RESUMO

O manejo clínico em Odontopediatria é individual, podendo variar nas diversas culturas mundiais. O objetivo desta revisão de literatura é reunir as principais diretrizes de diferentes países ao redor do mundo, incluindo o Brasil, visando identificar como em cada lugar o uso das técnicas de comportamento são aplicadas e sua eficiência. Inicialmente, foram selecionados os principais guias nacionais e internacionais, sendo eles retirados da Associação Internacional de Odontopediatria (IAPD) e Associação Americana de Odontopediatria (AAPD), além de artigos de diferentes países e continentes, como Argentina, Brasil, Europa e Ásia, também foram analisados se o protocolo dos principais guias estão condizentes com os protocolos do Departamento de Clínica Infantil da Faculdade de Odontologia de Ribeirão Preto - USP. Os resultados obtidos nos guias para manejo clínico odontológico brasileiro, americano, internacional e os artigos estudados recomendam inicialmente utilizar técnicas menos invasivas, com o intuito proporcionar um atendimento tranquilo e sem criar traumas para a criança, uma vez que muito do comportamento não cooperativo vem de experiências anteriores traumáticas. Entretanto, técnicas avançadas podem ser utilizadas para casos mais desafiadores. Concluímos com o estudo dos guias e artigos, que o cirurgião dentista possui diversas técnicas a serem aplicadas para que o atendimento infantil seja atraumático e restabelecer saúde ao paciente.

Clinical management in Pediatric Dentistry is individual and varies across different cultures around the world. The objective of this literature review is to bring together the main guidelines from different countries around the world, including Brazil, aiming to identify how the use of behavioral techniques are applied and their efficiency in each place. Initially, the main national and international guides were selected, taken from the International Association of Pediatric Dentistry (IAPD) and the American Association of Pediatric Dentistry (AAPD), as well as articles from different countries and continents, such as Argentina, Brazil, Europe and Asia, as well as It was analyzed whether the protocols of the main guides are consistent with the protocols of the Children's Clinic Department of the Faculty of Dentistry of Ribeirão Preto - USP. The results obtained in the guides for Brazilian, American and international dental clinical management and the articles studied recommend initially using less invasive techniques, with the aim of providing calm care and without creating trauma for the child, since much of the uncooperative behavior comes from previous traumatic experiences. However, advanced techniques can be used for more challenging cases. We conclude from studying the guides and articles that the dental surgeon has several techniques to be applied so that child care is atraumatic and restores health to the patient.

Assuntos

RESUMO

Resumen Introducción: El 90% de las lumbalgias agudas son de causa inespecífica. Existen guías internacionales que permiten identificar a aquellos pacientes que requieren atención especializada. En nuestro país la orientación a la atención primaria de la salud es escasa, centrada prin cipalmente en la atención en los hospitales. El objetivo del presente estudio fue describir los recursos de salud, diagnósticos y terapéuticos, utilizados en la atención inicial de pacientes con dolor lumbar que acuden a la consulta del médico especialista Métodos: Estudio descriptivo y transversal, con re colección prospectiva de los datos a través de un cues tionario destinado a pacientes con dolor lumbar que acuden por primera vez a la consulta especializada. Resultados: Se incluyeron 44 pacientes, edad media 53 años; 50% concurrió por dolor crónico. La derivación informal se asoció con: especialidad de derivación (no traumatólogo), pacientes con mayor número de consul tas a guardia y mayor demora en obtener la consulta. El 52% concurrió con al menos un estudio complementario. Conclusión: La mayor parte de las derivaciones fueron correctas, sin embargo, predominó la derivación infor mal. Solo 1/5 de los pacientes fue examinado y menos del 30% de los pacientes con banderas rojas acudió con estudios complementarios adecuados. La mediana del tiempo de espera para la consulta fue 24 días.

Abstract Introduction: 90% of cases of acute low back pain have no specific underlying cause. International guide lines are available to help identify those individuals who require specialized care. However, in our country, there is a limited emphasis on primary healthcare, with the primary focus on hospital-based care. The aim of this study is to provide an overview of the diagnostic and therapeutic resources utilized in the initial care of patients experiencing low back pain at their first con sultation with a specialist physician. Methods: Descriptive and cross-sectional study, with prospective data collection through a questionnaire administered to patients experiencing low back pain during their first visit to a specialist's office. Results: A total of 44 patients were included, with an average age of 53 years; 50% sought medical atten tion for chronic pain. Informal referrals were associated with the referring physician's specialty (non-orthopedic), patients with a higher number of emergency depart ment visits, and longer waiting times to obtain the consultation; 52% of patients arrived with at least one complementary study. Conclusion: Most of the referrals were appropriate; however, informal referrals were more common. Only 1/5 of the patients underwent an physical examination, and less than 30% of those with red flag symptoms presented with suitable complementary studies. The median wait ing time for the consultation was 24 days.

RESUMO

Resumen Las malformaciones arteriovenosas AVM del cuero cabelludo, comúnmente conocidas como aneurismas cirsoides, son colecciones complejas de arterias y venas que se comunican directamente. Dependiendo de su tamaño y complejidad, se puede utilizar una variedad de estrategias para tratarlos. Se presenta el caso de un paciente del sexo masculino de 53 años de edad, que acudió a valoración por presentar una aumento de volumen de una lesión pulsátil que se extendía desde la región parietotemporal derecha acompañado de cefalea holocraneana y tinnitus, se realizó una angiotomografía cerebral en la que se observó una lesión compuesta de imágenes serpentiformes ectásicas, con una localización extracraneal derecha, posteriormente se realizó una angiografía cerebral diagnóstica que demostró un cortocircuito arteriovenoso plexiforme y fistuloso frontoparietal derecho alimentado por aferencias provenientes de la arteria temporal superficial, auricular posterior, occipital y meníngea media derechas, con drenaje a través de una vena varicosa y ectásica hacia la vena yugular externa. Se realizó por vía femoral una embolización por vía endovascular del cortocircuito arteriovenoso en dos tiempos, logrando una construcción de "olla a presión" para realizar la inyección de líquido embolizante y tener una embolización subtotal del 93%, con esto se pudo realizar una resección microquirúrgica con un abordaje frontoparietotemporal derecho, resecando la parte más profunda, y dejando la piel cabelluda con vasos embolizados sin resecar. Para el cierre de la herida quirúrgica se realizó rotación de colgajo simple para cubrir el defecto de piel derivado de su resección. Se sometió al paciente a panangiografía cerebral postresección, y se identificó la ausencia de cortocircuito arteriovenoso. Dependiendo de la extensión y la complejidad anatómica de la malformación, las manifestaciones clínicas pueden variar. Más del 80% de las MAV estarán presentes al nacer y el resto se pueden desarrollar después de un trauma craneal o intervenciones quirúrgicas. Se necesita una intervención terapéutica adecuada a través de una angiografía selectiva, durante la cual se puede realizar la embolización endovascular de los principales vasos de alimentación antes de la intervención quirúrgica abierta. Las reconstrucciones por tomografía computarizada tridimensionales por volumen se pueden utilizar para una mayor planificación quirúrgica, la reducción del aporte arterial postembolización disminuirá la hemorragia intraoperatoria, facilitando la resección quirúrgica total. La eliminación puede dar lugar a defectos cutáneos grandes y de espesor completo que pueden ser difíciles de reconstruir sin comprometer los resultados funcionales y cosméticos.

