Primary care doctors' attitude towards drug allergy in Portugal: a questionnaire.

Summary: Background. The aim of the study was to learn about perception of drug allergy by general practitioners (GP) from continental Portugal, identify difficulties and educational needs for its management. Methods. A total of 372 answers were obtained. A questionnaire was addressed to GPs. Results. The most commonly identified drugs were antibiotics for 65.3% of the GPs and skin was the most commonly affected organ for 65.8%. Drug allergy was considered as very important in clinical practice by 73.7%, but difficulties in recognizing it were stated by 70.2%. Further education in this field wouldbe welcome by 97.8% of the doctors. The collaboration of Immunoallergology centers was considered non satisfactory by 39.8% of GPs and 45.7% of them stated that two-thirds of the suspected reactions were not investigated. Conclusions. These points deserve consideration in future health educational and organizational strategies.

Prevalence of enteroparasitic infections and related hormonal and immunological repercussions that may compromise students' physical performance.

The aim of this study was to evaluate the prevalence of enteroparasitic infections in students and their hormonal and immunological repercussions on physical development. Students of basic education of both sexes were evaluated. Parasitological stool tests were performed using the Hoffman and Kato-Katz methods. The students were divided into two groups: a control group (negative parasitological examination, N=25) and an infected group (positive parasitological test, N=25). Anthropometric variables (height, weight, and BMI), concentrations of hormones (melatonin and cortisol), cytokine/chemokine levels (IL-1ß, IL-6, IL-8, IL-10, IL-12, IL-17 and TNF-α) and physical performance (aerobic capacity, upper- and lower-limb muscle strength and abdominal performance) were evaluated. The prevalence of parasitic infection among the students was 7.98%. No anthropometric differences were observed among the groups. IL-2 and TNF-α levels were higher and IL-8 levels were lower in serum from students who were positive for parasitic infection. Serum from students who were positive for parasitic infection showed higher levels of melatonin than that from parasitenegative students. No differences were observed in cortisol levels. Students who were positive for parasitic infection presented greater lower-limb strength and lower abdominal performance than parasite-negative students. In the parasitic infection group, IL-12 was positively correlated with melatonin. In the parasitic infection group, IL-8 showed a positive correlation with aerobic capacity, while IL-17 and TNF-α showed a positive correlation with abdominal performance. These data suggest that parasitic infections determine the profile of inflammatory cytokines and that melatonin may be involved in the control of this process to minimize tissue damage. Additionally, students' difficulty in practising physical exercises can be an indication of enteroparasitic infection.

Effect of inhibition of nitric oxide synthase on blood pressure and renal sodium handling in renal denervated rats.

The role of sympathetic nerve activity in the changes in arterial blood pressure and renal function caused by the chronic administration of N G-nitro-L-arginine methyl ester (L-NAME), an inhibitor of nitric oxide (NO) synthesis, was examined in sham and bilaterally renal denervated rats. Several studies have demonstrated that sympathetic nerve activity is elevated acutely after L-NAME administration. To evaluate the role of renal nerve activity in L-NAME-induced hypertension, we compared the blood pressure response in four groups (N = 10 each) of male Wistar-Hannover rats weighing 200 to 250 g: 1) sham-operated vehicle-treated, 2) sham-operated L-NAME-treated, 3) denervated vehicle-treated, and 4) denervated L-NAME-treated rats. After renal denervation or sham surgery, one control week was followed by three weeks of oral administration of L-NAME by gavage. Arterial pressure was measured weekly in conscious rats by a tail-cuff method and renal function tests were performed in individual metabolic cages 0, 7, 14 and 21 days after the beginning of L-NAME administration. L-NAME (60 mg kg-1 day-1) progressively increased arterial pressure from 108 +/- 6.0 to 149 +/- 12 mmHg (P<0.05) in the sham-operated group by the third week of treatment which was accompanied by a fall in creatinine clearance from 336 +/- 18 to 222 +/- 59 microl min-1 100 g body weight-1 (P<0. 05) and a rise in fractional urinary sodium excretion from 0.2 +/- 0. 04 to 1.62 +/- 0.35% (P<0.05) and in sodium post-proximal fractional excretion from 0.54 +/- 0.09 to 4.7 +/- 0.86% (P<0.05). The development of hypertension was significantly delayed and attenuated in denervated L-NAME-treated rats. This was accompanied by a striking additional increase in fractional renal sodium and potassium excretion from 0.2 +/- 0.04 to 4.5 +/- 1.6% and from 0.1 +/- 0.015 to 1.21 +/- 0.37%, respectively, and an enhanced post-proximal sodium excretion compared to the sham-operated group. These differences occurred despite an unchanged creatinine clearance and Na+ filtered load. These results suggest that bilateral renal denervation delayed and attenuated the L-NAME-induced hypertension by promoting an additional decrease in tubule sodium reabsorption in the post-proximal segments of nephrons. Much of the hypertension caused by chronic NO synthesis inhibition is thus dependent on renal nerve activity.

