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OBJECTIVE: To create an educational intervention for health professionals and test its effectiveness in implementing the use of CPAP in hospitalized patients with pleural effusion undergoing thoracic drainage. METHODS: This implementation study was developed in 5 hospitals in Brazil and one in Belgium within four phases: (I) Situational diagnosis (professionals and patients' knowledge about CPAP usage for drained pleural effusion and checking medical records for the last 6 months); (II) Education and training of professionals; (III) New situational diagnosis (equal to phase I); (IV) Follow-up for two years. RESULTS: 65 professionals, 117 patients' medical records, and 64 patients were enrolled in this study. Initially, only 72% of medical records presented a description of interventions. CPAP usage was mentioned in only one patient with a chest tube. After phase III, the number of professionals who used CPAP for their patients with drained pleural effusion increased from 28.8% to 66.7%, p < 0.001. Similarly, the acceptability of this therapy for this clinical situation also increased among professionals from 6.4 ± 1.3 to 7.8 ± 1.4, p < 0.001. However, before the implementation, only one medical record described the use of CPAP in one patient with drained pleural effusion. After two years, the use of CPAP therapy by healthcare professionals for patients with drained thoracic drainage was sustained in 3 hospitals. CONCLUSIONS: The educational intervention for the use of CPAP in patients with drained pleural effusion was effective for health professionals. Results were sustained after two years in three of the six hospitals.

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INTRODUCTION: Cardiac surgery is a frequent surgical procedure and may present a high risk of complications. Among the prophylactic strategies studied to decrease the rates of negative outcomes, respiratory care seems to reduce pulmonary complications. Incentive spirometry (IS) is a low-cost, respiratory exercise technique, used for the prevention and treatment of postoperative pulmonary complications (PPC). The aim of this review was to evaluate whether IS is superior to respiratory care, mobilization exercises, and noninvasive ventilation on PPC, and clinical outcomes. METHODS: Systematic review. Medical Literature Analysis and Retrieval System Online (or MEDLINE®), Embase®, Cochrane Central Register of Controlled Trials (or CENTRAL), Physiotherapy Evidence Database (or PEDro), Cumulative Index of Nursing and Allied Health (or CINAHL®), Latin American and Caribbean Health Sciences Literature (or LILACS), Scientific Electronic Library Online (or SciELO), Allied, Scopus®, and OpenGrey databases, clinical trial registration sites, conferences, congresses, and symposiums were searched. RESULTS: Twenty-one randomized trials and one quasi-randomized trial (1,677 participants) were included. For partial pressure of oxygen (PaO2), IS was inferior to respiratory care (mean difference [MD] -4.48; 95% confidence interval [CI] -8.32 to -0.63). Flow-oriented IS was inferior to respiratory care on PaO2 (MD -4.53; 95% CI -8.88 to -0.18). However, compared to respiratory care, flow-oriented IS was superior on recovery vital capacity. CONCLUSIONS: This meta-analysis revealed that IS was not superior to standard respiratory care for PPCs and clinical outcomes, therefore its use should not be widely recommended until further studies with high quality be performed to ensure this clinical guidance.

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ABSTRACT Introduction: Cardiac surgery is a frequent surgical procedure and may present a high risk of complications. Among the prophylactic strategies studied to decrease the rates of negative outcomes, respiratory care seems to reduce pulmonary complications. Incentive spirometry (IS) is a low-cost, respiratory exercise technique, used for the prevention and treatment of postoperative pulmonary complications (PPC). The aim of this review was to evaluate whether IS is superior to respiratory care, mobilization exercises, and noninvasive ventilation on PPC, and clinical outcomes. Methods: Systematic review. Medical Literature Analysis and Retrieval System Online (or MEDLINE®), Embase®, Cochrane Central Register of Controlled Trials (or CENTRAL), Physiotherapy Evidence Database (or PEDro), Cumulative Index of Nursing and Allied Health (or CINAHL®), Latin American and Caribbean Health Sciences Literature (or LILACS), Scientific Electronic Library Online (or SciELO), Allied, Scopus®, and OpenGrey databases, clinical trial registration sites, conferences, congresses, and symposiums were searched. Results: Twenty-one randomized trials and one quasi-randomized trial (1,677 participants) were included. For partial pressure of oxygen (PaO2), IS was inferior to respiratory care (mean difference [MD] -4.48; 95% confidence interval [CI] -8.32 to -0.63). Flow-oriented IS was inferior to respiratory care on PaO2 (MD -4.53; 95% CI -8.88 to -0.18). However, compared to respiratory care, flow-oriented IS was superior on recovery vital capacity. Conclusions: This meta-analysis revealed that IS was not superior to standard respiratory care for PPCs and clinical outcomes, therefore its use should not be widely recommended until further studies with high quality be performed to ensure this clinical guidance.