Abstract Scalp arteriovenous malformations AVMs, commonly known as cirsoid aneurysms, are complex collections of arteries and veins that communicate directly. It has been postulated that AVMs occur both through the activation of inactive fistulous lesions and through the formation of new fistulous vascular channels through the canalization of injured vessels. Depending on their size and complexity, a variety of strategies can be used to treat them. The case of a 53-year-old male is presented who came for evaluation due to an increase in the volume of a pulsating lesion that extended from the right parietotemporal region accompanied by holocraneal headache and tinnitus. A cerebral angiotomography was performed in which a lesion composed of ectatic serpentine images, with a right extracranial location, subsequently diagnostic cerebral angiography was performed demonstrating a right frontoparietal fistulous and plexiform arteriovenous shunt fed by afferents from the right superficial temporal, posterior auricular, occipital and middle meningeal arteries, with drainage through a varicose and ectatic vein towards the external jugular vein. An endovascular embolization of the arteriovenous shunt was performed via the femoral route in two stages, achieving a "pressure cooker" construction to perform the injection of embolizing fluid and have a subtotal embolization of 93%, with this it was possible to perform a microsurgical resection with a right fronto-parietal-temporal approach resecting the deepest part, leaving the scalp with embolized vessels without resecting. To close the surgical wound, a simple flap rotation was performed to cover the skin defect derived from its resection. The patient underwent post-resection cerebral panangiography, identifying the absence of arteriovenous shunt. Depending on the extent and anatomical complexity of the malformation, clinical manifestations may vary. More than 80% of AVMs will be present at birth and the rest may develop after head trauma or surgical interventions. Appropriate therapeutic intervention is needed through selective angiography, during which endovascular embolization of the major feeding vessels can be performed before open surgical intervention. Volume-based three-dimensional computed tomography reconstructions can be used for further planning. Surgical reduction of post-embolization arterial supply will reduce intraoperative hemorrhage, facilitating total surgical resection. Removal can result in large, full-thickness skin defects that may be difficult to reconstruct without compromising functional and cosmetic results.

RESUMO

Introdução:Disfunções temporomandibularessão um termo coletivopara uma série de sinais e sintomas clínicos que envolvem os músculos mastigatórios, a articulação temporomandibular e estruturas associadas. O tratamento de pacientes deverá envolver uma equipe multidisciplinareparaquehajauma intervenção eficaz notratamento da disfunção é necessário que os profissionais envolvidos atuem emconjuntoetenhamplenoconhecimento das funções estomatognáticas.Objetivo:revisar aliteratura sobreas formas terapêuticas das disfunções temporomandibulares e sua eficácia.Metodologia:Trata-se de um estudosobre o panorama atual das terapêuticas utilizadas para o tratamento de disfunções temporomandibulares.Para compor o presente trabalho foi consultado o banco de dados da PubMed utilizando as palavras-chave "temporomandibular disorder" e "therapy" associados ao operador booleano AND. Os critérios de inclusão foram os artigos publicados, limitando-se ao período de 2020 a 2024 no idioma inglês. A busca computou um total de 545 artigos, dos quais foram excluídos os artigos que desviavam do tema proposto, artigos que abordavam técnicas com pouco embasamento científico e os artigos que não estavam disponíveis por completo.Resultados:os achados na literatura corroboram com a escolhaem primeiro plano de um tratamentoconservador, reversível e não invasivo. Dentre as opções destacam-se orientações de autocuidado, confecção de placa oclusal, terapias manuais, exercícios musculares, biofeedback e manejo farmacológico em casos de sintomas somáticos. A toxina botulínica tem sido sugerida para tratamento em casos de disfunções temporomandibularesmusculares, no entanto, com baixa evidência científicaquanto aos efeitos adversos. Técnicas cirúrgicas são indicadas em casos de não resolução com terapias conservadoras.Conclusões:Apesar dagrande diversidade nos protocolos,o tratamento conservador demonstra resolução do problema na maioria dos casos de disfunções temporomandibularese aquelestratamentos que combinam várias técnicasevidenciam melhores resultados do que tratamentos isolados (AU).

Introduction: Temporomandibular disorders are a collectiveterm for a range of clinical signs and symptoms involving the masticatory muscles, the temporomandibular joint, and associated structures. Treating patients with disorder temporomandibularshould involve a multidisciplinary team, and for effective intervention in dysfunction treatment, it is necessary for the involved professionals to work together and have a comprehensive understanding of stomatognathic functions. Objective: review the literature on therapeutic modalities for temporomandibular disorders and their effectiveness. Methodology:This is a study on the current landscape of therapies used for the treatment of temporomandibular disorders. To compose this work, the PubMed database was consulted using the keywords "temporomandibular disorder" and "therapy" associated with the boolean operator AND. Inclusion criteria were articles published in English from 2020 to 2024. The search yielded a total of 545 articles, from which articles deviating from the proposed theme, articles discussing techniques with little scientific basis, and articles not fully available were excluded. Results:Literature findings support the prioritization of conservative, reversible, and non-invasive treatment. Among the options, self-care guidance, occlusal splint fabrication, manual therapies, muscle exercises, biofeedback, and pharmacological management for somatic symptoms stand out. Botulinum toxin has been suggested for treatment in cases of muscular disordertemporomandibular, however, with low scientific evidence regarding adverse effects. Surgical techniques are indicated in cases where conservative therapies fail to resolve the issue. Conclusions:Despite the diversity in protocols, conservative treatment demonstrates resolution of the problem in most cases of disorder temporomandibular,and treatments combining multiple techniques show better results than isolated treatments (AU).

