Transoperative refusion: a simple and safe method in emergency surgery

The objective is to reinforce the importance of blood reinfusion as a cheap, safe and simple method, which can be used in small hospitals, especially those in which there is no blood bank. Moreover, even with the use of devices that perform the collection and filtration of blood, more recent studies show that the cost-benefit ratio is much better when autologous transfusion is compared with blood transfusions, even when there is injury to hollow viscera and blood contamination. It is known that the allogeneic blood transfusion carries a number of risks to patients, among them are the coagulation disorders mediated by excess enzymes in the conserved blood, and deficiency in clotting factors, mainly the Factor V, the proacelerin. Another factor would be the risk of contamination with still unknown pathogens or that are not investigated during screening for selection of donors, such as the West Nile Fever and Creutzfeldt-Jacob, better known as "Mad Cow" disease. Comparing both methods, we conclude that blood autotransfusion has numerous advantages over heterologous transfusion, even in large hospitals. We are not against blood transfusions, just do not agree that the patient's own blood is discarded without making sure there will be enough blood in stock to get him out of the hemorrhagic shock.

Comparative study between patients with acute appendicitis treated in primary care units and in emergency hospitals

Objective: To retrospectively analyze the relationship of time of care, combined with possible post-appendectomy complications, with the promptness of transfer of patients seen in Emergency Care Units (UPA) to the emergency hospital.Methods: We analyzed patients with preoperative diagnosis of acute appendicitis undergoing appendectomy from January to July 2012. Patients were divided into two groups according to the site of the first care. Group A included patients who received initial care directly in the emergency department of the Lourenço Jorge County Hospital (HMLJ) and group B consisted of patients seen in the UPA and forwarded to HMLJ to undergo surgical treatment.Results: the average time between initial treatment and surgery in group A was 29 hours (SD = 21.95) and 54 hours in group B (SD = 54.5). Considering the onset of symptoms, the patients in group A were operated on average 67 hours after (SD = 42.55), while group B, 90 hours (SD = 59.58). After the operation, patients in group A were hospitalized, on average, for 94 hours (SD = 73.53) and group B, 129 hours (SD = 193.42).Conclusion: there was no significant difference in the time elapsed between the onset of symptoms, initial treatment and early surgical treatment, or time elapsed between surgery and discharge.

Importance of bone assessment and prevention of osteoporotic fracture in patients with prostate cancer in the gonadotropic hormone analogues use

The antiandrogenic therapy (ADT) for prostate cancer represents an additional risk factor for the development of osteoporosis and fragility fractures. Still, bone health of patients on ADT is often not evaluated. After literature research we found that simple preventive measures can prevent bone loss in these patients, resulting in more cost-effective solutions to the public health system and family when compared to the treatment of fractures.

Unintentionally retained foreign bodies after surgical procedures. Analysis of 4547 cases

Objective: this study aims to explore the experience of Brazilian surgeons on Unintentionally Retained Foreign Bodies (RFB) after surgical procedures. Methods: A questionnaire was sent to surgeons by electronic mail, between March and July 2012. The questions analyzed their experience with foreign bodies (FB), foreign bodies' types, clinical manifestations, diagnoses, risk factors and legal implications. Results: in the 2872 eligible questionnaires, 43% of the surgeons asserted that they had already left FB and 73% had removed FB in one or more occasions, totalizing 4547. Of these foreign bodies, 90% were textiles, 78% were discovered in the first year and 14% remained asymptomatic. Among doctors with less than five years after graduation, 36% had already left a FB. The most frequently surgical procedures mentioned were the elective (57%) and routine (85%) ones. Emergency (26%), lack of counting (25%) and inadequate conditions of work contributed (12.5%) to the occurrence. In 46% of the cases patients were alerted about the FB, and 26% of them sued the doctors or the institution. Conclusions: challenging medical situations, omission of security protocols and inadequate work conditions contributed to RFB. However, RFB occurs mostly in routine procedures such as cesarean or cholecystectomy, and at the beginning of the professional career, highlighting, particularly in poorest countries, the need for primary prevention. Textiles predominated causing clinical repercussions and they were diagnosed in the first postoperative months. Surgeons were sued in 11.3% of the RFB cases.

