Filarial disease in the Brazilian Amazon and emerging opportunities for treatment and control.

Following the successful eradication of Wuchereria bancrofti, there are now just three species of conventional microfilaremic human filarial parasites endemic to the Brazilian Amazon region: Mansonella ozzardi, Mansonella perstans and Onchocerca volvulus. The zoonotic filarial parasite Dirofilaria immitis is also found in the Amazon region as are several sylvatic filarial parasites, some of which have been recorded causing zoonoses and some of which have never been recorded outside the region. Onchocerca volvulus is only found in the Amazonia onchocerciasis focus in the Brazilian state of Roraima where it affects the people of the Yanomami tribe living around the densely forested Venezuela border region. Mansonella ozzardi is by far the most common filarial parasite in Brazil and has a broad but patchy distribution throughout the western Amazon region. Recorded in the Brazilian states of Acre, Roraima, Matto Grosso, and within almost every municipality of Amazonas state, it is believed that pollution of the urban stream and river systems prevents the development of the simuliid vectors of M. ozzardi and explains the parasite's reduced distribution within urban areas and an absence of recent reports from the state capital Manaus. Decades of WHO-led periodic ivermectin treatment of Yanomami tribe's people have resulted in the partial suppression of O. volvulus transmission in this focus and has also probably affected the transmission of M. ozzardi in the region. Mansonella perstans, O. volvulus and very probably M. ozzardi infections can all be treated and most likely cured with a 4-6-week treatment course of doxycycline. The Brazilian Ministry of Health does not, however, presently recommend any treatment for mansonellosis infections and thus parasitic infections outside the Amazonia focus are typically left untreated. While the long treatment courses required for doxycycline-based mansonellosis therapies preclude their use in control programmes, new fast-acting filarial drug treatments are likely to soon become available for the treatment of both onchocerciasis and mansonellosis in the Amazon region. Filarial disease management in the Brazilian Amazon is thus likely to become dramatically more viable at a time when the public health importance of these diseases is increasingly being recognized.

Comparison of validation protocols for blood pressure measuring devices in children and adolescents.

Accuracy of blood pressure (BP) measurement is important for the evaluation of hypertension in children and adolescents, and it is critically dependent upon the accuracy of the BP measuring device. A device that could pass validated protocols with reliable accuracy would be desirable in clinical and research settings. Several scientific organizations have published recommendations on the validation of different BP measuring devices. Most of them focus on adults but separate recommendations and validation criteria for BP devices intended for use in children and adolescents are included in some validation protocols. In this review, we compare the validation criteria for BP measuring devices among consensus documents from different scientific organizations focusing on the pediatric population and we discuss the evidence gaps targeting the needs for validated BP measuring devices in children and adolescents. We also highlight common pitfalls in the validation studies of BP measuring devices in children and adolescents using the example of office BP devices.

Nephrotic syndrome on sickle cell disease: the impact of Hydroxyurea.

Nephropathy is a common under-recognised complication of sickle cell disease (SCD) and one of the main factors of poor prognosis in these patients. The association between nephrotic syndrome and SCD in children is rare. Strategies for sickle cell nephropathy prevention are still poorly established. Blood pressure control as well as monitoring of microalbuminuria and renal function are mandatory. The use of antiproteinuric drugs, such as anti-ACE inhibitors (ACEis) and hydroxyurea, should be considered in early stages. Here, we report a case of a female adolescent with SCD and inaugural nephrotic syndrome who, after an initial treatment failure with corticotherapy, had a remarkable recovery after treatment with hydroxyurea and ACEis.

Sleep disturbance in pediatric patients on automated peritoneal dialysis.

