Analgesia pós-operatória para crianças com menos de 1 ano: análise retrospectiva

JUSTIFICATIVA E OBJETIVOS: A dor pós-operatória continua sendo uma das principais complicações pós-operatórias e motivo de desconforto, principalmente em crianças. O objetivo deste estudo foi avaliar o uso de analgésicos desde o término da cirurgia até a alta da sala de recuperação pós-anestésica (SRPA), como medida terapêutica ou profilática, para crianças com menos de 1 ano de idade. MÉTODO: Utilizando o banco de dados do Departamento de Anestesiologia, foi realizada análise retrospectiva, envolvendo o período de janeiro de 2000 a abril de 2001, das anestesias de crianças menores que 1 ano de idade submetidas a procedimentos cirúrgicos diversos, avaliando aspectos relacionados à analgesia pós-operatória. RESULTADOS: No período do estudo, foram anestesiadas 402 crianças menores que 1 ano, sendo que 194 (48,2%) não receberam analgésicos e 208 (51,8%) receberam. Com relação ao uso ou não de analgésicos, foi observado o que se segue: Sem analgésicos: (1) Idade: até 1 mês, 68/99; entre 1 e 6 meses, 53/126; entre 6 meses e 1 ano, 73/177. (2) Peso: 6,7 ± 3,1 kg (3). Sexo: masculino, 106/240; feminino, 88/162. (4) Estado físico ASA: ASA I, 69/187; ASA II, 56/113; ASA III, 46/79; ASA IV, 23/23. (5) Anestesia peridural sacral: 3/4. (6) Tempo de anestesia: 106 ± 32 minutos. (7) Encaminhamento para unidade de terapia intensiva (UTI): 93/119. Uso de analgésicos: (1) Idade: até 1 mês, 31/99; entre 1 e 6 meses, 73/126; entre 6 meses e 1 ano, 104/177. (2) Peso: 9 ± 2,3 kg. (3) Sexo: masculino, 134/240; feminino, 74/162. (4) Estado físico ASA: ASA I, 118/187; ASA II, 57/113; ASA III, 33/79; ASA IV, 0/23. (5) Anestesia peridural sacral: 1/4. (6) Tempo de anestesia: 130 ± 38 minutos. (7) Encaminhamento para UTI: 26/119. Os fármacos empregados para promover analgesia foram: dipirona (60,6%), dipirona + tramadol (25,5%), dipirona + nalbufina (5,3%), tramadol (3,8%), nalbufina (3,8%), meperidina (0,5%) e fentanil (0,5%). CONCLUSÕES: Utilizar analgésicos em crianças desde o término da cirurgia até a alta da SRPA não foi habitual, principalmente nas crianças menores e mais graves e em procedimentos cirúrgicos mais rápidos. O uso de dipirona, isoladamente, ou a associação dipirona/tramadol, foram as drogas analgésicas mais freqüentemente empregadas.

Auto-percepção de aluna de enfermagem ao desenvolver relação de ajuda a familiares de criança em fase terminal

O presente estudo visa relatar e analisar o processo de relacionamento terapêutico entre aluna de enfermagem e mãe de criança internada em UTI pediátrica, em fase terminal. As interações desenvolvidas neste processo foram gravadas e analisadas no enfoque do Relacionamento Terapêutico. Utilizando técnicas de comunicação terapêutica e medidas terapêuticas de enfermagem, a aluna envolveu-se empaticamente com a mãe da criança e com os demais familiares, propondo-se a ajudá-los a superar suas dificuldades diante da criança em fase terminal. Neste estudo a aluna analisa a sua própria ansiedade diante da situação e as dificuldades que teve devido aos seus conflitos diante da terminalidade do seu paciente.

The changing pattern of analgesic and anti-inflammatory drug use in cleft lip and palate repair

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Unicentric study of cell therapy in chronic obstructive pulmonary disease/pulmonary emphysema

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Uso do óxido nítrico em pediatria

Objective: To review the literature on inhaled nitric oxide and to describe its main clinical applications in pediatrics. Sources of data: A 10 year literature review with selection of the most important publications on inhaled nitric oxide, using the Medline and Cochrane Systematic Review databases. Summary of the findings: This review was organized as follows: introduction; metabolism and biological effects; clinical applications; dosage, gas administration and weaning; precautions and side-effects. Inhaled nitric oxide use was described in persistent pulmonary hypertension and hypoxia of the newborn, acute respiratory distress syndrome, primary pulmonary hypertension, heart surgery, chronic obstructive pulmonary disease, sickle cell anemia, and bronchospastic disease. Conclusions: Inhaled nitric oxide is a therapeutic approach with wide clinical applications in pediatrics. Its use is safe when administered in pediatric intensive care units under strict monitoring. As a pulmonary vasodilator, nitric oxide has beneficial effects on gas exchange and ventilation. Controlled trials, focusing on early gas administration should be performed under many clinical conditions, especially acute respiratory distress syndrome.

