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OBJETIVO: Analisar o resultado cirúrgico em portadores de transposição das grandes artérias com septo interventricular intacto, operados após o período neonatal. MÉTODOS: Entre janeiro de 1998 e março de 2004 foram atendidas 121 crianças com transposição das grandes artérias com septo interventricular intacto, sendo 29 (24%) após o período neonatal. A seleção para tratamento cirúrgico foi baseada na avaliação ecocardiográfica pelo cálculo da massa do ventrículo esquerdo e da configuração do septo interventricular. Das 29 crianças, 12 foram selecionadas para correção anatômica primária, 12 para correção em dois estágios, após preparo cirúrgico do ventrículo esquerdo e 5 submetidas a correção atrial. RESULTADOS: No grupo submetido à correção anatômica primária houve 1 (8,3%) óbito hospitalar por sepsis. No grupo de correção em dois estágios, 5 pacientes foram submetidos ao preparo lento, com correção 3-6 meses após o 1º estágio, ocorrendo 4 óbitos após o 1º estágio. Este fato determinou mudança no nosso protocolo, adotando-se a técnica de preparo rápido nos outros 7 pacientes, tendo todos atingido o 2º estágio. Das 8 crianças submetidas ao 2º estágio houve 1 óbito hospitalar e outro óbito tardio. A evolução clínica tardia das crianças de ambos os grupos é excelente. CONCLUSÃO: A seleção ecocardiográfica adequada da transposição de grandes artérias com septo interventricular intacto quando abordada após o período neonatal, permitiu uma orientação segura da escolha da melhor abordagem cirúrgica nestes pacientes.

Objective: To investigate whether tri-ponderal mass index and body mass index Z scores are equivalent for screening children and adolescents with insulin resistance., Methods: Cross-sectional study with 296 children and adolescents enrolled at public schools of Vitória, Espírito Santo, Brazil, aged eight to 14 years. The tri-ponderal mass index was calculated as the ratio between weight and height cubed. The body mass index was calculated as the ratio between weight and height squared. Insulin resistance was defined with the homeostatic model assessment (HOMA-IR)., Results: The HOMA-IR was higher in the 4th quartile of body mass index Z scores and tri-ponderal mass index compared to 1st and 2nd quartiles for both girls and boys. The areas under the age-adjusted receiver operating characteristic curves were similar between the indices for girls (body mass index Z scores=0.756; tri-ponderal mass index=0.763) and boys (body mass index Z scores=0.831; tri-ponderal mass index=0.843). In addition, according to the simple linear regression analyses estimations, both body mass index Z scores and tri-ponderal mass index explained a significant fraction of the homeostatic model assessment variability for girls (body mass index Z scores: R2=0.269; tri-ponderal mass index: R2=0.289; p<0.001) and boys (body mass index Z scores: R2=0.175; tri-ponderal mass index: R2=0.210; p<0.001)., Conclusions: The tri-ponderal mass index and body mass index Z scores were similar to discriminate children and adolescents with insulin resistance. It is noteworthy that the use of tri-ponderal mass index is clearly advantageous, because it can be calculated with no concerns on adjustments for the age, a fact that makes it very applicable in the clinical practice.

Background: The outcome of Chagas disease patients after receiving implantable cardioverter defibrillator (ICD) is still controversial., Objective: To compare clinical outcomes after ICD implantation in patients with chronic Chagas cardiomyopathy (CCC) and ischemic heart disease (IHD)., Methods: Prospective study of a population of 153 patients receiving ICD (65 with CCC and 88 with IHD). The devices were implanted between 2003 and 2011. Survival rates and event-free survival were compared., Results: The groups were similar regarding sex, functional class and ejection fraction. Ischemic patients were, on average, 10 years older than CCC patients (p < 0.05). Patients with CCC had lower schooling and monthly income than IHD patients (p < 0.05). The number of appropriate therapies was 2.07 higher in CCC patients, who had a greater incidence of appropriate shock (p < 0.05). Annual mortality rate and electrical storm incidence were similar in both groups. There was no sudden death in CCC patients, and only one in IHD patients. Neither survival time (p = 0.720) nor event-free survival (p = 0.143) significantly differed between the groups., Conclusion: CCC doubles the risk of receiving appropriate therapies as compared to IHD, showing the greater complexity of arrhythmias in Chagas patients., Competing Interests: Potential Conflict of Interest No potential conflict of interest relevant to this article was reported.

