Pain Relief and Functional Recovery in Patients with Complex Regional Pain Syndrome after Motor Cortex Stimulation

In addition to pain and neurovegetative symptoms, patients with severe forms of complex regional pain syndrome (CRPS) develop a broad range of symptoms, including sensory disturbances, motor impairment and dystonic posturing. While most patients respond to medical therapy, some are considered refractory and become surgical candidates. To date, the most commonly used surgical procedure for CRPS has been spinal cord stimulation. This therapy often leads to important analgesic effects, but no sensory or motor improvements. We report on 2 patients with pain related to CRPS and severe functional deficits treated with motor cortex stimulation (MCS) who not only had significant analgesic effects, but also improvements in sensory and motor symptoms. In the long term (27 and 36 months after surgery), visual analog scale pain scores were improved by 60-70% as compared to baseline. There was also a significant increase in the range of motion in the joints of the affected limbs and an improvement in allodynia, hyperpathia and hypoesthesia. Positron emission tomography scan in both subjects revealed that MCS influenced regions involved in the circuitry of pain. Copyright (C) 2011 S. Karger AG, Basel

Surviving sepsis campaign in Brazil

Severe sepsis and septic shock have long been a challenge in intensive care because of their common occurrence, high associated costs of care, and significant mortality. The Surviving Sepsis Campaign (SSC) was developed in an attempt to address clinical inertia in the adoption of evidence-based strategies. The campaign relies on worldwide support from professional societies and has gained consensus on the management of patients with severe sepsis. The guidelines have subsequently been deployed into two bundles, with each bundle component sharing a common relationship in time. The widespread adoption of such evidence-based practice in clinical care has been disappointingly slow despite the quantifiable benefits regarding mortality. In Brazil, a country of continental dimensions with a heterogeneous population and unequal access to health services, this reality is no different. From 2004 to 2007, four prospective studies were published describing the country`s reality. In the multicenter Promoting Global Research Excellence in Severe Sepsis (PROGRESS) Study, the in-hospital mortality rate was higher in Brazil when compared with other countries: 56% against 30% in developed countries and 45% in other developing countries. During these 2.5 years of the campaign in Brazil, 43 hospitals have been receiving the necessary training to put in practice the recommended measures in all Brazilian regions, except for the North. The idea of the campaign is based on a 25% reduction in the relative risk of death from severe sepsis and septic shock within 5 years in the SSC-participating Brazilian hospitals. Ideally, the mortality rate should come to a 41.2% level subject to the 2009 deadline. This article aims to describe the actual scenario of the SSC implementation in Brazilian institutions and to report on some initiatives that have been used to overcome barriers.

Is pain relief equally efficacious and free of side effects with repeated doses of oral sucrose in preterm neonates?

The aim of the present study was to examine the efficacy and potential side effects of repeated doses of oral sucrose for pain relief during procedures in NICU. Thirty-three preterm neonates were randomly allocated in blind fashion into two groups, the sucrose group (SG = 17) and the control group (CG = 16). The responses of neonates to pain and distress were assessed during blood collection on four consecutive assessment (ass.) days. For the first assessment, the neonates did not receive any solution before the blood collection procedure. During the next three days, the SG received oral sucrose (25%; 0.5 ml/kg) and the CG received sterile water, 2 min before each minor acute painful procedure. The neonates were evaluated during blood collection each morning. The assessment was divided into five phases: Baseline (BL), Antisepsis (A), Puncture (P), Dressing (D), and Recovery (R). The neonates` facial activity (NFCS), behavioral state, and heart rate were evaluated. The data analysis used cut-off scores for painful and distressful responses. No side effects of using sucrose were detected. There were significantly fewer SG neonates with facial actions signaling pain than CG neonates in P (ass.2) and in A (ass.3). We found significantly fewer SG neonates in the awake state than CG neonates in P (ass.2 and ass.4). There were significantly fewer SG neonates crying during A (ass.2), P (ass.2 and ass.4), and D (ass.3). There was no statistical difference between-groups for physiological response. The efficacy of sucrose was maintained for pain relief in preterm neonates with no side effects. (C) 2007 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Determinants of nurses' intention to administer opioids for pain relief

A statewide cross-sectional survey was conducted in Australia to identify the determinants of registered nurses' intention to administer opioids to patients with pain. Attitudes, subjective norms and perceived control, the key determinants of the Theory of Planned Behavior, were found to independently predict nurses' intention to administer opioids to these patients. Perceived control was the strongest predictor. Nurses reported positive overall attitudes towards opioids and their use in pain management. However, many negative attitudes were identified; for example, administering the least amount of opioid and encouraging patients to have non-opioids rather than opioids for pain relief. The findings related to specific attitudes and normative pressures provide insight into registered nurses' management of pain for hospitalized patients and the direction for educational interventions to improve registered nurses' administration of opioids for pain management.