Introducción:Las disfunciones temporomandibulares son un término colectivopara una serie de signos y síntomas clínicos que afectan a los músculos masticatorios, la articulación temporomandibular y estructuras asociadas. El tratamiento de pacientes con disfunciones temporomandibularesdebe involucrar a un equipo multidisciplinario para una intervención efectiva, requiriendo que los profesionales actúen conjuntamente y conozcan bien las funciones estomatognáticas. Objetivo:revisar la literatura sobre las terapias paradisfunciones temporomandibularesy su eficacia. Metodología:Estudio comparativo de las terapias actuales para disfunciones temporomandibulares, utilizando la base de datos PubMed con las palabrasclaves "temporomandibular disorder" y "therapy" y el operador booleano AND, limitado a 2020-2024 en inglés. La búsqueda obtuvo un total de 545 artículos de los cuales fueron excluidos los que no abordaban el tema propuesto. Resultados:Los hallazgos respaldan un tratamiento conservador, reversible y no invasivo, destacando el autocuidado, placas oclusales, terapias manuales, ejercicios, biofeedback y manejo farmacológico. La toxina botulínica se sugiere para disfunciones temporomandibulares musculares, pero con poca evidencia científica de sus efectos adversos. Las técnicas quirúrgicas se reservan para casos sin resolución.Conclusiones: A pesar de la diversidad de protocolos, el tratamiento conservador resolveula mayoría de los casos de disfunciones temporomandibulares, y los tratamientos combinados muestran mejores resultados que los aislados (AU).

Assuntos

RESUMO

INTRODUCTION: Management of the patient with cirrhosis of the liver that requires surgical treatment has been relatively unexplored. In Mexico, there is currently no formal stance or expert recommendations to guide clinical decision-making in this context. AIMS: The present position paper reviews the existing evidence on risks, prognoses, precautions, special care, and specific management or procedures for patients with cirrhosis that require surgical interventions or invasive procedures. Our aim is to provide recommendations by an expert panel, based on the best published evidence, and consequently ensure timely, quality, efficient, and low-risk care for this specific group of patients. RESULTS: Twenty-seven recommendations were developed that address preoperative considerations, intraoperative settings, and postoperative follow-up and care. CONCLUSIONS: The assessment and care of patients with cirrhosis that require major surgical or invasive procedures should be overseen by a multidisciplinary team that includes the anesthesiologist, hepatologist, gastroenterologist, and clinical nutritionist. With respect to decompensated patients, a nephrology specialist may be required, given that kidney function is also a parameter involved in the prognosis of these patients.

Assuntos

RESUMO

Resumo Fundamento A remodelação adversa dos vasos pulmonares eleva a pressão pulmonar e provoca hipertensão arterial pulmonar (HAP). A HAP resulta em aumento da pós-carga do ventrículo direito (VD), causando hipertrofia ventricular e consequente insuficiência cardíaca. Não existe um tratamento específico para o remodelamento desadaptativo do VD secundário à HAP. Objetivos Este estudo tem como objetivo explorar duas abordagens terapêuticas, o suco de uva (SU) e os hormônios tireoidianos (HT), no tratamento do estresse oxidativo induzido pela HAP e nas alterações funcionais cardíacas. Métodos Parâmetros ecocardiográficos relacionados à resistência dos vasos pulmonares (relação TA/TE), contratilidade do VD (ESPAT) e função diastólica do VD (relação dos picos E/A) foram avaliados. Além disso, foram medidos ROS totais, peroxidação lipídica, enzimas antioxidantes, proteínas de manipulação de cálcio, expressão de proteínas pró-oxidantes e antioxidantes. Valores de p<0,05 foram considerados estatisticamente significativos. Resultados Ambos os tratamentos, com SU e HT, demonstraram uma redução na resistência pulmonar (~22%), além de melhorias na ESPAT (inotropismo ~11%) e na relação TA/TE (~26%) (p<0,05). Não houve alterações entre os grupos na relação do pico de E/A. Embora ROS e TBARS não tenham sido estatisticamente significativos, os tratamentos com SU e HT diminuíram os níveis de xantina oxidase (~49%) e normalizaram a expressão de HSP70 e proteínas de manipulação de cálcio (p<0,05). No entanto, apenas o tratamento com HT melhorou a função diastólica (~50%) e aumentou o imunoconteúdo de NRF2 (~48%) (p<0,05). Conclusões Até onde sabemos, este estudo é pioneiro ao mostrar que o HT administrado em conjunto com o SU promoveu melhorias funcionais e bioquímicas em um modelo de HAP. Além disso, nossos dados sugerem que os tratamentos com SU e HT se mostraram cardioprotetores, sejam combinados ou não, e exibiram seus benefícios ao modular o estresse oxidativo e as proteínas de manipulação do cálcio.

Abstract Background Adverse remodeling of lung vessels elevates pulmonary pressure and provokes pulmonary arterial hypertension (PAH). PAH results in increased right ventricle (RV) afterload, causing ventricular hypertrophy and the onset of heart failure. There is no specific treatment for maladaptive RV remodeling secondary to PAH. Objectives This study aims to explore two therapeutic approaches, grape juice (GJ) and thyroid hormones (TH), on PAH-induced oxidative stress and cardiac functional changes. Methods Parameters of echocardiography related to lung vessel resistance (AT/ET ratio), RV contractility (TAPSE), and RV diastolic function (E/A peaks ratio) were evaluated. Also, total ROS, lipid peroxidation, antioxidant enzymes, calcium handling proteins, pro-oxidant and antioxidant protein expression were measured. Values of p<0.05 were considered statistically significant. Results Both GJ and TH treatments demonstrated reductions in pulmonary resistance (~22%) and improvements in TAPSE (inotropism ~11%) and AT/ET ratio (~26%) (p<0.05). There were no changes amongst groups regarding the E/A peak ratio. Although ROS and TBARS were not statistically significant, GJ and TH treatments decreased xanthine oxidase (~49%) levels and normalized HSP70 and calcium handling protein expression (p<0.05). However, only TH treatment ameliorated diastolic function (~50%) and augmented NRF2 immunocontent (~48%) (p<0.05). Conclusions To the best of our knowledge, this study stands as a pioneer in showing that TH administered together with GJ promoted functional and biochemical improvements in a PAH model. Moreover, our data suggest that GJ and TH treatments were cardioprotective, combined or not, and exhibited their beneficial effects by modulating oxidative stress and calcium-handling proteins.

