Inhaled nitric oxide in the management of persistent pulmonary hypertension of the newborn: a meta-analysis

OBJECTIVES: To evaluate the use of inhaled nitric oxide (NO) in the management of persistent pulmonary hypertension of the newborn. METHODS: Computerized bibliographic search on MEDLINE, CURRENT CONTENTS and LILACS covering the period from January 1990 to March 1998; review of references of all papers found on the subject. Only randomized clinical trials evaluating nitric oxide and conventional treatment were included. OUTCOMES STUDIED: death, requirement for extracorporeal membrane oxygenation (ECMO), systemic oxygenation, complications at the central nervous system and development of chronic pulmonary disease. The methodologic quality of the studies was evaluated by a quality score system, on a scale of 13 points. RESULTS: For infants without congenital diaphragmatic hernia, inhaled NO did not change mortality (typical odds ratio: 1.04; 95% CI: 0.6 to 1.8); the need for ECMO was reduced (relative risk: 0.73; 95% CI: 0.60 to 0.90), and the oxygenation was improved (PaO2 by a mean of 53.3 mm Hg; 95% CI: 44.8 to 61.4; oxygenation index by a mean of -12.2; 95% CI: -14.1 to -9.9). For infants with congenital diaphragmatic hernia, mortality, requirement for ECMO, and oxygenation were not changed. For all infants, central nervous system complications and incidence of chronic pulmonary disease did not change. CONCLUSIONS: Inhaled NO improves oxygenation and reduces requirement for ECMO only in newborns with persistent pulmonary hypertension who do not have diaphragmatic hernia. The risk of complications of the central nervous system and chronic pulmonary disease were not affected by inhaled NO.

The nurse in the management of materials in teaching hospitals

OBJECTIVETo present the nurse's integration within materials management of six teaching hospitals of Paraná - Brazil, and to describe the activities performed by nurses within this process.METHODA study of a qualitative approach and descriptive nature, conducted in teaching hospitals in Paraná, between June and August of 2013. The data collection was conducted through semi-structured interviews with eight nurses who worked in materials management; data were analyzed using content analysis.RESULTSThese showed that nurses perform ten categories of activities, distributed into four of the five steps of the materials management process.CONCLUSIONThe nurse, in performing of these activities, in addition to favoring the development of participative management, contributes to the organization, planning, and the standardization of the hospital supply process, giving greater credibility to the work with professionals who use the materials, and to the suppliers.

Management of slips and its effect on growth and production of 'Pérola' pineapple plants

The lack of good quality planting material has limited the expansion and contributed to yield reduction of the Brazilian pineapple culture. Alternatives of 'Pérola' pineapple slips management were studied aiming at obtaining superior planting material within a shorter time period and making good use of healthy slips of low vigor, that are commonly discarded by growers. Two experiments were carried out at the Experimental Field of Embrapa Cassava & Fruits, Cruz das Almas, Bahia, Brazil, and another one in a commercial plantation in the region of Itaberaba, BA, using blocks or entirely randomized designs with at least four replications. In the first one, the development of slips of different initial sizes (6 to 20 cm long), when grown on mother plants after fruit harvest, was compared with that of slips grown in a nursery after their removal from the mother plants. It became clear that larger slips grow more vigorously and that the removal from the mother plant delays their growth. However, results from the second study showed that those slips grown in nursery had vegetative and agronomic performance similar to that of conventional slips and close to that of plantlets produced from plant stem sections. Independently from the type of planting material used, the larger ones presented a more vigorous growth and produced higher yields. In the third study, it was observed the influence of mineral fertilization, pest control and growth regulator application after fruit harvest on slip development. The treatments applied did not significantly accelerate slip growth. Slips reached 50 cm length and at least 300 g fresh weight within 90 days after fruit harvest, indicating that vigorous plants have enough nutritional storage material for slips development.

Management of Bidens pilosa and Commelina benghalensis in organic corn cultivation under no-tillage

Mowing is one of the most important methods used to control weeds in organic farming, under the no-tillage system. This study aimed to evaluate the effects of three weed management techniques on weed development, using the weeds Bidens pilosa and Commelina benghalensis, in competition with organic corn {mowing at the three-leaf stage (14 days after corn emergence - DACE), mowing at the three- and six-leaf stage (14 and 25 DACE), and no mowing. Single cultivation with no mowing was also evaluated for these weeds. Mowings performed at 14 and 25 DACE prevented the production of B. pilosa seeds, ensuring efficient control of this species. However, the use of this technique was shown to be inefficient in the control of C. benghalensis.

MANAGEMENT OF MAIZE STOVER WITH UNDERDOSES RATES OF GLYPHOSATE APPLICATIONS IN NO-TILLAGE

ABSTRACTGlyphosate has significant effects on the growth and development of plants when in underdoses. This work was developed to verify the effect of the application of glyphosate in underdoses in lignin synthesis and consequently decomposition of maize stover. Two experiments were conducted; the first one in a greenhouse for underdoses adjustments and the second one in the production area. The experimental design of the first trial was completely randomized with four replications. The treatments consisted in the application of the underdoses: 0, 25, 50 and 100 g ha-1 of glyphosate. In the production area, the experimental design was a randomized block with four replications, in underdoses: 0, 12.5, 25 and 50 g ha-1. The results were submitted to analysis of variance and regression. The underdoses of 25 g a.e. ha-1in a greenhouse promoted 36% increase in productivity of stover, in addition to increasing the lignin content in 16%, with no change in the unwanted growth of maize plants. In the production area, the concentration of 12.5 g a.e. ha-1 of glyphosate reduced the lignin content and the other underdoses have not changed this feature in maize plants. None of the underdoses affected the height and biomass produced by the maize plants. The highest underdose tested promoted acceleration in the decomposition of maize stover.

