[Evolution of tutoring in an orthopaedic surgery department: feedback]. / Évolution du tutorat dans un service de chirurgie orthopédique : retour d'expérience.

Tutoring involves a commitment on the part of tutors to welcoming, teaching and supporting student nurses. Tutoring plays a central role in our orthopedic surgery department, and we make it a priority. Its operation evolves according to needs, changes in tutors, student levels and the expectations of the nursing training institute. Our constant commitment to tutoring reflects our awareness of the need to support our future colleagues. Drawing on our various backgrounds and experiences, we felt it necessary to review the way we supervise ISTs and carry out our role as tutors.

[Accompanying teams to decipher and manage emotions in certain care situations]. / Accompagner les équipes pour décrypter et gérer les émotions dans certaines situations de soins.

Caring for others means being confronted with situations that arouse emotions. To provide the right care, the caregiver must be able to manage them, whether they are positive or negative. To support caregivers, the health executive plays a fundamental role and must be able to propose actions to facilitate the management of emotions within the team as well as towards patients and their relatives.

[Caregiving expertise and hospital management of the spinal surgery patient]. / Expertises soignantes et prise en charge hospitalière du patient opéré du rachis.

The care of spinal surgery patients requires the paramedical team to have precise, varied and adapted knowledge, whether it is a question of mobilization, nutrition, specific monitoring and the prevention of complications. The nurse - nursing assistant pair expresses all its know-how in the care of patients operated on a spine. Supporting the return to autonomy is a priority, especially for young patients who have undergone scoliosis surgery.

CC chemokine receptor polymorphism CCR5Δ32 in Portuguese Behçet's disease patients.

OBJECTIVES: To investigate whether CCR5 deletion is associated with susceptibility to Behçet's disease (BD) in a Portuguese population. METHODS: A total of 122 BD patients and 227 ethnically-matched controls were studied. Genotyping of the CCR5Δ32 polymorphisms was performed using polymerase chain reaction product sizing. RESULTS: No significant differences were observed in the allelic frequencies of CCR532 between patients and controls (OR=0.820; p=0.512). Stratification for gender and for the presence of HLA-B*51 did not reveal any significant differences. CONCLUSIONS: These results indicate that CCR5Δ32 is unlikely to contribute to susceptibility to BD in Portuguese patients. This may be explained by the known functional redundancy of this signalling system.

In vitro antitumoral activity of compounds isolated from Artemisia gorgonum Webb.

Artemisia gorgonum (Asteraceae) is an endemic plant to the Cape Verde islands and plays an important role in traditional medicine. The chloroform extract of the plant aerial parts afforded six sesquiterpene lactones, two methoxylated flavonoids, two lignans, and one tetracyclic triterpene, which were isolated by chromatographic methods and their structure established by physical and spectroscopic techniques. The cytotoxic activity of the three major constituents, namely, arborescin, artemetin, and sesamin, was evaluated on neuroblastoma (SH-SY5Y), hepatocarcinoma (HepG2), and nontumoral bone marrow stromal (S17) cell lines. The application of different concentrations of the compounds significantly decreased tumor cells viability at different extents, especially at the highest concentrations tested. Arborescin is the most promising compound as it was able to reduce tumoral cell viability with an IC50 significantly lower (229-233 µM; p < 0.01) than that of S17 cells (445 µM). Arborescin and artemetin were less toxic to nontumoral cells than the antitumoral drug tested, etoposide. Our results indicate that arborescin has a significant cytotoxic activity in vitro, more pronounced on the cancer cell lines, confirming A. gorgonum as a source of potential antitumoral molecules.

Broadened T-cell repertoire diversity in ivIg-treated SLE patients is also related to the individual status of regulatory T-cells.