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Introdução: Cerca de 31% dos pacientes hospitalizados com COVID-19 perdem mais de 5% de seu peso inicial, levando a fraqueza muscular. Portanto, a composição corporal tornou-se foco de investigação, para estimar comprometimento pulmonar, força da musculatura inspiratória e mortalidade. Objetivos: Investigar se a perda de peso e a composição corporal de pacientes internados com COVID-19 influenciam na função pulmonar e na força muscular inspiratória após alta hospitalar. Métodos: Estudo transversal. Pacientes adultos foram avaliados após internação por COVID-19. Os desfechos avaliados foram função pulmonar, pressão inspiratória máxima (Pimáx), composição corporal e mortalidade. As correlações entre as variáveis foram estimadas pelo Coeficiente de Correlação de Pearson. Resultados: A capacidade Vital Forçada (CVF) foi correlacionada com perda de peso, massa muscular esquelética, massa magra, perna esquerda e massa livre de gordura; o volume expiratório forçado no primeiro segundo (VEF1) correlacionou-se apenas com a perda de peso; e a Pimáx foi correlacionada com massa muscular esquelética, massa magra, perna esquerda, perna direita e massa livre de gordura. Conclusão: Observou-se correlação moderada entre CVF e as variáveis de composição corporal analisadas, exceto massa magra da perna esquerda; entre VEF1 e perda de peso; e entre Pimáx e as variáveis de composição corporal analisadas, exceto perda de peso.

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Background: Adherence to treatment is critical when dealing with chronic diseases. One of the difficulties in maintain long-term adherence is the distance from home to rehabilitation center. Objective: To determine the influence of the distance from subjects' residence to rehabilitation center on adherence of a 12-week pulmonary rehabilitation program in chronic respiratory disease. Methods: This retrospective study analyzed patients' medical records with chronic respiratory diseases from a pulmonary rehabilitation center. Driving distance between patients' home and rehabilitation center was calculated with Google maps. The home-rehabilitation center distances were classified in three levels: up to 10, 10-30 and more than 30 km. Results: 280 medical records from patients with chronic pulmonary diseases with medical indication to follow the pulmonary rehabilitation program were found and 148 medical records were included in our study. Out of them, the majority (n = 93) had chronic obstructive pulmonary disease (COPD). Seventy percent of patients lived up to 10 km, 24% lived between 10 and 30 km and 6% lived more than 30 km. No difference in adherence was found comparing the three groups based on the distance from home to rehabilitation center. Conclusion: In this study, distance between home and rehabilitation center did not influence adherence to pulmonary rehabilitation program. (AU)

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Introduction: Patients receiving cardiac surgeries present high risk of developing postoperative complications. Incentive spirometry (IS) is used for the prevention and treatment of postoperative pulmonary complications in patients undergoing cardiac surgeries. Publications have suggested that IS is ineffective. In contrast, some studies have shown that when IS is adequately used, it may lead to beneficial outcomes. Objectives: To assess the effect of IS in patients undergoing cardiac surgeries. Methods/design: Systematic Reviews with randomised and quasi-randomised trials with adult patients undergoing cardiac surgeries, evaluating the effect of flow or volumeoriented IS. Outcome measures: postoperative pulmonary complications; adverse events; mortality; length of hospital stay; length of intensive care unit stay; reintubation rate; pulmonary function; antibiotic use; oxygenation; and respiratory muscle strength. Search: MEDLINE, EMBASE, CENTRAL, PEDro, CINAHL, LILACS, SCIELO, Allied, AMED, Scopus, Open Grey database, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), ClinicalTrials.gov, clinicaltrialsregister.eu, and ReBec. Two authors will independently extract data. PEDro scale will be used to evaluate the methodological quality of the studies. Metaanalysis will be performed using the inverse variance method and the random effects model in RevMan 5.3. We will use the I 2 statistic to estimate the amount of heterogeneity across studies in each meta-analysis. Ethics and dissemination: The approval of an ethical committee is not required. Only clinical trials that have complied with ethical guidelines and followed the Declaration of Helsinki, will be included in this systematic review. The findings of this study will help clarify uncertainties about the effects of incentive spirometry in the postoperative period of cardiac surgery and may be disseminated to clinicians, assisting in decision making and including the best evidence in the treatment of their patients. Discussion: This review will clarify the uncertainty over whether IS is a useful technique for patients undergoing cardiac surgeries. While good quality studies have shown IS is an effective prophylactic technique, other studies have suggested that there is no evidence to support IS utilization. (AU)