Oral lichen planus versus oral lichenoid reaction: Difficulties in the diagnosis

Lichen planus (LP) is a mucocutaneous disease with well-established clinical and microscopic features. The oral mucosa and skin may present clinical and microscopic alterations similar to those observed in LP, called lichenoid reactions (LRs), which are triggered by systemic or topical etiological agents. The difficulties faced to establish the differential diagnosis between the two pathologies were investigated in the literature. It was observed that the etiology of LP is still under discussion, with a tendency to self-immunity, while the etiology of LRs is related to the contact with specific agents, such as metallic restorative materials, resins, and drugs, allowing the establishment of a cause-effect relationship. In this case, the disease is caused by the antigen fixation in the epithelial cells, which are destructed by the immune system. Based on these data, protocols are suggested for this differentiation. The important role played by the integration between the clinician and the oral pathologist in the diagnostic process is highlighted. The treatment of LP comprises mainly the utilization of corticosteroids and the LR is treated by removal of the causal factor. Differentiation between the two diseases allows an effective and correct therapeutic approach.

Mucocele of the glands of Blandin-Nuhn-clinical, pathological, and therapeutical aspects

Purpose: This study aims to review anatomical, clinical, and pathological concepts as well as to discuss the most adequate therapeutic approach to the mucoceles of the glands of Blandin-Nuhn. Discussion: The glands of Blandin-Nuhn are localized in the ventral part of the tongue, next to the apex in the lingual median plane. Development of a mucocele in this site is rarely seen; besides, as the glands of Blandin-Nuhn are not encapsulated and are directly overlapped to the muscle tissues, their manipulation tends to be different from the other oral mucoceles. Conclusion: As Blandin-Nuhn mucoceles are uncommon and their clinical appearance could be similar to other lesions, it is important that health professionals know their clinical and histopathological features to avoid having them misdiagnosed. © 2010 Springer-Verlag.

Incidence of the ossified pterygoalar ligament in Brazilian human skulls and its clinical implications

The ossified pterygoalar ligament is formed between the lateral lamina of the pterygoid process and the infratemporal surface of the sphenoid bone or its greater wing and was not connected to the sphenoid spine. The aim of this study was to evaluate the incidence of the ossified pterygoalar ligament in Brazilian human skulls and analyzing its clinical importance. 183 Brazilian adult (between 30 to 60 years old) dry human skulls were evaluated. Was evaluated the incidence of skulls with complete or partial ossification of the pterygoalar ligament, bilaterally and unilaterally and in the presence on the right and left sides. Were found 5 skulls had the ossified pterygoalar ligament, resulting in an overall incidence of 2.73%. There was 1 skull in the presence of the incomplete ossification of the pterygoalar ligament, unilaterally and on the left side resulting in incidence of 0.54%. There were 4 skulls in the presence of the complete ossification of the pterygoalar ligament, unilaterally and on the right side resulting in incidence of 2.18%. The ossified pterygoalar ligament is a major cause of the entrapment of the lingual nerve or a branch of the mandibular nerve and may cause mandibular neuralgia. The incidence of the ossified pterygoalar ligament and the pterygoalar foramen is low in the Brazilian population. However, these structures have clinical significance as this ligament establish relationships with the ovale foramen and difficulty in accessing in this foramen in a therapeutic approach.

Aparecimento de psoríase durante o tratamento das doenças inflamatórias intestinais com infliximabe: A terapia biológica deve ser suspensa?

Context - Several paradoxical cases of infliximab-induced or-exacerbated psoriatic lesions have been described in the recent years. There is disagreement regarding the need to discontinue infliximab in order to achieve the resolution of these adverse cutaneous reactions specifically in inflammatory bowel disease (IBD) patients. Objective - To systematically review the literature to collect information on IBD patients that showed this adverse cutaneous reaction, focusing mainly on the therapeutic approach. Methods - A systematic literature review was performed utilizing Medline, Embase, SciELO and Lilacs databases. Published studies were identified, reviewed and the data were extracted. Results - Thirty-four studies (69 IBD patients) met inclusion criteria for review. There was inconsistency in reporting of some clinical and therapeutic aspects. Most patients included had Crohn's disease (89.86%), was female (47.83%), had an average age of 27.11 years, and no reported history of psoriasis (84.05%). The patients developed primarily plaque-type psoriasis (40.58%). There was complete remission of psoriatic lesions in 86.96% of IBD patients, existing differences in the therapeutic approaches; cessation of infliximab therapy led to resolution in 47.83% of cases and 43.48% of patients were able to continue infliximab therapy. Conclusion - As increasing numbers of IBD patients with psoriasis induced or exacerbated by infliximab, physicians should be aware of its clinical manifestations so that appropriate diagnosis and treatment are properly established. The decision whether to continue or discontinue infliximab should be individualized.