RESUMO

El síndrome de Apert, marcado por la acrocéfalo-sindactilia, es una condición genética que genera deformidades dentofaciales incluyendo craneosinostosis, alteraciones faciales y malformaciones en extremidades. La mutación en el gen FGFR2, ya sea heredada o resultante de mutaciones esporádicas, desencadena esta compleja condición. La relevancia de abordar el síndrome de Apert se manifiesta no sólo en las implicaciones estéticas, sino también en su impacto en la salud oral. Romper con los paradigmas odontológicos actuales implica reconocer las particularidades de estos pacientes y proporcionar una atención especializada. La necesidad de una capacitación específica para los profesionales de la salud oral es evidente, permitiendo un enfoque integral que aborde la prevención y el tratamiento de las malformaciones craneofaciales asociadas. Superar los desafíos tradicionales implica adoptar una perspectiva inclusiva y personalizada en la atención odontológica. Esto no sólo mejora la calidad de vida de los pacientes con síndrome de Apert, sino que también destaca la importancia de una atención adaptada que trascienda los límites convencionales, ofreciendo soluciones innovadoras para las complejidades bucodentales asociadas a esta condición genética (AU)

Apert syndrome, marked by acrocephalosyndactyly, is a genetic condition that generates dentofacial deformities, including craniosynostosis, facial alterations and limb malformations. Mutation in the FGFR2 gene, whether inherited or resulting from sporadic mutations, triggers this complex condition. The relevance of addressing Apert syndrome is manifested not only in the aesthetic implications, but also in its impact on oral health. Breaking with current dental paradigms involves recognizing the particularities of these patients and providing specialized care. The need for specific training for dental health professionals is evident, allowing a comprehensive approach that addresses the prevention and treatment of associated craniofacial malformations. Overcoming traditional challenges means taking an inclusive and personalized perspective on dental care. This not only improves the quality of life of patients with Apert syndrome, but also highlights the importance of tailored care that transcends conventional boundaries, offering innovative solutions for the oral complexities associated with this genetic conditio (AU)

Assuntos

RESUMO

Resumen (analítico) De acuerdo con las ideas de que la concepción del tiempo es un recurso valioso para el ser humano y que la estructuración y manejo de este durante la pandemia afectó a las juventudes debido a las medidas sanitarias implementadas, el objetivo fue describir el grado de estructuración y propósito en el manejo del tiempo de una muestra de jóvenes mexicanos(as) durante la pandemia por covid-19. Participaron 192 jóvenes, quienes respondieron una cédula de datos personales y el cuestionario de estructura del tiempo. Los resultados sugieren que variables como la escolaridad, las condiciones de vivienda y familia, así como las pérdidas por covid-19 modularon la estructura del tiempo. Se concluye que la pandemia repercutió en la forma en la cual los(as) jóvenes y adultos jóvenes estructuraron el tiempo.

Abstract (analytical) Based on the idea that time is a valuable resource for human beings and the structuring and management of time during the pandemic affected young adults, the objective of this study was to describe the time structuring and management used by a sample of Mexican young people during the Covid-19 pandemic. A total of 192 young people answered a personal data survey and a Time Structure Questionnaire (TSQ). The results of the questionnaire suggest that variables such as schooling, housing, and family conditions, as well as the loss of family members due to Covid-19, modulated the young people's time structure. The authors conclude that the pandemic had an impact on the structuring and management of time among the young adults included in the sample.

Resumo (analítico) Partindo da ideia de que a concepção do tempo é um recurso valioso para o ser humano e que a sua estruturação e gestão, durante a pandemia, afetou a juventude devido às medidas sanitárias implementadas, objetivou-se descrever o grau de estruturação e finalidade na gestão do tempo de uma amostra de jovens mexicanos durante a pandemia de covid-19. Participaram 192 jovens, que responderam a um formulario de dados pessoais e ao Time Structure Questionnaire (TSQ). Os resultados sugerem que variáveis como escolaridade, moradia e condições familiares, bem como perdas por covid-19 influenciam a estrutura do tempo. Conclui-se que a pandemia teve impacto na forma como o tempo é estruturado nos jovens e adultos jovens da amostra.

RESUMO

Esta revisión ofrece un enfoque sistemático para establecer una prestación de atención dental segura, integral, coordinada y orientada a la familia del niño con complejidades médicas. Sugerimos que adoptar un enfoque individualizado basado en la fortaleza para la evaluación de niños con afecciones médicas complejas ofrece la base más segura para la prestación de atención en pacientes con enfermedad cardiaca y asma. El objetivo de esta revisión es brindar una visión razonada de atención en el paciente comprometido sistémicamente, basados en protocolos internacionales, y una serie de pasos y modificaciones que deben ser consideradas al momento del manejo odontológico. Se realizó la búsqueda científica en bases digitales contemplando información en idiomas inglés y español, acerca del manejo del paciente dependiendo de su diagnóstico médico y sus complicaciones. Concluimos que el tratamiento dental de pacientes pediátricos con enfermedades sistémicas se puede llevar a cabo de manera eficiente en presencia de un equipo dental bien equipado y apoyo de los padres. Un dentista pediátrico juega un papel importante en el alivio de la ansiedad del niño, manteniendo una relación positiva y haciendo que los servicios de atención se conviertan en experiencias cómodas y libres de complicaciones para pacientes infantiles con enfermedades sistémicas de base, como cardiopatías y/o asma (AU)

This review provides a systematic approach to establishing safe, comprehensive, coordinated, and family-oriented dental care delivery for the child with medical complexities. We suggest that adopting an individualized, strength-based approach to evaluating children with complex medical conditions provides the surest basis for delivering care to heart disease and asthma patients. This review aims to provide a reasoned care approach for the patient with a systemic compromise based on international protocols and a series of steps and modifications that should be considered during dental management. A scientific search was conducted in digital databases, including information in English and Spanish, on managing patients according to their medical diagnosis and complications. We conclude that dental treatment of pediatric patients with systemic diseases can be carried out efficiently in the presence of a well-equipped dental team and parental support. A pediatric dentist plays a vital role in relieving the child's anxiety, maintaining a positive relationship, and making care services become comfortable and complication-free experiences for pediatric patients with underlying systemic diseases, such as heart disease and/or asthma (AU)

Assuntos

RESUMO

En la actualidad, la oferta de cuidados paliativos especializados ha sido superada por la demanda, por lo cual la atención a pacientes con enfermedades en estado terminal o en fase final de la vida suele estar a cargo del médico del nivel primario de asistencia. En ese sentido, los cuidados paliativos primarios incluyen el diagnóstico, el tratamiento paliativo, la planificación anticipada, la gestión y coordinación de intervenciones multidisciplinarias y la transferencia a cuidados especializados cuando sea necesario y haya disponibilidad para ello. Al respecto, en este artículo se exponen brevemente algunos elementos sobre el tema y se propone, además, un algoritmo práctico y fácil de aplicar en la atención primaria, que permitirá identificar a la población aquejada por dolencias en esas etapas, con diferenciación en cuanto a afecciones neoplásicas o no neoplásicas.