Integrated Management of Childhood Illness: efficiency of primary health in Northeast Brazil

OBJECTIVE: The Integrated Management of Childhood Illness is a strategy designed to address major causes of child mortality. The aim of this study was to assess the impact of the strategy on the quality of child health care provided at primary facilities. METHODS: Child health quality of care and costs were compared in four states in Northeastern Brazil, in 2001. There were studied 48 health facilities considered to have had stable strategy implementation at least two years before the start of study, with 48 matched comparison facilities in the same states. A single measure of correct management of sick children was used to assess care provided to all sick children. Costs included all resources at the national, state, local and facility levels associated with child health care. RESULTS: Facilities providing strategy-based care had significantly better management of sick children at no additional cost to municipalities relative to the comparison municipalities. At strategy facilities 72% of children were correctly managed compared with 56% in comparison facilities (p=0.001). The cost per child managed correctly was US$13.20 versus US$21.05 in the strategy and comparison municipalities, respectively, after standardization for population size. CONCLUSIONS: The strategy improves the efficiency of primary facilities in Northeastern Brazil. It leads to better health outcomes at no extra cost.

A municipal level approach to the management of schistosomiasis control in Peri-Peri, MG, Brazil

A schistosomiasis control program was implemented between 1974/87 in Peri-Peri,. MG (622 inhabitants). Molluscicide (niclosamide) was applied at three monthly intervals in water sources with Biomphalaria glabrata, and individuals eliminating Schistosoma mansoni eggs in the feces were treated annually with oxamniquine. From 1974 to 1983 the control measures were undertaken by staff of the "René Rachou" Research Center FIOCRUZ (CPqRR), and from 1984 to 1987 these measures were included in the Capim Branco basic health network activities. During both periods, the prevalence, incidence, intensity of infection and hepatosplenic form as well as the number of infected snails decreased significantly. The prevalence decreased from 43.5 to 4.4%, the incidence from 19.0 to 2.9%, the overall intensity of S. mansoni from 281 to 87 and of the hepatosplenic form from 5.9 to 0.0%. The results obtained suggest that the municipal management of control measures was as effective as the vertical program conducted by CPqRR staff.

Clinical guideline for diagnosis and management of melioidosis

Melioidosis is an emerging infection in Brazil and neighbouring South American countries. The wide range of clinical presentations include severe community-acquired pneumonia, septicaemia, central nervous system infection and less severe soft tissue infection. Diagnosis depends heavily on the clinical microbiology laboratory for culture. Burkholderia pseudomallei, the bacterial cause of melioidosis, is easily cultured from blood, sputum and other clinical samples. However, B. pseudomallei can be difficult to identify reliably, and can be confused with closely related bacteria, some of which may be dismissed as insignificant culture contaminants. Serological tests can help to support a diagnosis of melioidosis, but by themselves do not provide a definitive diagnosis. The use of a laboratory discovery pathway can help reduce the risk of missing atypical B. pseudomallei isolates. Recommended antibiotic treatment for severe infection is either intravenous Ceftazidime or Meropenem for several weeks, followed by up to 20 weeks oral treatment with a combination of trimethoprim-sulphamethoxazole and doxycycline. Consistent use of diagnostic microbiology to confirm the diagnosis, and rigorous treatment of severe infection with the correct antibiotics in two stages; acute and eradication, will contribute to a reduction in mortality from melioidosis.

LABORATORY EVALUATION OF THE DEVELOPMENT OF Aedes aegypti IN TWO SEASONS: INFLUENCE OF DIFFERENT PLACES AND DIFFERENT DENSITIES

Aedes aegypti is an important vector in Brazil being the main vector of the dengue-fever. This paper employs survival curves to describe the time in days from larvae to adult forms of Aedes aegypti raised, individually and collectively, and compares it during winter and spring when positioned inside and outside a laboratory. The study was conducted in São Vicente, a coastal city in Southeastern Brazil. The lowest water temperature in winter and in spring was 20 °C and the highest was 26 °C in spring. Higher and more stable temperatures were measured in the intra compared to the peri in both seasons. Consequently, larvae positioned in the intra resulted in the lowest median time to develop in the individual and collective experiment (nine and ten days, respectively). At least 25% of the larvae positioned in the intra in the individual experiment in the spring took only seven days to reach adulthood. Sex ratios and the median time development by sex did not show significant differences. These results indicate that efforts to control Aedes aegypti must be continuous and directed mainly to prevent the intra-domiciliary sites that can be infested in a week in order to reduce the human-vector contact.

Challenge in the management of infective endocarditis with multiple valvular involvement

We describe the case of a 41-year-old man with congenital heart disease and infective endocarditis (IE), who presented multiple vegetations attached to the pulmonary, mitral, and aortic valves. Three valve replacements were performed, but the patient developed an abscess at the mitral-aortic intervalvular fibrosa and died due to sepsis. We briefly discuss the indications for surgery in IE, emphasizing its role in the treatment of uncontrolled infection.