RESUMO
BACKGROUND: Healthcare-associated infections (HAIs) have a significant impact on patients' morbidity and mortality, and have a detrimental financial impact on the healthcare system. Various strategies exist to prevent HAIs, but economic evaluations are needed to determine which are most appropriate. AIM: To present the financial impact of a nationwide project on HAI prevention in intensive care units (ICUs) using a quality improvement (QI) approach. METHODS: A health economic evaluation assessed the financial results of the QI initiative 'Saúde em Nossas Mãos' (SNM), implemented in Brazil between January 2018 and December 2020. Among 116 participating institutions, 13 (11.2%) fully reported the aggregate cost and stratified patients (with vs without HAIs) in the pre-intervention and post-intervention periods. Average cost (AC) was calculated for each analysed HAI: central-line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CAUTIs). The absorption model and time-driven activity-based costing were used for cost estimations. The numbers of infections that the project could have prevented during its implementation were estimated to demonstrate the financial impact of the SNM initiative. RESULTS: The aggregated ACs calculated for each HAI from these 13 ICUs - US$8480 for CLABSIs, US$10,039 for VAP, and US$7464 for CAUTIs - were extrapolated to the total number of HAIs prevented by the project (1727 CLABSIs, 3797 VAP and 2150 CAUTIs). The overall savings of the SNM as of December 2020 were estimated at US$68.8 million, with an estimated return on investment (ROI) of 765%. CONCLUSION: Reporting accurate financial data on HAI prevention strategies is still challenging in Brazil. These results suggest that a national QI initiative to prevent HAIs in critical care settings is a feasible and value-based approach, reducing financial waste and yielding a significant ROI for the healthcare system.
Assuntos
Infecções Relacionadas a Cateter , Infecção Hospitalar , Pneumonia Associada à Ventilação Mecânica , Infecções Urinárias , Humanos , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/prevenção & controle , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Unidades de Terapia Intensiva , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Infecções Urinárias/prevenção & controle , Atenção à SaúdeRESUMO
The present study focused on investigating the antioxidant, antiglycation activity, digestive enzymes inhibition, bioaccessibility and hypoglycemic effect of C. arabica leaves extracts. The extracts deactivated the O2â¢-, ROOâ¢, H2O2, HOCl reactive oxygen species. Coffee leaves showed strong inhibition of α-glucosidase (IC50 = 40.30 µg mL-1) greater than the isolated metabolites and acarbose. There was also inhibition of pancreatic lipase (IC50 = 56.43 µg mL-1) in addition to a hypoglycemic effect in zebrafish similar to acarbose and metformin. With the exception of rutin, all biocompounds were detected at all stages of in vitro digestion. Finally, these results suggest that C. arabica leaf extracts possess antidiabetic and anti-obesity properties that can be attributed to the main metabolites and the synergistic action between them.Communicated by Ramaswamy H. Sarma.
Assuntos
Antioxidantes , Coffea , Animais , Antioxidantes/farmacologia , Hipoglicemiantes/farmacologia , Extratos Vegetais/farmacologia , Acarbose , Peróxido de Hidrogênio , Peixe-ZebraRESUMO
Despite the advances of molecular tools, new nematode species are still described mainly based on morphological characters. Parapharyngodon and Thelandros are two genera of oxyurids with unclear related taxonomic histories. Here we use morphological characters (linear measurements and categorical variables) and genetic information (18S rRNA, 28S rRNA and COI partial gene sequences) to confirm the relationships between representatives of these two genera and to determine whether they can be discriminated morphologically. Genetic results confirm the existence of two main clades, mostly congruent with Parapharyngodon and Thelandros genera but with several discordances. Thelandros is polyphyletic, with two of the species analysed (T. filiformis and T. tinerfensis) being part of the Thelandros clade, but with a third one (T. galloti) falling within the Parapharyngodon clade. Regarding the Parapharyngodon clade, P. cubensis, P. scleratus and Parapharyngodon sp. from Mexico form congruent lineages, while most P. echinatus samples cluster in another group, with one exception. Interestingly, P. micipsae samples are scattered across the Parapharyngodon clade, suggesting that they were misidentified or rather represent alternative morphotypes of other species. Morphological analysis identified the length of the tail, number of caudal papillae, position of the nerve ring, presence of caudal alae and length of the lateral alae as reliable characters to distinguish between Parapharyngodon and Thelandros genetic clades. Our study highlights the current taxonomic inconsistency in these groups, mainly derived from the exclusive use of morphological data. As such, we advocate for the routine implementation of molecular data in nematode taxonomic studies.
