Skin and soft tissue complications of bone-anchored hearing aids: Introducing a new classification system.

OBJECTIVES: There have been significant surgical and technological advances in bone-anchored hearing aid (BAHA) design, function, and implantation technique, but peri-implant skin complications remain the most frequent complication. The most important aspect in dealing with cutaneous complications is to identify the type of cutaneous lesion. Although Holger's Classification has been an extremely useful clinical tool, this grading system has been shown to be unsuitable for some cases. We therefore propose a new consistent and easy assessment classification of cutaneous complications associated with BAHA. METHODS: A retrospective clinical study was carried out at a tertiary centre, between January 2008 and December 2014. All patients under 18 years old with a unilateral BAHA were included in the study. RESULTS: A total of 53 children, with a BAHA, were included in the study. Post-operative skin complications were observed in 49.1% of the patients. Of the children, 28.3% presented with soft tissue hypertrophy, the most frequently reported skin complication, and grading according to the Holger's classification was not considered feasible. To overcome the difficulties we face in clinical practice, a new classification was developed and presented. CONCLUSION: The new proposed classification - Coutinho Classification - aims to fill the gaps in the one used currently by introducing new clinical features, most importantly the presence/absence of tissue overgrowth, and by providing a better description of what each category encompasses. This is an inclusive and objective new classification system, maintaining applicability, and useful in guiding the treatment.

Skin and soft tissue complications of bone-anchored hearing aids: Introducing a new classification system / Complicaciones de la piel y los tejidos blandos de los audífonos osteointegrados: introducción de un nuevo sistema de clasificación

Objectives: There have been significant surgical and technological advances in bone-anchored hearing aid (BAHA) design, function, and implantation technique, but peri-implant skin complications remain the most frequent complication. The most important aspect in dealing with cutaneous complications is to identify the type of cutaneous lesion.Although Holger's Classification has been an extremely useful clinical tool, this grading system has been shown to be unsuitable for some cases. We therefore propose a new consistent and easy assessment classification of cutaneous complications associated with BAHA.MethodsA retrospective clinical study was carried out at a tertiary centre, between January 2008 and December 2014. All patients under 18 years old with a unilateral BAHA were included in the study.ResultsA total of 53 children, with a BAHA, were included in the study. Post-operative skin complications were observed in 49.1% of the patients. Of the children, 28.3% presented with soft tissue hypertrophy, the most frequently reported skin complication, and grading according to the Holger's classification was not considered feasible.To overcome the difficulties we face in clinical practice, a new classification was developed and presented.ConclusionThe new proposed classification – Coutinho Classification – aims to fill the gaps in the one used currently by introducing new clinical features, most importantly the presence/absence of tissue overgrowth, and by providing a better description of what each category encompasses. This is an inclusive and objective new classification system, maintaining applicability, and useful in guiding the treatment. (AU)

Objetivos: La técnica de implantación de los audífonos osteointegrados (bone-anchored hearing aid [BAHA]) ha experimentado avances tecnológicos y quirúrgicos significativos en el diseño y en la función, aunque las complicaciones cutáneas periimplantarias son frecuentes. El aspecto más importante del tratamiento de las complicaciones cutáneas es identificar el tipo de lesión cutánea.Aunque la clasificación de Holger ha sido una instrumento clínico extremadamente útil, este sistema de clasificación ha demostrado ser inadecuado en algunos casos. Por lo tanto, proponemos una nueva clasificación, consistente y fácil, de las complicaciones cutáneas asociadas con BAHA.MétodosSe realizó un estudio clínico retrospectivo en un centro de tercer nivel, entre enero de 2008 y diciembre de 2014. Se incluyeron en el estudio todos los pacientes menores de 18 años a los que se colocó BAHA unilateral.ResultadosUn total de 53 niños a los que se colocaron BAHA fueron incluidos en el estudio. Se observaron complicaciones cutáneas postoperatorias en el 49,1% de los pacientes. El 28,3% de los niños presentaron hipertrofia de tejidos blandos, la complicación cutánea más frecuentemente reportada, y la clasificación de Holger no se consideró adecuada.Para superar las dificultades con que nos enfrentamos en la práctica clínica, se desarrolló y se presentó una nueva clasificación. (AU)

Changes in Coagulation Study and Risk of Developing Cholesteatoma: Is There a Link?

