Acidentes de Servi��o em Profissionais de Sa��de: Identifica����o, Representa����es e Comportamentos Face �� Exposi����o Microbiol��gica Acidental

Este estudo de investiga����o teve subjacente a preocupa����o com a exposi����o microbiol��gica acidental nos profissionais de sa��de, sabendo que os acidentes de trabalho por exposi����o microbiol��gica acidental constituem um dos principais riscos de transmiss��o ocupacional de infec����es por contacto com sangue e outros fluidos corporais. Os agentes infecciosos mais frequentemente envolvidos neste tipo de acidente s��o os v��rus da hepatite B, C e o v��rus da imunodefici��ncia humana (VIH). Teve como objectivo identificar e caracterizar os acidentes de trabalho por exposi����o microbiol��gica acidental ocorridos nos profissionais de sa��de de um Hospital Central da regi��o de Lisboa durante os anos de 2002 a 2006 e conhecer as Representa����es e os Comportamentos dos profissionais de sa��de aquando da ocorr��ncia de uma exposi����o microbiol��gica acidental. Tratou-se de um estudo descritivo e explorat��rio, inserido numa abordagem quantitativa e qualitativa. Os participantes deste estudo foram os profissionais de sa��de (m��dicos, enfermeiros e t��cnicos de diagn��stico e terap��utica) que tenham sofrido um acidente de trabalho com exposi����o microbiol��gica acidental do ano de 2002 at�� Julho do ano de 2007, tendo-se constitu��do uma amostra n��o probabil��stica de 20 participantes utilizando a t��cnica de amostragem por conveni��ncia e que se disponibilizaram a participar no estudo ap��s o Consentimento Informado. Para a realiza����o do estudo optou-se por recorrer a um conjunto de m��todos de colheita de dados, privilegiando a an��lise documental atrav��s do question��rio epidemiol��gico de caracteriza����o e an��lise dos acidentes de trabalho e do processo de sa��de individual e da realiza����o de uma entrevista semi-directiva no ��mbito da qual se aplicou um question��rio de caracteriza����o s��cio-demogr��fica, apoio social e actividades de tempos livres, aspectos relacionados com a percep����o sobre os riscos a que se encontram expostos no ambiente hospitalar e com o circuito de notifica����o do acidente de servi��o/trabalho. Elaborou ��� se um gui��o de entrevista semi-directiva de acordo com os objectivos da investiga����o. Optou-se por uma metodologia quantitativa no que diz respeito �� an��lise dos acidentes de trabalho que envolveram exposi����o microbiol��gica durante o per��odo em estudo e dos dados s��cio-demogr��ficos do question��rio aplicado no ��mbito da entrevista, atrav��s do programa inform��tico pakage estat��stico ���Statistica/Program for Social Sciences-SPSS��� para Windows (vers��o 12). Posteriormente optou-se por uma metodologia qualitativa no que concerne ao tratamento dos dados relativos ��s entrevistas efectuadas, que consistiu na an��lise de conte��do tem��tico das entrevistas. A an��lise dos resultados obtidos revelaram que os acidentes de trabalho ocasionados por material perfuro-cortante entre os profissionais de sa��de s��o frequentes devido ao n��mero elevado de manipula����o destes instrumentos, principalmente de agulhas e apresentam preju��zos aos profissionais e �� Institui����o. Verifica-se que dos 305 acidentes notificados, a categoria profissional que tem o maior n��mero de notifica����es �� a dos enfermeiros com 142 acidentes no total dos anos representando 46,6%. A picada acidental �� o tipo de acidente mais frequente com 205 acidentes o que representa 67% do total. O instrumento que esteve associado directamente com a ocorr��ncia destes acidentes foram as agulhas (41,6%), nomeadamente as agulhas subcut��neas (18,8%), as agulhas intravenosas (9,4%), as agulhas intramusculares (5%), outras agulhas (8,4%). As l��minas de bisturi representam 13,1% dos acidentes ocorridos nos anos de 2002 a 2006. Estes acidentes podem oferecer riscos �� sa��de f��sica e mental dos profissionais de sa��de, com repercuss��es psicossociais, levando a mudan��as nas rela����es sociais, familiares e de trabalho. Da forma como o indiv��duo viv��ncia e ultrapassa a situa����o e dos meios encontrados para lidar com o stress provocado pelo acidente, depende o seu bem-estar futuro na profiss��o e na Organiza����o evitando o turnover. Todos os entrevistados manifestam a percep����o que o maior risco na sua actividade �� a relacionada com a exposi����o a agentes biol��gicos com ��nfase na preocupa����o em adquirir uma doen��a infecto-contagiosa. A percep����o do risco de contamina����o atrav��s do sangue e fluidos corporais est�� relacionada com a ideia do VIH conduzir a uma doen��a fatal e incur��vel apesar de existir uma perspectiva de esperan��a e qualidade de vida devido aos avan��os das terap��uticas actualmente. Os sentimentos e as emo����es ocasionadas ap��s a exposi����o microbiol��gica e manifestadas pelos participantes s��o a ansiedade, o medo, a ang��stia e a preocupa����o, raramente referem a frustra����o e a revolta por se sentirem tra��dos, da�� a import��ncia do apoio social que tiveram por parte da sa��de ocupacional, da fam��lia e amigos, bem como dos colegas de trabalho, fundamental para ultrapassar um epis��dio cr��tico da sua vida. No entanto a representa����o que t��m das doen��as como o VIH/SIDA e das hepatites B e C, como podem ser prevenidas e o n��vel de controlo que sentem exercer sobre os factores de transmiss��o, reflectem a percep����o de que as medidas preventivas podem reduzir o risco de contamina����o. Uma das conclus��es deste estudo prende-se com a necessidade de reformula����o do circuito de notifica����o dos acidentes de trabalho, com o objectivo de diminuir o tempo e os v��rios constrangimentos durante o percurso. A an��lise dos dados referentes aos acidentes de servi��o por exposi����o microbiol��gica, os relat��rios de an��lise das causas, a selec����o e avalia����o dos instrumentos aplicados promovem a cria����o de uma cultura de seguran��a. Como medidas organizacionais, a preven����o pressup��e o treino e a forma����o dos profissionais de sa��de nos procedimentos de preven����o da transmiss��o da infec����o, o incentivo �� notifica����o das exposi����es e o desenvolvimento de um sistema adequado de monitoriza����o e gest��o das exposi����es ocupacionais. Sendo que a preven����o destes acidentes passa essencialmente pela introdu����o de dispositivos m��dicos com sistemas de seguran��a, por pr��ticas de trabalho seguras, e pela forma����o dos profissionais de sa��de.

