Impact of Skull Defects on the Role of CTA for Brain Death Confirmation.

BACKGROUND AND PURPOSE: Intracranial pressure modifications caused by a skull defect, such as craniectomy or craniotomy, may change the hemodynamics and decrease the accuracy of CTA to confirm brain death. This study aimed to evaluate the impact of a skull defect and the interpretation criteria of images on this diagnostic test. MATERIALS AND METHODS: A series of consecutive patients with a clinical diagnosis of brain death underwent CTA (case group), while the control group comprised patients with acute ischemic stroke in the same period. CTA criteria adopted to confirm brain death were the absence of opacification of the M4 branches and internal cerebral veins. The evaluation also included the presence of "stasis filling." Cases were stratified as intact skull, craniotomy, and craniectomy. Three neuroradiologists evaluated all examinations independently. RESULTS: In the case group, according to the Frampas criteria, the sensitivity of CTA to confirm brain death was 95.5% in patients with intact skull, 87.5% with craniotomy, and 60% with craniectomy. False-negative diagnoses of brain death were 15.6%, related to stasis filling in 71.4% (P < .001). However, according to the "modified Frampas criteria," the sensitivity of CTA to confirm brain death was 100% in patients with intact skull, 93.8% with craniotomy, and 80% with craniectomy. False-negative diagnoses of brain death were found in 6.2% of patients, and there was no stasis filling. CTA showed 100% specificity in the control group. There were no disagreements among observers. CONCLUSIONS: CTA had a high diagnostic accuracy and reproducibility to confirm brain death in patients with an intact skull. The modified Frampas criteria increased the sensitivity of CTA, particularly in patients with a skull defect. A concurrent skull defect, especially craniectomy, can decrease the sensitivity of CTA to confirm brain death.

Effect of melatonin administration on subjective sleep quality in chronic obstructive pulmonary disease.

Disturbed sleep is common in chronic obstructive pulmonary disease (COPD). Conventional hypnotics worsen nocturnal hypoxemia and, in severe cases, can lead to respiratory failure. Exogenous melatonin has somnogenic properties in normal subjects and can improve sleep in several clinical conditions. This randomized, double-blind, placebo-controlled study was carried out to determine the effects of melatonin on sleep in COPD. Thirty consecutive patients with moderate to very severe COPD were initially recruited for the study. None of the participants had a history of disease exacerbation 4 weeks prior to the study, obstructive sleep apnea, mental disorders, current use of oral steroids, methylxanthines or hypnotic-sedative medication, nocturnal oxygen therapy, and shift work. Patients received 3 mg melatonin (N = 12) or placebo (N = 13), orally in a single dose, 1 h before bedtime for 21 consecutive days. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI) and daytime sleepiness was measured by the Epworth Sleepiness Scale. Pulmonary function and functional exercise level were assessed by spirometry and the 6-min walk test, respectively. Twenty-five patients completed the study protocol and were included in the final analysis. Melatonin treatment significantly improved global PSQI scores (P = 0.012), particularly sleep latency (P = 0.008) and sleep duration (P = 0.046). No differences in daytime sleepiness, lung function and functional exercise level were observed. We conclude that melatonin can improve sleep in COPD. Further long-term studies involving larger number of patients are needed before melatonin can be safely recommended for the management of sleep disturbances in these patients.

Effect of melatonin administration on subjective sleep quality in chronic obstructive pulmonary disease

Disturbed sleep is common in chronic obstructive pulmonary disease (COPD). Conventional hypnotics worsen nocturnal hypoxemia and, in severe cases, can lead to respiratory failure. Exogenous melatonin has somnogenic properties in normal subjects and can improve sleep in several clinical conditions. This randomized, double-blind, placebo-controlled study was carried out to determine the effects of melatonin on sleep in COPD. Thirty consecutive patients with moderate to very severe COPD were initially recruited for the study. None of the participants had a history of disease exacerbation 4 weeks prior to the study, obstructive sleep apnea, mental disorders, current use of oral steroids, methylxanthines or hypnotic-sedative medication, nocturnal oxygen therapy, and shift work. Patients received 3 mg melatonin (N = 12) or placebo (N = 13), orally in a single dose, 1 h before bedtime for 21 consecutive days. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI) and daytime sleepiness was measured by the Epworth Sleepiness Scale. Pulmonary function and functional exercise level were assessed by spirometry and the 6-min walk test, respectively. Twenty-five patients completed the study protocol and were included in the final analysis. Melatonin treatment significantly improved global PSQI scores (P = 0.012), particularly sleep latency (P = 0.008) and sleep duration (P = 0.046). No differences in daytime sleepiness, lung function and functional exercise level were observed. We conclude that melatonin can improve sleep in COPD. Further long-term studies involving larger number of patients are needed before melatonin can be safely recommended for the management of sleep disturbances in these patients.

Feeding dynamics and ecomorphology of Oligosarcus jenynsii (Gunther, 1864) and Oligosarcus robustus (Menezes, 1969) in the Lagoa Fortaleza, southern Brazil.