Evaluation of the efficacy of hydrated sodium aluminosilicate in the prevention of aflatoxin-induced hepatic cancer in rainbow trout

The use of aluminum silicates for decontaminating animal feed containing aflatoxins has yielded encouraging results in chicken and turkey poults. In contrast, very few studies have tested these substances in aquaculture. In this work, we investigated the efficacy of a trout diet containing 0.5% hydrated sodium aluminosilicate (HSAS) in protecting against contamination with aflatoxin B1. Trout were reared on these diets for one year and the experimental groups were examined monthly for hepatic presumptive preneoplastic and neoplastic lesions. Regardless of the presence of HSAS, all of the fish that received aflatoxin in their diet have shown hepatic lesions indicative of a carcinogenic process, presenting also the development of cancer in some fish. The concentration of HSAS used in this study was ineffective in preventing the onset of hepatic lesions induced by aflatoxin B1 in rainbow trout.

Sodium bicarbonate as prevention of metabolic acidosis in sheep submitted to experimental ruminal acidosis

The aim of this study was to evaluate the preventive effect of sodium bicarbonate on systemic acidosis due to ruminal acidosis, which was induced by ingestion of concentrate after prolonged fasting. Fourteen sheep were divided into three experimental groups: control group (Cg), with four sheep, submitted to fasting without development of ruminal acidosis; no-treated group (NTg), with five sheep with rumen acidosis without preventive treatment; and treated group (Tg), with five sheep with rumen acidosis and preventively treated with sodium bicarbonate. Assessments of ruminal pH and arterial hemogasometry were performed for 48 hours after ingestion of the concentrate. There was a reduction in the ruminal pH in all groups, whereas the Cg showed a reduction only after 24 hours. A reduction in the arterial pH, bicarbonate and base excess in all groups was also noted, indicating systemic metabolic acidosis, but the NTg presented the greatest alteration. It is concluded that sodium bicarbonate prevents systemic metabolic acidosis, reducing its severity in sheep subjected to ruminal acidosis.

Analysis of emergency braking performance with particular consideration of temperature effects on brakes

During vehicle deceleration due to braking there is friction between the lining surface and the brake drum or disc. In this process the kinetic energy of vehicle is turned into thermal energy that raises temperature of the components. The heating of the brake system in the course of braking is a great problem, because besides damaging the system, it may also affect the wheel and tire, which can cause accidents. In search of the best configuration that considers the true conditions of use, without passing the safety limits, models and formulations are presented with respect to the brake system, considering different braking conditions and kinds of brakes. Some modeling was analyzed using well-known methods. The flat plate model considering energy conservation was applied to a bus, using for this a computer program. The vehicle is simulated to undergo an emergency braking, considering the change of temperature on the lining-drum. The results include deceleration, braking efficiency, wheel resistance, normal reaction on the tires and the coefficient of adhesion. Some of the results were compared with dynamometer tests made by FRAS-LE and others were compared with track tests made by Mercedes-Benz. The convergence between the results and the tests is sufficient to validate the mathematical model. The computer program makes it possible to simulate the brake system performance in the vehicle. It assists the designer during the development phase and reduces track tests.

Dental Health in Preschool and Schoolchildren in Relation to Dental Fear and Some Fear-Related Factors, and the Outcome of a Caries Prevention Program in Offspring of Fearful Mothers