BACKGROUND AND OBJECTIVES: The etiopathogenesis of acquired pediatric cholesteatoma has not yet been fully clarified. Recent studies and modern technologies have led researchers to look for explanations at a molecular level. This study aims to understand if the origins of cholesteatoma could be related to dysfunctions in coagulation factors, thereby emphasizing its role in angiogenesis. Subjects and. METHODS: This was a retrospective case-control study carried out at a tertiary hospital center between January 2010 and December 2020. The study included 92 children. The variables of the summary coagulation study (partial thromboplastin time, prothrombin time, and international normalized ratio) were compared among children with and without development of chronic otitis media with cholesteatoma. RESULTS: The cases and controls were comparable in terms of age, type, and number of times that ventilation tubes were placed. Partial thromboplastin times tended to be higher in children who developed cholesteatoma, with a statistically significant difference between the two groups in terms of normal and abnormal partial thromboplastin times (p=0.029). CONCLUSIONS: The results of this case control study indicate that slight extension of partial thromboplastin times in the coagulation study may not meet the criteria for diagnosis of certain hematological pathologies or clinical significance, but at a molecular level may already have implications for activation of angiogenesis and other growth factors involved in the onset, growth, and expansion of acquired pediatric cholesteatoma.

Role of mastoid pneumatization in predicting tympanoplasty results: Will it have the same importance in different age groups?

INTRODUCTION: There are several factors that seem to affect the surgical success rate of tympanoplasty, one of them being the pneumatization of the contralateral mastoid. In the current literature, several studies have been published with classification proposals for temporal bone pneumatization pattern. This study aims to evaluate the role of mastoid air cell extension in relation to the sigmoid sinus in predicting the surgical success of tympanoplasty. MATERIAL AND METHODS: This case-control study was performed on patients diagnosed with chronic otitis media (COM) who underwent type I tympanoplasty. The study group did not close the tympanic membrane, or there was a retraction or lateralization of the graft. The control group consisted of patients with surgical success. RESULTS: No statistically significant difference was found between groups regrading age, gender, perforation side/type, previous nasal surgery, and the presence of chronic otitis media in contralateral ear. A statistically significant difference was found when groups were compared in relation to the degree of pneumatization of the contralateral ear (p = 0.046), and this relationship does not seem to be influenced by age. CONCLUSION: To predict surgical success in terms of tympanic membrane closure in tympanoplasty, classification of contralateral ear pneumatization degree using the sigmoid sinus as a reference seems to be a valid and easy to apply method, and makes it possible to restrict the evaluation of pneumatization to the mastoid, a cell complex that does not seem to change with age.

Frequency and predisposing factors for canine otitis externa in the UK - a primary veterinary care epidemiological view.

BACKGROUND: Otitis externa is a commonly diagnosed disorder in dogs and can carry a high welfare impact on affected animals. This study aimed to report the prevalence and explore the role of breed and aural conformation as predisposing factors for canine otitis externa in the UK. The study used a cohort design of dogs under UK primary veterinary care at clinics participating in the VetCompass Programme during 2016. Risk factor analysis used multivariable logistic regression modelling. RESULTS: The study included a random sample of 22,333 dogs from an overall population of 905,554 dogs under veterinary care in 2016. The one-year period prevalence of otitis externa was 7.30% (95% confidence interval [CI]: 6.97 to 7.65). Breed and ear carriage were the highest ranked risk factors. Compared with crossbred dogs, sixteen breed types showed increased odds, including: Basset Hound (odds ratio [OR] 5.87), Chinese Shar Pei (OR 3.44), Labradoodle (OR 2.95), Beagle (OR 2.54) and Golden Retriever (OR 2.23). Four breeds showed protection (i.e. reduced odds) of otitis externa: Chihuahua (OR 0.20), Border Collie (OR 0.34), Yorkshire Terrier (OR 0.49) and Jack Russell Terrier (OR 0.52). Designer breed types overall had 1.63 times the odds (95% CI 1.31 to 2.03) compared with crossbred dogs. Compared with breeds with erect ear carriage, breeds with pendulous ear carriage had 1.76 times the odds (95% CI 1.48 to 2.10) and breeds with V-shaped drop ear carriage had 1.84 times the odds (95% CI 1.53 to 2.21) of otitis externa. CONCLUSIONS: Breed itself and breed-associated ear carriage conformation are important predisposing factors for canine otitis externa. Greater awareness of these associations for both predisposed and protected breeds could support veterinary practitioners to promote cautious and low-harm approaches in their clinical advice on preventive care for otitis externa, especially in predisposed breeds.