Estratégias de comunicação em projetos de desenvolvimento - estudo de caso de um projeto de promoção da saúde materna e infantil na África Subsaariana e Haiti

Comunicação apresentada no 3º Encontro Conhecimento e Cooperação, INA, Lisboa, 17 de setembro de 2015

Measles antibody prevalence after mass immunization campaign in Niterói, State of Rio de Janeiro, Brazil

Three months after a mass vaccination campaign (coverage: 100%) against measles a random seroepidemiological survey was carried out in students aged 1 to 19 years old in the Municipality of Niterói, State of Rio de Janeiro. Blood samples were tested for measles antibodies by enzyme immunosorbent assay (EIA) and negative cases were tested again using hemagglutination inhibition (HI) and plaque reduction neutralization (PRN). Of the 798 samples tested by EIA, 718 (90.2%) were positive for measles antibodies. PRN test was more sensitive than EIA and HI in detecting measles specific antibodies. The total antibody prevalence increased from 90.2% to 93.2% when HI was employed in EIA negative specimens and to 98.9% when PRN was used. After the mass vaccination campaign a marked decrease in measles incidence was observed in the municipality studied, showing the effectiveness of the strategy used for measles control in developing countries.

Aseptic meningitis in a large MMR vaccine campaign (590,609 people) in Curitiba, Paraná, Brazil, 1998

The aseptic meningitis after Measles-Mumps-Rubella vaccine (MMR) is a well recognized complication, and different incidences have been observed in several studies. We retrospectively analyzed forty cases of aseptic meningitis, during a large public immunization campaign (1998) in Curitiba, Southern Brazil (590,609 people), admitted in our Service. The vaccine utilized was Leningrad-3-Zagreb mumps strain, Edmonston-Zagreb measles strain, and RA 27#3 rubella strain. In all county, a total number of 87 cases were reported, resulting in a incidence of 1.7 cases per 10,000 given doses . The mean age was 23.7 ± 12.8 years. The female:male ratio was 1.35:1. Severe headache with meningismus (92.5%), fever (87.5%), nausea/vomiting (82.5%) were the most common clinical findings. Three cases (7.5%) developed mild mumps. All patients underwent cerebrospinal fluid (CSF) tap with the following findings: mononuclear pleocytosis from 100 to 500 cells/mm³ in 17 cases (42.5%; 257.5 ± 260.6 cells/mm³); increased protein 28 cases (67.5%; 92.1 ± 76.9 mg/dL); glucose was normal in all cases (56.8 ± 11.2 mg/dL) except in 4 (10%) cases, which presented less than 44 mg/dL. All serological tests (latex to bacterial meningitis, Cryptococcus, cysticercosis, VDRL) and bacteriological cultures were negative. Virus identification were also negative in 8 samples. None of the patients had neurological deficits or related symptoms after one year of onset. We believe the benefit of vaccination clearly outweights the incidence of benign vaccine-associated meningitis.

Diurnal variability of rainfall in southwest Amazonia during the LBA-TRMM field campaign of the austral summer of 1999

The TRMM-LBA field campaign was held during the austral summer of 1999 in southwestern Amazonia. Among the major objectives, was the identification and description of the diurnal variability of rainfall in the region, associated with the different rain producing weather systems that occurred during the January-February season. By using a network of 40 digital rain gauges implemented in the state of Rondônia, and together with observations and analyses of circulation and convection, it was possible to identify details of the diurnal cycle of rainfall and the associated rainfall mechanisms. Rainfall episodes were characterized by regimes of "low-level easterly" and "westerly" winds in the context of the large-scale circulation. The westerly regime is related to an enhanced South Atlantic Convergence Zone (SACZ) and an intense and/or wide Low Level Jet (LLJ) east of the Andes, which can extend eastward towards Rondônia, even though some westerly regime episodes also show a LLJ that remains close to the foothill of the Andes. The easterly regime is related to easterly propagating systems (e.g. squall-lines) with possible weakened or less frequent LLJs and a suppressed SACZ. Diurnal variability of rainfall during westerly surface wind regime shows a characteristic maximum at late afternoon followed by a relatively weaker second maximum at early evening (2100 Local Standard Time LST). The easterly regime composite shows an early morning maximum followed by an even stronger maximum in the afternoon.

The results of the Campaign for evaluating sphygmomanometers accuracy and their physical conditions

OBJECTIVE: To evaluate the sphygmomanometers calibration accuracy and the physical conditions of the cuff-bladder, bulb, pump, and valve. METHODS: Sixty hundred and forty five aneroid sphygmomanometers were evaluated, 521 used in private practice and 124 used in hospitals. Aneroid manometers were tested against a properly calibrated mercury manometer and were considered calibrated when the error was <=3mm Hg. The physical conditions of the cuffs-bladder, bulb, pump, and valve were also evaluated. RESULTS: Of the aneroid sphygmomanometers tested, 51% of those used in private practice and 56% of those used in hospitals were found to be not accurately calibrated. Of these, the magnitude of inaccuracy ranged from 4 to 8mm Hg in 70% and 51% of the devices, respectively. The problems found in the cuffs - bladders, bulbs, pumps, and valves of the private practice and hospital devices were bladder damage (34% vs. 21%, respectively), holes/leaks in the bulbs (22% vs. 4%, respectively), and rubber aging (15% vs. 12%, respectively). Of the devices tested, 72% revealed at least one problem interfering with blood pressure measurement accuracy. CONCLUSION: Most of the manometers evaluated, whether used in private practice or in hospitals, were found to be inaccurate and unreliable, and their use may jeopardize the diagnosis and treatment of arterial hypertension.