Cuidando de pacientes em fase terminal: a perspectiva de alunos de enfermagem

Este estudo busca compreender como alunos de graduação em Enfermagem percebem a si mesmos ao cuidar de pacientes em fase terminal e expor os significados da experiência vivida. Foram entrevistados 14 alunos, respondendo à questão: Como se mostra a você o cuidar do paciente na fase terminal? Para os alunos, é sempre uma experiência dolorosa, que os coloca face a face com suas fragilidades e inseguranças. Eles atribuem suas dificuldades à própria incapacidade de aceitar a morte e ao despreparo e inexperiência. Relatam que falta apoio dos profissionais com quem compartilham esse cuidado. No que se refere à formação profissional, para alguns a experiência foi positiva, apesar das dificuldades; outros a avaliam negativamente, resultando em rejeição a situações semelhantes. Novas investigações sobre o tema são necessárias para aprofundar e ampliar a reflexão para o âmbito da formação dos enfermeiros em nível nacional.

Caring for organ donors: The intensive care unit nurses' view

The nursing care for patients who are pronounced brain-dead but kept alive to serve as organ donors demands technical-scientific skills and the ability to handle situations that are often in conflict with the traditional concepts of nursing care. Based on the phenomenological approach in this article, essential themes of the lived experience of caring for these patients, including the technical and specific nursing care, the relationship with organ donors and their families, and the nurses' perception of themselves in this professional situation are described. The results point to the contradictions and ambiguities of this type of nursing, especially in regards to the affective and philosophical aspects.

Behavioral evaluation during dental care in children ages 0 to 3 years

Purpose: Many studies concluded that the behavior of babies complicated dental care because of child immaturity or the difficulty of establishing acceptable communication and comprehension. Methods: The records of 696 babies were randomly selected from the baby clinic of Araçatuba in Brazil. Patient age ranged from 0 to 36 months. They were divided into 6 groups according to age: Group I-0 to 6 months; Group II-7 to 12 months; Group III-13 to 18 months; Group IV-19 to 24 months; Group V-25 to 30 months; Group VI-31 to 36 months. The behavior of the child was evaluated upon entrance in the dental office and during the first 4 clinical appointments with a clinical exam and oral physiotherapy. The baby was classified as collaborator (C) or noncollaborator (NC). Statistical analysis was performed using Pearson's chi-square method (P< .05). Results: The percentage of NC for Groups II, III, IV, and V (66%), was significantly higher than for groups I (30%) and VI (50%). Conclusions: Babies from 0 to 6 months showed a collaborative behavior; babies from 7 to 30 months showed noncollaborative behavior; and babies from 31 to 36 months showed no statistically significant difference between the percentage of C and NC.

Vascular hyporeactivity to angiotensin II induced by Escherichia coli endotoxin is reversed by Nω-Nitro-L-Arginine, an inhibitor of nitric oxide synthase

Septic shock or sepsis is reported to be one of the major causes of death when followed by systemic infectious trauma in humans and other mammals. Its development leads to a large drop in blood pressure and a reduction in vascular responsiveness to physiological vasoconstrictors which, if not contained, can lead to death. It is proposed that this vascular response is due to the action of bacterial cell wall products released into the bloodstream by the vascular endothelium and is considered a normal response of the body's defenses against infection. A reduction in vascular reactivity to epinephrine and norepinephrine is observed under these conditions. In the present study in rats, the aim was to assess whether those effects of hypotension and hyporeactivity are also related to another endogenous vasoconstrictor, angiotensin II (AII). We evaluated the variation in the power of this vasoconstrictor over the mean arterial pressure in anesthetized rats, before and after the establishment of hypotension by Escherichia coli endotoxin (Etx). Our results show that in this model of septic shock, there is a reduction in vascular reactivity to AII and this reduction can be reversed by the inhibitor of nitric oxide synthase, Nω-Nitro-L- Arginine (NωNLA). Our results also suggest that other endogenous factors (not yet fully known) are involved in the protection of rats against septic shock, in addition to the L-arginine NO pathway.