Otitis externa is a common and often painful condition of the ears of dogs. The probability of otitis externa varies widely between dogs depending on their tendency towards other skin problems such as allergic skin disease. However, breed-related anatomical features such as the degree and point of folding of the ear flap or the overall size of the dog can act to further predispose towards otitis externa. Greater understanding of these predisposing factors could lead to opportunities for breeders to breed away from predisposing features and also help owners and veterinarians to predict which dogs are most at risk of this painful condition.Veterinarians record clinical notes when dogs visit for veterinary care, and these clinical notes can act as a rich source of information on the health of these dogs. This study accessed anonymised clinical records of almost a million dogs in the UK to identify dogs diagnosed with otitis externa. The breed, age, bodyweight and other information available on these dogs were used to explore why certain dog types were predisposed to otitis externa.A random sample of 22,333 dogs was selected for analysis. Of these, 7.30% (over 7 in a hundred) were diagnosed with otitis externa in a single year. There were 16 breeds with higher risk of otitis externa compared with crossbred dogs. Breeds with the highest risk were Basset Hound (× 5.87), Chinese Shar Pei (× 3.44), Labradoodle (× 2.95), Beagle (× 2.54) and Golden Retriever (× 2.23). Four breeds showed reduced risk: Chihuahua (× 0.20), Border Collie (× 0.34), Yorkshire Terrier (× 0.49) and Jack Russell Terrier (× 0.52). Breeds with pendulous ear carriage (× 1.76) and V-shaped drop ear carriage (× 1.84) had higher risk of otitis externa compared with breeds with erect ear carriage.Breed itself and also breed-associated ear carriage conformation are associated with differing probability of otitis externa in dogs. Better understanding about how these factors affect the probability of otitis externa in dogs can help veterinary practitioners to promote cautious and low-harm approaches to preventing otitis externa (e.g., by advocating ear cleaning with a dry paper cloth, judicious use of ear cleaners with antimicrobial properties and avoidance of overzealous ear-cleaning) and can also assist breeders to breed away from features of dogs that predispose to otitis externa.

Swallowed by the bone - Is skin reaction the "tip of the iceberg"?

The most frequent complications of osseointegrated implantation include implant-site infections, soft tissue overgrowth and failure of osseointegration. Bone overgrowth is also a complication at the abutment site and infrequently reported. We describe a rare case of difficult control and exuberant bone overgrowth, with total implant involvement, in a short period of time never before described in the literature. Bone growth around the implant is frequently underestimated and can be the cause of difficult control of skin reactions, that in some cases is just the "tip of the iceberg". Timely surgical review with removing excess bone may lead to implant preservation and control of skin reaction and healing.

Craniodiaphyseal dysplasia: A Rare And Successful Bone-Anchored Hearing Aid Implantation.

Craniodiaphysial dysplasia is an extremely rare genetic disorder characterized by a severe form of bone dysplasia and a distinctive facial dysmorphisms, as a result of a massive generalized hyperostosis and sclerosis, primarily involving the facial bones and the skull. We present a 10-years-old girl referred to an otolaryngology consultation with complaints of progressive hearing loss. The clinical aspects, pathogenesis and management of this disease are also review in this paper. Furthermore, we describe the first case of craniodiaphysial dysplasia rehabilitated with Bone-Anchored Hearing Aid, despite the concerns inherent to the involvement of the skull bone that characterizes the disease.