OBJECTIVE: There are few reports describing sleep disturbance (SD) in children on automated peritoneal dialysis (APD), and they are mostly based on the application of questionnaires. As far as we know, only two studies used polysomnography (PSG), the gold standard for the diagnosis of SD. This is the first study assessing SD in children with chronic kidney disease (CKD) on APD in our country. METHODS: This was an observational and descriptive study. Children up to 18 years of age who had undergone APD for a minimum of three months were considered eligible. Exclusion criteria were diabetes, neurologic disorders and sedative/hypnotic therapy. PSG was performed while the children were on their usual cycler nocturnal dialysis regimen. A questionnaire was completed on the same day. Informed, written consent was provided by all participants. RESULTS: Eight children on APD were studied. The median age was 10 years (range, 1-18 years) and the mean body mass index z-score was -0.35 (±0.71). The average duration on dialysis was 8.4 months. SD was noted in five (62.5%) patients. The results of PSG showed decreased sleep efficiency (81.05 ± 0.09%) and latency (13.6 ± 11.6 min), increased awake time (23.08% of total sleep time (TST) ± 14.3), apnea/hypopnea index (1.8/h ± 1.9) and desaturation index (4.5 ± 3.7). Periodic leg movements index average was normal (0.78/h ± 0.77). Subjective data obtained by the sleep questionnaire underestimated PSG findings. CONCLUSION: Our study shows that SD was present in more than half of children on PD. This result, in a small sample of patients, alerts to the need for systematic screening for sleep problems in children with CKD with a low threshold for a formal PSG.

[Nephrocalcinosis and subcutaneous fat necrosis]. / Nefrocalcinose e Necrose Gorda do Tecido Celular Subcutâneo.

Subcutaneous fat necrosis of the newborn is an uncommon, transient and self-healing panniculits. This entity generally follows an uncomplicated course, however there are rare and important complications. The authors present a case of a newborn with subcutaneous fat necrosis complicated by hypercalcemia and nephrocalcinosis. The pathogenesis of hypercalcemia is not fully understood and the nephrocalcinosis can evolve to chronic kidney disease. Clinicians should be aware of subcutaneous fat necrosis as a possible risk factor for hypercalcemia and patients should have serial serum and urinary calcium determinations for up to 6 months after the appearance of the skin lesions. The early diagnosis and prompt treatment of hypercalcemia are essential to prevent severe complications.

A necrose gorda do tecido celular subcutâneo do recém-nascido é uma paniculite rara, transitória e auto-limitada. Tipicamente apresenta evolução favorável, contudo podem surgir complicações potencialmente graves. Apresenta-se um caso que evoluiu com hipercalcémia e nefrocalcinose. A etiopatogenia da hipercalcémia é ainda pouco compreendida e a nefrocalcinose pode constituir uma causa de doença renal crónica. A monitorização regular dos valores de cálcio sérico e urinário neste contexto é essencial, no mínimo até 6 meses após a resolução das lesões cutâneas, porque o diagnóstico precoce e a terapêutica adequada constituem a única possibilidade de prevenir complicações mais graves.

Vitamin D-dependent rickets: a resurgence of the rachitic lung in the 21st century.

Respiratory complications of rickets may be life-threatening particularly in developing countries. A 7-month-old boy presented with recurrent infections, seizures, failure to thrive, wheezing and respiratory distress progressing to global respiratory failure. Several antimicrobial regimens, bronchodilators and corticosteroids resulted in only short-term improvement. He was transferred from Cape Verde to a third-care hospital in Portugal. He was hypotonic and undernourished, with respiratory anguish and classical skeletal signs of rickets, despite vitamin D supplementation. Hypocalcaemia, normal phosphate levels and normal vitamin D status 25(OH)D3 and 1.25(OH)2D3) pointed to vitamin D-dependent rickets type II. Treatment with high doses of calcium and calcitriol allowed progressive respiratory, musculoskeletal and neurological recovery. Although respiratory manifestations of rickets were described many years ago, the present case raises relevant issues about the level of diagnostic support, the risk of complications and how they should be assessed and monitored.

A novel mutation of the HNF1B gene associated with hypoplastic glomerulocystic kidney disease and neonatal renal failure: a case report and mutation update.

Hepatocyte nuclear factor 1 beta (HNF1B) plays an important role in embryonic development, namely in the kidney, pancreas, liver, genital tract, and gut. Heterozygous germline mutations of HNF1B are associated with the renal cysts and diabetes syndrome (RCAD). Affected individuals may present a variety of renal developmental abnormalities and/or maturity-onset diabetes of the young (MODY). A Portuguese 19-month-old male infant was evaluated due to hypoplastic glomerulocystic kidney disease and renal dysfunction diagnosed in the neonatal period that progressed to stage 5 chronic renal disease during the first year of life. His mother was diagnosed with a solitary hypoplastic microcystic left kidney at age 20, with stage 2 chronic renal disease established at age 35, and presented bicornuate uterus, pancreatic atrophy, and gestational diabetes. DNA sequence analysis of HNF1B revealed a novel germline frameshift insertion (c.110_111insC or c.110dupC) in both the child and the mother. A review of the literature revealed a total of 106 different HNF1B mutations, in 236 mutation-positive families, comprising gross deletions (34%), missense mutations (31%), frameshift deletions or insertions (15%), nonsense mutations (11%), and splice-site mutations (8%). The study of this family with an unusual presentation of hypoplastic glomerulocystic kidney disease with neonatal renal dysfunction identified a previously unreported mutation of the HNF1B gene, thereby expanding the spectrum of known mutations associated with renal developmental disorders.