Nowadays, the offer of specialized palliative care has been overcome by the demand, reason why care to patients with terminal illness or in end-of-life period is usually in charge of the doctor from primary care level. In that sense, primary palliative care includes the diagnosis, palliative treatment, early planning, administration and coordination of multidisciplinary interventions and referring to specialized care when it is necessary and the service is available. In this respect, some elements on the topic are shortly exposed in this work and, also, a practical and easy implementation algorithm in primary care is proposed that will allow identifying population suffering from pain in those stages, with differentiation as for neoplastic or non neoplastic affections.

Assuntos

RESUMO

Introducción: La obstrucción intestinal supone un 20% de las consultas por dolor abdominal en urgencias y hasta un 75% se deben a adherencias por cirugías previas. A pesar de las altas tasas de resolución con el tratamiento conservador, es a menudo recurrente y amerita manejo quirúrgico. Objetivo: Determinar la epidemiología quirúrgica de la obstrucción intestinal por adherencias en el servicio de cirugía general del Complejo Hospitalario Dr. Arnulfo Arias Madrid en el período 2015-2020. Metodología: Se realizó un estudio observacional descriptivo, retrospectivo, transversal mediante revisión de expedientes de pacientes con diagnóstico de obstrucción intestinal por adherencias. Resultados: El 54% de los pacientes fueron mujeres y el 46% hombres. Con mayor frecuencia en >65 años y una edad media de 72,5 años. La mayoría de los pacientes presentaban al menos un antecedente quirúrgico abdominal previo (89%). El tiempo transcurrido desde la última cirugía fue más de 10 años (53%). La respuesta al tratamiento conservador fue del 75%. De los pacientes operados, al 77% se le realizó adherenciolisis, al 13% resección y anastomosis intestinal, al 3% ostomías y al 7% otros procedimientos. La moda del tiempo de hospitalización fue de <5 días para el manejo conservador y de 5-10 días para el manejo quirúrgico. Conclusiones: Este estudio marca el inicio de una serie de proyectos, encaminados a evaluar los riesgos y resultados del tratamiento, y decidir el momento óptimo para la intervención quirúrgica, con el objetivo primordial de disminuir la morbi-mortalidad y mejorar la calidad de vida de la población. (provisto por Infomedic International)

Introduction: Intestinal obstruction accounts for 20% of emergency department visits for abdominal pain and up to 75% are due to adhesions from previous surgery. Despite high resolution rates with conservative treatment, it is often recurrent and requires surgical management. Objective: To determine the surgical epidemiology of intestinal obstruction due to adhesions in the general surgery service of the Complejo Hospitalario Dr. Arnulfo Arias Madrid in the period 2015-2020. Methodology: A descriptive, retrospective, cross-sectional, retrospective, observational study was carried out by reviewing the records of patients with a diagnosis of intestinal obstruction due to adhesions. Results: 54% of the patients were women and 46% men. With a higher frequency in >65 years and a mean age of 72.5 years. Most patients had at least one previous abdominal surgical history (89%). The time elapsed since the last surgery was more than 10 years (53%). The response to conservative treatment was 75%. Of the operated patients, 77% underwent adhesiolysis, 13% underwent intestinal resection and anastomosis, 3% underwent ostomies and 7% underwent other procedures. The mode of hospitalization time was <5 days for conservative management and 5-10 days for surgical management. Conclusions: This study marks the beginning of a series of projects, aimed at evaluating the risks and results of treatment, and deciding the optimal time for surgical intervention, with the primary objective of decreasing morbi-mortality and improving the quality of life of the population. (provided by Infomedic International)

RESUMO

El enfrentamiento de las personas que viven con VIH es amplio y requiere dedicación en múltiples dimensiones, más allá de la terapia antirretroviral. Estas recomendaciones abordan el manejo desde el diagnóstico, primera visita, seguimiento, manejo de comorbilidades infecciosas y no infecciosas, tamizaje de neoplasias, profilaxis antimicrobiana y vacunas, entre otras.

Management of people living with HIV is broad and multiple dimensions must be considered, beyond antiretroviral therapy. These recommendations include management from diagnosis, first visit, patient follow-up, infectious and non-infectious comorbidities, malignancies screening, antimicrobial and immunizations prophylaxis, among others.

Assuntos

RESUMO

En Guatemala, los huevos de tortuga parlama son aprovechados para su comercialización. El esquema de conservación se basa en un sistema de cuotas, en la que se establece que el 20% de los huevos recolectados deberán ser entregados a un tortugario registrado. Se estima que alrededor de 673,304 huevos son puestos por año en la Costa Pacífica con un valor en playa aproximado de Q1,124,869.00. En Guatemala, el aprovechamiento de huevos de tortuga funciona como un amortiguador clave en las economías de las comunidades. En los últimos años, la compra de huevos por parte de los tortugarios ha aumentado. Estos criaderos, además de recibir la cuota de conservación, compran el resto de la carga de huevos del nido. Como resultado, el número de nidos plantados en los tortugarios también ha aumentado. Sin embargo, esto también ha provocado que haya un mercado mas grande para los huevos de tortuga. La venta de huevos se ha convertido en una fuente de ingresos muy exitosa con menos riesgo y costos que la pesca. Esto ha llevado a algunos pescadores artesanales a cambiar a la recolección de huevos como su actividad principal. Es necesario evaluar los esquemas de conservación actuales y la efectividad de los incentivos de manera integral, tomando en cuenta impactos ambientales, rentabilidad y efectos sociales. El presente análisis aporta información útil para identificar la calidad de los incentivos, para poder reformar o eliminar los incentivos ineficientes o perversos, de manera que los escasos recursos de conservación se puedan invertir de la manera más efectiva