Assuntos
Oxyuroidea/classificação , Filogenia , Animais , DNA de Helmintos , Feminino , Lagartos/parasitologia , Masculino , México , Oxiuríase/parasitologia , Oxyuroidea/anatomia & histologia , RNA Ribossômico 18S/genética , RNA Ribossômico 28S/genética , Análise de Sequência de DNARESUMO
In order to better understand the pathogenesis of VVC, focusing on the role of C. albicans virulence factors in triggering this infirmity; we evaluated four virulence factors of 62 clinical isolates of C. albicans sequentially obtained from the vagina and anus of patients with sporadic and recurrent VVC. Virulence factors were phenotypically evaluated in vitro, including: adhesion capacity to epithelial cells obtained from healthy individuals, morphogenesis in the presence of fetal bovine serum, biofilm formation in polystyrene microtiter plates and proteinase activity using bovine serum albumin. Colonizing anal isolates were as able as infecting vaginal isolates to express the virulence factors evaluated in vitro. It was observed an association between the expression of virulence factors studied and the signs and symptoms of VVC presented by the patients. No statistically significant difference was observed in the expression of virulence factors between vaginal isolates of C. albicans obtained from patients with sporadic VVC and those obtained from patients with recurrent VVC. Our results suggest that the ability to express virulence factors is important for the pathogenesis of VVC, but it seems not to be crucial for the transition from colonization to infection.
Assuntos
Canal Anal/microbiologia , Candida albicans/isolamento & purificação , Candidíase Vulvovaginal/microbiologia , Vagina/microbiologia , Fatores de Virulência/metabolismo , Adulto , Biofilmes , Brasil , Candida albicans/enzimologia , Candida albicans/patogenicidade , Feminino , Humanos , Pessoa de Meia-Idade , Peptídeo Hidrolases/metabolismoRESUMO
BACKGROUND: Maternal supplementation is a viable strategy to combat vitamin E deficiency in newborns, although a protocol for maternal vitamin E supplementation has not been defined. The present study assessed the effect of maternal supplementation in a single dose on the serum of postpartum women up to 60 days after delivery. METHODOLOGY: Fifty healthy breastfeeding women were recruited at two maternity hospitals both located in Natal, RN, Brazil. The participants were randomly allocated to a control group and a treatment group in a 1 : 1 ratio. Serum was collected 1, 20, 30 and 60 days after delivery. Immediately after the first collection, the treatment group received a single dose of 400 IU of RRR-α-tocopherol. α-Tocopherol was quantified by high-performance liquid chromatography. The usual dietary vitamin E intake was determined using four 24-h recalls, and intake adequacy was assessed based on the estimated average requirements for lactating women (16 mg day-1 ). RESULTS: The mean dietary vitamin E intakes of the both groups were similar (P > 0.05) and inadequate. The serum levels of α-tocopherol assessed at 1, 20, 30 and 60 days indicated adequate vitamin E status in both the control group (1194.6, 907.7, 910 and 748.6 µg dL-1 , respectively) and treatment group (1183.7, 956.0, 935.9 and 766.4 µg dL-1 , respectively). The comparison at each day showed no difference between treatments (P > 0.05). CONCLUSIONS: A single vitamin E supplement did not change the mean serum level of α-tocopherol in breastfeeding women; thus, it does not improve their vitamin E status in the first 60 days after delivery.