Ensaios sobre a relação do homem com a morte

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Cellular and molecular studies of the effects of a selective COX-2 inhibitor celecoxib in the cardiac cell line H9c2 and their correlation with death mechanisms

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Experimental infection of laying hens with Salmonella enterica serovar Gallinarum

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

O significado da morte para adolescentes, adultos e idosos

Apesar do aumento na quantidade de trabalhos que visam a abordar a morte como tema de investigação, observa-se que ainda prevalece a interdição do assunto morte, dificultando que ela seja abordada e discutida. Este estudo buscou ampliar a compreensão de como pessoas, em diferentes etapas desenvolvimentais, lidam com perdas e com a própria finitude. Para isso, 7 adolescentes, 14 adultos de meia-idade e 10 idosos foram entrevistados, e os dados foram compreendidos mediante análise de conteúdo. Entre os participantes, os adultos foram os que mostraram mais aflição e inquietação, ao falarem sobre a própria finitude e sobre a possibilidade da morte de pessoas queridas. Os adolescentes abordaram-na como um acontecimento distante e impessoal, enquanto os idosos se referiram a ela com maior proximidade e aceitação. Sugere-se a realização de estudos que aprofundem tais compreensões, relacionando-as às diferentes religiões, classes sociais e experiências com perdas.

Environmental torques acting on a low Earth orbiter cylindrical spacecraft

Classical models of gravity gradient, solar radiation, aerodynamic and magnetic torques acting on a circular cylinder satellite. The magnitude of each such are compared with parameterization in terms of the dimensions of the satellite and its altitude in relation to the Earth's surface. Two different satellite data are considered. The results agree with the classical results and show that for altitude between 0 and 800 km the gravity gradient, aerodynamic and magnetic torques decrease with altitude while the solar radiation torque is almost independent of the altitude. The relative importance of these torques depends on the size, mass, moments of inertia and altitude of the satellite. The results can be useful to propagate the satellite attitude, to satellite missions analysis and to validate the analytical approaches. (C) 2003 COSPAR. Published by Elsevier B.V. Ltd. All rights reserved.

Incidência de parada cardíaca durante anestesia, em hospital universitário de atendimento terciário: estudo prospectivo entre 1996 e 2002

JUSTIFICATIVA E OBJETIVOS: A incidência e causas de parada cardíaca (PC) durante a anestesia variam e são difíceis de comparar diante dos diversos métodos usados nos estudos. A pesquisa teve como objetivo estudar todas as PC ocorridas no intra e pós-operatório, durante um período de sete anos, de 1996 a 2002, em hospital de ensino de atendimento terciário para determinar incidência e causas da PC. MÉTODO: A incidência prospectiva de PC ocorrida durante a anestesia em 40.941 pacientes consecutivos foi identificada, utilizando-se um Banco de Dados. Todos os casos de PC e óbito foram revisados por uma Comissão, para determinar o fator desencadeante da PC ou óbito. A incidência de PC foi calculada em relação à idade, sexo, estado físico, segundo a classificação da ASA, tipo de atendimento, fatores desencadeantes, como alteração do estado físico do paciente e complicações cirúrgicas e anestésicas, tipo de anestesia e evolução para óbito. RESULTADOS: Ocorreram 138 PC (33,7:10.000), sendo a maioria em recém-nascidos, crianças até um ano e idosos, no sexo masculino (65,2%), em pacientes com estado físico ASA III ou superior, em atendimento de emergência e durante anestesia geral. Alterações do estado físico foram o principal fator de PC (23,9:10.000), seguidas de complicações cirúrgicas isoladamente (4,64:10.000) ou associadas a alterações do estado físico (2,44:10.000) e da anestesia isoladamente (1,71:10.000) ou associadas a alterações do estado físico (0,98:10.000). O risco de óbito relacionado à anestesia como fator principal ou contributivo foi igual para ambos (0,49:10.000). As principais causas da mortalidade associada à anestesia foram os problemas ventilatórios (45,4%), eventos relacionados à medicação empregada (27,3%), aspiração pulmonar (18,2%) e hidratação excessiva (9,1%). CONCLUSÕES: A incidência de PC durante a anestesia ainda continua elevada. A maioria das PC e óbitos associados à anestesia foi relacionada ao manuseio das vias aéreas e à administração de medicamentos e anestésicos.

Primary Pulmonary Choriocarcinoma After Human Chorionic Gonadotropin Normalization Following Hydatidiform Mole A Report of Two Cases