PURPOSE: Intravenous IgG (ivIg) is a therapeutic alternative for lupus erythematosus, the mechanism of which remains to be fully understood. Here we investigated whether ivIg affects two established sub-phenotypes of SLE, namely relative oligoclonality of circulating T-cells and reduced activity of CD4 + Foxp3+ regulatory T-cells (Tregs) reflected by lower CD25 surface density. METHODS: We conducted a longitudinal study of 15 lupus patients (14 with SLE and one with discoid LE) treated with ivIg in cycles of 2-6 consecutive monthly infusions. Among these 15 patients, 10 responded to ivIg therapy with clear clinical improvement. We characterized Tregs and determined TCR spectratypes of four Vß families with reported oligoclonality. Cell counts, cytometry and TCR spectratypes were obtained from peripheral blood at various time points before, during and after ivIg treatment. T-cell oligoclonality was assessed as Vß-familywise repertoire perturbation, calculated for each patient in respect to an individual reference profile averaged over all available time points. RESULTS: For 11 out of 15 patients, average Vß1/Vß2/Vß11/Vß14 repertoires were less perturbed under than outside ivIg therapy. The four exceptions with relatively increased average perturbation during ivIg therapy included three patients who failed to respond clinically to an ivIg therapy cycle. Patients' Treg CD25 surface density (cytometric MFI) was clearly reduced when compared to healthy controls, but not obviously influenced by ivIg. However, patients' average Treg CD25 MFI was found negatively correlated with both Vß11 and Vß14 perturbations measured under ivIg therapy. CONCLUSIONS: This indicates a role of active Tregs in the therapeutic effect of ivIg.

Rescued Cats Prefer to Scratch Fabrics Commonly Used to Cover Upholstered Furniture.

Preference responses of cats for scratching fabrics commonly used on furniture were evaluated during four consecutive days in three Non-Governmental Organizations (NGOs) that rescue companion animals. Cats were grouped and their choices were registered at a group level (no individual identification). Daily choices for chenille, suede, synthetic leather, or waterproof grosgrain fabrics were evaluated for the cats' groups. A preference for chenille and non-preference for synthetic leather and waterproof grosgrain was found, independent of the NGO. In conclusion, although not using chenille does not assure that cats stop scratching furniture - especially if no other option to scratch is available - synthetic leather and waterproof grosgrain seem to be less attractive fabrics for these animals. Further studies are needed to investigate whether these findings apply to cats in a home scenario, when just one or a few individuals are usually present and only one type of fabric covering furniture is commonly available. Although we did not investigate the effect of providing scratching posts for these animals, we recommend such posts are available in the environment as scratching behavior is important to cats.

Brain-computer interface combined with mental practice and occupational therapy enhances upper limb motor recovery, activities of daily living, and participation in subacute stroke.

Background: We investigated the effects of brain-computer interface (BCI) combined with mental practice (MP) and occupational therapy (OT) on performance in activities of daily living (ADL) in stroke survivors. Methods: Participants were randomized into two groups: experimental (n = 23, BCI controlling a hand exoskeleton combined with MP and OT) and control (n = 21, OT). Subjects were assessed with the functional independence measure (FIM), motor activity log (MAL), amount of use (MAL-AOM), and quality of movement (MAL-QOM). The box and blocks test (BBT) and the Jebsen hand functional test (JHFT) were used for the primary outcome of performance in ADL, while the Fugl-Meyer Assessment was used for the secondary outcome. Exoskeleton activation and the degree of motor imagery (measured as event-related desynchronization) were assessed in the experimental group. For the BCI, the EEG electrodes were placed on the regions of FC3, C3, CP3, FC4, C4, and CP4, according to the international 10-20 EEG system. The exoskeleton was placed on the affected hand. MP was based on functional tasks. OT consisted of ADL training, muscle mobilization, reaching tasks, manipulation and prehension, mirror therapy, and high-frequency therapeutic vibration. The protocol lasted 1 h, five times a week, for 2 weeks. Results: There was a difference between baseline and post-intervention analysis for the experimental group in all evaluations: FIM (p = 0.001, d = 0.56), MAL-AOM (p = 0.001, d = 0.83), MAL-QOM (p = 0.006, d = 0.84), BBT (p = 0.004, d = 0.40), and JHFT (p = 0.001, d = 0.45). Within the experimental group, post-intervention improvements were detected in the degree of motor imagery (p < 0.001) and the amount of exoskeleton activations (p < 0.001). For the control group, differences were detected for MAL-AOM (p = 0.001, d = 0.72), MAL-QOM (p = 0.013, d = 0.50), and BBT (p = 0.005, d = 0.23). Notably, the effect sizes were larger for the experimental group. No differences were detected between groups at post-intervention. Conclusion: BCI combined with MP and OT is a promising tool for promoting sensorimotor recovery of the upper limb and functional independence in subacute post-stroke survivors.

