Implementation of the small bites closure of abdominal midline incisions in clinical practice is correlated with a reduction in surgical site infections.

BACKGROUND: Small steps wound closure of midline laparotomy has been reported to decrease the incidence of incisional hernia development in two randomized controlled trials. The aim of the present study was to evaluate the effect of implementing the small steps wound closure technique in clinical practice with regards to the development of incisional ventral hernia (IVH) and surgical site infections (SSI) in clinical practice. METHODS: Implementation of the small steps wound closure technique using the small tissue bites technique as the standard closure technique for abdominal midline incisions in our clinical practice was done in March 2015. For this study, all patients from June 2013 until June 2016 with a midline laparotomy, either long or small in case of specimen extraction in laparoscopic surgery, in either elective or emergency setting were included. Conventional large bite wound closure was compared to small steps wound closure with regards to the development of SSI, IVH as well as burst abdomen. RESULTS: A total of 327 patients were included. The small steps suture technique was used in 136 (42%) of the patients, whereas the conventional large bites suture technique was used in 191 patients (58%). A total of 54 patients in the large bites group developed SSI (28%) compared to 23 (17%) patients in the small steps group (p = 0.02). A total number of 10 patients (7%) developed IVH in the small steps group compared to 27 patients (14%) in the large bites group (p = 0.08). CONCLUSION: Implementation of small bites wound closure of abdominal midline incisions in clinical practice was correlated with a reduction in surgical site infections.

Multivariate statistics applied to the reaction of common bean plants to parasitism by Meloidogyne javanica.

The availability of common bean cultivars tolerant to Meloidogyne javanica is limited in Brazil. Thus, the present study aimed to evaluate the reactions of 33 common bean genotypes (23 landrace, 8 commercial, 1 susceptible standard and 1 resistant standard) to M. javanica, employing multivariate statistics to discriminate the reaction of the genotypes. The experiment was conducted in a greenhouse using a completely randomized design with seven replicates. The seeds were sown in 1-L pots containing autoclaved soil and sand in a 1:1 ratio (v:v). On day 19, after emergence of the seedlings, the plants were treated with inoculum containing 4000 eggs + second-stage juveniles (J2). At 60 days after inoculation, the seedlings were evaluated based on biometric and parasitism-related traits, such as number of galls, final nematode population per root system, reproduction factor, and percent reduction in the reproduction factor of the nematode (%RRF). The data were subjected to analysis of variance using the F-test. The Mahalanobis generalized distance was used to obtain the dissimilarity matrix, and the average linkage between groups was used for clustering. The use of multivariate statistics allowed groups to be separated according to the resistance levels of genotypes, as observed in the %RRF. The landrace genotypes FORT-09, FORT-17, FORT-31, FORT-32, FORT-34 and FORT-36 presented resistance to M. javanica; thus, these genotypes can be considered potential sources of resistance.

Micro-CT evaluation of calcium hydroxide removal through passive ultrasonic irrigation associated with or without an additional instrument.

AIM: To use computerized microtomography (micro-CT) to evaluate the efficacy of passive ultrasonic irrigation (PUI), with or without an additional file (F5), in removing calcium hydroxide medication. METHODOLOGY: The root canals of single-rooted human teeth were prepared with a ProTaper(®) F4 file (Dentsply Maillefer) and filled with calcium hydroxide/propylene glycol 400 paste. After 30 days of storage under 100% humidity, the teeth were divided into four groups (n = 8) according to the removal technique: passive ultrasonic irrigation (PUI) only, additional file only (file F5), PUI + additional file and master apical file only (F4, control). The specimens were scanned (SkyScan 1174, resolution: 14.36 µm) after chemomechanical preparation, 30 days after the application of Ca(OH)2 paste and following its removal. The percentage of medicament remaining was calculated in terms of total canal volume and medicament volume after storage, based on microtomographic images. Data were analysed using three-way anova/Tukey's test or Kruskal-Wallis/Student-Newman-Keuls test (alpha: 5%). RESULTS: The use of PUI resulted in lower Ca(OH)2 residue volumes (3.7%) compared to when PUI was not used (6.4%; P < 0.001). The use of the additional file did not significantly influence the percentage of remaining Ca(OH)2 . The percentage of Ca(OH)2 residue was greater in the apical region (6.4%) than in the cervical region (3.8%; P < 0.01). CONCLUSIONS: The use of PUI resulted in more effective Ca(OH)2 paste removal relative to the control regardless of the use of the additional file. The apical region had the highest residue volumes in all techniques.

Method development for the control determination of mercury in seafood by solid-sampling thermal decomposition amalgamation atomic absorption spectrometry (TDA AAS).