In Guatemala, olive ridley sea turtle (Lepidochelys olivacea) eggs are harvested. The conservation scheme is based Modelo de publicación sin fines de lucro para conservar la naturaleza académica y abierta de la comunicación científica on a quota system, which requires that 20% of the collected eggs be delivered to a registered turtle nursery. It is estimated that approximately 673,304 eggs are laid annually on the Pacific coast, with an approximate beach value of Q1,124,869.00. In Guatemala, the harvesting of turtle eggs serves as a key buffer in the economies of coastal communities. In recent years, the purchase of eggs by turtle nurseries has increased. These nurseries, in addition to receiving the conservation fee, buy the rest of the load of eggs from the nest. As a result, the number of planted nests in nurseries has also increased. However, this has also led to a larger market for turtle eggs. The sale of eggs. The sale of eggs has become a highly successful source of income, with fewer risks and costs than fishing. This has led some artisanal fishermen to switch to egg collection as their main activity. This analysis provides useful infromation for identifying the quality of incentives, in order to reform or elinate inefficient or perverse incentives, so that scarce conservation resource will allow for the identification of the quality of the incentives, aiming to reform or eliminate inefficient or perverse incentives so that scarce conservation resources can be invested in the most effective way

RESUMO

Resumen: Los manuales de emergencia desarrollados a partir de las ayudas cognitivas son componente esencial dentro de la sala de operaciones para el manejo oportuno de crisis, con la ventaja de disminuir los errores por omisión. El propósito de esta redacción fue retomar la experiencia mundial actualizada con los mismos y compararla con la del Centro Médico ABC. El proceso de recolección de datos se hizo mediante una encuesta a través de Google Forms; los datos obtenidos de la encuesta se convirtieron en porcentajes y se usaron para resumir las variables categóricas. Los resultados mostraron que la mayoría de los médicos tenían conocimiento de esta herramienta en quirófano y más de la mitad en efecto lo utilizaron en situaciones críticas. Las situaciones más descritas fueron: broncoespasmo, choque anafiláctico y sospecha de hipertermia maligna.

Abstract: The emergency manuals based on cognitive aids are an essential component within the operating room for timely crisis management, with the advantage of reducing errors due to omission. The purpose of this writing was to resume the current world experience with them and compare it with the ABC Medical Center. The data obtained from the survey were converted into percentages and used to summarize the categorical variables. The results showed that most doctors were aware of this tool in the operating room and more than a half actually used it in critical situations. The most described situations were: bronchospasm, anaphylactic shock and suspicion of malignant hyperthermia.

RESUMO

A dermatite atópica (DA) e o prurigo nodular (PN) são doenças inflamatórias da pele que cursam com lesões variadas, como eczemas, pápulas e nódulos, acompanhados de intenso prurido e, nos casos graves, de importante prejuízo da qualidade de vida para os pacientes e seus familiares. O dupilumabe está aprovado no Brasil para o manejo das duas condições: DA moderada/grave e PN que não responde aos tratamentos tópicos. A eficácia e segurança do dupilumabe foram amplamente estabelecidas para ambas as condições em ensaios clínicos e estudos de vida real. Este artigo tem como objetivo revisar os principais eventos adversos (EAD) associados ao uso do dupilumabe em DA e PN, e auxiliar no seu manejo. Desde o início do uso da medicação, há alguns anos, os principais EAD reportados foram: a reação no local da injeção, a doença da superfície ocular (conjuntivite não infecciosa, blefarite, olhos secos), a eosinofilia e o eritema de face/pescoço. Outras manifestações também foram observadas em pacientes com DA em uso de dupilumabe, mas sem associação comprovada: psoríase, artralgia e alopecia areata. Apesar de muito infrequentemente levarem à suspensão do dupilumabe, é fundamental que os médicos prescritores deste medicamento para estas condições, dermatologistas e imunoalergistas, saibam detectar e manejar seus possíveis eventos adversos.

Atopic dermatitis (AD) and prurigo nodularis (PN) are inflammatory skin diseases characterized by various lesions such as eczema, papules, and nodules, with marked pruritus and, in severe cases, significant impairment of quality of life for patients and their families. Dupilumab is approved in Brazil for the management of both moderate/severe AD and PN that does not respond to topical treatments. The efficacy and safety of dupilumab have been extensively established for both conditions in clinical trials and real-world studies.This article aims to review the main adverse events (AEs) associated with the use of dupilumab in AD and PN and assist in their management. Since the introduction of dupilumab a few years ago, the main reported AEs have been injection site reactions, ocular surface disease (non-infectious conjunctivitis, blepharitis, dry eyes), eosinophilia, and facial/neck erythema. Other manifestations have also been observed in patients with AD on dupilumab, but without proven association: psoriasis, arthralgia, and alopecia areata. Although AEs very infrequently lead to discontinuation of dupilumab, it is crucial that physicians prescribing it for these conditions, dermatologists, and immunologists know how to detect and manage its possible adverse effects.

Assuntos

RESUMO

During the past two decades, the videolaryngoscope (VDL) has become a valuable and effective tool for the management of the airway, not just in the realm of anesthesiology, but also in other medical specialties in clinical scenarios requiring tracheal intubation. In countries such as the United States, this represents over 15 million cases in the operating room and 650,000 outside the OR. The overall accumulated incidence of difficult airway is 6.8% events in routine practice and between 0.1 and 0.3 % of failed intubations, both associated with complications such as desaturation, airway injury, hemodynamic instability and death. Notwithstanding the fact that the VDL has proven advantages such as improved visualization of the glottis, higher first attempt success rates, and a shortened learning curve, most of the time its use is limited to rescue attempts or as a secondary option. The aim of this article is to comment the advantages and limitations of the VDL vs. the direct laryngoscope in a wide range of clinical settings, including the operating room, intensive care units, emergency departments, pediatrics, obstetrics, and Covid-19 to consider its routine use.