Assuntos
Aleitamento Materno , Suplementos Nutricionais , alfa-Tocoferol/administração & dosagem , alfa-Tocoferol/sangue , Adolescente , Adulto , Brasil , Dieta , Relação Dose-Resposta a Droga , Feminino , Humanos , Lactente , Recém-Nascido , Lactação , Rememoração Mental , Necessidades Nutricionais , Estado Nutricional , Período Pós-Parto , Estudos Prospectivos , Fatores Socioeconômicos , Resultado do Tratamento , Deficiência de Vitamina E/sangue , Deficiência de Vitamina E/prevenção & controle , Adulto JovemRESUMO
The development of immunodiagnostic tests for paucibacillary leprosy (PB) is based on Mycobacterium leprae specific-cell mediated immunity (CMI)/IFN-γ production. Recently, novel M. leprae protein antigens that stimulate CMI have been described. This study evaluated different M. leprae antigen combinations in whole blood assay (WBA). Five study groups were tested (20 per group): newly diagnosed, untreated PB patients and multibacillary leprosy patients (MB); household contacts of MB patients (HHC); healthy endemic controls (EC); pulmonary tuberculosis patients (TB). WBA (heparinized, 24 h 37 °C 5% CO2) were stimulated with: 10 µg/ml of each individual M. leprae recombinant protein (rML) and five combinations of rML (46f + LID-1, ML0276 + LID-1, ML2055 + ML1632 + ML2044, ML0276 + 46f, ML2055 + LID-1)-M. leprae cell sonicate (MLCS, 10 µg/ml), PHA (1 µg/ml), and PBS alone. Human IFN-γ ELISA (QuantiFERON-TB Gold/QFT-G, Cellestis) was performed using stimulated plasma (arbitrary cut-off = 50 pg/ml). Three out of five antigen combinations (46f + LID-1, ML0276 + LID-1, ML2055 + ML1632 + ML2044) were able to increase the levels of IFN-γ production in WBA in a larger number of responders among both PB leprosy and contacts. However, the magnitude of IFN-γ responses was higher among contacts. The antigen combination (46f + ML0276) stimulated IFN-γ only in symptomatic PB leprosy patients and not in asymptomatic contacts. Few controls (EC, TB) responded to combinations (0-15%), indicating the specificity of the response in an endemic area with high BCG coverage. The synergistic effect of new combinations of M. leprae proteins upon IFN-γ production in WBA indicates their potential use for the development of an interferon gamma release assay/IGRA for the diagnosis of PB leprosy.
Assuntos
Interferon gama/metabolismo , Hanseníase Paucibacilar/diagnóstico , Mycobacterium leprae/imunologia , Adulto , Idoso , Antígenos de Bactérias/sangue , Antígenos de Bactérias/imunologia , Estudos de Casos e Controles , Feminino , Humanos , Testes de Liberação de Interferon-gama , Hanseníase Paucibacilar/sangue , Hanseníase Paucibacilar/imunologia , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Hantavirus pulmonary syndrome (HPS) is a zoonosis and a public health concern in the Americas due to its high fatality rate. Since the first cases were identified in USA in 1993, HPS has been observed over a wide area of the American continents. Over 1600 HPS cases have been confirmed in Brazil since 1993, and different genotypes of hantavirus have been identified in several biomes in this country of continental dimensions. We performed a retrospective study of data from 2001 to 2011 that encompassed all notified cases of HPS in the National Disease Notification System (SINAN) of Brazil to determine the regional differences and temporal trends of the disease. During the study period, 1486 cases were reported, and analyses of the temporal trends of the disease revealed that the number of cases in Brazil increased over this period (P < 0·01). The frequency distributions of the cases stratified by region revealed different patterns of seasonality; however, these patterns were not statistically significant with the exception of the South region (P < 0·05). We found regional differences in the occurrence of the disease throughout the year and a trend towards an increasing number of cases. These findings reinforce the necessity of adjusting surveillance tools and control policies to respond effectively to this public health problem.