Introdução: Pacientes submetidos a cirurgias cardíacas apresentam alto risco de desenvolver complicações pós-operatórias. A espirometria de incentivo (EI) é utilizada para a prevenção e tratamento de complicações pulmonares pós-operatórias em pacientes submetidos a cirurgias cardíacas. As publicações têm sugerido que a EI é inefetiva. Em contrapartida, alguns estudos têm demonstrado que quando a EI é utilizada adequadamente, pode levar a resultados benéficos. Objetivos: Avaliar o efeito da EI em pacientes submetidos a cirurgias cardíacas. Métodos/desenho: Revisões sistemática de estudos randomizados e quase randomizados com pacientes adultos submetidos a cirurgias cardíacas, avaliando o efeito da EI a fluxo ou a volume. Medidas de desfecho: complicações pulmonares pós-operatórias; eventos adversos; mortalidade; tempo de internação hospitalar; tempo de internação na unidade de terapia intensiva; taxa de reintubação; função pulmonar; uso de antibióticos; oxigenação e força muscular respiratória. Busca: MEDLINE, EMBASE, CENTRAL, PEDro, CINAHL, LILACS, SCIELO, Allied, AMED, Scopus, Open Grey database, World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), ClinicalTrials.gov, clinicaltrialsregister.eu, e ReBec. Dois autores irão extrair dados de forma independente. A escala PEDro será utilizada para avaliar a qualidade metodológica dos estudos. A meta-análise será realizada utilizando o método do inverso da variância e o modelo de efeitos aleatórios no RevMan 5.3. Será utilizada a estatística I 2 para estimar a heterogeneidade entre os estudos em cada meta-análise. Ética e disseminação: A aprovação de um comitê de ética não é necessária. Somente estudos clínicos que tenham cumprido as diretrizes éticas e seguido a Declaração de Helsinque serão incluídos nesta revisão sistemática. Os resultados deste estudo ajudarão a esclarecer incertezas sobre os efeitos da espirometria de incentivo no período pós-operatório de cirurgia cardíaca e poderão ser divulgados aos clínicos, auxiliando na tomada de decisões e incluindo as melhores evidências no tratamento de seus pacientes. Discussão: Esta revisão esclarecerá a incerteza sobre a utilidade da EI para pacientes submetidos à cirurgia cardíaca. Embora estudos de boa qualidade tenham demonstrado que a EI é uma técnica profilática eficaz, outros estudos sugeriram que não há evidências que apoiem a utilização da EI. (AU)

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Objective. To identify the main difficulties first-time mothers experience in the postpartum period, during the first six months of the baby's life. Methods. Level I qualitative, exploratory-descriptive study. The sample consisted of 11 first-time mothers of full-term healthy newborns. The data were collected through the "focus group" method. The mothers' discourse was subject to content analysis, categorizing the registry units. Results. Three categories emerged from the data analyzed that indicate the mothers' main difficulties in this period: postpartum recovery; baby care; marital relationship. Conclusion. The results indicate that, although motherhood is an event marked by positive emotions, the difficulties that emerge in the mothers' daily life can interfere negatively in the quality of parenthood. In this scenario, the nurses play a determinant role in the enhancement of interventions that are sensitive to these needs and that, at the same time, favor these mothers and their families' empowerment, thus optimizing the children's development trajectories. (AU)