[Kidney failure associated with Plasmodium falciparum infection]. / Insuficiência renal associada a infecção por Plasmodium falciparum.

Plasmodium falciparum infection may be a cause of acute renal failure (ARF). Whereas renal failure appears to be a common complication of severe malaria in adults, it seldom occurs in children. The authors report a case of a previously healthy 9-year-old child, who was admitted with fever, vomits, diarrhoea, jaundice and obnubilation of consciencious. The results of laboratory tests performed confirmed the diagnosis of falciparum malaria. At the 2nd day of hospitalization she was in ARF and dialysis was necessary. We admitted that the probable underlying factors leading to this complication were: intravascular haemolysis, volume depletion, hypotension and hyperparasitaemia. Despite the presence of predictive factors of bad outcome the evolution was favourable with gradual recuperation of renal function.

[Nutcracker syndrome. Hematuria without diagnosis?]. / Síndrome de Nutcracker. Hematúria sem diagnóstico?

The nutcracker syndrome is associated with left renal vein compression in its passage between the abdominal aorta and superior mesenteric artery. This phenomenon can cause left renal vein hypertension manifested by abdominal pain, hematuria, and pelvic congestion syndrome. The diagnosis is essentially clinical, supported by imaging and necessarily one of exclusion. The literature suggests that it occurs with a reasonable prevalence in children who present with isolated hematuria but is commonly misdiagnosed. We describe two clinical cases of children with hematuria whose investigation led to the diagnosis of Nutcracker Syndrome. In the presence of hematuria of unknown origin it's necessary to consider this entity, highlighting the essential role of a noninvasive test such as renal ultrasound with Doppler in its diagnosis.

Aspectos higienicossanitários de unidades de alimentação e nutrição escolares da rede municipal de ensino em Coari - AM

O controle das condições higienicossanitárias nos processos de produção e distribuição da alimentação escolar é uma das condições fundamentais para a promoção e a manutenção da saúde. O presente estudo objetivou analisar as condições higienicossanitárias em dez Unidades de Alimentação e Nutrição (UAN's) de instituições de ensino da rede municipal de Coari - AM. Para isso, aplicou-se um checklist contendo 92 itens de verificação, agrupados em oito blocos: Instalações e edificação; Controle de vetores e pragas; Abastecimento de água; Manejo de resíduos; Equipamentos, móveis e utensílios; Higienização de equipamentos, móveis e utensílios; Manipulador de alimentos; e Armazenamento e produção dos alimentos. Assim, constatou-se que nenhuma unidade alcançou conceito "bom", enquanto 20% apresentaram classificação "regular"e 80% foram caracterizadas como "ruim". Desta forma, as condições higienicossanitárias foram consideradas insatisfatórias na maioria das UAN' s, o que evidencia um baixo atendimento aos critérios exigidos na legislação. Os resultados reforçam a necessidade de adequação física, supervisão continuada por profissional nutricionista, bem como a inserção de programas de treinamento regulares e eficazes para as merendeiras, e subsequente adoção de Boas Práticas de Fabricação em todas as unidades avaliadas.

The control of sanitary conditions in the processes of production and distribution of school meals is one of the fundamental conditions for the promotion and maintenance of health. The present study aimed to analyze the hygienic and sanitary conditions in ten Units of Food and Nutrition (UFN's) of educational institutions in the municipal of Coari - AM. For this, we applied a checklist containing 92 items of verification, grouped into eight blocks: building and facilities; Vector control and plagues, piped water supply, waste management; Equipment, furniture and fixtures; Sanitizing equipment, furniture and utensils, food handlers, and food production and storage. So, it was found that no unit reached the concept "good", while 20% presented a "regular" rating and 80% were characterized as "bad''. Given that the sanitary conditions were deemed unsatisfactory in most UFN's, this shows a low compliance with the criteria required by the legislation. The results reinforce the need for physical adequacy, continued supervision by professional nutritionist, and the inclusion of regular and effective training programs for cookers, and subsequent adoption of Good Manufacturing Practices in all the evaluated units.