En las últimas dos décadas, el videolaringoscopio (VDL) se ha convertido en una herramienta valiosa y eficaz para el manejo de la vía aérea no solo en el ámbito de anestesiología, sino en otras especialidades médicas durante escenarios clínicos que requieren la intubación traqueal y las cuales, en países como Estados Unidos corresponden anualmente a más de 15 millones dentro de salas de cirugía y 650.000 fuera de ella. Aproximadamente, hay una incidencia global acumulada de 6,8 % de eventos de vía aérea difícil en la práctica rutinaria y 0,1 al 0,3 % de intubaciones fallidas, ambas asociadas a complicaciones como desaturación, daño en la vía aérea, inestabilidad hemodinámica y muerte. Pese a que el VDL ha demostrado ventajas como mejoría de la visualización de la glotis, aumento de tasa de éxito al primer intento y menor curva de aprendizaje, su uso en la mayoría de las veces se ve limitado como dispositivo de rescate o de manera secundaria. El propósito de este artículo es comentar acerca de las ventajas y limitaciones del VDL vs. el laringoscopio directo en un variado número de escenarios clínicos, como salas de cirugía, unidades de cuidado intensivo, emergenciología, pediatría, obstetricia y covid-19, con el fin de considerar si su uso debiera hacerse de manera rutinaria.

RESUMO

INTRODUÇÃO: A dor lombar possui alta prevalência, sendo uma das principais causas de incapacidade no Brasil e no mundo. A dor lombar apresenta etiologia multifatorial, sendo extremamente comum em trabalhadores. OBJETIVOS: Verificar o conhecimento sobre os fatores de risco para dor lombar, crenças e atitudes sobre o manejo da dor lombar entre profissionais de saúde (fisioterapeutas e ergonomistas) atuantes na área ocupacional. MATERIAIS E MÉTODOS: Foi realizado um estudo observacional transversal com 81 profissionais de saúde ocupacional brasileiros. Os participantes preencheram um questionário eletrônico composto por dados profissionais, sociodemográficos, itens sobre fatores de risco para dor lombar e a Brazilian version of the Pain Attitudes and Beliefs Scale for Physiotherapists. Conhecimentos, crenças e atitudes foram analisados por meio do teste do qui-quadrado para fatores de risco para dor lombar e um modelo de regressão linear para crenças e atitudes dos profissionais de saúde. RESULTADOS: Obesidade (7,4%), ficar sentado mais de 2 horas (8,6%), atividade física (9,9%), falta de apoio psicossocial no trabalho (11,1%) e consumo de álcool (37,0%), apresentaram os menores índices de conhecimento sobre fatores de risco da dor lombar pelos profissionais. Itens sobre saúde geral apresentaram o menor conhecimento. Uma orientação biomédica e psicossocial equilibrada de crenças e atitudes sobre o manejo da dor lombar foi observada. CONCLUSÃO: Profissionais de saúde ocupacional brasileiros carecem de conhecimento sobre os fatores de risco não ocupacionais da dor lombar, especialmente o estado geral de saúde. Esses profissionais também possuem conceitos biomédicos e psicossociais equilibrados no manejo da dor lombar.

INTRODUCTION: Low back pain (LBP) is highly prevalent and is one of the main causes of disability in Brazil and around the world. LBP presents a multifactorial etiology, being extremely common in workers. OBJECTIVE: This study aimed to verify the knowledge about the LBP risk factors, beliefs and attitudes about the management of LBP among health professionals (physiotherapists and ergonomists) working in the occupational area. MATERIALS AND METHODS: A cross-sectional observational study was conducted with 81 Brazilian occupational health professionals. Participants completed an electronic questionnaire comprising professional data, sociodemographics, items about LBP risk factors, and the Brazilian version of the Pain Attitudes and Beliefs Scale for Physiotherapists. Knowledge, beliefs and attitudes were analyzed using the chi-square test for LBP risk factors and the linear regression model for health professionals' beliefs and attitudes. RESULTS: Obesity (7.4%), sitting for more than 2 hours (8.6%), physical activity (9.9%), lack of psychosocial support at work (11.1%) and consuming alcohol (37.0%) presented the lowest rate of knowledge about LBP risk factors by professionals. Items about general health showed the lowest knowledge. A balanced biomedical and psychosocial orientation of beliefs and attitudes about managing LBP was observed. CONCLUSION: Brazilian occupational health professionals lack knowledge about non-occupational LBP risk factors, especially general health status. These professionals also have balanced biomedical and psychosocial concepts in managing LBP.

Assuntos

RESUMO

Abstract Introduction: Short-term gametes storage is an inexpensive and simple technique that allows the use of the same batch of eggs or sperm at different times, maximizing the application of research protocols and the use of gametes in production. Arbacia dufresnii is a sea urchin species with proven aquaculture potential and already used in the nutraceutical industry. Aging of its gametes is unknown and is a needed information to scale up the production. Objective: Determine the effect of male and female gamete aging on the fertilization success of Arbacia dufresnii. This will allow optimizing the use of gametes after collection decoupling spawning from fertilization. Methods: A. dufresnii individuals were induced to spawn and gametes were kept at 12 ± 1 °C throughout each bioassay. Sperm was separated into two treatments: activated sperm in seawater (AS), and dry sperm (DS). Two bioassays were made: Bioassay 1 evaluated the effect of time on fertility by performing fertilization tests at 0 h, 24 h, 48 h, 72 h, and 96 h after spawning. Bioassay 2 evaluated the contribution of each type of aged gamete on fertility, combining aged gametes (96 h) with fresh gametes (0 h). Results: Bioassay 1: the fertilization success obtained by combining eggs (E) with AS or DS presented important differences. While the fertilization success remained acceptable (greater than 50 %) for up to 72 h using ExDS, it only remained acceptable for up to 48 h using ExAS. Bioassay 2: acceptable fertilization success was found by combining aged E (96 h) with fresh sperm, or aged DS (96 h) with fresh E, but not using aged AS with fresh E. Conclusions: The findings of this work show that fertilization success in A. dufresnii gametes remains relatively unchanged for up to 48 h after spawning when combining ExAS, and for up to 72 h when combining ExDS. However, when combining aged E or aged DS with a fresh gamete, post-collection fertilization can be extended up to 96 h. In this work, the first steps have been taken to understand the conservation time of A. dufresnii gametes with minimum intervention.