Objetivo. Identificar las principales dificultades de las madres primíparas en el posparto y durante los primeros seis meses de vida del bebé. Métodos. Estudio cualitativo de nivel exploratorio-descriptivo. La muestra estuvo constituida por 11 madres primíparas de recién nacidos saludables a término. Se utilizó el grupo focal como método de recolección de los datos. Los discursos de las madres se sometieron a análisis de contenido, categorizando las unidades de registro. Resultados. Del análisis de los datos emergieron tres categorías indicadoras de las principales dificultades de las madres en este período: la recuperación del posparto, el cuidado del bebé, y la relación conyugal. Conclusión. Los resultados obtenidos indican que, a pesar de que la maternidad es un acontecimiento marcado por emociones positivas, las dificultades que surgen en el cotidiano de las madres pueden interferir negativamente en la calidad de la maternidad. Los enfermeros tienen, en este escenario, un papel determinante en la dinamización de intervenciones sensibles a estas necesidades y, simultáneamente, favorecedoras del empoderamiento de estas madres y de sus familias, lo que optimiza de este modo las trayectorias de desarrollo de sus hijos.(AU)

Objetivo. Identificar as principais dificuldades sentidas por mães primíparas no pós-parto, nos primeiros seis meses de vida do bebé. Métodos. Estudo qualitativo de nível I do tipo exploratório-descritivo. Amostra constituída por 11 mães primíparas de recém-nascido saudável de termo. Foi utilizado como o método de recolha de dado "Focus Group", sendo os discursos das mães sujeitos à análise de conteúdo, categorizando-se as unidades de registo. Resultados. Da análise dos dados emergiram três categorias indicadoras das principais dificuldades das mães neste período: a recuperação pós-parto; o cuidar do bebé; a relação conjugal. Conclusão. Os resultados obtidos indicam que, apesar da maternidade ser um acontecimento marcado por emoções positivas, as dificuldades que surgem no quotidiano das mães podem interferir negativamente na qualidade da parentalidade. Os enfermeiros têm, neste cenário, um papel determinante na dinamização de intervenções sensíveis a estas necessidades e, simultaneamente, favorecedoras do empowerment destas mães e de suas famílias, otimizando deste modo, as trajetórias de desenvolvimento das crianças.(AU)

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OBJECTIVES: To identify the main difficulties first-time mothers experience in the postpartum period, during the first six months of the baby's life. METHODS: Level I qualitative, exploratory-descriptive study. The sample consisted of 11 first-time mothers of full-term healthy newborns. The data were collected through the "focus group" method. The mothers' discourse was subject to content analysis, categorizing the registry units. RESULTS: Three categories emerged from the data analyzed that indicate the mothers' main difficulties in this period: postpartum recovery; baby care; marital relationship. CONCLUSIONS: The results indicate that, although motherhood is an event marked by positive emotions, the difficulties that emerge in the mothers' daily life can interfere negatively in the quality of parenthood. In this scenario, the nurses play a determinant role in the enhancement of interventions that are sensitive to these needs and that, at the same time, favor these mothers and their families' empowerment, thus optimizing the children's development trajectories.

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Hydrocarbon-degrading bacterial communities from freshwater, marine, and hypersaline Brazilian aquatic ecosystems (with water salinities corresponding to 0.2%, 4%, and 5%, respectively) were enriched with different hydrocarbons (heptadecane, naphthalene, or crude oil). Changes within the different microcosms of bacterial communities were analyzed using cultivation approaches and molecular methods (DNA and RNA extraction, followed by genetic fingerprinting and analyses of clone libraries based on the 16S rRNA-coding gene). A redundancy analysis (RDA) of the genetic fingerprint data and a principal component analysis (PCA) of the clone libraries revealed hydrocarbon-enriched bacterial communities specific for each ecosystem studied. However, within the same ecosystem, different bacterial communities were selected according to the petroleum hydrocarbon used. In general, the results demonstrated that Acinetobacter and Cloacibacterium were the dominant genera in freshwater microcosms; the Oceanospirillales order and the Marinobacter, Pseudomonas, and Cycloclasticus genera predominated in marine microcosms; and the Oceanospirillales order and the Marinobacter genus were selected in the different hydrocarbon-containing microcosms in hypersaline water. Determination of total petroleum hydrocarbons (TPHs) in all microcosms after 32 days of incubation showed a decrease in the hydrocarbon concentration compared to that for the controls. A total of 50 (41.3%) isolates from the different hydrocarbon-contaminated microcosms were associated with the dominant operational taxonomic units (OTUs) obtained from the clone libraries, and their growth in the hydrocarbon contaminating the microcosm from which they were isolated as the sole carbon source was observed. These data provide insight into the general response of bacterial communities from freshwater, marine, and hypersaline aquatic ecosystems to petroleum hydrocarbon contamination.