Patients with Cervical Dystonia Demonstrated Decreased Cognitive Abilities and Visual Planning Compared to Controls.

BACKGROUND: Cervical dystonia (CD) involves clinical and motor manifestations, and visual and cognitive dysfunctions may also be frequent. OBJECTIVE: To evaluate functional vision, visual attention, and cognitive aspects in patients with CD compared with a control group. METHODS: Fifty patients with CD were assessed using the Useful Field of View Test (UFOV), the Mini Mental State Examination (MMSE), and the Trail Making Tests (TMT-A and TMT-B), and compared with an identical number of health controls matched by sex, age, and educational level. RESULTS: No differences were seen between the groups in terms of MMSE score (P = 0.481), but the CD patient group had poorer scores for the TMA-A (P = 0.004) and TMT-B (P = 0.004). For the UFOV subtests, a decrease was found for visual processing speed (P < 0.001), divided attention (P < 0.001), and selective attention (P = 0.001), as well as higher frequency in the categories with higher risk index in the UFOV test (P < 0.001). CONCLUSION: Patients with CD may exhibit decreased functional vision and visual attention, as well as higher risk in performing complex activities.

What does the susceptible-dose dependent interpretive category for cefepime in ESBL-producing bacteria?

In this study, we investigated the frequency of isolates included in the susceptible-dose dependent (SDD) category, according to the Clinical and Laboratory Standards Institute guidelines, carrying blaTEM, blaSHV and blaCTX genes among 92 Klebsiella pneumoniae and 80 Enterobacter cloacae clinical isolates. The presence of one or more extended-spectrum ß-lactamases (ESBLs) genes was observed in 64% K. pneumoniae and 69% E. cloacae isolates. Nineteen isolates were included in SDD interpretive category criteria, of which 15 carried ESBL genes (seven K. pneumoniae and eight E. cloacae). Considering the high proportion of ESBL gene-containing isolates included in the SDD category (79%), we recommend that physicians exercise caution in the use of cefepime for treatment of infections caused by these isolates, reducing possible therapeutic failure, particularly in cases of ESBL-producing bacterial strains.

Lupus mastitis.

We report a case of a 28-year-old female with the diagnosis of systemic lupus erythematosus (SLE) referred to our breast pathology consultancy in 2002 due to a left breast nodule. Further investigation revealed bilateral coarse calcifications. Biopsy was consistent with a diagnosis of lupus mastitis.

Characterization of the variable region in the class 1 integron of antimicrobial-resistant Escherichia coli isolated from surface water.