Results of Surgery for Ebstein Anomaly: a Multicenter Study from the European Congenital Heart Surgeons Association

OBJECTIVE: Since most centers' experience with Ebstein anomaly is limited, we sought to analyze the collective experience of participating institutions of the European Congenital Heart Surgeons Association with surgery for this rare malformation. METHODS: The records of all 150 patients (median age 6.4 years) who underwent surgery for Ebstein anomaly in the 13 participating Association centers between January 1992 and January 2005 were reviewed retrospectively. Patients with congenitally corrected transposition were excluded. RESULTS: Most patients (81%) had Ebstein disease type B or C and significant functional impairment (61% in New York Heart Association class III or IV) and 16% had prior operations. Surgical procedures (n = 179) included valve replacement (n = 60, 33.5%), valve repair (n = 49, 27.3%), 1(1/2) ventricle repair (n = 46, 25.6%), palliative shunt (n = 13, 7.26%), and other complex procedures (n = 11, 6.14%). There were 20 hospital deaths (operative mortality 13.3%) after valve replacement in 5 patients, valve repair in 3, 1(1/2) ventricle repair in 7, palliative procedures in 3, and miscellaneous procedures in 2. Younger age and palliative procedures were univariate risk factors for operative death, but only age was an independent predictor on multivariable analysis. CONCLUSIONS: Most patients coming to surgery presented in childhood and were significantly symptomatic. More than half underwent valve replacement or repair, but a considerable proportion had severe disease necessitating 1(1/2) ventricle repair or palliative procedures. Operative mortality did not differ significantly among repair, replacement, and 1(1/2) ventricle repair but was associated with palliative procedures for severe disease early in life, young age being the only independent predictor of operative death.

Fexofenadine is Efficacious and Safe in Children (Aged 6-11 Years) with Seasonal Allergic Rhinitis

Background: This is the first prospective, randomized, doubleblind, placebo-controlled study showing statistical improvement of an H1-antihistamine in children with seasonal allergic rhinitis in all symptoms throughout the entire treatment period. Objective: This randomized, placebo-controlled, parallelgroup,double-blind study was performed to assess the efficacy and safety of fexofenadine in children with seasonal allergic rhinitis. Methods: This study was conducted at 148 centers in 15 countries. Nine hundred thirty-five children (aged 6-11 years) were randomized and treated with either fexofenadine HCl 30 mg (n = 464) or placebo (n = 471) tablets twice a day for 14 days. Individual symptoms (sneezing; rhinorrhea; itchy nose, mouth, throat, and/or ears; itchy, watery, and/or red eyes; and nasal congestion) were assessed at baseline and then daily at 7:00 AM and 7:00 PM (��1 hour) during the double-blind treatment period. Each total symptom score was the sum of all symptoms, excluding nasal congestion. The primary efficacy variable was the change from baseline in the average of the daily 12-hour evening reflective total symptom scores throughout the double-blind treatment. Safety was evaluated from adverse-event reporting, vital signs, physical examinations, and clinical laboratory data at screening and study end point.