Resumen Introducción: El almacenamiento de gametos a corto plazo es una técnica económica y sencilla que permite utilizar el mismo lote de óvulos o espermatozoides en diferentes momentos, maximizando la aplicación de protocolos de investigación y el uso de gametos en la producción. Arbacia dufresnii es una especie con probado potencial acuícola como fuente de gametos para la industria nutracéutica. Sin embargo, se desconoce el envejecimiento de sus gametos y es una información necesaria para escalar la producción. Objetivo: Determinar el efecto del envejecimiento de los gametos masculinos y femeninos en el éxito de la fecundación de Arbacia dufresnii con el fin de optimizar el aprovechamiento de los gametos después de la recolecta desincronizando el desove de la fecundación. Métodos: Se indujo el desove de individuos de A. dufresnii y los gametos se mantuvieron a 12 ± 1 °C durante cada bioensayo. El esperma se separó en dos tratamientos: esperma activado en agua de mar (AS) y esperma seco (DS). Se realizaron dos bioensayos: El Bioensayo 1 evaluó el efecto del tiempo sobre la fertilidad realizando pruebas de fecundación a las 0 h, 24 h, 48 h, 72 h y 96 h después del desove. El bioensayo 2 evaluó la contribución de cada tipo de gameta envejecida (96 h) sobre la fertilidad, combinando gametos envejecidas (96 h) con gametos frescas (0 h). Resultados: Bioensayo 1: el éxito de fecundación obtenido combinando huevos (E) con AS o DS presentó diferencias importantes. Si bien el éxito de la fecundación se mantuvo aceptable (más del 50 %) durante un máximo de 72 h con ExDS, solo permaneció aceptable hasta 48 h con ExAS. Bioensayo 2: se encontró un éxito de fecundación aceptable combinando E envejecidos (96 h) con esperma fresco, o DS envejecido (96 h) con E fresco (0 h), pero no usando AS envejecido con E fresco (0 h). Conclusiones: Los hallazgos de este trabajo muestran que el éxito de la fecundación en los gametos de A. dufresnii permanece relativamente sin cambios hasta 48 h después del desove cuando se combina ExAS, y hasta 72 h cuando se combina ExDS. Sin embargo, cuando se combina E envejecido o DS envejecido con un gameto fresco, el tiempo entre la recolección y la fecundación puede extenderse hasta 96 h. En este trabajo se han dado los primeros pasos para entender el tiempo de conservación de los gametos de A. dufresnii con mínima intervención.

Assuntos

RESUMO

El divertículo de Meckel es la malformación gastrointestinal congènita más frecuente y se produce por la involución parcial o total del conducto onfalomesentérico durante el desarrollo embrionario, resultando en un divertículo verdadero, puesto que contiene todas las capas del intestino delgado. Posee una incidencia de 0,6-4% en la población general y corresponde a la principal causa de hemorragia digestiva baja en pacientes pediátricos. Mayoritariamente, permanece asintomático hasta la adultez, pudiendo presentar cuadros clínicos sugerentes de apendicitis aguda, obstrucción intestinal y hemorragia digestiva baja. El hallazgo del divertículo suele ser incidental y en solo 4-6% de las ocasiones se encuentra como estudio dirigido de esta anormalidad. Existen múltiples estudios diagnósticos disponibles, pasando por la tomografía computarizada (TC), cintigrafía con pertecnetato de Tecnecio-99m (Tc-99m), videocápsula endoscópica y la laparoscopía/laparotomía. El manejo del divertículo de Meckel es quirúrgico, especialmente, debido a sus múltiples complicaciones, siendo detalladas en el presente artículo. El uso de técnicas mínimamente invasivas y las mejores tecnologías y métodos de detección han permitido disminuir la mortalidad de las complicaciones del divertículo de Meckel. Finalmente, esta patología supone un reto para cualquier especialista, puesto que la baja incidencia y el cuadro clínico similar a enfermedades diverticulares significa un mayor reto tanto en el diagnóstico como en el manejo.

Meckel's diverticulum is the most common congenital gastrointestinal malformation and is caused by partial or total involution of the omphalomesenteric duct during embryonic development, resulting in a true diverticulum, since it contains all the layers of the small intestine. It has an incidence of 0.6-4% in the general population and is the main cause of lower gastrointestinal bleeding in pediatric patients. Most of them remain asymptomatic until adulthood, and may present clinical symptoms suggestive of acute appendicitis, intestinal obstruction and lower gastrointestinal bleeding. The finding of the diverticulum is usually incidental and only 4-6% of the time it is found as a directed study of this abnormality. There are multiple diagnostic studies available, including computed tomography (CT), Technetium-99m pertechnetate (Tc-99m) scintigraphy, video capsule endoscopy, and laparoscopy/laparotomy. The management of Meckel's diverticulum is surgical, especially due to its multiple complications, which are detailed in this article. The use of minimally invasive techniques and the best technologies and detection methods have made it possible to reduce the mortality of Meckel's diverticulum complications. Finally, this pathology is a challenge for any specialist, since the low incidence and symptoms similar to diverticular diseases pose a greater challenge both in diagnosis and management.

RESUMO

RESUMEN El dolor se define como una experiencia sensorial y emocional desagradable que se asocia con el daño. Es un fenómeno multifactorial y subjetivo que presenta una incidencia de hasta el 60 % en los pacientes críticos y que puede ocasionar consecuencias negativas a nivel cardiovascular, respiratorio, digestivo, muscular, hematológico y psicológico. El estándar de oro para la evaluación del dolor es el reporte del paciente, quien puede indicar la presencia de dolor respondiendo a la pregunta simple «¿Tenés/tiene dolor?¼ o expresar la intensidad mediante la escala numérica del dolor (NRS, por sus siglas en inglés). El paciente capaz de comunicarse puede brindar también información sobre otras características del dolor. En pacientes que no pueden comunicarse pero pueden manifestar respuesta a estímulos, es apropiado utilizar escalas conductuales, las cuales se basan en observar la presencia de comportamientos asociados al dolor. El objetivo del presente paso a paso es describir la evaluación del dolor en pacientes adultos críticos.

ABSTRACT Pain is defined as an unpleasant sensory and emotional experience associated with damage. It is a multifactorial and subjective phenomenon with an incidence of up to 60 % in critically ill patients, which may lead to negative consequences at cardiovascular, respiratory, digestive, muscular, hematological, and psychological levels. The gold standard for pain assessment is the patient's report, who can indicate the presence of pain by answering the simple question «Do you have pain?¼ or express its intensity using the numeric pain rating scale (NRS). Patients who can communicate may also provide information regarding other characteristics of pain. In patients unable to communicate but capable of responding to stimuli, it is appropriate to use behavioral scales, which are based on observing the presence of behaviors associated with pain. The objective of this study is to describe the pain assessment in critically ill adult patients.