[Pulmonary Artery Sarcoma - diagnostic and treatment difficulties]. / Sarcoma da artéria pulmonar-dificuldades diagnósticas e terapêuticas.

Primary Pulmonary Artery Sarcoma is a rare entity, which shares some clinical features with Thromboembolic Pulmonary Disease (TEPD), complicating differential diagnosis. The authors report a Clinical Case of a Primary Pulmonary Artery Sarcoma in a 59 years old man, admitted with a history of dyspnoea on exertion, chest pain and general symptoms. Chest X-ray, Computed Tomography Scan, Angiographies and Magnetic Resonance Imaging suggested TEPD. Blood Analysis performed before anticoagulation therapy: Lupus Anticoagulant-and Ig M Anticardiolipin +. Our presumptive initial diagnosis was TEPD in a patient with a hypercoagulable state. Intravenous heparin was started, with some clinical improvement but 2 months later he was readmitted, due to clinical and radiological deterioration. Pulmonary Thromboendarterectomy was considered but a right pneumonectomy was necessary because of bleeding. He died of ARDS in a single lung in the 7th day after surgery. Pathology revealed pulmonary artery sarcoma with pulmonary and pleural metastases.

[Primary nursing: adapting a new working model at the surgical nursing service of the Clinics Hospital of Porto Alegre]. / Primary nursing: adaptando um novo modelo de trabalho no Serviço de Enfermagem Cirúrgica do Hospital de Clínicas de Porto Alegre.

The present article reports the evolution of organizational models of health care in the hospital area, portraying part of this process at the Surgical Nursing Service of the Hospital de Clínicas de Porto Alegre. The different kinds of care are discussed on how they interfere on the Nursing duties. We approached Primary Nursing concepts and its repercussion in the nurse-patient relationship proposing alternatives to move our current work close to this trend.

[Evaluating the performance appraisal in daily nursing practice]. / Avaliando a avaliação de desempenho na prática de enfermeiros.

The objective of this study was determine the development of performance appraisal in daily nursing practice aiming to up-date and adequate the program of Nursing Management Post-graduation Courses. The sample was composed by 27 nurses students of the first and second post-graduation course in 1994 and 1995. The results showed that performance appraisal is not established in the nurses work reality (51%) and 70% of respondents assert that they did not receive any training in this field. The qualitative results added to quantitative data allow to point the necessity to invest in nursing education both in graduation and post-graduation levels, to carry out the performance appraisal like a process searching the development and improvement of human resources and working relations.

[Nurse activities in a Surgery Unit of a University Hospital]. / Atividades do enfermeiro em Unidade de Internação Cirúrgica de um Hospital Universitário.

The present study analyzes the process of the nurse work, classifying and quantifying the types of activities accomplished by this professional in a Inward Surgical Unit of the Hospital de Clínicas de Porto Alegre (HCPA). From this study on we point out alternatives to improve life quality in work and the quality of the patient care.

[Study of variables in the planning of nursing personnel in hospitals of Porto Allegre]. / Estudo das variáveis que participam do dimensionamento de pessoal de enfermagem em hospitais de Grande Porte.

The study intends to discuss the reality of nursing personnel planning, trying to describe the qualitative and quantitative variables that are involved in this process in hospitals of Porto Alegre city. In spite of numberless variables found, we can verify a great diversity between the criterious accepted by the nursing chief's and the inexistence of official criterious. The data analisys allowed grouping the variables in four main categories: hospital, nursing service, unit and clientele. To exist best utilization the quantitative variables related unit and clientele categories and restriction of autonomy nursing service to decide about this theme.

[The opinion of nurses concerning the shift transfer]. / Opinião de enfermeiros sobre a passagem de plantão.