Assuntos
Geografia , Síndrome Pulmonar por Hantavirus/epidemiologia , Estações do Ano , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
The lack of standardization of efficient procedures to clean and disinfect laryngoscope blades and handles, which may be important sources of infection during their clinical use, has been reported previously, revealing contamination with blood, body fluids and micro-organisms. This paper aimed to evaluate the evidence available in the literature regarding the risk of laryngoscope blades and handles as a source of patient contamination. An integrative review of the literature was performed using databases such as Medline, LILACS, SciELO, Cochrane Library, BDENF and PubMed, and keywords in Medical Subject Headings (MeSH). The sample comprised 20 articles published between 1994 and 2012. The studies demonstrated risk of cross-infection and no consensus in current guidelines regarding cleaning and disinfection of this equipment. It was concluded that there are important gaps to be filled and urgent investigations required in order to facilitate standardization of efficient procedures to clean and disinfect laryngoscope blades and handles, and in turn to reduce the potential risk to which the patient and/or health team is exposed.
Assuntos
Infecção Hospitalar , Laringoscópios/microbiologia , Laringoscopia/efeitos adversos , Desinfecção/normas , Guias como Assunto , HumanosRESUMO
Metrodorea nigra (Rutaceae) is an endemic Brazilian tree of great ecological importance, frequently found in the submontane regions of ombrophilous dense and semideciduous forests. This tree is useful for reforesting degraded areas and the wood can be employed in construction. We developed 12 microsatellite markers from a genomic library enriched for GA/CA repeats, for this species. Polymorphisms were assessed in 40 trees of a highly fragmented population found in Cravinhos, State of São Paulo, in southeastern Brazil. Among the 12 loci, 8 were polymorphic and only one had fixed alleles in this population. The number of alleles per locus and expected heterozygosity ranged from 2 to 11 and from 0.190 to 0.889, respectively. These results revealed moderate levels of genetic variation in M. nigra population when compared to other tropical species. Additionally, transferability of the 12 primers was tested in seven other Brazilian Rutaceae tree species (endemics: M. stipularis, Galipea jasminiflora, Esenbeckia leiocarpa and non-endemics: E. febrifuga, E. grandiflora, Balfourodendron riedelianum, Zanthoxylum riedelianum). Transferability ranged among species, but at least 8 loci (~67%) amplified in M. stipularis, demonstrating a high potential for transferring microsatellite markers between species of the same genus in the Rutaceae family.
Assuntos
Variação Genética , Repetições de Microssatélites/genética , Rutaceae/genética , Alelos , Brasil , Genética Populacional , Genótipo , Polimorfismo de Nucleotídeo ÚnicoRESUMO
OBJECTIVES: This pilot study aims to investigate the prevalence of noncarious cervical lesions (NCCLs) in a student population at the Faculty of Dentistry of AraçatubaUNESP and to assess the potential relation between buccal hygiene habits and the presence and number of NCCLs. METHODS: This study was conducted with a sample of 58 young volunteers (15 men and 43 women; mean age, 23.6 ± 1.8 years and 22.3 ± 2.4 years, respectively). The research was divided into three steps: 1) clinical assessment; 2) oral-hygiene practices self-report questionnaire; and 3) analysis of toothbrush filament deformations. After the clinical exam the participants were divided into two groups, a control group (without NCCLs) and a test group (NCCLs), according to NCCL presence. The data were statistically analyzed with SPSS 16.0 software, using t-test, χ2, Fisher exact test, and Spearman correlation. RESULTS: NCCLs were present in 53% of the subjects. The presence of NCCLs was marginally statistically associated with age (p=0.15) and proportionally more prevalent in male (80%) subjects (p=0.01). NCCLs were more concentrated in the posterior-superior quadrant (93%) in both the right (90%) and left (55%) sides of the mouth. The direct rank correlation was presented between presence of NCCLs and toothbrush firmness; and between number of NCCLs and age and force applied during toothbrushing. CONCLUSION: Within the limitations of this pilot study, the use of medium and hard toothbrushes and greater force applied during toothbrushing might contribute to the development and/or aggravation of NCCLs.