As representações sociais das pessoas vivendo com HIV/AIDS sobre o uso do antirretroviral enfuvirtida / The social representations of people living with HIV/AIDS on the use of enfuvired anti-retroviral

Trata-se de uma pesquisa qualitativa ancorada na teoria das representações sociais, cujos objetivos foram analisar as representações sociais das pessoas vivendo com HIV/AIDS sobre o uso do antirretroviral Enfuvirtida, as repercussões em sua vida cotidiana e comparar as repercussões dessa nova abordagem terapêutica, no cotidiano de pessoas que vivem com HIV/AIDS, com o esquema medicamentoso anterior. O estudo foi realizado no ambulatório de doenças infectoparasitárias de um Hospital Universitário de Minas Gerais, com oito pessoas vivendo com HIV/Aids sob uso do antirretroviral Enfuvirtida. Para a coleta de dados, utilizou-se um roteiro semiestruturado. Na categoria de análise denominada "A adaptação ao novo ­ Da compreensão à habilidade no uso da enfuvirtida", percebeu-se que os aspectos que envolvem o uso de antirretrovirais ultrapassam os benefícios de uma nova possibilidade terapêutica, uma vez que os relatos mostram o desejo por uma abordagem que repercuta minimamente no estar e viver o cotidiano das pessoas. As representações dos usuários sobre a Enfuvirtida são significantes para orientar e organizar as condutas pessoais e sociais, dos profissionais, traduzindo o significado e o investimento afetivo que estas pessoas atribuem ao uso desta medicação e os hábitos que incorporam para a condução do tratamento e autocuidado.

This is a qualitative research, based on the theory of social representations, whose objectives were to analyze the social representations of people living with HIV / AIDS on the use of antiretroviral Enfuvirtide and the repercussions on their daily lives and to compare the repercussions of this new approach in the daily routine of people living with HIV / AIDS, with the previous drug regimen. The study was carried out at the outpatient clinic for infectious diseases at a University Hospital of Minas Gerais, with eight people living with HIV / AIDS using the antiretroviral Enfuvirtide. For the data collection, a semi-structured script was used. In the category of analysis called: adaptation to the new - from understanding to the ability to use enfuvirtide, it was noticed that the aspects that involve the use of antiretrovirals outweigh the benefits a new therapeutic possibility, since the reports show the desire for a an approach that minimally impacts on being and living the daily lives of people. The representations of the users about Enfuvirtide are significant to guide and organize the personal and social behaviors of the professionals, translating the meaning and the affective investment that these people attribute to the use of this medication and the habits that incorporate for the conduction of the treatment and self-care.

Promoção da saúde: a concepção do enfermeiro que atua no programa saúde da família / Health promotion: the conception among nurses working in the Family Health Program

Objetivo: Investigar a concepção dos enfermeiros do Programa Saúde da Família (PSF) sobre Promoção da Saúde. Métodos: Tratou-se de um estudo qualitativo do tipo descritivo, realizado em cinco unidades de Atenção Primária à Saúde (UAPS) que aderem ao PSF, da cidade de Juiz de Fora – MG, Brasil, no período de março a abril de 2010. Os sujeitos foram cinco enfermeiros do PSF, sendo um de cada uma das unidades participantes, selecionados aleatoriamente, de acordo com a disponibilidade e aceitação dos mesmos em participar do estudo. A coleta de informações se utilizou da técnica de entrevista semiestruturada. As falas foram analisadas se utilizando da análise temática. Resultados: A partir da análise das falas, ficou evidente que os enfermeiros confundem promoção da saúde com prevenção. E foram unânimes quanto ao papel de educador que o enfermeiro exerce. Conclusões: Os enfermeiros revelaram ter concepção distorcida sobre promoção da saúde e as práticas de saúde ainda são desenvolvidas dentro da visão preventiva. O conceito de promoção de saúde gera questionamentos no grupo estudado, devendo ser mais debatido pelos enfermeiros.

Objective: To investigate the conception of Health Promotion among nurses working in the Family Health Program. Methods: This was a qualitative descriptive study, conducted in five Primary Health Care Units that are connected to the Family Health Program, in the city of Juiz de Fora - MG, Brazil, from March to April, 2010. Subjects were five nurses, one from each participating unit, randomly selected, according to their availability and acceptance to participate in the study. Data collection used semi-structured interview technique. The speeches were analyzed using thematic analysis. Results: From the analysis of the speeches it was evident that nurses misunderstand health promotion and prevention. They unanimously cited the role of educator played by nurses. Conclusion: The nurses were found to have a distorted conception of health promotion and health practices are still developed based on a preventive approach. Concept of health promotion generates questions among the studied group, therefore, it should be more discussed by nurses.