Background: Cardiac resynchronization therapy (CRT) is the recommended treatment by leading global guidelines. However, 30%-40% of selected patients are non-responders., Objective: To develop an echocardiographic model to predict cardiac death or transplantation (Tx) 1 year after CRT., Method: Observational, prospective study, with the inclusion of 116 patients, aged 64.89 ± 11.18 years, 69.8% male, 68,1% in NYHA FC III and 31,9% in FC IV, 71.55% with left bundle-branch block, and median ejection fraction (EF) of 29%. Evaluations were made in the pre‑implantation period and 6-12 months after that, and correlated with cardiac mortality/Tx at the end of follow-up. Cox and logistic regression analyses were performed with ROC and Kaplan-Meier curves. The model was internally validated by bootstrapping., Results: There were 29 (25%) deaths/Tx during follow-up of 34.09 ± 17.9 months. Cardiac mortality/Tx was 16.3%. In the multivariate Cox model, EF < 30%, grade III/IV diastolic dysfunction and grade III mitral regurgitation at 6‑12 months were independently related to increased cardiac mortality or Tx, with hazard ratios of 3.1, 4.63 and 7.11, respectively. The area under the ROC curve was 0.78., Conclusion: EF lower than 30%, severe diastolic dysfunction and severe mitral regurgitation indicate poor prognosis 1 year after CRT. The combination of two of those variables indicate the need for other treatment options.

Background: 30-40% of cardiac resynchronization therapy cases do not achieve favorable outcomes., Objective: This study aimed to develop predictive models for the combined endpoint of cardiac death and transplantation (Tx) at different stages of cardiac resynchronization therapy (CRT)., Methods: Prospective observational study of 116 patients aged 64.8 ± 11.1 years, 68.1% of whom had functional class (FC) III and 31.9% had ambulatory class IV. Clinical, electrocardiographic and echocardiographic variables were assessed by using Cox regression and Kaplan-Meier curves., Results: The cardiac mortality/Tx rate was 16.3% during the follow-up period of 34.0 ± 17.9 months. Prior to implantation, right ventricular dysfunction (RVD), ejection fraction < 25% and use of high doses of diuretics (HDD) increased the risk of cardiac death and Tx by 3.9-, 4.8-, and 5.9-fold, respectively. In the first year after CRT, RVD, HDD and hospitalization due to congestive heart failure increased the risk of death at hazard ratios of 3.5, 5.3, and 12.5, respectively. In the second year after CRT, RVD and FC III/IV were significant risk factors of mortality in the multivariate Cox model. The accuracy rates of the models were 84.6% at preimplantation, 93% in the first year after CRT, and 90.5% in the second year after CRT. The models were validated by bootstrapping., Conclusion: We developed predictive models of cardiac death and Tx at different stages of CRT based on the analysis of simple and easily obtainable clinical and echocardiographic variables. The models showed good accuracy and adjustment, were validated internally, and are useful in the selection, monitoring and counseling of patients indicated for CRT.

The research aimed to identify the interaction of nurses and clients suffering from bulimia and anorexia. We use the case study as a resource in which we collect clinical data and did interviews with eight of fourteen nurses, who have been our subject-object. According to the nurses, clients are isolated from the world living in a world without hunger and mirrors reflecting a body always above the "ideal weight", they were lonely people, personnel who have lost their shine, sending signals that could extinguish their lives at any time. In the study, was possible to identify the manner in which nurses interacted and perceived customers and, as a result, we elucidate a peculiar practice in nursing.