The study intends to survey nurse's opinions regarding shift changes in their workplaces. It aims deepening our knowledge about how this activity contributes to the work organization, considering the process of caring in nursing. We emphasize the importance of shift change and of data gathered by nursing staff as a connecting link of the health system. They are fundamental activities for the unit work organization, being a decisive factor to maintain the quality of the assistance, since they allow updating information about the patient and nursing actions adjustment.

[Absenteeism as a variable in human resource planning in nursing]. / Estudo do absenteísmo como variável no planejamento de recursos humanos em enfermagem.

The study of absenteeism in Nursing is an important item that subsizes planning and adjusting human resources, regarding the continuity of nursing labor 24 hours a day in a hospital. Absenteeism is the absence from work at moments workers should be regularly executing their duties. We identified an absenteeism rate and also characterized the kinds of absences from work among nursing personel in surgical wards of a University Hospital. This investigative study had a quantitave, qualitative and retrospective aspect. Data were obtained from January to December of 1998. Results showed 29.63% of absences on that period. This total is composed by 23.28% of predictable absences and 6.35% of non-predictable absences as an index of calculated absenteeism.

[Hospital nursing service--introducing this silent giant]. / O serviço de enfermagem hospitalar-apresentando este gigante silencioso.

This article shows the importance of the nursing service in the health organizations. The metaphor "giant" will be used to describe the extent of this service, and the term "silent" will be used to refer to the little acknowledgment the nursing service receives from the community. The extent and complexity of the nursing assistance is vital for the effectiveness of the processes of health care, however its structure and organization is unknown by the community. The nursing service congregates a great number of personnel with different levels of education. The planning, organization, structure and operation of this service follow the principles of the General Theory of Administration. Knowledge from this area has also been used to help health institutions to achieve its goals and objectives. This study also approaches the client and the quality of health assistance, pointing out the need of reexamining the administrative model adopted and looking forward to systemic alternatives.

Effect of inhibition of nitric oxide synthase on blood pressure and renal sodium handling in renal denervated rats

The role of sympathetic nerve activity in the changes in arterial blood pressure and renal function caused by the chronic administration of NG-nitro-L-arginine methyl ester (L-NAME), an inhibitor of nitric oxide (NO) synthesis, was examined in sham and bilaterally renal denervated rats. Several studies have demonstrated that sympathetic nerve activity is elevated acutely after L-NAME administration. To evaluate the role of renal nerve activity in L-NAME-induced hypertension, we compared the blood pressure response in four groups (N = 10 each) of male Wistar-Hannover rats weighing 200 to 250 g: 1) sham-operated vehicle-treated, 2) sham-operated L-NAME-treated, 3) denervated vehicle-treated, and 4) denervated L-NAME-treated rats. After renal denervation or sham surgery, one control week was followed by three weeks of oral administration of L-NAME by gavage. Arterial pressure was measured weekly in conscious rats by a tail-cuff method and renal function tests were performed in individual metabolic cages 0, 7, 14 and 21 days after the beginning of L-NAME administration. L-NAME (60 mg kg-1 day-1) progressively increased arterial pressure from 108 + or - 6.0 to 149 + or - 12 mmHg (P<0.05) in the sham-operated group by the third week of treatment which was accompanied by a fall in creatinine clearance from 336 + or - 18 to 222 + or - 59 µl min-1 100 g body weight-1 (P<0.05) and a rise in fractional urinary sodium excretion from 0.2 + or - 0.04 to 1.62 + or - 0.35 per cent (P<0.05) and in sodium post-proximal fractional excretion from 0.54 + or - 0.09 to 4.7 + or - 0.86 per cent (P<0.05). The development of hypertension was significantly delayed and attenuated in denervated L-NAME-treated rats. This was accompanied by a striking additional increase in fractional renal sodium and potassium excretion from 0.2 + or - 0.04 to 4.5 + or - 1.6 per cent and from 0.1 + or - 0.015 to 1.21 + or - 0.37 per cent, respectively, and an enhanced post-proximal sodium excretion compared to the sham-operated group. These differences occurred despite an unchanged creatinine clearance and Na+ filtered load. These results suggest that bilateral renal denervation delayed and attenuated the L-NAME-induced hypertension by promoting an additional decrease in tubule sodium reabsorption in the post-proximal segments of nephrons. Much of the hypertension caused by chronic NO synthesis inhibition is thus dependent on renal nerve activity.