Conhecimento e prática de enfermeiros sobre cuidados aos pacientes com feridas / Conocimiento y práctica de enfermeros acerca del cuidado de los pacientes con heridas / Knowledge and practice of nurses about care for patients with wounds

Objective: identifying the knowledge, practice and nurses information sources about the care of patients with wounds. Method: a cross-sectional, descriptive and exploratory study performed in a university hospital in July 2010. The data were collected through an adapted questionnaire. The study included 35 nurses assigned to different sectors of work. The data was submitted to descriptive and analytical statistical treatment. Results: considering the overall results, the nurses had an average of 69.4% of hits (sd = 13.5%). The nurses that have cited utilizing sometimes some sources of information had a higher percentage of hits. Conclusion: it was concluded that nurses had insufficient knowledge in some areas on the subject. There is need to update professionals' knowledge on advances of the current evidences that base wound care, in order to guide, with the context studied, the planning of strategies to implement the best evidences available.

Objetivo: identificar o conhecimento, prática e fontes de informações de enfermeiros sobre o cuidado de pacientes com feridas. Método: estudo transversal, descritivo-exploratório, realizado em um hospital universitário em julho de 2010. Os dados foram coletados por meio de um questionário adaptado. Participaram deste estudo 35 enfermeiros distribuídos em diferentes setores de trabalho. Os dados sofreram tratamento estatístico descritivo e analítico. Resultados: considerando os resultados globais, os enfermeiros obtiveram, em média, 69,4% de acertos (dp= 13,5%). Os enfermeiros que citaram utilizar às vezes algumas fontes de informações tiveram maior porcentagem de acertos. Conclusão: conclui-se que os enfermeiros apresentaram conhecimento insuficiente em algumas áreas referentes ao tema. Destaca-se a necessidade da atualização dos profissionais quanto aos avanços das evidências atuais que embasam o cuidado de feridas, a fim de nortear, no contexto estudado, o planejamento de estratégias para a implementação das melhores evidências disponíveis.

Objetivo: identificar el conocimiento, la práctica y las fuentes de información de los enfermeros, sobre el cuidado con las heridas. Método: estudio transversal, descriptivo y exploratorio realizado en un hospital universitario en julio de 2010. Los datos fueron recolectados a través de un cuestionario adaptado. Participaron en el estudio 35 enfermeros asignados a diferentes sectores de trabajo. Los datos se sometieron a tratamiento estadístico descriptivo y analítico. Resultados: teniendo en cuenta los resultados globales, los enfermeros obtuvieron, en promedio, el 69,4% de respuestas correctas (de = 13,5%). Los enfermeros que informaron el uso, a veces algunas fuentes de información tuvieron el mayor porcentaje de respuestas correctas. Conclusión: se concluye que los enfermeros tenían un conocimiento insuficiente en algunas áreas acerca del tema. Se destaca la necesidad de actualizar a los profesionales sobre los avances de las evidencias actuales que sustentan el cuidado de las heridas, con el fin de orientar, en el contexto estudiado, la planificación de estrategias para la implementación de las mejores evidencias disponibles.

Rituximab use in pediatric autoimmune diseases: four case reports.

Rituximab (RTX) is currently used in many diseases, but its efficacy and safety in juvenile systemic lupus erythematosus (SLEj) is still unknown. In this chapter we present four case reports of children treated with RTX: three SLE and one immune thrombocytopenic purpura (ITP). Two of the three SLEj patients had class IV lupus nephritis (LN) and hematologic manifestations (pancytopenia), both reaching complete recovery of blood counts and improvement of LN with RTX treatment. Our third SLE patient had a severe onset with generalized microangiopathic manifestations in association with antiphospholipid antibodies and has been in remission for almost 1 year after RTX. However, our fourth case, a patient with ITP and renal failure, was treated with RTX without either hematologic or renal response.

[Hypothyroidism and terminal renal failure in the neonatal period]. / Hipotiroidismo e insuficiência renal terminal no período neonatal.