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The family Simuliidae is the host of simbiontes fungi that inhabit the digestive tracts of arthropods. This paper reports the presence of fungi in Simulium goeldii Cerqueira & Nunes de Mello larvae in Amazonia. We observed that the larvae are a good component of aquatic systems to isolate filamentous fungi.

A família Simuliidae é hospedeira de fungos simbiontes que habitam o trato digestivo de artrópodos. Este estudo reporta a presença de fungos em larvas de Simulium goeldii Cerqueira & Nunes de Mello da Amazônia. Foi observado que as larvas são bons componentes do sistema aquático para isolar fungos filamentosos.

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1. Oxalic acid protects adrenalin against oxidation, in the presence of copper, as well as other substances of biological interest, such as ascorbic acid, p-aminobenzoic acid and tyrosin. 2. The mechanism ol action can be a combination of oxalic acid with copper and iron ions in the oxidative system, forming very little ionizable copper and iron oxalate. 3. Oxalic acid should not be considered as an undesirable catabolic product, but on the contrary, as an agent with active participation in the phenomenon of intra-organic oxido-reduction.

O artigo não apresenta resumo.

RESUMO

1. Oxalic acid has a definite protective action on ascorbic acid in its oxidation by ascorbic acid oxidase, an enzyme whose active group contains copper; this action is best revealed at pH 4.5. 2. Oxalic acid exerts also its protective action on ascorbic acid oxidation by copper; the comparison between the oxidative effect of copper oxalate and that of copper sulphate shows that the latter is much more intense. 3. The protective action of thiourea exerts itself in the oxidation by copper though less intensively than that of oxalic acid but it does not reveal itself in the oxidation by ascorbic acid oxidase. 4. The protective action of oxalic acid in the oxidation of ascorbic acid by the ascorbic acid oxidase suggests a new field of investigation in the branch of knowledge of those substances, not identified up to the present, which, in natural substrata, protect the ascorbic acid against such an oxidation.

O artigo não apresenta resumo.

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Confirming the studies of F onseca R ibeiro and Guimarães, the authors showed besides that with a contact for 15 minutes, 0.5 ml. of hydro-soluble chlorophyll at 1% neutralizes 500 M.L.D. of tetanic toxine; that 100 ml. of tetanic toxine (concentration of 1 ml. = 15,000 M.L.D. guinea pigs) in contact with 1,0 g. of hydro-soluble chlorophyll in the incubator at 37ºC. loses completely its toxicity in from 8 to 10 days, while still keeping its antigenic quality: 32 guinea pigs injected with 1 ml. each of this toxin, detoxicated by chlorophyll, were injected 30 days after with 5 and 10 M.L.D. of toxine, and 68.4% and 46.1%, respectively, survived; the light factor is of less importance than the lemperature factor (incubator 37ºC.) in the detoxication of tetanic toxine by the hydro-soluble chlorophyll process.

Confirmando o trabalho de Fonseca Ribeiro e Guimarães, os AA. demonstraram mais que, com 15 minutos de contacto, 0,5 cm3 de clorofila hidrossolúvel a 1% neutraliza 500 D.M.M. de toxina tetânica; que 100 cm3 de toxina tetânica (1 cm3 = 15.000 D.M.M. cobaia) em contacto com 1,0 g de clorofila hidrossolúvel, na esufa a 37 ºC, perde totalmente sua toxicidade, ao cabo de 8-10 dias, conservando o poder antigênico: 32 cobaias injetadas com 1 cm3 cada, da toxina desintoxicada pela clorofila, são injetadas 30 dias depois, com 5 e 10 D.M.M. de toxina, sobrevivendo, respectivamente, 68,4% e 46,1%; demonstraram ainda que o fator luz é menos importante do que o fator temperatura (estufa 379C) na desintoxicação da toxina tetânica pela clorifila hidrossolúvel.