Vivências de adultos submetidos ao transplante de medula óssea autólogo / Experiences of adults subject to autologous bone marrow transplant / Vivencias de adultos sometidos al trasplante de médula ósea autólogo

Este artigo, que apresenta as vivências de adultos submetidos ao transplante de medula óssea autólogo, resulta de uma investigação qualitativa, do tipo estudo de caso, envolvendo sete pessoas com idades entre 18 e 59 anos, residentes em um município do Interior de Minas Gerais, que vivenciaram este tipo de transplante e tiveram alta no período de outubro de 2004 a setembro de 2010. Os dados empíricos foram coletados por meio de entrevista semiestruturada, em visitas domiciliares. Na análise do conteúdo evidenciou-se que as respostas ao processo de transplante iniciam-se e vão se modificando desde o diagnóstico da patologia, passando pela definição e vivência do procedimento até o momento da alta. Identificou-se que a vivência dos sujeitos passa pelo desequilíbrio das rotinas da vida, pelo isolamento social e por reações que variam desde o medo e a ansiedade até a felicidade. Esta advém no momento da alta, que chega a ser considerada como uma segunda data de aniversário.Concluiu-se que o cuidado de enfermagem influencia e promove impactos na recuperação do paciente desde o diagnóstico até a alta, sendo relevante que o plano de cuidados para a alta se inicie desde a admissão do paciente para o transplante.

It is a qualitative research study aimed at understanding the experiences of adults undergoing bone marrow transplant, from diagnosis of the underlying disease until hospital discharge. For data collection, interviews were conducted through semi-structured home visits with seven transplant patients ages 18 to 59, living in a city in Minas Gerais, discharged between October 2004 and September 2010. Through thematic analysis, it was possible to approach questions concerning the impact of the diagnosis of a serious illness, the possibility and realization of the bone marrow transplant and feelings at the time of hospital discharge. Therefore, this study provides subsidy for the planning of nursing with a view to the guidelines and actions for potential needs of people undergoing bone marrow transplant recovery process related to the period after hospital discharge.

Este artículo, que presenta las vivencias de adultos sometidos al trasplante de médula ósea autólogo, resulta de una investigación cualitativa, del tipo estudio de caso, involucrando siete personas con edades entre 18 y 59 años, residentes en un municipio del Interior de Minas Gerais, que vivieron este tipo de trasplante y tuvieron alta en el período de octubre de 2004 a septiembre de 2010. Los datos empíricos fueron recolectados por medio de entrevista semiestructurada en visitas domiciliarias. En el análisis de contenido se evidenció que las respuestas al proceso de trasplante se inician y van modificándose desde el diagnóstico de la patología, pasando por la definición y vivencia del procedimiento hasta el momento del alta. Se identificó que la vivencia de los sujetos pasa por el desequilibrio de las rutinas de la vida, por el aislamiento social y por reacciones que varían desde el miedo y la ansiedad hasta la felicidad. Esta sucede en el momento del alta, que suele ser considerada como una segunda fecha de cumpleaños. Se concluye que el cuidado de enfermería influye y promueve impactos en la recuperación del paciente desde el diagnóstico hasta el alta, siendo relevante que el plan de cuidados para el alta se inicie desde la admisión del paciente para el trasplante.

A vida após o transplante de medula óssea: implicações para o cotidiano / Life after bone marrow transplant: implications for daily routines / La vida después del transplante de médula ósea: implicaciones para el cotidiano

Estudo qualitativo buscou compreender as vivências de adultos submetidos ao transplante de medula óssea autólogo e identificar as implicações no cotidiano dos sujeitos que o vivenciam. Foram realizadas entrevistas orientadas por roteiro semiestruturado, com sete adultos transplantados residentes em um município do interior de Minas Gerais e que tiveram alta entre de outubro de 2004 e setembro de 2010. Evidenciaram-se questões relativas às implicações no cotidiano das pessoas com mudanças na vida após o transplante de medula óssea. Após a análise de conteúdo temática surgiram três categorias empíricas: Afastamento do trabalho; Estado de vigília: preocupação constante com recidivas após a alta e Reestruturação da vida após o transplante de medula óssea - ressignificações do existir. Conclui-se que é necessária a incorporação de condutas profissionais permeadas de adaptação, utilizando-se diferentes estratégias, como criatividade, emoção e, sobretudo, saber científico.