It has been described alterations of the thyroid function in patients with chronic renal disease without primary disease of the thyroid gland. Nevertheless primary hypothyroidism is more frequent in this population than in other non renal chronic disease. Authors report two cases of hypothyroidism diagnosed in infants with terminal renal failure in the neonatal period, secondary to renal hypoplasia / dysplasia, both in peritoneal dialysis programme. The diagnosis was made by elevated value of thyrotropin (TSH) on the metabolic screening test (TSH/PKU screening test) and confirmed later by measure of serum TSH, total triiodothyronine (T3), total thyroxine (T4), free triiodothyronine (FT3), free thyroxine (FT4) and thyroglobulin (TGB). It was also investigated antithyroid autoantibodies. Both infants initiated hormonal substitution with thyroxin, which have been suspended in one of them by two years of age when thyroid function was normal.

Concordância entre enfermeiros quanto ao risco dos pacientes para úlcera por pressão / Agreement between nurses regarding patients' risk for developing pressure ulcer

OBJETIVOS: Avaliar a concordância entre enfermeiros quanto à avaliação e classificação de risco dos pacientes para desenvolvimento da Úlcera por Pressão. MÉTODOS: Estudo descritivo exploratório realizado com 22 enfermeiros assistenciais em quatro Unidades de Terapia Intensiva de hospital universitário brasileiro. Utilizou-se a escala de Braden para avaliação e classificação do risco dos pacientes para Úlcera por Pressão. Para avaliação da concordância, considerou-se o escore obtido pela pesquisadora, enfermeira especialista, como parâmetro ouro para comparação com os escores pontuados pelos enfermeiros assistenciais. RESULTADOS: Verificou-se concordância geral entre os enfermeiros somente na avaliação das subescalas Percepção Sensorial, Mobilidade, Fricção e Cisalhamento. Quanto à classificação em níveis de risco, houve concordância apenas em duas Unidades. CONCLUSÃO: Foram encontradas divergências de concordância entre os enfermeiros assistenciais e diferença na classificação dos pacientes em níveis de risco.

OBJECTIVES: To evaluate the agreement between nurses regarding classification and assessment of patients' risk for developing pressure ulcer. Methods: A descriptive exploratory study conducted with 22 nurses in four intensive care units of Brazilian university hospitals. The Braden Scale was used for assessment and classification of the patients' risk for developing pressure ulcer. To assess agreement, we considered the score obtained by the researcher, nurse specialist, as gold standard parameter for comparison with scores punctuated by assisting nurses. RESULTS: There was general agreement among nurses only in the assessment of the subscales Sensory Perception, Mobility, Friction & Shear. For classification into risk levels, there was agreement in only two units. CONCLUSION: There were differences of agreement between assisting nurses and difference in classification of patients into risk levels.

Escrevendo para publicação em periódicos: o que você deve saber? / Escribiendo para publicación en periódicos: ¿qué debes saber? / Writing to periodicals: what should you know?

Trata-se de uma revisão de literatura com objetivos de sumarizar as evidências disponíveis, por meio daspesquisas realizadas, sobre os erros e dificuldades encontrados no processo de publicação científica, e oferecer subsídiospara a implementação de modificações que promovam a qualidade e a publicação das informações produzidas peloscampos da ciência, entre eles, a Enfermagem. O levantamento bibliográfico foi realizado nas bases de dados da LILACS eBDENF do sítio da Biblioteca Virtual de Saúde. Foram identificados como principais erros e fatores de rejeição de artigossubmetidos à publicação: o fato do artigo ser pobremente escrito; informações e/ou dados desatualizados; falha nametodologia; erros de revisão de literatura e de redação; informações insuficientes e inadequadas; problemas estatísticose uso de estatísticas incorretas. Como sugestões aos autores, para facilitar a publicação científica, foram elencadas: aatualidade da literatura; domínio da metodologia aplicada ao estudo e análise dos dados concisa.

It is a literature review, which had the purpose of summarizing the available evidences in researches on ?theerrors and difficulties found in the process of scientific publication? subject, as well as offering subsidies for theimplementation of changes that promote the quality and the publication of information produced by the s of sciences,such as nursing. The bibliographic survey was gathered from the LILACS and BDENF databases in the health virtuallibrary website. The main errors and rejection factors of the submitted articles were: poor writing; out of date informationand/or data; methodology failures, mistakes on the literature review; misspelling; insufficient and inadequate information;statistics problems and use of incorrect statistics. As main suggestions for authors to make the process of publicationeasier: the review of literature must be up to date; the fully understanding of the chosen methodology; the data analysismust be concise.