Assuntos
Abrasão Dentária/etiologia , Colo do Dente/patologia , Escovação Dentária/efeitos adversos , Adulto , Distribuição de Qui-Quadrado , Estudos Transversais , Relação Dose-Resposta a Droga , Desenho de Equipamento , Feminino , Humanos , Masculino , Projetos Piloto , Fatores Sexuais , Estatísticas não Paramétricas , Adulto JovemRESUMO
Onion anthracnose, caused by Colletotrichum gloeosporioides, is one of the main diseases of onions in the State of Pernambuco. We examined the pathogenicity of 15 C. gloeosporioides strains and analyzed their genetic variability using RAPDs and internal transcribed spacers (ITS) of the rDNA region. Ten of the strains were obtained from substrates and hosts other than onion, including chayote (Sechium edule), guava (Psidium guajava), pomegranate (Punica granatum), water from the Capibaribe River, maracock (Passiflora sp), coconut (Cocus nucifera), surinam cherry (Eugenia uniflora), and marine soil; five isolates came from onions collected from four different regions of the State of Pernambuco and one region of the State of Amazonas. Pathogenicity tests were carried out using onion leaves and bulbs. All strains were capable of causing disease in leaves, causing a variable degree of lesions on the leaves; four strains caused the most severe damage. In the onion bulb tests, only three of the above strains caused lesions. Seven primers of arbitrary sequences were used in the RAPD analysis, generating polymorphic bands that allowed the separation of the strains into three distinct groups. The amplification products generated with the primers ITS1 and ITS4 also showed polymorphism when digested with three restriction enzymes, DraI, HaeIII and MspI. Only the latter two demonstrated genetic variations among the strains. These two types of molecular markers were able to differentiate the strain from the State of Amazonas from those of the State of Pernambuco. However, there was no relationship between groups of strains, based on molecular markers, and degree of pathogenicity for onion leaves and bulbs.
Assuntos
Colletotrichum/genética , Colletotrichum/patogenicidade , Cebolas/microbiologia , Brasil , Colletotrichum/classificação , DNA Fúngico/genética , DNA Espaçador Ribossômico/genética , Variação Genética/genética , Doenças das Plantas/microbiologia , Técnica de Amplificação ao Acaso de DNA PolimórficoRESUMO
Obstructive sleep apnea-hypopnea syndrome involves recurring episodes of total obstruction (apnea) or partial obstruction (hypopnea) of airways during sleep. Obstructive sleep apnea-hypopnea syndrome affects mainly obese individuals and it is defined by an apnea-hypopnea index of five or more episodes per hour associated with daytime somnolence. In addition to anatomical factors and neuromuscular and genetic factors, sleep disorders are also involved in the pathogenesis of sleep apnea. Obesity affects upper airway anatomy because of fat deposition and metabolic activity of adipose tissue. Obstructive sleep apnea-hypopnea syndrome and metabolic syndrome have several characteristics such as visceral obesity, hypertension and insulin resistance. Inflammatory cytokines might be related to the pathogenesis of sleep apnea and metabolic syndrome. Sleep apnea treatment includes obesity treatment, use of equipment such as continuous positive airway pressure, drug therapy and surgical procedures in selected patients. Currently, there is no specific drug therapy available with proven efficacy for the treatment of obstructive sleep apnea-hypopnea syndrome. Body-weight reduction results in improvement of sleep apnea, and obesity treatment must be emphasized, including lifestyle changes, anti-obesity drugs and bariatric surgery.
