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Labor is a known risk factor for pelvic floor dysfunction (PFD); however, the impact of operative vaginal delivery (OVD), particularly spatulas, remains unclear. The aim of this study was to compare postpartum PFD symptoms in women undergoing spontaneous vaginal delivery (SVD) and those undergoing OVD. An observational prospective study (MOODS: Maternal-neonatal Outcomes in Operative Vaginal Delivery) was enrolled at Hospital de Braga from February to October 2018. All singleton term OVD (Thierry spatulas and vacuum extractor) and a convenience SVD sample were recruited, in a 2:1 ratio. To assess PFD symptoms Pelvic Floor Distress Inventory-20 (PFDI-20) was applied at 3, 6, and 12 months postpartum. The questionnaire is divided into three subscales: Urinary (UDI), Colorectal-Anal (CRADI), and Pelvic Organ Prolapse Distress Inventory (POPDI). Of the 304 women recruited, 207 were included, 34.3% with SVD and 65.7% with OVD. Thierry spatulas were used in 53.7% of women undergoing OVD. Frequency of nulliparous (p

Background and Aims Renal amyloidosis include amyloid A (AA) and light chain (AL) as well as amyloidogenic leukocyte chemotactic factor 2 (ALECT2) and numerous hereditary forms. After identifying amyloidosis by its suggestive pale pink amorphous appearance in optic microscopy (OM) and Congo red positivity, a correct diagnosis of the amyloidogenic precursor protein is determinant to establish prognosis and treatment. Immunohistochemistry (IHC) and immunofluorescence (IF) studies use a limited number of antibodies to detect specific epitopes and may be difficult to interpret. The gold standard has become proteomics but laser microdissection and mass spectroscopy are not routinely available. Other options include electron microscopy with immunogold staining and complementary exams such as scintigraphy with 99mTc-DPD to detect transthyretin-related amyloidosis. Since the cause of amyloidosis vary among regions, analyzing local patterns can help establish a diagnostic procedure. We aimed at describing cases of kidney amyloidosis identified by biopsy during a 4-year interval and discuss possible implication for future diagnosis. Method We analyzed our kidney biopsy database and selected all cases of renal amyloidosis collecting clinical, laboratory and imaging data. Results From January 2016 until December 2019, 194 kidney biopsies were performed at the Hospital of Braga in the Portuguese province of Minho. Among these, 8 (4.1%) revealed amyloidosis. Mean age was 63.8±9.2 years of age, 5 were female, 6 were referred for nephrotic syndrome and 2 for what seemed like acute kidney injury. Mean creatinine at presentation was 3.2±2.3mg/dL. Among them, 2 had AL amyloidosis with light chain restriction by IF, 1 had AA amyloidosis with intense IHC stain and 5 patients had non-AL and non-AA forms of amyloidosis. Of these, 3 had probable fibrinogen A alpha-chain (AFib) amyloidosis, after a heterozygous mutation FGA p.Glu545Val was detected, 1, who did not have IHC performed, was assumed as having AA amyloidosis due to a history of serious recurrent infections and 1 is still under study. Four performed scintigraphy with 99mTc-DPD which was negative. The 2 patients with AL amyloidosis had, by OM, in one case glomerular and tubulointerstitial and on the other, glomerular and vascular involvement and, by IF, both had k light chain restriction. Both had additional cardiac and neurovegetative involvement, were treated with cyclophosphamide-bortezomib-dexamethasone and oral doxycycline with complete hematologic response and stabilization of kidney function. In 1 case, proteinuria only showed a slow decline 2 years after treatment. The 2 patients with AA amyloidosis had glomerular, vascular and tubular deposits. One had bronchiectasis and allergic bronchopulmonary aspergillosis and the other had common variable immunodeficiency with recurrent gastrointestinal and urinary infections with frequent bacteremia. None of them had confirmed extra-renal involvement, although the latter had hepatic fibrosis awaiting biopsy. Both progressed to dialysis soon after diagnosis. The 3 patients with AFib amyloidosis all had glomerular amyloidosis with additional amyloid deposition at tubular, vascular and both respectively. Two had had an increased creatinine and subnephrotic proteinuria for some years whereas 1 had kidney function decline and nephrotic syndrome in the course of few months. All were hypertensive and none had evident extra-renal deposits. Conclusion Identifying the amyloidogenic precursor may be difficult. Algorithms for diagnosis may vary according to local prevalence of specific types and available resources. AFib amyloidosis was very significant in our series. It was also described in 4.5% of hemodialysis patients in the district of Braga making it one of the first causes of amyloidosis in our region. This high prevalence may justify early genetic testing for the specific mutation in non-AL and non-AA forms.

Background and Aims Diabetic kidney disease (DKD) develops in almost half of diabetic patients and is the leading cause of chronic kidney disease (CKD). SGLT2 inhibitors (SGLT2i) have consistently shown to confer kidney protection in patients with type 2 diabetes (T2D). The recent KDIGO guidelines suggest their use as a first line medication along with metformin. After the study CREDENCE was published, in mid-2019, DKD patients at the Nephrology outpatient department of the Hospital of Braga were started on SGLT2i. We aimed at assessing these patients’ clinical and laboratory data after the introduction of the new drug. Method We collected data on age, gender, weight, blood pressure (BP) values, the use of renin-angiotension-aldosterone system inhibitors (RAASi), kidney function, glycated hemoglobin (HbA1c), glycosuria, proteinuria and albuminuria at baseline and during the two next patient assessments. Data was analyzed using SPSS®. Results Twenty-nine DKD patients who started SGLT2i between May 2019 and August 2020 were followed. Mean age was 71.2±13.5 years, 22 patients were male and their mean weight was 86.9±13.9 kg. They had had T2D for a mean of 15.9±10.3 years and a significant percent had end organ damage: 34% had diabetic retinopathy, 24% complaints suggestive of neuropathy, 51% had documented heart failure and 27% had cerebral vascular disease. Most were hypertensive with a mean BP of 156±19/83±11mmHg and 72.4% were taking RAASi. One third were treated with insulin. Most patients were started on canagliflozin (n=28) and one patient started empagliflozin. After starting the drug, patients were evaluated at a mean time of 141±55 days and had a second reevaluation at a mean time of 254±72 days. On the first evaluation they showed a significant reduction in the mean systolic BP to 140±15.1mmHg (p=0.001). Glycated hemoglobin decreased from a mean of 7.4±1.3% to 7.1±1.1% although this difference was not significant (p=0.4). Protein-creatinine urinary ratio was significantly reduced from a median value of 1.48 (IQR 0.24-1.85) to 0.93 (IQR 0.40-1.56). Mean serum creatinine increased significantly from baseline until the first evaluation at 1.96±0.49 to 2.27±0.66mg/dL (p=0.00) but remained stable on the second evaluation (2.29±0.79mg/dL). Seventy percent of the patients developed significant glycosuria (urinary concentration >500mg/dL) after starting SGLT2i. When asked about adherence, most non-glycosuric patients admitted not having started the drug. Conclusion Despite having a weak effect in the reduction of HbA1c, SGLT2i are an exciting drug for kidney protection in DKD. Patient adherence is easy to assess based on glycosuria. In our experience and based on this criterion drug compliance was acceptable (at least 70%) and we were able to reinforce instructions among non-compliant patients. Some of the benefits of SGLT2i were evident soon after they were started such as the improvement in BP and proteinuria. The initial increase in plasma creatinine was expected due to reduction in intraglomerular pressure and hyperfiltration and was noticeable only on the first assessment. We expect to continue SGLT2i use DKD patients.

The objective of this study was to evaluate the effect of feed restriction on some physical and blood parameters in horses kept outdoors under natural conditions. Twenty horses were deprived of food for 48 h. They were closely monitored and examined, and blood samples were taken at the beginning (0) of the experiment and 6, 12, 18, 24, 30, 36, 42 and 48 hours afterward. During the experimental period, the control group (12 animals) had free access to water and hay, while the restricted group had free access to water only. Data were submitted to two-way analysis of variance with repeated measures, and statistical significance was P ≤ 0.05. The horses tolerated feed restriction without complications. Feed restriction had no effect on body mass and body condition score, heart rate, respiratory rate, capillary filling time and body temperature. However, feed restriction decreased the intensity of gastrointestinal sounds (P, O objetivo deste estudo foi avaliar o efeito da restrição alimentar sobre parâmetros físicos e sanguíneos em equinos mantidos a pasto de Tifton (Cynodon spp) e em condições naturais. Vinte cavalos foram privados de alimento por 48 h. Eles foram monitorados, examinados e amostras de sangue foram coletadas no início (0) do experimento e 6, 12, 18, 24, 30, 36, 42 e 48 horas depois. Durante o período experimental, o grupo controle (12 animais) teve livre acesso a água e feno, enquanto o grupo restrito teve livre acesso apenas a água. Os dados foram submetidos à análise de variância bidirecional com medidas repetidas e a significância estatística foi P ≤ 0,05. Os cavalos toleraram a restrição alimentar sem complicações. A restrição alimentar por 48 h não teve efeito sobre a massa corporal e escore de condição corporal, frequência cardíaca, frequência respiratória, tempo de enchimento capilar e temperatura corporal. No entanto, o jejum alimentar diminuiu a intensidade dos sons gastrointestinais (P

Introduction: SARS‑CoV2 represents a challenge for hemodialysis (HD). By August 24 2020, the disease had affected 55720 people in Portugal. The northern Minho province has had 4428 cases. The Minho has 870 HD patients among 11 ambulatory HD centers and the Nephrology Department of Braga Hospital. Braga Hospital centralized HD treatments of COVID‑19 patients. We describe our experience managing these patients. Results: We used a 2‑station room and dedicated nurse with PPE but, as numbers increased, HD was performed in the main HD room. Disinfection protocols and specific routes were created. Swabs were repeated 14 days after diagnosis and then weekly until recovery. A total of 17 HD COVID‑19 patients were diagnosed in the Minho, 16 of which performed HD in Braga Hospital. The first patient was diagnosed on March 16 and the last on May 5. Ten were males, mean age 60.6±13.2 years and median dialysis vintage 38.5 months (IQR 23.5‑85.8). Four patients were diabetic and 10 were hypertensive. Only 1 of the 5 hospitalized patients was admitted for symptoms attributable to COVID‑19. One developed severe respiratory insufficiency; 3 took hydroxychloroquine and 1 died. The 11 patients on ambulatory care had mild or no symptoms. At diagnosis, the mean hemoglobin was 10.1±1.8g/dL; mean leukocytes count 6.5±3.4x10/μL; mean platelet count 161±7x10/μL and mean LDH 241±148U/L. Median C reactive protein was 11.3mg/L (IQR 1.6‑ 23.8). Patients’ swabs turned negative after a mean of 22±10 days. No association was found between the duration of a positive swab and gender, diabetes or hypertension. Discussion: Compared with the general population, Minho HD patients had a higher incidence of cases, possibly due to an increased risk and more testing. Incidence and mortality were lower than in other series. Centralizing infected patients may help prevent the spread of the disease and reduce the burden on HD centers.

Coexistence of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and inflammatory bowel disease (IBD) is rare (Sy et al. in Semin Arthritis Rheum 45:475-482, 2016). Nevertheless, we present a case of an AAV in a 53-year-old female with enteropathic spondylarthritis previously treated with tumor necrosis factor α inhibitors (TNFi). Management of vasculitis in a patient with IBD may be problematic due to the difficulty in distinguishing if the vasculitis is an extraintestinal manifestation of the IBD or a new coexistent entity. Moreover, in our report, the previous treatment with TNFi is a possible confounding factor due to the paradoxical effects induced by TNFi, including vasculitis (Ramos-Casals et al. in Curr Rheumatol Rep 10:442-448, 2008). The reported case alerts to the complexity in the management of patients with enteropathic spondylarthritis and vasculitis, as well as discusses the diversity of differential diagnosis in this particular clinical scenario.

Objetivo: avaliar o processo de realização do banho no leito e os cuidados realizados pela equipe de enfermagem antes, durante e após o banho no leito. Métodos: estudo transversal e observacional, realizado na Unidade de Terapia Intensiva de um Hospital/Escola, com oito técnicos de enfermagem. Para a coleta de dados foi utilizado instrumento estruturado tipo checklists em 30 momentos de observação de 1080 ações. Resultados: foram observados 10 cuidados antes e 28 durante e após o banho no leito. O banho foi realizado de forma automática sem comunicação prévia, sem considerar a individualidade e privacidade do paciente, principalmente naqueles submetidos a ventilação mecânica. Não houve participação do enfermeiro e a maioria das ações realizadas pela equipe de enfermagem não atendeu às recomendações da literatura. Conclusões: há necessidade de melhoria da qualidade do banho no leito realizado pela enfermagem e adoção de práticas baseadas em evidências no processo de cuidar.

Background: After 2006 the cross-border region between the state of Mato Grosso do Sul (Brazil) and the Germán Busch Province (Bolivia) became risk areas for canine rabies antigenic variant 1, previously unknown in the Brazilian territory. Objectives: To perform a descriptive analysis of canine rabies from 2006 to 2014, analyzing the database of the official rabies diagnostic laboratory of the State Agency of Animal and Plant Health Protection of Mato Grosso do Sul. Methods: A descriptive analysis of canine rabies from 2006 to 2014 was performed using the database of the official rabies diagnostic laboratory of the State Agency of Animal and Plant Health Protection of Mato Grosso do Sul. Location, time and residence status of the animals were analyzed. Monthly frequencies were calculated as the ratio of the number of positive samples to the total of sent samples and were then statistically compared. Findings: In the period, 539 samples of nervous system from dogs and cats were sent for rabies diagnosis, of which 37 (6.9%; CI95% 5.0–9.3) canine and no positive feline samples were found positive. Twenty-four (64.9%, CI95% 48.8–78.2) positive samples were from Bolivia and 13 (31.1%, CI95% 21.8–51.2) from Brazil. Most positive animals were owned. The years 2008 and 2009 showed the highest occurrence of canine rabies, with 18 cases recorded in 2008 and 6 in 2009 (17 in Bolivia and 7 in Brazil). Annual samples sent in Brazil presented a decreasing trend (R2 = 0.53) and, over the months, a higher concentration of samples was observed between May and August (R2 = 0.69). No annual or monthly trends were observed for Bolivian samples (R2 < 0.003). Conclusions: AgV1 canine rabies due to antigenic variant 1 is still considered an endemic disease in the Brazil-Bolivia border region, requiring an international One Health Approach to mitigate canine rabies in Latin America.

O alho age na hipertensão de diversas formas, primeiramente exercendo um efeito dilatador, tanto pela liberação de óxido nítrico, quanto pelo aumento da adenosina disponível, contribuindo dessa forma para o mecanismo hipotensor, podendo-se considerar o alho um forte aliado no tratamento desta patologia, o estudo teve como problemática “Qual a eficácia do uso de extrato de alho como fitoterapia no controle da hipertensão de acordo com a Literatura?”. Onde objetivou-se verificar nas produções cientificas disponíveis os efeitos do extrato de alho em indivíduos hipertensos. O presente estudo trata-se de uma pesquisa bibliográfica do tipo Revisão Integrativa (RI) da literatura, consultou-se por meio de descritores e palavras-chave as bases de dados PubMed, BVS, coordenada pela BIREME e composta de bases de dados bibliográficas produzidas pela Rede BVS, como LILACS, além da base de dados Medline e CINAHL. Ao final oito (8) artigos atenderam a questão norteadora e foram adicionados ao estudo e evidenciou o uso do alho na prática clínica, os beneficios da utilização do alho como terapia complementar no tratamento HAS e dentro da dieta, além dos principais efeitos colaterais. Conclui-se que aumentar a ingestão de vegetais allium, pode estar associada a redução de triglicerídeos e depuração de creatinina, o que proporciona uma melhoria da função renal e diminuição da pressão arterial.

A hanseníase é uma doença infecciosa crônica. Sua causa é o Mycobacterium leprae, uma bactéria ácido-alcoólica francamente gram-positiva e resistente que pode infectar os nervos periféricos. Este estudo teve como objetivo descrever os aspectos epidemiológicos da hanseníase no município de Caxias-MA. Trata-se de um estudo documental, descritivo, retrospectivo e quantitativo, realizado no período de 2013 a 2017, utilizando dados do Sistema de Informação de Agravos de Notificação (SINAN) do Ministério da Saúde. Este estudo avaliou 349 casos de hanseníase no período de 2013 a 2017 no município de Caxias do estado do Maranhão. Os coeficientes mais elevados foram registrados no ano de 2013 (6,15/10000) e 2015 (5,03/10000), Quanto ao perfil dos pacientes identificados houve prevalência do sexo masculino com 191 (54,7%) dos casos, em que houve predominância da faixa etária de 50 a 59 ano (18,6%), a avaliação da classificação operacional mostra que a forma multibacilar foi a mais frequente (74,5%); quanto ao percentual de lesões cutâneas em decorrência da hanseníase o maior índice são de duas a cinco lesões com 151 (43,3%) dos casos, e com relação ao esquema terapêutico, 260 (74,5%) receberam tratamento poliquimioterápico multibacilar (PTQ/MB) de 12 doses. A hanseníase ainda é considerada uma doença negligenciada, apesar de existir politicas púbicas voltadas para erradicação da mesma, ainda estamos numa longa e lenta trajetória para eliminação da doença. Mas muitas ações e atividades de rastreamento veem se intensificando para o diagnóstico e tratamento precoce da hanseníase com objetivo de reduzir as altas taxas de casos multibacilares.

To establish references ranges for the uterine arteries (UtA) Doppler and cervical length (CL) measurements at 11-13(+6) weeks of gestation in a Brazilian population.We performed a retrospective cross-sectional study with singleton low-risk pregnant women who underwent first trimester ultrasound exams of fetuses with crown-rump length (CRL) ranging from 45 to 84 mm. The mean UtA Doppler and CL measurements were performed by transvaginal route. The mean pulsatility index (PI) of uterine arteries was obtained with color Doppler at the level of cervico-corporeal junction. The CL was obtained in a sagittal view using the cervical gland area as landmark. We determined mean ± standard deviation (SD), ranges for mean PI of UtA and CL in each gestational age. Polynomial regression was performed to establish reference values.We have assessed 598 first-trimester pregnancies: the CL measurement was obtained from 497, while the mean PI UtA Doppler was available in 450 pregnant women. The mean CL ranged from 33.41 to 35.58 mm while the PI UtA Doppler ranged from 1.89 to 1.45. The best fit curves were: CL = 30.790 + 0.057 × CRL and UtA PI = 2.411-0.011 × CRL.References ranges for the mean UtA PI Doppler and CL measurement at 11-13(+6) weeks of gestation in a Brazilian population were established.

We present a case of a 34-year-old multiparous woman who had been diagnosed with a 14 weeks' gestation showing an abdominal wall bulge possibly representing an omphalocele, containing liver and intestinal loops, at her first-trimester ultrasound scan. At 16 weeks' gestation, an amniocentesis was performed and karyotype analysis revealed a balanced Robertsonian translocation between chromosomes 13 and 14 in a female fetus (45,XX,der(13;14)(q10;q10)). Given this result and ultrasound findings, karyotype and molecular study of the couple were suggested. The results pointed out the absence of maternal contribution to the analysed regions by paternal uniparental disomy for chromosome 14 (isodisomy), which is associated with a severe phenotype. The correlation between ultrasound findings and the genetic study is primordial to guide the diagnostic assessment and to establish the prognosis of the fetal pathology., (undefined)

O objetivo deste estudo foi avaliar características endócrinas (ACTH e cortisol plasmático), metabólicas (glicogênio e lactato muscular) e indicadoras de qualidade da carne em bovinos Nelore castrados e não castrados. Foram abatidos 130 animais (78 castrados e 52 não castrados), entre os anos de 2009 e 2011. Amostras de sangue foram coletadas, in vivo e post mortem (IV e PM), para mensurações endócrinas. Para os metabólitos, foram coletadas amostras do músculo Longissimus dorsi (LD). Para as análises físico-químicas, três bifes do músculo LD (entre a 10ª e 12ª costelas) foram maturados por um, sete e 14 dias. O pH e a temperatura dos animais foram mensurados a uma e 24 horas PM. As análises estatísticas foram realizadas por meio do procedimento de modelos mistos, com auxílio do programa Statistical Analysis System. Observou-se que as concentrações de cortisol (IV e PM) e lactato muscular foram superiores (P

The subdermal etonogestrel contraceptive implant has a current approved duration of 3 years. There is, however, recent and strong evidence of its effectiveness for 2 additional years during which no pregnancies were documented., Background: The subdermal etonogestrel contraceptive implant has a current approved duration of 3 years. There is, however, recent and strong evidence of its effectiveness for 2 additional years during which no pregnancies were documented. Case: We report a case of a 28-year-old woman who had an etonogestrel implant inserted 4 years earlier and wished to get pregnant. The implant was, however, deep in the triceps muscle and could not easily be removed. Her serum levels of etonogestrel remained positive even 6 years after insertion. As infertility investigation revealed endometriosis and bilateral tubal obstruction she was referred for assisted reproduction. Despite obtaining oocytes during an ovarian stimulation cycle, the endometrium was never above 4 mm, precluding embryo transfer. It was decided to remove the implant in order to improve endometrial conditions, after which the patient achieved pregnancy. Conclusion: This case report suggests that the etonogestrel implant is effective for even longer than the most recent studies have shown., info:eu-repo/semantics/publishedVersion

Carcinosarcoma of the uterine cervix is a very rare tumour that has been described in less than 70 cases in the literature. It is less common compared with carcinosarcoma of the uterine corpus and it can have two origins: the Müllerian ducts and the mesonephric duct remnants. The association of mesonephric carcinoma with a sarcomatous component was reported in only 11 cases, including the following. We describe a case of a 64-year-old woman, presenting with vaginal bleeding and a cervical lesion reported as a sarcoma of endometrial stroma in the first biopsy. After exclusion of distant disease, she was submitted to radical surgery and the final histopathological examination showed a carcinosarcoma of the cervix with mesonephric origin.

Imperforate hymen is the most frequent cause of haematocolpos, although it is a rare malformation (1:2000). We present two cases of young girls with cyclic abdominal pain and urinary symptoms. At gynaecological examination, they all presented imperforate hymen and ultrasound revealed significant vaginal distension. X-shaped hymenectomy was performed in all patients. The later the diagnosis of imperforate hymen, the higher the risk of complications like haematometra, haematosalpinx, haemoperitoneum and infections such as tubo-ovarian abscesses, peritonitis and endometriosis (retrograde menstruation theory).

Objetivos: A disfunção sexual feminina (DSF) é altamente prevalente, situando-se entre os 40% e 70% em Portugal, e traduz-se por uma alteração em qualquer uma das fases do ciclo de resposta sexual da mulher (desejo, excitação e orgasmo) ou ainda por perturbações dolorosas associadas ao ato sexual. O presente estudo pretendeu estudar a prevalência da DSF numa amostra de mulheres em idade reprodutiva, a prevalência dos diferentes subtipos de DSF e a existência de fatores associados. Tipo de estudo: Tratou-se de um estudo observacional, transversal e analítico. