Necrólise epidérmica tóxica/síndrome de Stevens Johnson: emergência em dermatologia pediátrica

Contexto: É descrito caso clínico de farmacodermia grave e de alta letalidade, cujo reconhecimento imediato é fundamental. Relato decaso: Paciente do sexo masculino de três anos de idade, cuja mãe refere histórico de crises convulsivas, consultou-se com neurologistaparticular, que prescreveu ácido valproico. Uma semana depois, voltou a ter crise convulsiva, sendo então introduzida lamotrigina.Poucos dias depois, a criança começou apresentar tosse e coriza hialina. Procurou pronto-socorro de sua cidade e foi orientada a usarfluimucil. Iniciou, então, febre e exantema máculo-papular inicialmente na face, que depois se generalizou. Foi levantada a hipótesediagnóstica de farmacodermia secundária à associação de anticonvulsivante. Discussão: Síndrome de Stevens-Johnson e necróliseepidérmica tóxica são variantes do mesmo processo mucocutâneo agudo, raro e grave, causado principalmente por reação adversaa fármacos e caracterizado por erupção cutânea macular de padrão eritematoso, formação de bolhas de conteúdo sero-hemático edestacamento epidérmico. As afecções são diferenciadas pela porcentagem de superfície corpórea acometida, sendo menor que10% na síndrome de Stevens-Johnson, e maior que 30% na necrólise epidérmica tóxica. O prognóstico pode ser estimado através doescore Severity Illness Score for Toxic Epidermal Necrolysis (SCORTEN), que prevê mortalidade de até 90% para os casos mais graves.O tratamento consiste na interrupção imediata da droga, transferência do paciente para unidade de queimados ou unidade de terapiaintensiva, e medidas de suporte. Terapias adjuvantes, como imunoglobulinas intravenosas e corticosteroides, ainda não têm papelconsolidado na literatura. Conclusões: Relata-se afecção rara e extremamente grave cuja suspeição clínica é importante na conduçãodo tratamento.

Enfermagem cuidando de paciente adulto e família no processo de morte em sala de emergência

The purpose of the study was to understand the experience of nursing professionals on the care provided to adult patients and relatives who experience the dying process in an emergency room. Statements of 12 nursing professionals, being 8 technicians and 4 registered nurses of the emergency room of a high-complexity university hospital were analyzed. Data was collected by means of semi-structured interviews and evaluated according to Bardin’s content analysis. As a result, the theme entitled the relative’s mourning process emerged with two categories: alterity as an opening and suffering as a limit. when subjectivity, which was revealed under the principle of alterity, permeated the subjects’ actions, the nursing practices were targeted at the patients and their relative’s needs, but suffering as a limit imposed distancing by the professionals during care provision, even when it was perceived as necessary.

Controle químico em pós-emergência de espécies de Brachiaria em três estádios vegetativos

The aim of this study was to correlate the chemical control efficacy in post-emergence of Brachiaria decumbens Stapf. (signal grass) and Brachiaria plantaginea Hitchc. (alexandergrass) through ACCase-inhibitor enzyme herbicide application in function of the stage of development of the plant in order to contribute to the chemical management of these weed species. B. decumbens and B. plantaginea were sown in plastic pots filled with soil and kept in a greenhouse. For chemical control evaluation, the following herbicides were tested (g ha-1): fluazifop-p-butyl at 150, haloxyfop-methyl at 50, and sethoxydim at 230. The herbicides were applied in all three plant development phases: stage 1 (plants presenting 4-6 leaves at 15 days after emergence), stage 2 (plants presenting 3-4 tillers at 23 days after emergence), and stage 3 (adult plants in the beginning of flowering at 48 days after emergence). Evaluations were done at 4, 7, 10, 14, 17, 21, 24, and 28 days after herbicide application. The developmental stage of the two Brachiaria species was instrumental in the efficiency of the control provided by different herbicides. Sethoxydim was the most efficient herbicide in controlling Brachiaria species in the three evaluated development stages.

Ciclo de cogeração a partir de resíduos de poda de árvores na cidade de Guaratinguetá

The current socio-economic situation has brought a need to look for alternative ways to get energy that allow reducing the high dependence on fossil fuel sources while deflect from the climate change arising from the result of the use of these energy resources. Renewable sources of energy, low and medium temperature appear as high potential of energy resources, which have a major influence on the way of life of the people to enable decentralized energy production. In Brazil, in particular, have also the need to decentralize the energy grid, currently focused on energy from water source. The current water crisis, exemplifies the urgency of betting on other energy sources, as a way to help in emergency situations such as the current one. Therefore, this study evaluates the possibility of using biomass as a heat source in a Rankine Cycle Organic where instead of water; it uses thermal fluid as working fluid, was compared the urban areas of the city of Guaratinguetá with the urban area of the metropolitan region of São Paulo. Thus, it was established two scenarios, so it was possible to establish the cycle to be used

Avifauna em matas ciliares: caracterização visando ações de emergência, mitigação e compensação em caso de derramamento de combustíveis em vias hidroviárias

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)