Assuntos
Obesidade/complicações , Obesidade/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/etiologia , Comorbidade , Citocinas/sangue , Humanos , Resistência à Insulina , Síndrome Metabólica/complicações , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/terapia , Obesidade/terapia , Fatores de Risco , Apneia Obstrutiva do Sono/terapiaRESUMO
The aim of this trial was to implement a method to obtain a tool for analyses of tramadol and the main metabolite, o-desmethyltramadol (M1), in goat's plasma, and to evaluate the pharmacokinetics of these substances following intravenous (i.v.) and oral (p.o.) administration in female goats. The pharmacokinetics of tramadol and M1 were examined following i.v. or p.o. tramadol administration to six female goats (2 mg/kg). Average retention time was 5.13 min for tramadol and 2.42 min for M1. The calculated parameters for half-life, volume of distribution and total body clearance were 0.94+/-0.34 h, 2.48+/-0.58 L/kg and 2.18+/-0.23 L/kg/h following 2 mg/kg tramadol HCl administered intravenously. The systemic availability was 36.9+/-9.1% and half-life 2.67+/-0.54 h following tramadol 2 mg/kg p.o. M1 had a half-life of 2.89+/-0.43 h following i.v. administration of tramadol. Following p.o., M1 was not detectable.
Assuntos
Analgésicos Opioides/farmacocinética , Cabras/metabolismo , Tramadol/análogos & derivados , Tramadol/farmacocinética , Administração Oral , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/sangue , Animais , Área Sob a Curva , Feminino , Injeções Intravenosas/veterinária , Tramadol/administração & dosagem , Tramadol/sangueRESUMO
With a review of the literature, we report our experience with surgical treatment of deep-seated cavernomas (intraventricular, of the corpus callosum, the capsula interna, the insula and the brain stem). Outcome was good in all nine patients after surgery for deep-seated brain cavernomas. There we also 13 cases of the brain stem cavernomas treated surgically. Of them, nine patients were stabilized or improved, one patient worsened, one patient died and two were lost to follow-up. Whatever the location, surgery should only concern symptomatic or hemorrhagic lesions close to the pia-matter or the ependyma as well as those covered by a thin layer of parenchyma. Neuronavigation and microsurgical procedures are essential in the treatment of deep-seated cavernomas.
Assuntos
Gânglios da Base/patologia , Tronco Encefálico/patologia , Neoplasias do Sistema Nervoso Central/patologia , Córtex Cerebral/patologia , Ventrículos Cerebrais/patologia , Corpo Caloso/patologia , Hemangioma Cavernoso do Sistema Nervoso Central/patologia , Gânglios da Base/cirurgia , Tronco Encefálico/cirurgia , Brasil , Neoplasias do Sistema Nervoso Central/cirurgia , Córtex Cerebral/cirurgia , Revascularização Cerebral , Ventrículos Cerebrais/cirurgia , Corpo Caloso/cirurgia , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , HumanosRESUMO
Animal performance and health status are adversely affected by long-term cyanide ingestion; however, the effects of cyanide ingestion by pigs have not been fully determined. The aim of the present study was to determine the effects of prolonged exposure to different doses of potassium cyanide (KCN) in growing-finishing swine. Twenty-four pigs, 45 days of age, were divided into four equal groups and treated with different doses of KCN: 0, 2.0, 4.0 or 6.0 mg per kg body weight per day for 70 consecutive days. The results showed a significant alteration in thiocyanate, creatinine and urea levels and in alanine aminotransferase activity of swine dosed with 4.0 and 6.0 mg/kg/KCN. Thyroid weight was significantly increased in those pigs from 4.0 mg/kg KCN group, but no change in cholesterol, triiodothyronine or thyroline levels were observed. Body and carcase weights, body weight gain, and bacon thickness were not affected by KCN treatment. The histopathological study revealed increased numbers of vacuoles in the colloid of thyroid follicles, degeneration of cerebellar white matter and Purkinje cells, degeneration of renal tubular epithelial cells, caryolysis and pyknosis in hepatocytes, and disturbance of the normal lobular architecture of the liver in all treated pigs. Thus, long-term administration of KCN to swine affects several tissues and could adversely affect animal production.