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Confirming the studies of F onseca R ibeiro and Guimarães, the authors showed besides that with a contact for 15 minutes, 0.5 ml. of hydro-soluble chlorophyll at 1% neutralizes 500 M.L.D. of tetanic toxine; that 100 ml. of tetanic toxine (concentration of 1 ml. = 15,000 M.L.D. guinea pigs) in contact with 1,0 g. of hydro-soluble chlorophyll in the incubator at 37ºC. loses completely its toxicity in from 8 to 10 days, while still keeping its antigenic quality: 32 guinea pigs injected with 1 ml. each of this toxin, detoxicated by chlorophyll, were injected 30 days after with 5 and 10 M.L.D. of toxine, and 68.4% and 46.1%, respectively, survived; the light factor is of less importance than the lemperature factor (incubator 37ºC.) in the detoxication of tetanic toxine by the hydro-soluble chlorophyll process.

Confirmando o trabalho de Fonseca Ribeiro e Guimarães, os AA. demonstraram mais que, com 15 minutos de contacto, 0,5 cm3 de clorofila hidrossolúvel a 1% neutraliza 500 D.M.M. de toxina tetânica; que 100 cm3 de toxina tetânica (1 cm3 = 15.000 D.M.M. cobaia) em contacto com 1,0 g de clorofila hidrossolúvel, na esufa a 37 ºC, perde totalmente sua toxicidade, ao cabo de 8-10 dias, conservando o poder antigênico: 32 cobaias injetadas com 1 cm3 cada, da toxina desintoxicada pela clorofila, são injetadas 30 dias depois, com 5 e 10 D.M.M. de toxina, sobrevivendo, respectivamente, 68,4% e 46,1%; demonstraram ainda que o fator luz é menos importante do que o fator temperatura (estufa 379C) na desintoxicação da toxina tetânica pela clorifila hidrossolúvel.

RESUMO

1. Oxalic acid has a definite protective action on ascorbic acid in its oxidation by ascorbic acid oxidase, an enzyme whose active group contains copper; this action is best revealed at pH 4.5. 2. Oxalic acid exerts also its protective action on ascorbic acid oxidation by copper; the comparison between the oxidative effect of copper oxalate and that of copper sulphate shows that the latter is much more intense. 3. The protective action of thiourea exerts itself in the oxidation by copper though less intensively than that of oxalic acid but it does not reveal itself in the oxidation by ascorbic acid oxidase. 4. The protective action of oxalic acid in the oxidation of ascorbic acid by the ascorbic acid oxidase suggests a new field of investigation in the branch of knowledge of those substances, not identified up to the present, which, in natural substrata, protect the ascorbic acid against such an oxidation.

O artigo não apresenta resumo.

RESUMO

1. Oxalic acid protects adrenalin against oxidation, in the presence of copper, as well as other substances of biological interest, such as ascorbic acid, p-aminobenzoic acid and tyrosin. 2. The mechanism ol action can be a combination of oxalic acid with copper and iron ions in the oxidative system, forming very little ionizable copper and iron oxalate. 3. Oxalic acid should not be considered as an undesirable catabolic product, but on the contrary, as an agent with active participation in the phenomenon of intra-organic oxido-reduction.

O artigo não apresenta resumo.

RESUMO

In this study of the effect of substances of the carotinoid type in the treatment of murine leprosy, it has been observed that there is a difference in the distribution of the Stefansky bacillus in the organism of mice according to whether the germs used in the inoculation are alive or have been killed by heat (autoclaving at 120ºC. for 20 minutes). Within the period of 80 days after inoculation, pieces of the liver were always negative when the inoculated germ was dead, and positive in the majority of cases when the germ was alive. Similar though less clear-cut findings were obtained with regard to the spleen. With infected animals treated with a crude substance of carotinoid type it was observed that the distribution of bacilli was the same as if they had been inoculated with dead germs, and that was also true when the treatment was with one of the fragments (fraction A) of the primitive substance. Two other fractions (b and C) were inactive, although it would appear probable that the active substance (fraction A) originates through an oxidation process from fraction C. A substance obtained in the laboratory through oxidation of raw carotinoid (fraction D) showed activity in a small number of observations.

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