Urtic��ria ao Frio: Uma Realidade em Caracteriza����o

Introdu����o: A urtic��ria ao frio (UF), habitualmente considerada como benigna e autolimitada, �� muitas vezes n��o diagnosticada nem devidamente valorizada. No entanto, pode ser causa de reac����o sist��mica grave, potencialmente fatal. Objectivos e M��todos: De forma a aprofundar o conhecimento sobre esta patologia, avali��mos 16 doentes com UF, caracterizando a cl��nica, etiologia e dura����o da doen��a. Resultados: A m��dia et��ria foi de 18,3 anos (7-54 anos), com predom��nio de crian��as com menos de 18 anos (63%) e do sexo masculino (62,5%). O in��cio dos sintomas ocorreu entre os 3 e os 46 anos. Em 5 doentes foi adquirida toler��ncia, variando a dura����o da doen��a entre 2 e 7 anos (m��dia de 3,8 anos). Nos 11 doentes que mantinham sintomas, o tempo m��dio da doen��a foi de 4,3 anos (1-9 anos). As queixas eram do tipo imediato em todos os doentes, ocorrendo sobretudo no decurso de actividades aqu��ticas, mas tamb��m com exposi����o a ar frio, chuva, neve, ingest��o de alimentos frios e manipula����o de objectos frios. O padr��o cl��nico foi do tipo I (urtic��ria/angioedema localizado) em 4 doentes, do tipo II (urtic��ria/angioedema generalizado, sem hipotens��o) em 6, e do tipo III (reac����o sist��mica grave) em 6 (dos quais 5 eram crian��as). O teste do cubo de gelo foi positivo em todos os casos, �� excep����o de 2 casos de UF at��pica. Na maioria dos doentes com padr��o cl��nico tipo III, o teste foi positivo com ��� 3 minutos de estimula����o. A maioria dos casos(81%) correspondeu a UF adquirida idiop��tica, destacando-se 3 casos de UF adquirida secund��ria: 1 crian��a com crioglobulin��mia prim��ria e 2 com uma forma secund��ria a infec����o por v��rus Epstein-Barr. Nenhum doente tinha hist��ria familiar de UF. Em 3 doentes a UF associava-se a outra urtic��ria f��sica: urtic��ria colin��rgica (2) e urtic��ria aquag��nica (1). A melhoria sintom��tica foi obtida em todos os doentes com anti histam��nicos (isoladamente ou em associa����o). Foi prescrito kit de adrenalina nos casos com padr��o cl��nico tipo III. Conclus��es: A UF adquirida idiop��tica foi o tipo mais frequente, destacando-se 3 casos raros de UF secund��ria, um a crioglobulin��mia prim��ria e dois a mononucleose infecciosa. A quantifica����o do resultado do teste do cubo de gelo revelou-se importante para a avalia����o da gravidade da doen��a e para o seguimento do doente. A UF manifestou-se, num elevado n��mero de doentes, por reac����o sist��mica grave, particularmente em crian��as e durante actividades aqu��ticas, real��ando a import��ncia do reconhecimento desta entidade cl��nica.

Blood Donation in the Hospital de S. Jos��. A 11-Year Retrospective Analysis of Deferrals and Exclusions