BACKGROUND: Primary pulmonary choriocarcinoma (PPC) is rare and frequently leads to death.CASES: Two young patients presented with previous molar pregnancy and spontaneous serum human chorionic gonadotropin (hCG) normalization. Patient 1 was referred to our center after partial response to chemotherapy. Pulmonary lobectomy was performed, and hCG rapidly declined. During further chemotherapy, liver metastasis was detected by positron emission tomography. Right hepatectomy was performed, and hCG declined for 28 days, but increased again despite chemotherapy. This patient died from hepatic failure 3 years after diagnosis. Patient 2 presented with persistently high hCG, though the affected organ was not identified. Chemotherapy was unsuccessful. Patient reevaluation showed an isolated pulmonary mass. Pulmonary lobectomy was performed; 2 weeks later, hCG was normal and consolidation with 2 cycles of chemotherapy was administered. The patient has been in remission for 24 months. PPC was confirmed by histo pathology and immunohistochemistry in both cases. Gestational origin of the tumor was confirmed by molecular genetic analysis (polymorphic microsatellite markers).CONCLUSION: The possibility of choriocarcinoma cannot be overlooked in young women with an isolated pulmonary mass. Early diagnosis, prompt chemotherapy, and surgical resection in a specialized center improves the prognosis. (J Reprod Med 2010;55:311-316)

POST-MORTEM LESIONS of UROLITHIASIS IN A LESSER SEED FINCH (Sporophila angolensis).

Urolithiasis is a disease that despite being a commonly observed problem in veterinary practice is uncommon in birds. Such disease was not reported in passeriforms to date. Accordingly, the aim of the present article is to describe a case of urolithiasis in an adult female lesser seed finch (Sporophila angolensis) pet bird which presented abdominal distension, respiratory distress, and apathy prior to death. The bird had history of being fed with a diet rich in protein. After the bird death, a necropsy was conducted in order to determine the cause of death. At necropsy, accentuated ascites, hydropericardium, and ureteral stones in the left ureter could be grossly observed. Additional tests related with viral and bacterial microbiological testing and with the determination of calculi composition could not be performed since the owner did not consent with the procedures because of the cost. Since the bird was fed on a high protein diet, a relationship between the ureteroliths and dietary imbalance was suggested with participation of protein in calculi development by providing the organic nuclei. Additionally, we conclude that the presence of calculi in the ureter resulted in urinary flow blockage, ascites, and consequent acute respiratory failure due to filling of air sacs with liquid.

Morphological evidences indicate that the interference of cimetidine on the peritubular components is responsible for detachment and apoptosis of Sertoli cells

Cimetidine, referred as antiandrogenic agent, has caused alterations in the seminiferous tubules, including alterations in the peritubular tissue and death of myoid cells by apoptosis. Regarding the structural and functional importance of the peritubular tissue for the maintenance of Sertoli cells (SC), we purpose to investigate the SC-basement membrane interface, focusing the morphological features of SC and their interaction with the basement membrane in the affected tubules by cimetidine. Ten animals were distributed into two groups, control (CG) and cimetidine (CmG) which received saline solution and 50 mg of cimetidine per kg of body weight, respectively, for 52 days. The testes were fixed, dehydrated and embedded for analyses under light and transmission electron microscopy. Paraffin sections were submitted to the TUNEL method; sections of testes embedded in glycol methacrylate were submitted to PAS method and stained by H&E for morphological and quantitative analyses of Sertoli Cells. In the CmG, the SC nuclei were positive to the TUNEL method and showed typical morphological alterations of cell death by apoptosis (from early to advanced stages). A significant reduction in the number of Sertoli Cells was probably due to death of these cells by apoptosis. A close relationship between SC nuclear alterations (including a high frequency of dislocated nuclei from the basal portion) and damage in the peritubular tissue was observed. The ultrastructural analysis showed a parallelism between the gradual advancement of apoptotic process in SC and detachment of the anchoring sites (hemidesmosomes) of SC plasma membrane from the lamina densa. The presence of portions of lamina densa underlying the detached hemidesmosomes indicates a continuous deposition of lamina densa, resulting in the thickening of the basal lamina. The results indicate a possible disarrangement of the SC cytoskeleton, including the focal adhesion structure. These alterations are related to SC apoptosis and probably result from disturbs induced by cimetidine on the peritubular tissue.

Macromolecular properties of cepacian in water and in dimethylsulfoxide

Cepacian is the exopolysaccharide produced by the majority of the so far investigated clinical strains of the Burkholderia cepacia complex. This is a group of nine closely related bacterial species that might cause serious lung infections in cystic fibrosis patients, in some cases leading to death. In this paper the aggregation ability and the conformational properties of cepacian chain were investigated to understand its role in biofilm formation. Viscosity and atomic force microscopy studies in water and in mixed (dimethylsulfoxide/water) solvent indicated the formation of double stranded molecular structures in aqueous solutions. Inter-residue short distances along cepacian chain were investigated by NOE NMR, which showed that two side chains of cepacian were not conformation ally free due to strong interactions with the polymer backbone. These interactions were attributed to hydrogen bonding and contributed to structure rigidity. (c) 2007 Elsevier Ltd. All rights reserved.