A very simple and rapid method for the determination of total mercury in fish samples using the Direct Mercury Analyser DMA-80 was developed. In this system, a previously weighted portion of fresh fish is combusted and the released mercury is selectively trapped in a gold amalgamator. Upon heating, mercury is desorbed from the amalgamator, an atomic absorption measurement is performed and the mercury concentration is calculated. Some experimental parameters have been studied and optimised. In this study the sample mass was about 100.0 mg. The relative standard deviation was lower than 8.0% for all measurements of solid samples. Two calibration curves against aqueous standard solutions were prepared through the low linear range from 2.5 to 20.0 ng of Hg, and the high linear range from 25.0 to 200.0 ng of Hg, for which a correlation coefficient better than 0.997 was achieved, as well as a normal distribution of the residuals. Mercury reference solutions were prepared in 5.0% v/v nitric acid medium. Lyophilised fish tissues were also analysed; however, the additional procedure had no advantage over the direct analysis of the fresh fish, and additionally increased the total analytical process time. A fish tissue reference material, IAEA-407, was analysed and the mercury concentration was in agreement with the certified value, according to the t-test at a 95% confidence level. The limit of quantification (LOQ), based on a mercury-free sample, was 3.0 µg kg(-1). This LOQ is in accordance with performance criteria required by the Commission Regulation No. 333/2007. Simplicity and high efficiency, without the need for any sample preparation procedure, are some of the qualities of the proposed method.

Co-infections with bovine herpesvirus type 5 and bovine viral diarrhoea virus

During a series of experiments attempting to reproduce clinically apparent bovine herpesvirus type 5 (BoHV-5) infections, a group of calves was inadvertently infected with bovine viral diarrhoea virus (BVDV). Another group of calves was infected with BoHV-5 only. This paper reports the outcome of such infections. Two out of six calves solely infected with BoHV-5 displayed moderate to severe clinical signs. Three out of four calves of the group co-infected with BoHV-5 and BVDV developed severe clinical signs, two of them died. BoHV-5 virus was isolated to higher titres and for a longer period from the group of calves infected with both viruses. These results suggest that BVDV may enhance clinical signs induced by BoHV-5 and may also play a role in extending the period of BoHV-5 shedding.

Durante a realização de experimentos envolvendo inoculações experimentais com herpesvírus bovino tipo 5 (BoHV-5), um grupo de bovinos foi acidentalmente também inoculado com vírus da diarréia viral bovina (BVDV). Os dados obtidos nesta co-infecção foram então comparados a aqueles observados em animais inoculados exclusivamente com BoHV-5. No grupo infectado com BoHV-5 somente, dois dos seis animais inoculados mostraram sinais clínicos de moderados a graves. No grupo co-infectado com BoHV-5 e BVDV, três dos quatro animais desenvolveram doença grave, e dois deles morreram. BoHV-5 foi isolado em títulos maiores e por um período de tempo mais longo no grupo co-infectado. Os resultados sugerem que o BVDV pode exacerbar os sinais clínicos induzidos pelo BoHV-5 e, ainda, aumentou os níveis de excreção deste último.

[Caring of the mental patient in the emergency room: feelings and attitudes of the nursing team members]. / O atendimento do doente mental em pronto-socorro geral: sentimentos e ações dos membros da equipe de enfermagem.

This work is based upon a day-by-day study of the services provide by a nurse team at a mentally impaired emergency room. Our aim is to study staff's reactions toward the patients as well as service itself. We could feel the dynamic relation among thinking, feeling and performance created strong conceptions on individuals based upon a common sense. The feelings noticed are: pity, scare and rage depending upon behavior. The assistance given to the mentally impaired is, at large, based exclusively on technical data resorted to organic/biological aspects.

[The nurse in mental health outpatient clinics]. / O enfermeiro em ambulatórios de saúde mental.

This study emerged from the preoccupation to evaluate the learning needs of psychiatric nurses working in an ambulatory of Mental Health. We verified the type of education they had, the actions they performed and the difficulties and facilities they found in the development of nursing interventions. It was also examined whether these actions are in conformity to the ones prerecognized by the literature or not. The data analysis showed that the majority of the actions are performed by nurses in distinct manners in 6 ambulatories. We perceived, in some events, the "function deviation" in nursing activities of nurse and the nursing team.

[The nursing care of patients with a behavioral manifestation arising from a withdrawal from reality]. / Assistência de enfermagem a pacientes com manifestação de comportamento decorrente de alheamento da realidade.

With this study the authors want to furnish the nurses with one more reference source to guide their actions in caring for the patient with manifestation of reality withdrawal. Some concepts of withdrawal are presented and, summarily, the clinical manifestation. Nursing care is described considering their problems and general measures to be taken into account for patients individuality.

Anotacoes de enfermagem. / Nursing notes

As autoras sugeram normas gerais para o procedimento das anotacoes de enfermagem, visando a homogeneizar o ensino e facilitar a sedimentacao do aprendizado dos alunos de enfermagem

Assistencia de enfermagem a pacientes com comportamento caracterizado por manigestacoes de agitacao e agressividade. / Nursing care of patients with characterized behavior by manifestations of agitation and aggressiveness

As autoras apresentam aspectos gerais da assistencia de enfermagem para atender pacientes com manifestacoes de agitacao e agressividade, com o objetivo de preservar a integridade fisica e psiquica destes, das pessoas que o rodeiam e o desenvolvimento do controle sobre seu comportamento