Background: Approximately 5% of the population donates blood each year in developed countries. Recruiting and maintaining a pool of altruistic and healthy blood donors is a challenging task. Blood donation as a dynamic process must naturally co-exist with the arguably essential deferrals. Aims: To analyse a 11-year cohort of donors and blood donations in order to determine the profile of the average donor and the typical donation. Characterize the donor���s population in terms of gender, age, number of donations, most common causes for deferral and exclusion and the possible relationships between them. Establish the tendency flow of donations per year. Methods: Analysis of 95861 blood donations from 31550 donors collected between 2000 and 2010 (11 years) in the Immunohemotherapy Department of the ������Centro Hospitalar Lisboa Central - Hospital de Sa��o Jose�������� (Lisboa, Portugal). Prior to blood donation, donors were required to fill out a form of informed consent, a questionnaire of 21 ������yes or no������ questions and were submitted to a clinical assessment and physical examination including: measurement of weight, blood pressure, pulse and capillary hemoglobin levels. Post-donation, the collected blood was tested for ALT elevation and blood-borne viral agents (HBV, HCV, HIV 1 and 2 and HTLV 1 and 2) and other infections (Treponema pallidum). Blood donors and donations were registered in a database and statistically studied in terms of: gender and age distribution, number of donations, most common causes for deferral and exclusion. The frequency of blood donations throughout the period of observation was analyzed and statistically significant relationships between the collected variables were investigated. Results: From the population of 31550 donors 61% were male and a mean age of 41.5 years (�� 12.5 years) was found. From the total of 95682 blood donations collected 78% were successful while the most common causes for deferral were: donation incompatible hemoglobin levels (5% of the blood donations and 22% of deferrals), ALT elevation (3% and 14%), positive blood screening test for Treponema pallidum (1% and 6%), medication (1% and 4%), positive serological blood markers for HBV (1% and 4%), endoscopy in the previous 12 months (1% and 3%), arterial hypertension (1% and 3%), infectious conditions (1% and 3%), influenza or influenza-like symptoms (1% and 2%) and positive serological blood markers for HCV (1% and 2%). Summary/Conclusions: Several factors may have contributed to a limited number of new regular donors in the population, namely: ageing population, the alienation of the individual from the community induced by modern lifestyles and job precariousness. It is of the utmost importance to refine our blood donation campaigns according to the existing population of donors. The optimization of the blood donation potential of a population of donors must be achieved through the development of reliable and consistent screening methods. In order to appeal to new donors it is important to promote blood donations considering the profile of the regular and healthy blood donor of the existing population.

Perinatal Ischemic Stroke: a Five-Year Retrospective Study in a Level-III Maternity

Objective To study the incidence, clinical presentation, risk factors, imaging diagnosis, and clinical outcome of perinatal stroke. Methods Data was retrospectively collected from full-term newborns admitted to the neonatal unit of a level III maternity in Lisbon with cerebral stroke, from January 2007 to December 2011. Results There were 11 cases of stroke: nine were arterial ischemic stroke and two were cerebral venous sinus thrombosis. We estimated an incidence of arterial ischemic stroke of 1.6/5,000 births and of cerebral venous sinus thrombosis of 7.2/100,000 births. There were two cases of recurrent stroke. Eight patients presented with symptoms while the remaining three were asymptomatic and incidentally diagnosed. The most frequently registered symptoms (8/11) were seizures; in that, generalized clonic (3/8) and focal clonic (5/8). Strokes were more commonly left-sided (9/11), and the most affected artery was the left middle cerebral artery (8/11). Transfontanelle ultrasound was positive in most of the patients (10/11), and stroke was confirmed by cerebral magnetic resonance in all patients. Electroencephalographic recordings were carried out in five patients and were abnormal in three (focal abnormalities n=2, burst-suppression pattern n=1). Eight patients had previously identified risk factors for neonatal stroke which included obstetric and neonatal causes. Ten patients were followed up at outpatients setting; four patients developed motor deficits and one presented with epilepsy. Conclusions Although a modest and heterogeneous sample, this study emphasizes the need for a high level of suspicion when it comes to neonatal stroke, primarily in the presence of risk factors. The prevalence of neurological sequelae in our series supports the need of long-term follow-up and early intervention strategies.

Time to Left Ventricular Reverse Remodeling after Cardiac Resynchronization Therapy: Better Late than Never

INTRODUCTION: Left ventricular reverse remodeling (LVRR), defined as reduction of end-diastolic and end-systolic dimensions and improvement of ejection fraction, is associated with the prognostic implications of cardiac resynchronization therapy (CRT). The time course of LVRR remains poorly characterized. Nevertheless, it has been suggested that it occurs ���6 months after CRT. OBJECTIVE: To characterize the long-term echocardiographic and clinical evolution of patients with LVRR occurring >6 months after CRT and to identify predictors of a delayed LVRR response. METHODS: A total of 127 consecutive patients after successful CRT implantation were divided into three groups according to LVRR response: Group A, 19 patients (15%) with LVRR after >6 months (late LVRR); Group B, 58 patients (46%) with LVRR before 6 months (early LVRR); and Group C, 50 patients (39%) without LVRR during follow-up (no LVRR). RESULTS: The late LVRR group was older, more often had ischemic etiology and fewer patients were in NYHA class ���II. Overall, group A presented LVRR between group B and C. This was also the case with the percentage of clinical response (68.4% vs. 94.8% vs. 38.3%, respectively, p<0.001), and hospital readmissions due to decompensated heart failure (31.6% vs. 12.1% vs. 57.1%, respectively, p<0.001). Ischemic etiology (OR 0.044; p=0.013) and NYHA functional class <III (OR 0.056; p=0.063) were the variables with the highest predictive value for late LVRR. CONCLUSIONS: Late LVRR has better clinical and echocardiographic outcomes than no LVRR, although with a suboptimal response compared to the early LVRR population. Ischemic etiology and NYHA functional class <III are predictors of late LVRR.