Assuntos
Cianeto de Potássio/toxicidade , Doenças dos Suínos/induzido quimicamente , Suínos/metabolismo , Glândula Tireoide/efeitos dos fármacos , Alanina Transaminase/sangue , Animais , Glicemia/metabolismo , Nitrogênio da Ureia Sanguínea , Peso Corporal/efeitos dos fármacos , Cerebelo/efeitos dos fármacos , Cerebelo/patologia , Colesterol , Creatinina/sangue , Histocitoquímica/veterinária , Rim/efeitos dos fármacos , Rim/patologia , Fígado/efeitos dos fármacos , Fígado/patologia , Distribuição Aleatória , Doenças dos Suínos/metabolismo , Doenças dos Suínos/patologia , Tiocianatos/sangue , Glândula Tireoide/patologia , Tiroxina/sangue , Tri-Iodotironina/sangueRESUMO
La septoplastia es una de las intervenciones endonasales más frecuentemente practicada por los otorrinolaringólogos. La inspección directa de las cavidades nasales y los senos paranasales han sido durante mucho tiempo, un importante inconveniente para el diagnóstico y la erradicación detalladas de las alteraciones obstructivas del septum nasal, sobre todo aquellas de localización más confinada.Tradicionalmente la septoplastia ha sido practicada a través de los orificios nasales,con visión limitada, asistida por frontoluz y con maniobras y procedimientos practicados a ciegas.La limitación de una inspección detallada, trae como resultado que muchas alteraciones obstructivas nasales septales y extraseptales, puedan pasar inadvertidas. El diagnóstico preciso es clave para aplicar un tratamiento exitoso. Una cirugía conservadora con escisión mínima de los componentes esqueléticos septales, es lo más prudente y recomendado en la actualidad para tratar la patología del tabique nasal. La septoplastia con asistencia endoscópica o cirugía funcional endoscópica del septun nasal permite un mejor resultado postoperatorio, ya que es posible evaluar y erradicar o reparar menos cruenta, con escisión mínima de los componen-tes esqueléticos septales, las deformidades y desviaciones, bajo visón directa. En el presente estudio, se hace una revisión de los diversos factores (anatómicos, fisiopatológicos e histopatológicos) de los componentes del septum nasal, responsables de las alteraciones que éste puede sufrir y que deben ser considerados en razón de un manejo quirúrgico con resultados más satisfactorios Realizaremos un repaso de los factores biomecánicos de los componentes del septum nasal que explican que un septum nasal desviado persista en esa posición después de operado y finalmente nos referiremos a nuestra experiencia y seguimiento en 2.730 casos de patología septal obstructiva, operados por cirugía funcional endoscópica del septum nasal con abrader electromecánico
Assuntos
Septo Nasal , Procedimentos Cirúrgicos Operatórios/métodosRESUMO
La concha bullosa o neumatización excesiva del cornete medio, es una anormalidad morfológica atribuible a sinusitis crónica. Sin embargo, esta condición se encuentra a menudo en pacientes con obstrucción nasal debido a la rinitis hipertrófica. El predominio de concha bullosa y su relación con las enfermedades nasales fue investigado en este estudio con la evaluación endoscópica de las cavidades nasales y tomografía computarizada coronal de los senos paranasales. El predominio de concha bullosa detectada en la tomografía computadorizada coronal de los senos paranasales, varia de 14 por ciento a 53 por ciento entre los estudios consultados. Esta variación obedece a la muestra de individuos escogidos en cada una de las investigaciones, por ejemplo, pacientes escogidos con sintomatología nasal o escogidos al azar. En el presente estudio se analizaron los resultados obtenidos de 1.059 pacientes con sintomas rinosinusales, a quienes se les practicó un estudio endoscopico nasal y una tomografía computadorizada de los senos paranasales, seleccionados de la práctica otorrinolaringológica privada del Instituto Médico La Floresta (Caracas-Venezuela), desde enero de 1997 a diciembre de 1999. La presencia/ausencia, el predominio y la morfología de la concha bullosa así como los presencia/ausencia de cambios patológicos asociados, fueron