Fecal bacteria are considered to be a potential reservoir of antimicrobial resistance genes in the aquatic environment and could horizontally transfer these genes to autochthonous bacteria when carried on transferable and/or mobile genetic elements. Such circulation of resistance genes constitutes a latent public health hazard. The aim of this study was to characterize the variable region of the class 1 integron and relate its genetic content to resistance patterns observed in antimicrobial-resistant Escherichia coli isolated from the surface waters of Patos Lagoon, Southern Brazil. Genetic diversity of the isolates and presence of the qacEΔ1 gene, which confers resistance to quaternary ammonium compounds, were also investigated. A total of 27 isolates were analyzed. The variable region harbored dfrA17, dfrA1 and dfrA12 genes, which confer resistance to trimethoprim, and aadA1, aadA5 and aadA22 genes that encode resistance to streptomycin/spectinomycin. Most of the isolates were considered resistant to quaternary ammonium compounds and all of them carried the qacEΔ1 gene at the 3' conserved segment of the integron. ERIC-PCR analyses of E. coli isolates that presented the integrons showed great genetic diversity, indicating diverse sources of contamination in this environment. These results suggest that fecal bacteria with class 1 integrons in aquatic environments are potentially important reservoirs of antibiotic-resistance genes and may transfer these elements to other bacteria that are capable of infecting humans.

Fatores que interferem na história da doença de pessoas com diagnóstico de hipertensão arterial: uma abordagem a partir do genograma e ecomapa / Factors that interfere in the history of the disease of people diagnosed with hypertension: an approach based on the genogram and ecomap

Na perspectiva do conceito ampliado da saúde, a família e comunidade parecem contribuir nos processos de saúde- doença dos indivíduos e no seu tratamento, sendo sua compreensão importante para a gestão do cuidado. Assim, objetivou-se compreender, por meio de genograma e ecomapa, fatores que interferem na história da doença de pessoas com diagnóstico de hipertensão arterial, acompanhadas na Atenção Primária à Saúde. O estudo teve a participação de 10 indivíduos, adscritos de uma Unidade Básica de Saúde do município de Recife, classificados e separados em dois grupos, compensado ou descompensado para a condição crônica pesquisada. A coleta de dados fez-se por meio do emprego da História de Vida Focal, analisados de acordo com o Modelo Calgary de Avaliação na Família, e posteriormente as informações foram transportadas para genogramas e ecomapas. No grupo de pacientes compensados para hipertensão arterial sugere-se que as coesões sociais, familiares e comunitárias, demonstradas graficamente pelo ecomapa e genograma, influenciam de forma positiva na história da doença e na sua terapêutica. Ao contrário, no grupo de pacientes descompensados, onde há pouca frequência de equipamentos sociais e relacionamentos em conflitos ou cortados, esses aspectos contribuem de alguma forma para um pior controle da condição crônica.

From the perspective of the expanded concept of health, family and community seem to contribute to the health- disease processes of individuals and their treatment, and their understanding is important for the management of care. Thus, through genogram and ecomap, the objective was to understand factors that interfere in the history of the disease of people diagnosed with arterial hypertension, followed up in Primary Health Care. Ten individuals participated in this study. They were enrolled in a Basic Health Unit in the municipality of Recife, separated into groups of compensated or decompensated type for the chronic condition studied. Data collection was conducted through Focal Life History and analyzed according to the Calgary Family Assessment Model. Later, the information was transferred to genograms and ecomaps. In the group of patients compensated for arterial hypertension, it is suggested that social, family, and community cohesion, shown graphically by the ecomap and genogram, positively influences the history of the disease and its treatment. On the contrary, in the group of decompensated patients, where there is little social equipment and relationships in conflict or mostly cut off, these aspects contribute in some way to the poor control of the chronic condition.

A rapid and simple method to detect ESBL in Enterobacter cloacae based on MIC of cefepime.

INTRODUCTION: The aim of this study was to identify a rapid and simple phenotypic method for extended-spectrum ß-lactamase (ESBL) detection in Enterobacter cloacae. METHODS: A total of 79 consecutive, non-repeated samples of E. cloacae were evaluated. Four phenotypic methods were applied for ESBL detection, results were compared to multiplex polymerase chain reaction (PCR) as the gold standard reference method: 1) ceftazidime and cefotaxime disks with and without clavulanate, both with boronic acid added; 2) disk approximation using cefepime and amoxicillin/clavulanate; 3) ESBL screening by minimum inhibitory concentration (MIC) ≥ 16µg/mL and 4) by MIC ≥ 2µg/mL for cefepime. RESULTS: Method 4 showed the best combination of sensitivity (100%) and specificity (94%). CONCLUSIONS: MIC ≥ 2µg/mL for cefepime would be very useful for the phenotypic detection of ESBL in samples of E. cloacae.