Annexin-A1 peptide down-regulates the leukocyte recruitment and up-regulates interleukin-10 release into lung after intestinal ischemia-reperfusion in mice

Background: Intestinal ischemia/reperfusion (IR) injury is a serious and triggering event in the development of remote organ dysfunction, from which the lung is the main target. This condition is characterized by intense neutrophil recruitment, increased microvascular permeability. Intestinal IR is also responsible for induction of adult respiratory distress syndrome, the most serious and life-threatening form of acute lung injury. The purpose of this study was to investigate the effect of annexin-A1 protein as an endogenous regulator of the organ remote injury induced by intestinal ischemia/reperfusion. Male C57bl/6 mice were subjected to intestinal ischemia, induced by 45 min occlusion of the superior mesenteric artery, followed by reperfusion. Results: The intestinal ischemia/reperfusion evoked a high intensity lung inflammation as indicated by the number of neutrophils as compared to control group. Treatment with annexin-A1 peptidomimetic Ac2-26, reduced the number of neutrophils in the lung tissue and increased its number in the blood vessels, which suggests a regulatory effect of the peptide Ac2-26 in the neutrophil migration. Moreover, the peptide Ac2-26 treatment was associated with higher levels of plasma IL-10. Conclusion: Our data suggest that the annexin-A1 peptidomimetic Ac2-26 treatment has a regulatory and protective effect in the intestinal ischemia/reperfusion by attenuation of the leukocyte migration to the lung and induction of the anti-inflammatory cytokine IL-10 release into the plasma. The anti-inflammatory action of annexin-A1 and its peptidomimetic described here may serve as a basis for future therapeutic approach in mitigating inflammatory processes due to intestinal ischemia/reperfusion. © 2013 Guido et al.; licensee BioMed Central Ltd.

Anti-inflammatory mechanisms of the annexin A1 protein and its mimetic peptide Ac2-26 in models of ocular inflammation in vivo and in vitro

Annexin A1 (AnxA1) is a protein that displays potent anti-inflammatory properties, but its expression in eye tissue and its role in ocular inflammatory diseases have not been well studied. We investigated the mechanism of action and potential uses of AnxA1 and its mimetic peptide (Ac2-26) in the endotoxin-induced uveitis (EIU) rodent model and in human ARPE-19 cells activated by LPS. In rats, analysis of untreated EIU after 24 and 48 h or EIU treated with topical applications or with a single s.c. injection of Ac2-26 revealed the anti-inflammatory actions of Ac2-26 on leukocyte infiltration and on the release of inflammatory mediators; the systemic administration of Boc2, a formylated peptide receptor (fpr) antagonist, abrogated the peptide's protective effects. Moreover, AnxA1-/- mice exhibited exacerbated EIU compared with wild-type animals. Immunohistochemical studies of ocular tissue showed a specific AnxA1 posttranslational modification in EIU and indicated that the fpr2 receptor mediated the anti-inflammatory actions of AnxA1. In vitro studies confirmed the roles of AnxA1 and fpr2 and the protective effects of Ac2-26 on the release of chemical mediators in ARPE-19 cells. Molecular analysis of NF-κB translocation and IL-6, IL-8, and cyclooxygenase-2 gene expression indicated that the protective effects of AnxA1 occur independently of the NF-κB signaling pathway and possibly in a posttranscriptional manner. Together, our data highlight the role of AnxA1 in ocular inflammation, especially uveitis, and suggest the use of AnxA1 or its mimetic peptide Ac2-26 as a therapeutic approach. Copyright © 2013 by The American Association of Immunologists, Inc.

Isolamento e caracterização de amostras comunitárias Staphylococcus aureus resistente à Meticilina (CA-MRSA) em uma população carcerária no município de Avaré

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Potencial anti-inflamatório de Pyrenocine A isolada do Penicillium paxilli: abordagem profilática e terapêutica

Pós-graduação em Biociências e Biotecnologia Aplicadas à Farmácia - FCFAR

Farmacocinética pré-clínica do composto 1-(2,6-diclorofenil)indolin-2-ona (DICCIC), pró-fármaco de diclofenaco

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

Identificação e validação de genes diferencialmente expressos em carcinoma de pênis

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