Dental caries and dental fear and anxiety (DFA) are common interrelated problems but so far little is known about these problems in Estonia. The aim was to study dental health in relation to DFA, some fear-related factors, and to study the effect of a caries prevention program in children of fearful mothers. Dental health and DFA were assessed in two Estonian [2-4-year-olds (n=472) and 8-10-year-olds (n=344)], and the effect of some medical conditions on DFA in one Finnish child group [3-year-olds (n=148)]. 120 mother-child-pairs participated in the xylitol-based prevention program. Dental health was examined using the WHO or the ICDAS criteria and expressed as dmft/DMFT-indices. The modified children’s fear survey schedule dental subscale (MCFSS-DS) was used to assess DFA of schoolchildren, one single question to assess parental DFA, and the Corah’s dental anxiety scale (DAS) to assess DFA of mothers in the prevention study. Dentine caries was diagnosed in 42% of the 2-4-year-old and in 93% of the 8-10-year-old Estonian children. DFA of 8-10-year-olds (17%) was associated with experience of dental treatment, and maternal and paternal DFA. Dental apprehension at 9 years of age was associated with frequent exposure to invasive medical care. The xylitol-based prevention was successful irrespective of poor dental hygiene habits and maternal severe DFA. In conclusion, experience of operative dental treatment and DFA of Estonian children were closely associated. Invasive medical care and parental DFA were also linked to children’s DFA. Habitual use of xylitol by mothers was effective in preventing caries even in children of severely fearful mothers.

Early detection of severe sepsis in the emergency room in adults - Clinical utility of prognostic markers

Vaikean sepsiksen varhainen tunnistaminen päivystyspoliklinikalla – merkkiaineiden käyttökelpoisuus aikuispotilaiden arvioinnissa Päivystyspotilaan vakavan yleisinfektion eli sepsiksen varhainen tunnistaminen ja taudin vaikeusasteen arviointi on päivystävälle lääkärille tärkeä haaste. Arvioimme prospektiivisessa kohorttitutkimuksessa eri merkkiaineiden hyödyllisyyttä sepsiksen varhaisessa tunnistamisessa ja vaikeusasteen arvioinnissa. Työssä I ja III oli 539 päivystyspotilasta, joilta kliinikko päätti ottaa veriviljelyn sepsistä epäillen. Tutkimuksessa II oli 525 potilasta ja tutkimuksessa IV 537 potilasta. Tutkimuksessa I plasman C-reaktiivisen proteiinin (CRP) pitoisuuksia verrattiin plasman prokalsitoniinin (PCT) ja interleukiinin (IL-6) pitoisuuksiin. Tutkimuksessa II verrattiin plasman baktersidisen/ permeabiliteettia lisäävän proteiinin (BPI), ryhmän IIA fosfolipaasi A2:n (PLA2GIIA) ja CRP:n pitoisuuksia sekä valkosolujen määriä toisiinsa. Tutkimuksessa III arvioitiin liukoisen urokinaasi-tyyppisen plasminogeenin aktivaattorireseptorin (suPAR) ja tutkimuksessa IV pentraksiini 3:n (PTX3) määrityksen käyttökelpoisuutta. Tutkimuksessa I todettiin päivystystilanteessa mitattujen korkeiden PCT - ja IL-6 - pitoisuuksien ennustavan vaikean sepsiksen kehittymistä paremmin kuin korkean CRP:n. Tutkimuksessa II plasman PLA2GIIA vaikutti hiukan paremmalta vaikean sepsiksen ennustajalta kuin CRP tai veren valkosolutaso, mutta BPI ei ollut hyödyllinen. Tutkimuksessa III korkea plasman suPAR- pitoisuus osoittautui itsenäiseksi kuolleisuuden riskitekijäksi ja se liittyi myös vaikean sepsiksen kehittymiseen. Tutkimuksessa IV korkea PTX3 - pitoisuus toimi samaan tapaan kuin suPAR. Kokonaisuutena PCT osoittautui parhaaksi merkkiaineeksi ennustamaan elinhäiriön kehittymistä ja suPAR kuolleisuutta. PTX3 ei tarjonnut merkittävää lisäetua PCT:iin ja suPAR:iin verrattuna. CRP osoitti suhteellisen hyvin bakteeri-infektion esiintymistä, mutta ennusteellista arvoa sillä ei ollut. suPAR on kiinnostava kuolleisuuden ja elinhäiriön kehittymisen merkkiaine.