Se trata de una revisión de literatura con objetivos de sumariar las evidencias disponibles a través de lasinvestigaciones realizadas sobre los errores y dificultades encontrados en el proceso de publicación científica, ofrecersubsidios para la implementación de modificaciones que fomentan la calidad y la publicación de las informaciones producidaspor los campos de ciencia, entre ellos, la Enfermería. El levantamiento bibliográfico se realizó en las bases de datos de laLILACS y BDENF del sitio de la biblioteca virtual de salud. Han sido identificados como principales errores y factores derechazo de artículos sometidos a la publicación el hecho del artículo ser pobremente escrito, informaciones insuficientese inadecuadas; problemas estadísticos y uso de estadísticas incorrectas. Como sugerencias a los autores para facilitar lapublicación científica fueron resaltadas la actualización de la literatura; dominio de la metodología aplicada al estudio yanálisis conciso de datos.

Protocolo assistencial para prevenção de úlcera por pressão em clientes críticos / Protocolo asistencial para prevención de úlcera por presión en pacientes críticos / Assistance protocol for bedsores prevention in critical patients

Úlcera por pressão é um problema de saúde grave que acomete grande parte dos clientes internados em unidade de terapiaintensiva, aumentando a permanência no serviço de saúde e, consequentemente, gerando mais gastos com internações. Nessesentido, esta pesquisa foi desenvolvida com o objetivo de analisar o indicador de úlcera por pressão em pacientes críticos internadosem unidade de terapia intensiva de um hospital escola do noroeste paulista, além de propor e aplicar um protocolo de assistência deenfermagem para prevenção desse tipo de lesão nas unidades estudadas. Trata-se de um estudo descritivo exploratório e retrospectivopor abordagem quantitativa, desenvolvido por meio da análise documental de relatórios e estatísticas realizadas nos meses de junho2009 a maio de 2010, em duas unidades do hospital. O indicador apresentou índices variáveis durante o ano todo nas duas unidades,apresentando-se elevado durante o seguimento de doze meses. Concluiu-se que uma assistência de enfermagem sistematizada ebaseada em conhecimentos científicos poderá prevenir úlceras por pressão, reduzindo o indicador e possibilitando também assistênciade enfermagem de maior qualidade.

Pressure ulcer is a serious health problem that affects most of the clients admitted to the intensive care unit, increasing thepermanence in the health service and thus generating more spending on hospitalizations. In this sense, this research was developedwith the aim of analyzing the indicator of pressure ulcers in critically ill patients admitted to the intensive care unit of a teachinghospital in northeastern São Paulo, and propose and implement a nursing care protocol for prevention of this type injury in the unitsstudied. It is a retrospective descriptive exploratory study and a quantitative approach, developed by the documental analysis ofreports and statistics conducted in June 2009 to May 2010, two units of the hospital. The indicator showed variable rates throughoutthe year the two units was increased during the following twelve months. It was concluded that a nursing care based on systematicand scientific knowledge can prevent pressure ulcers, reducing the index and also allowing for greater nursing care quality.

Una úlcera por presión es un problema de salud grave que acomete gran parte de los pacientes internados en Unidad de TerapiaIntensiva, aumentando la permanencia de esos pacientes en el servicio de salud y, consecuentemente, generando más gastos conlas internaciones. En ese sentido, esta pesquisa fue desarrollada con el objetivo de analizar el indicador de úlcera por presión enpacientes críticos internados en la unidad de terapia intensiva de un hospital escuela del noroeste de São Paulo – Brasil, y proponerun protocolo de asistencia de enfermería para prevención. Se trata de un estudio descriptivo exploratorio, retrospectivo conabordaje cuantitativo, por medio de analice documental de relatórios y estadísticas de los meses de junio de 2009 a mayo de 2010en dos UTIS generales del hospital. El indicador presentó índices variables durante todo el año en las dos UTIs, presentándoseelevado durante el seguimiento de doce meses. Se concluye que una asistencia de enfermaría sistematizada y basada en conocimientoscientíficos podrá prevenir las ulceras por presión, reduciendo el indicador y posibilitando una asistencia de enfermería de calidad.