estudiados en este trabajo. La concha bullosa se encontró en 240 pacientes de 1.059 casos que refirieron sintomas rinosinusales recurrentes o persistentes. La tomografía computarizada coronal demostró ser más útil que la endoscopia nasal en el diagnóstico de la concha bullosa. No obstante, el estudio endoscópico de las cavidades nasales permite apreciar en detalle la relación de la concha bullosa con el meato medio. Por ello, es importante señalar que la endoscopia nasal y la tomografía computarizada de los senos paranasales son, junto con la historia clínica del paciente, los elementos más relevantes en el diagnóstico rinosinusal. El estudio presente en concha bullosa con coronal CT, reveló que se encuentra más frecuentemente en pacientes con rinitis hipertrófica, donde los senos no se ventilan adecuadamente, predisponiendo a la sinusitis. Por lo tanto, la concha bullosa es una variación anatómica que podría causar una perturbación importante de la ventilación en el meato medio
Assuntos
Endoscopia , Conchas NasaisRESUMO
La celdilla del Agger Nasi es la más anterior de las celdillas del complejo etmoidal y posee una relevante importancia gracias a su participación en la patogenia de la sinusitis frontal y etmoidal y a su papel de referencia quirúrgica debido a su estrecha relación con las estructuras adyacentes a la pared lateral nasal, como el receso y el seno frontál, el proceso unciforme, el etmoides anterior, la lámina papirácea, el cornete medio y la fosa lacrimal. El abordaje quirúrgico de la celdilla del agger nasi solo puede ser realizado de manera adecuada y detallada a través de endoscopia, y es fundamental tener conocimiento de la anatomía endoscópica y tomográfica rinosinusal
Assuntos
Seio EtmoidalRESUMO
El cuidado en el tratamiento quirúrgico de la mucosa nasal durante la cirugía funcional endoscópica de los senos paranasales, es considerado un factor importante en la prevención de adherencias cicatriciales y sinequias post-operatorias del meato medio, ya que alteran el drenaje y clearence mucociliar de los senos tributarios al complejo ostio-meatal, ocasionando sinusitis obstructiva post-operatoria. La clave para prevenir las adherencias y sinequias post-operatorias es evitar y/o reducir la formación de cicatriz entre la pared lateral nasal y el cornete medio. Para prevenir tal situación, se han propuesto una variedad de espaciadores y stents. Sin embargo, la aspiración y el retiro endoscópico meticuloso y progresivo de material fibrinoide y costroso, y la instilación frecuente y periódica de solución salina, minimizan la formación de sinequias. Los cuidados pre-operatorios, la técnica intra-operatoria utilizada y los cuidados endoscópicos post-operatorios, son todos los elementos del tratamiento integral de la sinusitis crónica quirúrgica y de la prevención de adherencias y sinequias post-operatorias indeseables del meato medio. Palabras clave: adherencias de meato medio, sinequias, espaciadores, cirugía funcional endoscópica, senos paranasales
Assuntos
Seios Paranasais , Complicações Pós-OperatóriasRESUMO
Centipedes are arthropods of the class Chilopoda. The objective of this work was to study the incidence of accidents involving centipedes at "Centro de Informações Toxicológicas de Belém" (CIT-Belém) over a two-year period. Seventy-six patients were studied from March 30, 1998 until March 30, 2000. Centipede accidents occurred in 16.8% of all accidents by venomous animals at Centro de Informações Toxicológicas de Belém; compared to snake accidents, 44.4 % and scorpion accidents, 20.5%. The majority of cases occurred in the residence (86.8%). The most important age group was 20-49 years old (64.4%). The part of human body mostly affected was the superior members (47.4 %). Local pain and edema were found in 95.8% and 52.1% of the patients, respectively. Treatment was symptomatic. Healing occurred in 94.7%, although the outcome of 5.3% of cases was unknown. Centipede accidents are a benign accident, occurring within the residence and treatment consists of measures to decrease the pain.