Blackcurrant seed oil for prevention of atopic dermatitis

One hypothesis for the increased incidence of atopic diseases has been that it is associated with changing dietary habits, especially the changed intake of essential fatty acids (EFAs). The metabolism of EFAs produces eiconasoids, prostaglandins and leukotrienes, which are essential to organs and play a major role in regulation of inflammation and immune response. In some studies persons with atopic dermatitis have been found to have reduced levels of EFAs. The first year of infancy as well as the foetal period are crucial for the development of atopic immune response. The composition of blackcurrant seed oil (BCSO) corresponds to the recommended ratio of EFAs n-3 and n-6 in the diet (1/3-1/4) and as a dietary supplement could, even in small doses, modify the unbalance of EFAs in an efficient way. The purpose of this study was to find out whether atopic allergies can be prevented by supplementing the diet of pregnant mothers with blackcurrant seed oil and whether it could affect the immunological balance of a child. We also sought to find out whether a blackcurrant seed oil supplementation can affect the composition of breast milk to suppress the T helper 2 lymphocyte (Th2) responses in infants. 313 pregnant mothers were randomly assigned to receive BCSO (n=151) or olive oil as placebo (n=162). Supplementation was started at the 8th to 16th weeks of pregnancy, 6 capsules per day (dose of 3 g), and continued until the cessation of breastfeeding. It was thereafter followed by direct supplementation to infants of 1 ml (1 g) of oil per day until the age of two years. Atopic dermatitis and its severity (SCORAD index) were evaluated, serum total IgE was measured and skin prick tests were performed at the age of 3, 12 and 24 months. Peripheral blood mononuclear cell (PBMC) samples were taken at the age of 3 and 12 months and breast milk samples were collected during the first 3 months of breastfeeding. Parental atopy was common (81.7%) in the studied infants, making them infants with increased atopy risk. There was a significantly lower prevalence of atopic dermatitis in the BCSO group (33%) than in the olive oil group (47%) at the age of 12 months. Also, SCORAD was lower in the BCSO group than in the olive oil group. Dietary intervention with BCSO had immunomodulatory effects on breast milk, inducing cytokine production from Th2 to Th1 immunodeviation. It decreased the level of IL-4 and elevated the level of IFN-γ. BCSO intervention did not affect cytokines in the children’s PBMC. However, children of smoking parents in the combined BCSO and olive oil group had significantly elevated levels of Th2 type cytokines IL-4, IL-5 and the proinflammator cytokine TNF. Dietary supplementation with BCSO is safe. It is well tolerated and transiently reduces the prevalence of atopic dermatitis at the age of 12 months. It can possibly become a potential tool in prevention of atopic symptoms when used at the early stages of life.

Competition periods of crabgrass with rice and soybean crops

Determining the periods of weed competition with crops helps the producer to choose the most appropriate time to use weed control practices. This strategy allows for the reduction of the number of herbicide applications, reducing costs and the environmental impact of pesticides. The objectives were to determine the period before the interference (PBI) of crabgrass (Digitaria ciliaris) competing with flooded rice, the critical period of interference prevention (CPIP) of crabgrass with soybean and the effects of competition on the grains yield and their components. Experiments were conducted with the coexistence of BRS Querência rice cultivar with crabgrass, for periods of 0, 7, 14, 21, 28, 35, and 110 days after emergency (DAE) and Fundacep 53RR soybean cultivar, whose periods of coexistence and control of crabgrass were 0, 7, 14, 21, 28, 35, and 156 DAE. Rice can grow with crabgrass infestation until 18 DAE, while soybean should remain free from the presence of crabgrass in the period between 23 and 50 DAE. The grain yield and its components, in the crops studied, are affected when grown with crabgrass.

Rikottujen ikkunoiden nollatoleranssi. Tutkimus New Yorkin rikoksentorjunnan uuskonservatiivi-mallista Suomessa

Väitöskirja on kriminologista kontrollin ja rikoksentorjunnan tutkimusta sekä poliisitutkimusta. Kohteena on ympäri maailmaa levinnyt nollatoleranssiksi kutsuttu järjestyspoliisistrategia. Strategiaa kokeiltiin vuosituhannen vaihteessa vuoden kestäneessä järjestyksenvalvonnan hankkeessa Tampereella. Vaikka kyseessä oli kokeilu, niin tutkimuksessa osoitetaan toimintatavan olleen ja olevan pitkälti kiinteä osa perinteistä suomalaisen järjestyspoliisin toimintaperiaatetta. Artikkeliväitöskirja sisältää viisi vuosina 1998–2005 julkaistua kirjoitusta. Kokoavan yhteenvetoartikkelin tutkimusongelmat ovat seuraavat: Millaisia ovat Yhdysvaltojen ja Suomen järjestyspoliisitoiminnan nollatoleranssien mekanismien, kontekstien ja vaikutusten keskeiset erot ja yhtäläisyydet? Millainen on Tampereen nollatoleranssikokeilu ja New Yorkin rikottujen ikkunoiden nollatoleranssi rikoksentorjunnan arvioinnin ja moraalisäätelyn esimerkkeinä? Tampereen kokeilun prosessi- ja vaikuttavuusarviointitutkimus koostaa tutkimuksen empiirisen aineiston. Hankkeen alku- ja loppumittauksena toimi lomakekysely tamperelaisille (2 x n2000). Lisäksi analyysissä käytettiin kansalaiskyselyn uhrikyselyä, poliisin rikos- ja päivystyskeskustilastoja, Tilastokeskuksen tilastoja, hankkeen suoritelomakkeita sekä rangaistusvaatimus- ja rikesakkolomakkeita sekä kouluterveystutkimuksia. Tampereen poliiseille tehtiin lomakekysely ja teemahaastatteluja. Sosiaali-, nuoriso- ja vapaaehtoistyöntekijöitä sekä yli viisikymmentä tamperelaista nuorta sekä kymmenkunta tamperelaista aikuista haastateltiin. Yhdysvaltojen osalta nojaudutaan verrattain suureen määrään julkaistua korkeatasoista ja ajankohtaista kriminologista tutkimusta. New Yorkiin ja Yhdysvaltoihin sovelletussa hallintavalta- ja moraalisäätelyanalyysissa rikotut ikkunat -teoria osoittautuu uuskonservatiiviseksi moraaliprojektiksi, joka opastaa kaupunkeja hankkimaan itselleen oikeuden tiukkaan järjestyksenvalvontaan. Aiemmin sen oli estänyt kansalaisoikeusmyönteinen lakien tulkinta. New Yorkissa ja Tampereella syntyi useita kielteisiä sivu- ja vastavaikutuksia, kuten ongelmien siirtymistä (displacement). Tämä on yksi keskeinen tulos tilannetorjunnan ja kontrollin tehostamisen ja kohdistamisen hankkeissa. Tulokset haastavat arvioimaan kriittisesti, ovatko kaikki lapsiin ja nuoriin kohdistuvat varhaisen puuttumisen hankkeet seuraustensa perusteella oikeutettuja.

Early prediction of poor outcome in patients with acute asthma in the emergency room

Early identification of patients who need hospitalization or patients who should be discharged would be helpful for the management of acute asthma in the emergency room. The objective of the present study was to examine the clinical and pulmonary functional measures used during the first hour of assessment of acute asthma in the emergency room in order to predict the outcome. We evaluated 88 patients. The inclusion criteria were age between 12 and 55 years, forced expiratory volume in the first second below 50% of predicted value, and no history of chronic disease or pregnancy. After baseline evaluation, all patients were treated with 2.5 mg albuterol delivered by nebulization every 20 min in the first hour and 60 mg of intravenous methylprednisolone. Patients were reevaluated after 60 min of treatment. Sixty-five patients (73.9%) were successfully treated and discharged from the emergency room (good responders), and 23 (26.1%) were hospitalized or were treated and discharged with relapse within 10 days (poor responders). A predictive index was developed: peak expiratory flow rates after 1 h <=0% of predicted values and accessory muscle use after 1 h. The index ranged from 0 to 2. An index of 1 or higher presented a sensitivity of 74.0, a specificity of 69.0, a positive predictive value of 46.0, and a negative predictive value of 88.0. It was possible to predict outcome in the first hour of management of acute asthma in the emergency room when the index score was 0 or 2.