data suggest that a careful literature review did not supply evidence for the systematic use of BB in patients with low cardiac output syndrome who require dobutamine for inotropic support.

Avaliação da completitude e consistência do banco de dados das hepatites virais no Estado de Pernambuco, Brasil, no período de 2007 a 2010* / Evaluation of viral hepatitis database completeness and consistency in the State of Pernambuco, Brazil, 2007-2010

Objetivo: avaliar a completitude e consistência do banco de dados das hepatites virais do estado de Pernambuco e suas Gerências Regionais de Saúde. Métodos: foi realizado estudo descritivo com o universo das notificações de hepatites virais do Sistema de Informação de Agravos de Notificação (Sinan) no período 2007-2010. Resultados: do total de 4.974 casos confirmados, havia falta de preenchimento em 6,9 por cento dos registros sobre forma clínica, 51,9 por cento sobre fonte de infecção, 9,5 por cento sobre classificação etiológica e 16,6 por cento sobre classificação final; havia inconsistências em 66,2 por cento dos registros sobre provável fonte ou mecanismo de infecção, 9,5 por cento sobre resultado sorológico para hepatite A, 32,6 por cento para hepatite B e 12,3 por cento para hepatite C, assim como para a variável classificação etiológica (15,0 por cento); os indicadores de completitude e consistência apresentaram variações entre as Regionais de Saúde. Conclusão: constataram-se problemas, especialmente relacionados à completitude sobre fonte de infecção e consistência sobre confirmação do resultado sorológico, em todas as Regionais de Saúde.

Objective: to evaluate viral hepatitis database completeness and consistency in Pernambuco state and respective health regions. Methods: a descriptive study was performed on the viral hepatitis records contained on the Notifiable Diseases Information System for the period 2007-2010. Results: of the total of 4,974 confirmed cases, the following variables had incomplete data: clinical form (6.9 per cent); source of infection (51.9 per cent), etiological classification (9.5 per cent) and case conclusion (16.6 per cent). The inconsistencies found included 66.2 per cent of records on probable source of infection or exposure, serologic results for hepatitis A (9.5 per cent), hepatitis B (32.6 per cent), hepatitis C (12.3 per cent) and etiologic classification (15.0 per cent). Conclusion: problems were found mainly related to completeness of source of infection data and inconsistency of the serologic confirmation variable in all health regions.

Há evidências favorecendo o uso de betabloqueadores e dobutamina na insuficiência cardíaca aguda? / Is there evidence favoring the use of beta-blockers and dobutamine in acute heart failure?

Diversos estudos relataram os benefícios dos betabloqueadores (BB) para pacientes com insuficiência cardíaca sistólica. No entanto, muitos pacientes hospitalizados em decorrência de insuficiência cardíaca aguda já estão usando os BB e requerem dobutaminas para hipotensão arterial e baixo débito cardíaco. Portanto, deve-se tomar uma decisão a respeito de se o BB deve ser mantido ou até mesmo iniciado nesses casos. O objetivo deste estudo foi determinar se há provas que sustentem a segurança e a eficácia dos BB junto com a dobutamina para pacientes com insuficiência cardíaca aguda descompensada (ICAD). Foi realizada uma pesquisa na literatura de língua inglesa nas bases de dados MEDLINE, ISI Web of Science, Biblioteca Virtual em Saúde, Cochrane Library e o Portal de Revistas Científicas do Capes para identificar estudos relacionados. Literatura adicional foi obtida mediante a análise das respectivas referências encontradas nos artigos identificados. Os resultados esperados incluíram informações sobre o prognóstico (intra-hospitalar e na mortalidade no acompanhamento, número de dias de internação e reinternação), eficácia e segurança (agravamento dos sintomas, choque, intolerância) do uso concomitante desses medicamentos em pacientes hospitalizados com ICAD e baixo débito cardíaco. Esta análise incluiu nove estudos. No entanto, não foram encontrados ensaios clínicos randomizados sobre o assunto. A maioria dos estudos inclui baixo número de pacientes, e não foram encontrados estudos que abordem a segurança do uso concomitante desses medicamentos. Os dados resultantes sugerem que uma cuidadosa revisão da literatura não forneceu evidências para o uso sistemático de BB em pacientes com síndrome de baixo débito cardíaco que necessitam de suporte inotrópico com dobutamina.

Several studies have reported the benefits of beta-blockers (BB) for patients presenting with systolic heart failure. however, many patients hospitalized as a result of acute heart failure are already using BB and require dobutamine for arterial hypotension and low cardiac output. Therefore, a decision must be made regarding whether BB should be maintained or even started in such cases. The aim of this study was to establish whether there is evidence supporting the safety andyeffectiveness of BB together with dobutamine for patients presenting with acute decompensated heart failure (ADHF). We conducted a search of the English-language literature in the databases MEDLINE, ISI Web of Science, Virtual Health Library, Cochrane Library and the CAPES Portal of Scientific Journals to identify related studies. Additional literature was obtained through the review of relevant references in the identified articles. The expected outcomes included information on the prognosis (in-hospital and on follow-up mortality, number of days of hospitalization and readmission),yeffectiveness and safety (worsening of symptoms, shock, intolerance) of the concomitant use of these drugs in hospitalized patients with ADHF and low cardiac output. This review included nine studies. however, no randomized clinical trials on this subject were found. Most studies include a low number of patients, and no studies addressing the safety of the concomitant use of these drugs were found. The resulting data suggest that a careful literature review did not supply evidence for the systematic use of BB in patients with low cardiac output syndrome who require dobutamine for inotropic support.

Expression of social smile of pre-term infants with age adjusted

OBJECTIVE: To evaluate and compare the expression of the social smile of infants born preterm, with chronological age and corrected in order to provide more reasons for the effect of neurological maturation in this population. METHODS: This was an analytical, cross-sectional descriptive which saw the answer as to the behavior of the social smile in a cohort of premature infants in the third month of chronological age and corrected. To evaluate the expression of social smile, we used the Method of Assessment of Visual Infants. RESULTS: It was found that, of 105 preterm infants evaluated, 75 (71.43%) responded positively to evidence of social smile on chronological age, while 99 (94.29%), corrected age (p 0.001 Â) CONCLUSIONS: The expression of the social smile in infants born preterm, to be performed with the correction of gestational age allows these infants to express their real abilities...(AU)

OBJETIVO: avaliar e comparar a expressão do sorriso social de lactentes nascidos pré-termo, com idade cronológica e corrigida, com o propósito de prover maior fundamentação do efeito da maturação neurológica nessa população. MÉTODO: Trata-se de um estudo analítico, descritivo de corte transversal em que se verificou a resposta quanto ao comportamento do sorriso social em uma coorte de lactentes prematuros no terceiro mês de idade cronológica e corrigida. Para avaliação da expressão do sorriso social, utilizou-se o Método de Avaliação da Conduta Visual de Lactentes. RESULTADOS: Verificou-se que, dos 105 lactentes pré-termo avaliados, 75 (71,43%) responderam positivamente à prova do sorriso social na idade cronológica, enquanto 99 (94,29%), na idade corrigida (p  0,001). CONCLUSÕES: A avaliação da expressão do sorriso social em lactentes nascidos pré-termo, ao ser realizada com a correção da idade gestacional permite que esses lactentes expressem suas reais habilidades...(AU)

Use of an indicator to evaluate physician adherence to prescription guidelines for the treatment of heart failure

The aim of this study was to use indicators to evaluate physician adherence to prescription guidelines for heart failure treatment in a university hospital. This was a prospective cohort study conducted in a university hospital. The information collected at the time of patient admission, including therapeutic indication, absolute contra indications and intolerance, was utilised for the formulation of a guideline adherence indicator (GAI). This indicator was calculated as follows: (the number of patients who used the medication/the number of eligible patients) x 100. The percentage of eligible patients was calculated using the following formula: (the number of eligible patients/the total number patients) x 100. The GAI was applied to a population of 53 patients. Inhibitors of angiotensin-converting enzyme/angiotensin receptor blocker (ACE-I/ARB) combination therapy were used in the greatest percentage of eligible patients (92.4%) and demonstrated the largest GAI value (73.5%). The percentages of patients who were eligible for beta-blockers, spironolactone and digitalis treatments were 81.1%, 52.8% and 60.4%, respectively. The GAI values for the use of beta-blockers, spironolactone and digitalis were 60.4%, 57.1% and 56.2%, respectively. For the studied patient population, the GAI was consistent with the proportion of patients who were eligible to receive digitalis and spironolactone.

O objetivo deste estudo foi utilizar indicadores para avaliar a adesão de médicos às diretrizes para tratamento da Insuficiência Cardíaca em um hospital universitário. Estudo de coorte prospectivo, conduzido em um hospital universitário. As variáveis coletadas na admissão do paciente foram: indicação terapêutica, contraindicações absolutas e intolerância, sendo utilizadas para elaboração de um indicador de adesão à diretriz (IAD). Este indicador foi calculado através da relação: (número de pacientes que utilizaram o medicamento/número de pacientes elegíveis) x 100. A % de pacientes elegíveis foi calculada da seguinte forma: (número de pacientes elegíveis/número total de pacientes) x 100. Os IAD foram aplicados para uma população de 53 pacientes. Os Inibidores da Enzima Conversora de Angiotensina/Bloqueadores dos Receptores de Angiotensina foram as classes farmacológicas que apresentaram maior % de pacientes elegíveis (92,4%) e apresentaram o melhor IAD (73,5%). A % de pacientes elegíveis para beta-bloqueadores, espironolactona e digitálicos foi de 81,1%, 52,8% e 60,4%, respectivamente. O IAD para beta-bloqueadores foi 60,4%, espironolactona 57,1% e digitálicos 56,2%. Na população estudada, o IAD foi compatível com a proporção de pacientes elegíveis para digitálicos e espironolactona.

Expression of social smile of pre-term infants with age adjusted

OBJECTIVE: To evaluate and compare the expression of the social smile of infants born preterm, with chronological age and corrected in order to provide more reasons for the effect of neurological maturation in this population. METHODS: This was an analytical, cross-sectional descriptive which saw the answer as to the behavior of the social smile in a cohort of premature infants in the third month of chronological age and corrected. To evaluate the expression of social smile, we used the Method of Assessment of Visual Infants. RESULTS: It was found that, of 105 preterm infants evaluated, 75 (71.43%) responded positively to evidence of social smile on chronological age, while 99 (94.29%), corrected age (p 0.001 Â) CONCLUSIONS: The expression of the social smile in infants born preterm, to be performed with the correction of gestational age allows these infants to express their real abilities...

OBJETIVO: avaliar e comparar a expressão do sorriso social de lactentes nascidos pré-termo, com idade cronológica e corrigida, com o propósito de prover maior fundamentação do efeito da maturação neurológica nessa população. MÉTODO: Trata-se de um estudo analítico, descritivo de corte transversal em que se verificou a resposta quanto ao comportamento do sorriso social em uma coorte de lactentes prematuros no terceiro mês de idade cronológica e corrigida. Para avaliação da expressão do sorriso social, utilizou-se o Método de Avaliação da Conduta Visual de Lactentes. RESULTADOS: Verificou-se que, dos 105 lactentes pré-termo avaliados, 75 (71,43%) responderam positivamente à prova do sorriso social na idade cronológica, enquanto 99 (94,29%), na idade corrigida (p  0,001). CONCLUSÕES: A avaliação da expressão do sorriso social em lactentes nascidos pré-termo, ao ser realizada com a correção da idade gestacional permite que esses lactentes expressem suas reais habilidades...

Ceratoplastia lamelar em cães usando membrana amniótica equina: Estudo clínico e morfológico / Lamelar keratoplasty in dogs using equine amniotic membrane: Clinical and morphological study

A membrana amniótica (MA) consolidou-se no tratamento de afecções na superfície ocular. O objetivo deste estudo foi avaliar a viabilidade do implante de MA equina em ceratoplastia lamelar de cães. As membranas amnióticas foram preservadas em glicerina (98%). A eficácia do implante foi acompanhada por avaliação clínica, tempo de cicatrização, resposta inflamatória e reconstrução da arquitetura da córnea. Foram selecionados 12 cães, que foram divididos em quatro grupos de três animais. Em cada animal, foi realizada ceratotomia lamelar com 5 mm de diâmetro, seguida de aplicação do implante de MA. Após cirurgia, os animais foram avaliados em diferentes tempos: 2, 7, 21 e 40 dias. Duran- te o período de observação, os exames oftalmológicos foram realizados com intervalo de 48 h e, após a última avaliação, os animais foram submetidos à eutanásia. Os olhos foram enucleados, fixados e corados com hematoxilina-eosina (HE), ácido periódico de Schiff (PAS) e picrossirius. Os implantes foram completamente epitelizados em cerca de 10 dias após a cirurgia. Os neovasos apresentaram involução progressiva a partir de 21 dias e não foram detectados ao final de 40 dias pós-cirurgia, restando apenas uma nébula no local da lesão. À microscopia óptica, observou-se resposta inflama- tória moderada, presença de epitélio pavimentoso estratificado aos sete dias e epitelização completa aos 21 dias. Aos 40 dias, a membrana basal do epitélio apresentou-se reconstituída. Assim, concluímos que a membrana amniótica equina é viável como implante em córnea de cão, sendo incorporada ao estroma e resultando em restabelecimento parcial da transparência.

Amniotic membranes have been successfully used in the treatment of superficial corneal diseases. The purpose of this study was to assess the feasibility of use of equine amniotic membrane (AM) in lamellar keratoplasty of dogs. Amniotic membranes were preserved in glycerol (98%). Implant efficacy was assessed by clinical evaluation, time of healing, in-flammatory response, and the corneal architectural configuration. Twelve dogs were divided into four groups of three animals. In each animal, a 5-mm diameter lamellar keratectomy was performed, and followed by implantation of the AM. The animals were evaluated at the 2th, 7th, 21th, and 40th days after surgery. During this period, ophthalmological exams were performed at 48-h intervals, and the animals were euthanized after the last evaluation. The eyes were enu-cleated, included, fixed, and stained with hematoxylin-eosin (HE), periodic acid-Schiff (PAS), and picrosirius. Epitheli-zation of the implants was completed in about ten days after surgery. New vessels progressively diminished from 21 days on, were not detected on day 40 after surgery, and only a nebula was observed in the implant area. Optical microscopy revealed a mild inflammatory response, presence of squamous epithelium on day seven, and total epithelization on day 21 after surgery. On day 40, the basal epithelial membrane was shown to be reformed. Therefore, we conclude that use of equine amniotic membranes is feasible as implant for dog cornea since it is incorporated to the corneal stroma, and a relative transparency can be obtained.

Moderate stress enhances memory persistence: are adrenergic mechanisms involved?

Memory persistence in the inhibitory avoidance (IA) task has been recently shown to require a new event of consolidation 12 hr after acquisition. The immobilization stress (IS) model is largely used to study the effects of stress on memory. In this study we investigated the interactions between stress by immobilization and its effect on the persistence of memory, and also a possible effect mediated by ß-adrenergic modulation of stress on memory persistence. An enhancement of long-term memory (LTM) persistence caused by stress through immobilization applied 12 hr after IA training was observed when the animals were submitted to 15 min or 1 hr of IS, but not to 3 hr. The reversal of this memory enhancement caused by IS was observed when the ß-adrenergic antagonist propranolol was infused intraperitoneally prior to stress, which implies that ß-adrenergic receptors are involved in stress enhancement of LTM persistence.

Participation of hippocampal cholinergic system in memory persistence for inhibitory avoidance in rats.

Memory persistence needs a new event of consolidation 12h after the acquisition. We investigated the role of the cholinergic activity on the persistence of memory. For this purpose, we performed the treatments 9 or 12h after acquisition and the memory tested 2 or 7 days after inhibitory avoidance (IA) training. Here we report that activity of medial septum, by transitorily inactivating this structure with lidocaine 12h after IA training, is essential for memory persistence at the 7th day, but not for the formation at the 2nd day. We also report that muscarinic and nicotinic cholinergic receptors of CA1 area are engaged on memory persistence. Since scopolamine (mAChRs antagonist) and mecamylamine (nAChRs blocker) infusions, 12h post-training, demonstrated impairment on long term memory (LTM), persistence on the 7th day but no effect on LTM formation was found on the 2nd day in the IA test. The same effects were found with pirenzepine, an M1 antagonist. No effects on the formation and persistence of memory on the 2nd and 7th days were demonstrated after DHßE infusions (nAChRs subtype antagonist α4ß2, α3ß2). These findings suggest that mAChR and nAChR at the CA1 area, and also MS activation, are required for the persistence of memory.