This qualitative study sought to understand the experiences of adults who had submitted to autologous bone marrow transplant and to identify the implications for daily routines in the individuals who had gone through it. Interviews were undertaken, guided by a semi-structured script, with seven adult inpatients who had undergone the transplant, in a country town in the state of Minas Gerais, and who had been discharged between October 2004 and September 2010. Evidence was found for questions relevant to implications for daily routines of the people, with changes in life after the bone marrow transplant. After thematic content analysis, three empirical categories emerged: Withdrawal from work; Sleeplessness: Constant worry about relapses after discharge and Restructuring of one's life after bone marrow transplant - redefining existing. It is concluded that it is necessary to incorporate thoroughly adaptive professional conduct, using different strategies such as creativity, emotion and, above all, scientific knowledge.

Estudio cualitativo cuyo objetivo fue comprender las vivencias de adultos sometidos al transplante de médula ósea autólogo e identificar las implicaciones en el cotidiano de los sujetos que pasaron por ese proceso. Fueron realizadas entrevistas orientadas por guión semi estructurado, con siete adultos trasplantados que viven en un municipio del interior de Minas Gerais y que tuvieron alta entre octubre de 2004 y septiembre de 2010. Se evidenciaron cuestiones referentes a las implicaciones en el cotidiano de las personas con cambios en la vida después del transplante de médula ósea. Después del análisis de contenido temático surgieron tres categorías empíricas: Alejamiento del trabajo; Estado de vigilia: preocupación constante con recidivas después de alta y Restructuración de la vida después del transplante de médula ósea - resignificaciones del existir. Se concluye que es necesaria la adopción de conductas profesionales permeadas de adaptación, utilizándose diferentes estrategias, como creatividad, emoción y, sobretodo, saber científico.

Kawasaki disease and sensorineural hearing loss: an (un)expected complication.

UNLABELLED: Kawasaki disease (KD) is an acute, self-limiting, idiopathic form of vasculitis. The preventive effect of early therapy on coronary artery aneurysms, the hallmark of the disease, is well established. The spectrum of complication includes not only cardiac involvement but also central nervous system lesions. We report a 4-year-old boy with a clinical presentation suggestive of KD treated with intravenous immunoglobulin and acetylsalicylic acid. Clinical manifestations regressed within 24 hours and cardiac anomalies were not seen. Two weeks later, the parents noticed a sudden absence of response to sound stimuli. Investigations confirmed bilateral severe sensorineural hearing loss for which oral steroid therapy was given. This resulted in an improvement only on the right side, with severe hearing loss persisting on the left. CONCLUSION: Sensorineural hearing loss is an uncommonly reported complication of KD. Pediatricians should be aware of this potential complication to allow for early intervention.

Autocuidado após o transplante de medula óssea autólogo no processo de cuidar pelo enfermeiro / Self-care after autologous bone marrow transplantation within the nursing care process

Este artigo apresenta uma investigação qualitativa, apoiada nos pressupostos teóricos de Dorothea Orem, que objetivou compreender como as orientações fornecidas no momento da alta sobre os cuidados relacionados ao transplante de medula óssea influenciam no autocuidado após a alta. Foram sujeitos sete adultos de um município de Minas Gerais submetidos ao transplante e que obtiveram alta hospitalar entre outubro de 2004 e setembro de 2010. A coleta dos dados foi realizada em janeiro de 2011 por meio de visitas domiciliares, entrevistas semiestruturadas e observação. A partir da análise temática os resultados apontaram para uma discussão sobre as orientações recebidas no momento da alta e sobre os requisitos para o autocuidado após a alta do transplante. Conclui-se que as necessidades de autocuidado evidenciadas por este estudo reforçam a importância da sistematização do cuidado de enfermagem a fim de que as orientações no momento da alta representem efetiva contribuição à reabilitação dos pacientes.

Biologia, subjetividade e alteridade / Biology, subjectivity and alterity / Biología, subjetividad y alteridad

Este artigo tem a finalidade de apresentar e discutir o conceito de alteridade biológica. A questão da alteridade, do ponto de vista humano, se expressa além da dimensão abordada pela biologia; mas a faculdade de realizar escolhas conscientes e de se constituir na relação com o outro, teria uma raiz na biologia e estaria inscrita na existência de todo ser vivo. Estudos recentes da biologia e da filosofia apontam para novas formas de pensar a relação entre os seres vivos do ponto de vista ontogênico e coevolutivo. A condição humana é anteriormente biológica. Conceber a alteridade, enquanto natureza peculiar dos seres vivos, pode apontar para uma forma diferente e integrada de se compreender o corpo humano e as questões éticas relativas ao vivo e às práticas em saúde.

This article aims to present and discuss the concept of biological alterity. From a human point of view this issue is expressed beyond the dimension approached by biology. However, the ability to make conscious decisions and be constituted in the relationship with the other would have a biological root and would be embedded in the existence of every living being. Recent biology and philosophy studies have shown new ways of thinking about the relation among living beings from the point of view of ontogeny and co-evolution. The human condition has primarily biological origins. Addressing alterity as a peculiar nature of the living beings may indicate a different and integrated way of understanding human body as well as the ethical issues related to life and health practices.

Este artículo tiene la finalidad de presentar y discutir el concepto de alteridad biológica. La cuestión de la alteridad, del punto de vista humano, se expresa más allá de la dimensión planteada por la biología; pero la facultad de realizar escogimientos conscientes y de constituirse en la relación con el otro tendría una raíz en la biología y estaría inscrita en la existencia de todo ser viviente. Estudios recientes de la biología y de la filosofía apuntan para nuevas formas de pensar la relación entre los seres vivientes del punto de vista ontogénico y co-evolutivo. La condición humana es anteriormente biológica. Comprender la alteridad como naturaleza propia de los seres vivientes puede apuntar una forma integrada y diferente de comprender el cuerpo humano y las cuestiones éticas relativas al viviente y a las prácticas en salud.

Francisella-like endosymbiont in Dermacentor reticulatus collected in Portugal.

In Portugal, recent studies have confirmed the presence of Francisella tularensis in Dermacentor reticulatus. Bacterial endosymbionts with significant homology to F. tularensis have been described in several species of ticks. In this work we identified Francisella-like endosymbionts in D. reticulatus ticks (39%), confirming the presence of these bacteria in Portugal. This finding should be considered in future studies using molecular approaches to detect Francisella prevalence in ticks and environmental samples.

Comparative study of the concentration of salivary and blood glucose in type 2 diabetic patients.

The objective of the present study was to comparatively evaluate the concentrations of blood and salivary glucose as well as salivary flow and xerostomia in type 2 diabetic and non-diabetic patients. The mean salivary glucose level in diabetic patients was 14.03 +/-16.76 mg/dl and 6.35 +/- 6.02 mg/dl (P = 0.036) in the control group. The mean capillary blood glucose level in diabetic patients was 213 +/- 88 mg/dl, while that in non-diabetic patients was 99 +/- 14 mg/dl (P = 0.000). The mean value for resting salivary flow was 0.21 +/- 0.16 ml/min in diabetic patients and 0.33 +/- 0.20 ml/min in the control group (P = 0.002). The stimulated salivary flow was lower in the group of diabetic patients, with a mean of 0.63 +/- 0.43 ml/min, whereas the control group showed a mean of 1.20 +/- 0.70 ml/min (P = 0.000). Of the diabetic patients, 45% exhibited hyposalivation, in contrast to 2.5% of the non-diabetic patients (P = 0.000). Xerostomia was reported in 12.5% of diabetic patients and 5% of non-diabetic patients (P = 0.23). We can conclude that salivary glucose concentration was significantly higher in the experimental group and that there was no correlation between salivary and blood glucose concentrations in diabetic patients. The total salivary flow was significantly reduced in diabetic patients and there was no significant difference as to the presence of xerostomia in both groups.

Promoção de saúde no climatério: avaliação dos grupos educativos na ótica das mulheres participantes. / Health promotion in climacteric: evaluation of education groups under participant women?s point of view.

O projeto de extensão Viver Melhor ? assistência integral às mulheres no climatério é vinculado à Universidade Federal de Juiz de Fora e teve início em 2001. O trabalho é desenvolvido através de grupos coordenados por equipe interdisciplinar. A partir da constatação de que há usuárias que participam, há anos, deste projeto, surgiu a necessidade de avaliar qual o efeito da participação no mesmo para a saúde das mulheres. O objetivo deste artigo é apresentar a pesquisa qualitativa realizada com as participantes dos grupos para aferir os efeitos dessa participação, no sentido da prevenção e da promoção de saúde. Os resultados obtidos apontam para uma postura mais ativa das mulheres diante de sua saúde e maior qualidade de vida. Conclui-se que, embora este trabalho seja apenas uma introdução ao tema abordado, esta modalidade de atividade grupal deva ser realizada também em outras instituições que atuem com este público-alvo.

The Extension Project Viver Melhor (Living Better) - Integral Assistance to Women under Climacteric is linked to the Universidade Federal Juiz de Fora (UFJF ? Federal University of Juiz de Fora), and began in 2001. The work is being developed by groups coordinated by an interdisciplinary team. As there are users that have been taking part in this project for years, the need to evaluate which effects this participation cause to women?s health has arisen. The aim of this article is to show the qualitative research performed with the group participants, and to assess the effectiveness of this participation, regarding preventive measures and health promotion. The outcomes show a more active stand of women regarding their own health and better life quality. Although this work is only an introduction to the approached subject, it is concluded that this group activity should also be used in other institutions that deal with this kind of population.

O transplante e a questão da alteridade: biologia e subjetividade / Transplant and the question of otherness: biology and subjectivity

O desenvolvimento do conceito de corpo é marcado pela visão dissociada do homem em sua relação com a natureza, com conseqüentes implicações na epidemiologia. Este estudo tem aperspectiva de entender o corpo como integrado numa rede de elementos constitutivos, numa dinâmica de interações entre seus componentes e entre estes e outros seres e seu ambiente. Esta dinâmica se dá num contexto de alteridade, entendida não apenas no sentido das relaçõeshumanas, mas na sua acepção original, como qualidade do que é outro. Estudos recentes da biologia permitem supor um elo entre a questão da alteridade e suas raízes biológicas, integrando-a aos processos do adoecer. A capacidade de ação, de rearranjo do ser vivo emuma dinâmica de relações regulatórias e a noção de identidade são considerados na discussão dos fenômenos imunes. A alteridade aqui é vista como inata e biológica, no interior da qual asubjetividade é construída. Não há como considerar a alteridade sem aludir à subjetividade e à individualidade. Estes aspectos aparecem com clareza na experiência do transplante. Paradesvendá-la, foi realizado um estudo qualitativo com base na abordagem fenomenológica, inspirado nas teorias da complexidade e referenciado por aporte teórico de vários saberes,num diálogo interdisciplinar. Foram realizadas vinte entrevistas em profundidade com pessoas que passaram pela experiência do transplante, independentemente do tipo de transplante realizado, do sexo ou grau de instrução...

A percepção dos enfermeiros sobre sua prática: a ótica do profissional no contexto hospitalar / The nurses´ perception about their practice: the point of view of professionals in hospital context

Considerando a complexa conjutura que envolve a prática de enfermagem, este estudo, de natureza qualitativa, tem por objetivo conhecer como os enfermeiros se percebem inseridos no contexto da prática profissional. A pesquisa ocorreu em um Hospital Universitário Público, de Minas Gerais. Foram entrevistados 16 enfermeiros de diferentes setores do hospital. A análise das falas foi realizada conforme proposta de Bardin. Os resultados apontam a presença da incorporação do cuidado ao processo de trabalho, embora não tenham sido mencionados aspectos inerentes ao processo de trabalho como objeto, instrumentos, meios e fins. O cuidado aparece como fator de motivação e recompensa frente aos desafios da prática profissional.

Todo mundo tem um pouco: parâmetros para para a atuação do enfermeiro no Centro de Atenção Psicossocial - CAPS / Everybody has a little: nurse performance condition in Psycho-social Attention Center - PSAC

Este trabalho visa apresentar alguns parâmetros para atuação do enfermeiro nos Centro de Atenção Psicossocial - CAPS, construídos a partir da realização de um projeto para a melhoria da qualidade de vida de indivíduos portadores de sofrimento psíquico. As propostas são desenvolvidas por acadêmicos do Curso de Enfermagem e Obstetrìcia, sob a supervisão de uma docente que também atua na instituição. As principais atividades são a consulta de enfermagem, os grupos educativos e os grupos de medicação. Os resultados mostram que, à partir desta atuação, gerou-se uma demanda espontânea dos usuários que identificam nestas pessoas, o profissional enfermeiro.