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Background: An understanding of perceptions of parents and health caregivers who assist critically ill neonates is necessary to comprehend their actions and demands. Therefore this study aim to analyze the agreement among parents, nurse technicians and pediatricians regarding the presence and intensity of pain and distress in mechanically ventilated and intubated newborn infants., Methods: Cross-sectional study comprising 52 infants and 52 trios of adults composed of one parent, one nurse technician, and one pediatrician who all observed the same infant. All infants were intubated and under mechanical ventilation and were not handled during the observations. Each newborn was simultaneously observed by the trio of adults for 1 minute to evaluate the presence of pain and distress. The intensity of pain and distress that the adults believed was felt by the infants was marked in a visual analogical scale. Adults' agreement about the simultaneous presence of pain and distress in each infant was analyzed by marginal homogeneity and Cochran tests. The agreement about the intensity of pain and distress in each infant was studied by Bland-Altman plot and intraclass correlation coefficient (ICC)., Results: The assessments of pain and distress were heterogeneous in all three investigated groups of adults as determined by the results of a Bland-Altman plot. The presence of distress was more frequently reported compared with pain (marginal heterogeneity, p < 0.01). The pain and distress scores in each adult group were not correlated as shown by ICC [parents, 0.36 (95% CI: 0.01-0.63); nurses 0.47 (0.23-0.66); pediatricians, 0.46 (0.22-0.65)]., Conclusions: Adults systematically underscore pain in comparison to distress in mechanically ventilated newborns, without recognizing the association between them.

Background: Two digital mammography systems, based on different physical concepts, have been introduced in the last few years namely the full-field digital mammography (FFDM) system and computed radiography-based mammography using digital storage phosphor plate (DSPM)., Aims: The objective of this study was to compare the image quality for DSPM and FFDM using a grading scale based on previously published articles., Materials and Methods: This comparative diagnostic study was done for 5-month duration at the Breast Clinic. The system used was the Lorad Selenia FFDM system and the Mammomat 3000 Nova DSPM system. The craniocaudal and mediolateral oblique projections were done on both breast on 58 asymptomatic women using both DSPM and FFDM. The mammograms were evaluated for eight criteria of image quality: Tissue coverage, compression, exposure, contrast, resolution, noise, artifact, and sharpness by two independent radiologists., Statistical Analysis: Wilcoxon Signed Rank Test and Weighted Kappa., Results: FFDM was rated significantly better (P < 0.05) for five aspects: Tissue coverage, compression, contrast, exposure, and resolution and equal to DSPM for sharpness, noise, and artifact., Conclusion: FFDM was superior in five aspects and equal to DSPM for three aspects of image quality.

Outbreaks by carbapenem-resistant Providencia stuartii (CRPS) are rarely described. Clinical characteristics of patients with CRPS in an intensive care unit and resistance mechanisms were investigated. Carbapenemase production and/or outer membrane alterations were not detected; only CTX-M-2 and AmpC hyperproduction were noted. The outbreak was ultimately controlled in a 3-month period.

The chronic usage of nifedipine is associated with the appearance of gingival overgrowth (GO). The frequency of GO associated with chronic nifedipine therapy remains controversial and the possible subclinical effects of this drug on the gingival epithelium should be investigated. We investigated the epithelial proliferation index and apoptosis rate, and their association with epithelial enlargement. Proliferation (Ki67 and Cyclin B1) and apoptosis (BCL2, Bax and p53) markers were identified by immunohistochemistry in twenty-one samples of gingival tissue from patients undergoing chronic treatment with nifedipine and in eleven samples of gingival tissue from healthy patients who did not use drugs associated with GO (control). Our results show that the epithelial tissue of nifedipine users has considerably longer rete pegs compared to control (P = 0.01). However, the density of Ki67(+) and Cyclin B1(+) cells was similar in both groups. Regarding apoptosis, we found more BCL2(+) cells in the nifedipine group when compared to controls (P = 0.12). An increase in Bax(+) cells in the nifedipine group compared to control (P = 0.003) was also seen, and slightly lower levels of p53(+) expression were observed (P = 0.51). Our results suggest that the chronic use of nifedipine is not associated with subclinical changes in gingival tissue.

Objective: To verify whether parents and health professionals homogeneously evaluate presence and intensity of neonatal pain., Methods: This cross-sectional study enrolled 52 neonates and 154 adults. Inclusion criteria for neonates were admission to neonatal intensive care unit, presence of gastric tube, tracheal tube, and venous lines. Each newborn was observed by a different group of three adults (parent, nurse assistant and pediatrician) for 1 minute at the same time to evaluate presence and intensity of infant's pain. Homogeneity of pain evaluation was analyzed by a modified Bland-Altman plot and by intraclass correlation coefficient (ICC). Multiple linear regression analysis was used to evaluate association of neonatal characteristics and heterogeneity of pain scores for adults., Results: ICC showed disagreement of the pain scores given by the three groups of adults (ICC 0.066, agreement > 0.75). Bland-Altman analysis showed agreement among adults when they thought pain was absent. When they thought pain was present, there was heterogeneity of opinions regarding intensity of neonatal pain. Multiple regression analysis indicated that 10% of this disagreement could be explained by infant's gender and mode of delivery., Conclusions: Disagreement among adults about intensity of neonatal pain is a marker of the difficulty in deciding the need for analgesia in preverbal patients.