Elaboração de protocolos de enfermagem para pacientes submetidos à cirurgia oncológica do aparelho digestivo alto / Elaboration of nursing protocols for patients submitted to oncologic surgery of the upper digestive system

O interesse pela realização deste trabalho surgiu por meio da participação em uma equipe multidisciplinar de cirurgia oncológica do aparelho digestivo alto, motivando a realização de mudanças na assistência de enfermagem. O objetivo foi relatar a elaboração de protocolos de assistência de enfermagem no pré e no pós-operatório de pacientes submetidos a cirurgias oncológicas do aparelho digestivo alto. O processo de elaboração foi realizado entre os meses de fevereiro e outubro de 2006, no 6º andar do Hospital de Base deSão José do Rio Preto, interior de São Paulo. Para a elaboração dos protocolos foram traçadas três etapas de desenvolvimento: participação, observação e coleta de dados durante as visitas da equipe multidisciplinar; revisão na literatura sobre as intervenções e, por fim, a elaboração dos protocolos. Em conclusão, o trabalho em equipe multidisciplinar e especificamente com doentes com câncer no aparelho digestivo alto, gerou mudanças no comportamento da enfermagem que culminou com a criação e a implantação de novos protocolosde atendimento específicos para esses pacientes, bem como um protocolo para identificação precoce de infecção do sítio cirúrgico. Outra observação é que esses protocolos devem ser dinâmicos e implementados continuamente, permitindo a avaliação contínua da assistência médica e de enfermagem. Acredita-se que a implantação desses protocolos proporcionará a melhoria da qualidade do atendimento de enfermagem para os pacientes internados pela equipe de cirurgia oncológica do aparelho digestivo alto, além de permitir um enfoque sobre a incidência de infecção do sítio cirúrgico, resultando em benefícios para o paciente e criando oportunidades para futuras intervenções visando à melhoria contínua do serviço.

Being part of a multiprofessional team of oncologic surgery of the upper digestive system has motivated the interest to carry out this work. It has also induced some changes in the nursing care. The purpose of the present study was to report the elaboration of nursing care protocols in pre and postoperative periods of the patients submitted to oncologic surgery of the upper digestive system. The elaboration process was carried out between February and October 2006, at the 6th floor of Hospital de Base, a Teaching Hospital, in São José do Rio Preto, interior of São Paulo State. To develop the process three stages were outlined: participation, observation and data collection during the visits of the multidisciplinary team; the literature review oninterventions and, finally, the elaboration of nursing care protocols. In conclusion, the multidisciplinary team and, mainly, with patients with cancer of the upper digestive system produced changes in nursing behavior. This has culminated with the elaboration and introduction of new specific care protocols for these patients as well as a protocol for early i dentification of surgical site infection. Another observation is that these protocols should be dynamic and continually implemented, allowing the continuous evaluation ofboth medical and nursing care. The introduction of these protocols will promote the quality of nursing carefor the patient admitted by the oncologic surgery team of the upper digestive system. In addition, it allows focusing on the surgical site infection incidence resulting in benefits for the patients and creating opportunities for further interventions to continuously improve the service.

A utilização de curativos no tratamento de evisceração: relato de caso / The use of wound dressings in treatment of disembowelment: case report

A evisceração é caracterizada como projeção das vísceras para fora da cavidade abdominal ocorrendo simultaneamente à deiscência de sutura ou durante sua evolução. O objetivo deste trabalho é relatar a utilização de curativo com gaze não aderente embebida em petrolatum associada ao hidrogel e posteriormente o uso de Ácidos Graxos Essenciais (AGE), no tratamento de um paciente com deiscência abdominal e evisceração. Trata-se de um estudo de caso na modalidade qualitativa que foi realizado no Hospital de Base de São José do Rio Preto. Concluiu-se que os produtos utilizados apresentaram resultado satisfatório, pois a cicatrização completa da lesão ocorreu em aproximadamente três meses.

Tratamento de lesão por piomiosite tropical: relato de caso / Treatment of lesion by tropical pyomyositis: case report

A Piomiosite Tropical consiste na infecção primária de um agrupamento muscular, principalmente dos membros inferiores e tronco. O objetivo deste trabalho é relatar um caso de lesão por Piomiosite Tropical em região glútea, tratado com papaína gel 3 por cento, e posteriormente, óleo de girassol in natura, associado à Câmara Hiperbárica. Trata-se de um estudo de caso com abordagem qualitativa realizado no Hospital de Base de São José do Rio Preto. Concluiu-se que o uso da papaína, do óleo de girassol in natura associados à Câmara Hiperbárica contribuíram para a aceleração do processo cicatricial, tendo a cicatrização da ferida ocorrido em aproximadamente quatro meses. Observou-se ainda, a importância do papel do enfermeiro para a condução do caso.