Oligosarcus jenynsii and Oligosarcus robustus are fishes of Characidae family that occur in Rio Grande do Sul, Uruguay and northern Argentina. This work purported to study the feeding dynamics (repletion and hepatosomatic indexes and condition factor) over time, and to investigate the coexistence of these two species by evaluating the partition of resources using qualitative and quantitative analyses of diet, temporal and spatial segregation throughout the water column and some ecomorphological aspects of the species in the Lagoa Fortaleza. Specimens were sampled monthly, from May 2000 to April 2001 during 24 h/month, using stationary gill nets of different mesh sizes. The records of each individual included total and standard length; total, stomach and liver weight; sex and stomach repletion. The variation of the mean values of repletion index and relative frequencies of stomach repletion stages indicate that O. jenynsii and O. robustus do not present seasonal differences in feeding intensity. The hepatosomatic index shows an allocation of energy to the liver during every period except reproduction, when part of the energy is used for gonad maturation. The estimated condition factor for both species reveals an increase in the reproductive period, evidencing the influence of gonads upon the condition of the fish. The diet analysis revealed that O. robustus is piscivorous, whereas O. jenynsii is a generalist carnivore, tending to piscivory as well. The active period of O. robustus is more concentrated at sunrise and sunset, whereas O. jenynsii is continually active, a characteristic related to hunting for prey. The ecomorphological analysis revealed differences between the two species in the dimensions of the mouth. Evidence suggests that the species coexist, sharing food sources, differing in oral morphology but ingesting similar prey, possibly because food is not a limiting factor in the environment.

Feeding dynamics and ecomorphology of Oligosarcus jenynsii (Gunther, 1864) and Oligosarcus robustus (Menezes, 1969) in the Lagoa Fortaleza, southern Brazil

Oligosarcus jenynsii e Oligosarcus robustus são peixes pertencentes à família Characidae, sendo espécies ocorrentes no Rio Grande do Sul, Uruguai e norte da Argentina. Este estudo objetivou analisar os índices de repleção e hepatossomático e o fator de condição ao longo do tempo, fazer uma análise quali-quantitativa da dieta, e avaliar a segregação temporal e espacial ao longo da coluna d água e ecomorfologia, como parâmetros de coexistência entre estas duas espécies. Os exemplares foram amostrados mensalmente, de maio de 2000 a abril de 2001, durante 24 horas/mês, com o auxílio de redes de espera de diversas malhagens. De cada indivíduo foram registradas medidas de comprimento total e padrão, peso total, peso do estômago e do fígado, sexo e estádio de repleção estomacal. Os resultados demonstram que O. jenynsii e O. robustus não apresentam um período alimentar definido, alimentando-se durante todo o tempo conforme a variação dos valores médios do índice de repleção, bem como das freqüências relativas dos estádios de repleção estomacal. O índice hepatossomático demonstra uma alocação de energia para o fígado durante todo o período, exceto na época reprodutiva, quando a energia é transferida para a maturação gonadal. O fator de condição estimado para as duas espécies revelou um aumento na época reprodutiva, evidenciando a influência das gônadas na condição em que se encontra o peixe. As análises na dieta revelaram que O. robustus é piscívoro, enquanto O. jenynsii se mostrou um carnívoro mais generalista, tendendo à piscivoria. O período de atividade das espécies foi crepuscular e está diretamente relacionado com a captura de presas. As análises ecomorfológicas revelaram diferenças no tamanho da cabeça e dimensões da boca entre as espécies. Os resultados obtidos sugerem que as espécies coexistem partilhando o recurso alimentar, diferindo em sua morfologia bucal, ingerindo, no entanto, presas similares porque o alimento pode não ser um fator limitante no ambiente.

[The challenge of teaching how to deliver care from the perspective of the graduation nursing course student]. / Desafio de ensinar a cuidar sob a ótica do aluno do curso de graduação em enfermagem.

This paper refers to teaching/learning in a subject named Fundaments of Human Care III--Care Module--at the Nursing School of the Universidade Federal do Rio Grande do Sul, under the vision of the undergraduate student. In 1996, the subject started at the fourth semester of the curriculum, constituted of its basic thematic, and in which the students learn about the genesis of human care process. The daily reports of the students during this module practice at the Pediatric Oncology Unit (POU) of a University Hospital, in Porto Alegre, RS, were submitted to phenomenological analysis, based on Merleau-Ponty (Martins, 1992). From this analysis emerged the significance expressed by the student of the experiences on the POU; the relation between teaching-practice; theoretical basis and care.

[Womens' view of caregiving. Implications for revisions of the concept]. / Mulheres ressignificando o cuidado: implicações para revisão do conceito.

The goal of the workshop "Caregiving and Companionship" was to provide women living in Porto Alegre with an opportunity to participate in a caregiving activity in which they could exchange ideas, get to know and talk about the meaning of the word caregiving as perceived both in an artistic and/or a scientific realm. Testimonies collected from a group of 60, shed light on the concept of the word. New directions, news dimensions were added to the meaning of maternity--which for women represents caregiving in its fullest and most well-know sense. The workshop gave them a chance to reshape concepts, discover new potentials and share growth on a me to you basis, as a part of their daily endeavors.