Characterization of the neuropsychomotor development of children up to three years old: the ICF model in the context of the Family Health Support Center / Caracterização do desenvolvimento neuropsicomotor de crianças até três anos: o modelo da CIF no contexto do NASF

Abstract: Introduction: The neuropsychomotor development (NPMD) is dynamic and complex, explained by the contextual model, which can be discussed with an expanded view of health through the International Classification of Functioning, Disability, and Health (ICF). Objective: To characterize the NPMD of children up to 3 years old participating in the "Children's Milk Program" (CMP) from the ICF model in the context of the Family Health Support Center (FHSC) and to relate to individual, family, socioeconomic aspects and stimulation of the child in different environments. Method: In this study, 19 volunteer children, 10 (52.63%) boys and 9 girls (47.37%), aged 7-35 months old (19.42 ± 9.11), duly authorized by the person responsible participated in the study, evaluated through a semi-structured interview, and ABEP socioeconomic questionnaire, Denver Developmental Screening Test and Affordances in the Home Environment for Motor Development test. The instruments were related to ICF components for Children and Young People. The study was performed at the FHCS of a metropolitan city of Curitiba/PR, Brazil. Statistical analysis was performed using the Spearman's rô (rs) for non-parametric correlation, Mann-Whitney in quantitative comparison and Fisher's Exact Test in categorical data for occurrence probability. Results: Regarding the Denver II test, 9 (47.37%) children had questionable NPDM, and the language area was the most compromised (88.88%), 7 families (36.84% were classified in C1 by ABEP and 6 children (54.5%) up to 18 months old received adequate stimulation in the home environment and all the kids (n=8) over 19 months old, presented reasonable stimulation. The model proposed in this study responded to contextual approach of the ICF. Conclusion: It is necessary to use appropriate instruments to plan actions in basic care so children at risk to NPMD can be included in programs of early intervention, to enable the FHCS as a space for monitoring and promoting the NPMD. The ICF has proved to be an adequate and valid classification instrument for this context.

Resumo Introdução: O desenvolvimento neuropsicomotor (DNPM) é dinâmico e complexo, explicado pelo modelo contextual, que pode ser discutido com visão ampliada de saúde por meio da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Objetivo: Caracterizar o DNPM de crianças com até três anos participantes do Programa Leite das Crianças (PLC) a partir da abordagem contextual por meio da CIF, no contexto do Núcleo de Apoio à Saúde da Família (NASF), e relacionar com aspectos individuais, familiares, socioeconômicos e estimulação da criança nos diferentes ambientes. Método: Participaram deste estudo 19 crianças, 10 (52,63%) meninos e 9 meninas (47,37%), com idade entre 7 e 35 meses (19,42 ± 9,11), devidamente autorizadas pelo responsável, avaliadas por meio de entrevista semiestruturada, questionário socioeconômico da ABEP, teste de triagem de Denver II e questionário de oportunidades no ambiente domiciliar para o desenvolvimento motor. Os instrumentos foram relacionados com os componentes da CIF para crianças e jovens (CIF-CJ). O estudo foi realizado no NASF de uma cidade da região metropolitana de Curitiba/PR, Brasil. Para análise estatística utilizou-se rô de Spearman (rs) para correlação não-paramétrica, Mann-Whitney na comparação quantitativa e o Exato de Fisher em dados categóricos para probabilidade de ocorrência. Resultados: Com relação à triagem, 9 (47,37%) crianças apresentaram o DNPM questionável, sendo a área da linguagem a mais comprometida (88,88%), 7 famílias (36,84%) foram classificadas em C1 pela ABEP. Para a estimulação recebida no ambiente domiciliar, 6 crianças (54,5%) com até 18 meses tiveram estimulação adequada e todas (n=8) as crianças maiores de 19 meses apresentaram estimulação razoável. O modelo proposto neste estudo respondeu à abordagem contextual da CIF. Conclusão: É necessária a utilização de instrumentos adequados para planejar ações na atenção básica, para que crianças que apresentem risco ao DNPM possam ser incluídas em programas de intervenções precoces, para viabilizar o NASF enquanto espaço de acompanhamento e promoção do DNPM. A CIF mostrou-se um instrumento de classificação adequado e válido para este contexto.

Characterization of the variable region in the class 1 integron of antimicrobial-resistant Escherichia coli isolated from surface water

Abstract Fecal bacteria are considered to be a potential reservoir of antimicrobial resistance genes in the aquatic environment and could horizontally transfer these genes to autochthonous bacteria when carried on transferable and/or mobile genetic elements. Such circulation of resistance genes constitutes a latent public health hazard. The aim of this study was to characterize the variable region of the class 1 integron and relate its genetic content to resistance patterns observed in antimicrobial-resistant Escherichia coli isolated from the surface waters of Patos Lagoon, Southern Brazil. Genetic diversity of the isolates and presence of the qacEΔ1 gene, which confers resistance to quaternary ammonium compounds, were also investigated. A total of 27 isolates were analyzed. The variable region harbored dfrA17, dfrA1 and dfrA12 genes, which confer resistance to trimethoprim, and aadA1, aadA5 and aadA22 genes that encode resistance to streptomycin/spectinomycin. Most of the isolates were considered resistant to quaternary ammonium compounds and all of them carried the qacE Δ1 gene at the 3′ conserved segment of the integron. ERIC-PCR analyses of E. coli isolates that presented the integrons showed great genetic diversity, indicating diverse sources of contamination in this environment. These results suggest that fecal bacteria with class 1 integrons in aquatic environments are potentially important reservoirs of antibiotic-resistance genes and may transfer these elements to other bacteria that are capable of infecting humans.

Uma intervenção em um centro de juventude / An intervention in a youth center

O presente trabalho tem como objetivo apresentar a realização de uma intervenção em um Centro de Juventude, tendo por metodologia um período de observações da instituição como um todo, em um primeiro momento, seguida de uma intervenção, através de grupos operativos, a qual abrangeu todos os níveis hierárquicos. Este trabalho possibilitou um espaço de reflexão aos educadores e aos coordenadores, assim como uma melhora nas relações interpessoais estabelecidas na instituição. Com relação às crianças, abriu-se um espaço para jogos psicopedagógicos, que resultou em um desenvolvimento da capacidade de expressão e o crescimento de seu potencial criativo. Esses resultados levaram a concluir que 14 encontros de 02 horas semanais, sob a forma de grupos operativos, foram suficientes para promover alterações na dinâmica institucional, tendo havido uma melhora no todo da instituição.

Uma intervenção em um centro de juventude / An intervention in a youth center

O presente trabalho tem como objetivo apresentar a realização de uma intervenção em um Centro de Juventude, tendo por metodologia um período de observações da instituição como um todo, em um primeiro momento, seguida de uma intervenção, através de grupos operativos, a qual abrangeu todos os níveis hierárquicos. Este trabalho possibilitou um espaço de reflexão aos educadores e aos coordenadores, assim como uma melhora nas relações interpessoais estabelecidas na instituição. Com relação às crianças, abriu-se um espaço para jogos psicopedagógicos, que resultou em um desenvolvimento da capacidade de expressão e o crescimento de seu potencial criativo. Esses resultados levaram a concluir que 14 encontros de 02 horas semanais, sob a forma de grupos operativos, foram suficientes para promover alterações na dinâmica institucional, tendo havido uma melhora no todo da instituição (AU)