The development and application of information technology influence all areas of knowledge, enabling new ways of learning. The Wiki is a tool of information and communication technology provided by the Web 2.0 that can be exploited and used in teaching, learning, care and research in nursing education. Thus, this quantitative study is a descriptive and exploratory objective was to evaluate the nursing students with the criteria of Ergonomics and Usability of the tool Wiki as a technology to access information on nursing care in mechanical ventilation in the Intensive Care Unit. The tool was evaluated as "excellent" in the criteria for Ergonomics and Usability, and is considered a new emerging technology suitable for educational use.

Objective: To identify the prevalence of clinically significant prescription errors in a Brazilian university hospital compared with their occurrence in 2003 and 2007., Methods: Variables and group of variables, such as readability, compliance with legal and institutional procedures of prescription, and prescription errors analysis were analyzed., Results: When the prevalence rates of clinically significant prescription errors were calculated, a statistically significant decrease was shown [year of 2003 (29.25%), year of 2007 (24.20%); (z = 2.99; p = 0.03)], reflecting on the safety rate [year of 2003 (70.75%), year of 2007 (75.80%); (z = 3.30; p =0.0001)]., Conclusion: Despite significant, the increased safety rate reflected the quantitative reduction of errors, with no observed difference in severity between the studied periods. Our results suggest the institutional steps taken could reduce the number of errors, but they were ineffective in reducing the severity of the errors.

The treatment options for pregnant patients with invasive cervical cancer (ICC) depend on gestational age, clinical stage and the patient's wishes. Some authors have reported cases of neoadjuvant chemotherapy followed by radical surgery in these patients. The aim of this paper was to revisit this subject and to add a new case and review the literature. We report the case of a 30 year-old woman in the 24th week of gestation. She was diagnosed with ICC (squamous cell carcinoma grade 2), stage IIB (International Federation of Gynecology and Obstetrics - FIGO). Nulliparous, the patient refused to interrupt the pregnancy. After meticulous counseling, the patient accepted treatment with neoadjuvant chemotherapy (cisplatin 75 mg/m² and vincristine 1 mg/m²) and subsequent evaluation of radical surgery concomitant to a cesarean section. Four complete cycles of chemotherapy were administered without delays or significant adverse effects. A few days before the date scheduled for surgery, the patient was admitted in advanced labor (37th week of gestation). Due to tumor clinical response, the obstetric team decided to monitor the labor, and the patient gave birth to a male newborn (2,450 g) uneventfully. Radical surgery was performed three days after birth, and histopathology analysis revealed carcinoma confined to the cervix without lymphatic involvement. Mother and son are in good general condition 12 months after delivery. Cisplatin-based chemotherapy during the second or third trimester of pregnancy appears to be a safe option for patients who do not wish to interrupt a pregnancy while awaiting fetal maturity. However, additional studies are needed to confirm the prognosis and assure the safety of newborns and patients.

This article presents a reflection on the meaning of the terms citizenship and health, addressing the Theory of Social Representations as a strategy for implementing and evaluating health care models in Brazil. First, a brief history about the concept of citizenship is presented; then the article addresses the principles of freedom and equality according to Kant; the third section of the article shows that health is as a right of the citizen and a duty of the state. Finally, the Theory of Social Representations is emphasized as a strategy to evaluate and implement the health services provided to citizens by the current health care models in Brazil.

The purpose of the present study was to verify the prevalence of oral mucosal alterations in Brazilian adolescents institutionalized. A total of 231 adolescents, all male were examined. The criteria used for clinical diagnostic of the lesions were the former proposed by SB 2000 (Brazil). The total oral mucosal lesions prevalence was 27.70% (64 lesions). The total prevalence of buccal mucosal lesions were 27.70% (64 lesions) in 24,24% of the adolescents. The most frequent one was plaque. It was found 293 mucosal alterations. 78.35% of the adolescents examined presented at least one alteration. The melanin pigmentation was the most common alteration. The data collected had been analyzed statistically through Kruskall Wallis non-parametric test and associations through Qui-Square test, considering significant level of 5%. Statistical significant difference was identified concerning between basic lesions and/or mucosal alterations and race (p=0,002) and skin colours and average number of the mucosal alteration (p=0,000) and the present of the melanin pigmentation and leukoedema and race (p=0,000 and p=0,002). There wasn't any statistically significant difference between average number of the mucosal lesions and race (p=0,618).

Etnonursing, as a research methodology, is applied to approach the cultural context and of care in health of one specific culture. Aiming at demonstrating the process of application of this methodology in nursing, from what is proposed by Leininger, four steps of observation are presented, one of interview and for steps of analysis of data, covering specific and congruent criteria with the qualitative paradigm. These steps are not isolated, they relate to one another in an intricate way. It is considered that the knowledge produced can contribute largely for the subjects of the research as well as for the practice of the health workers, developing nursing as a science and providing new paths for the health care, for performing their jobs, through ethics, diversity of workers; complementing the theory of Leininger.

This research-action type study aimed to establish clinical evaluation parameters essential to the patient subject to hemodynamic monitoring by Pulmonary Artery Catheter (PAC) and to develop a Nursing Care Protocol to critical care patients using catheter with the nurses of an ICU in Santa Catarina State. The population consisted of a non-probabilistic intentional sample of five nurses, and the data were collected through group meetings and questionnaire. The study is presented with descriptive statistics and qualitative analyses of the subjective questions. In conclusion, the clinical evaluation criteria, essential to the patient subjected to hemodynamic monitoring, are constituted by invasive and non-invasive parameters and the protocol grounds making clinical decisions when caring for patient using PAC.

Background: The normal 24-hour albumin excretion rate is of 20 mg. A persistent rate of 30 to 300 mg/day is called microalbuminuria and is related to a higher prevalence of cardiovascular disease., Objective: 1) To determine the prevalence of microalbuminuria in a group of hypertensive patients and in a group of patients with coronary artery disease; 2) To determine the relationship between the presence of microalbuminuria and hypertension, diabetes mellitus, dyslipidemia, smoking and obesity., Methods: The presence of microalbuminuria in a group of hypertensive patients (73 individuals) and in a group of patients with coronary artery disease (39 individuals) was determined and compared with a control group (43 individuals). Microalbuminuria was defined as an albumin/creatinine ratio higher than 30 and lower than 300 in a spot morning urine sample. The chi-square test and the Fishers exact test were used in the statistical analysis., Results: Microalbuminuria was present in 9.5% of the hypertensive individuals and in 33% of the patients with coronary artery disease, and was absent in individuals of the control group. When the occurrence of microalbuminuria was analyzed according to the different clinical parameters, regardless of the group involved, a statistically significant correlation was found with age, diabetes and dyslipidemia., Conclusion: 1) The prevalence of microalbuminuria in hypertensive individuals is high, and is even higher in patients with coronary artery disease; 2) There is a correlation of the presence of microalbuminuria with age, diabetes and dyslipidemia.

We describe the clinical case of two siblings with different presentations of thrombotic phenomena, in which prothrombin mutation was observed.

Background and Objectives: Tracheal bronchus is a congenital abnormality affecting approximately 2% of general population, usually asymptomatic and of incidental diagnosis. It is characterized by the presence of the bronchus to the right upper lobe emerging directly from the trachea, close to the carina. Tracheal tube may obliterate its lumen, leading to right upper lobe atelectasis. This article aimed at reporting a case of right upper lobe atelectasis in infant, noticed after tracheal intubation, and also presenting a literature review on this abnormality, highlighting its anesthetic implications., Case Report: Male patient, mulatto, 5 months old, 5 kg, physical status ASA I, scheduled for anorectal fistula correction (Mini-Peña). Right subclavian vein was punctured after tracheal intubation, followed by desaturation and decreased right apex vesical murmur. Initial hypotheses were hemothorax, pneumothorax, bronchial secretion and selective intubation. Chest X-rays have shown right upper lobe atelectasis. Bronchoscopy revealed tracheal bronchus. Tube was repositioned with re-expansion of the affected lobe., Conclusions: Because of its relatively high incidence (2%), tracheal bronchus should be included among right upper lobe atelectasis differential diagnoses.

Background and Objectives: Rocuronium is an intermediate nondepolarizing neuromuscular blocker (NMB) with faster onset and indicated in situations requiring rapid tracheal intubation. Intravenous lidocaine is often used to decrease hemodynamic responses to tracheal intubation. The association of NMB to local anesthetics results in potentiation of NMB effects. The purpose of this study was to evaluate the influence of lidocaine on rocuronium's pharmacodynamics determined by acceleromyography., Methods: Forty-six ASA I-II patients, aged 18 to 65 years, were randomly distributed in two groups (CG: control and LG: lidocaine). Rocuronium was given to all patients for neuromuscular block. LG received lidocaine (1.5 mg.kg(-1)) 3 minutes before rocuronium. Neuromuscular function was evaluated by adductor pollicis muscle response to TOF. After NMB injection, times for first TOF response (T(1)) to reach 10 and 0% of baseline value and recover 25%, 75% and 95% of contraction height (Dur(25%), Dur(75%), Dur(95%)) were recorded. Recovery time of T(4)/T(1) = 0.8 and intervals Dur(75%)-Dur(25%) (IR(25-75)) and T(4)/T(1) = 0.8 - Dur(25%) were also recorded., Results: This study has not shown statistically significant differences between groups when T(1)= 10%, T(1) = 0, RI(25-75), T(4)/T(1) = 0.8 - Dur(25)% were compared. Times for Dur(25%), Dur(75%), Dur(95%) in LG were significantly higher as compared to CG., Conclusions: Lidocaine associated to rocuronium has prolonged early blockade recovery stage without interfering with onset or late recovery stage.

This case study aims at presenting the follow-up of a patient who underwent allogeneic bone marrow transplantation and the experience of the nursing team of the Centro de Transplante de Medula Ossea (Bone Marrow Transplantation Center) at the Hospital de Clínicas de Porto Alegre, Brazil, during the development of the systematization of the nurse practice emphasizing the period of elaboration of the nursing diagnosis. Twenty-six diagnosis established in this case are discussed and put together in the format of a table to allow the reader to have a view of their initial and ending periods, during the in-patient treatment time.

Background and Objectives: Dexmedetomidine is a highly selective alpha2-adrenoceptor agonist used in anesthesia for its hypnoanalgesic and cardiovascular effects. Stimulation of alpha2-adrenoceptors may determine pro and anti-platelet aggregation effects through direct and indirect mechanisms. This study aimed at determining the effects of dexmedetomidine on coagulation evaluated by thromboelastography., Methods: Twenty four patients were randomly distributed in 3 groups: Group 1 patients received saline solution (control group), Group 2 patients received 1 microg.kg-1 dexmedetomidine in 10 minutes, followed by 0.4 microg.kg-1.h-1 infusion for 20 minutes and Group 3 patients received 0.05 mg.kg-1 midazolam. Sedated patients maintained scores 3 or 4 in Ramsays sedation scale. Blood samples were collected before and 30 minutes after the treatment for thromboelastography., Results: Dexmedetomidine has significantly increased reaction time (parameter R) and decreased coagulation index in final curves as compared to initial ones. Values, however, have remained within ranges accepted as normal. This phenomenon was not observed in remaining groups., Conclusions: Dexmedetomidine pro and anti-platelet aggregation mechanisms interaction determines mild hypocoagulation, however maintaining coagulation within normal ranges. Dexmedetomidine effects on coagulation are probably not mediated by anxiolysis, since sedation was equivalent to the midazolam group.

The purpose of this study was to verify the chronically ill patient's quality of life. The study conceptual framework was deryged from the quality of life conceptualization according to Wenger et al. (1984). In this framework the main components of quality of life were viewed as a functional capacity, perception and symptoms. The study sample consisted of 94 chronically ill patients. Of these, 35 were in and outpatients with cardiovascular diseases (GROUP I), 29 patients were on a special rehabilitation program for cardiovascular patients (GROUP II), and 30 were diabetic patients (GROUP III). The McMaster Health Index questionnaire developed by Chambers (1984) was used for data collection. The findings revealed that patients of the GROUP II showed better quality of life than the patients of GROUP I and GROUP III in relation to the physical function, health perception, and life satisfaction.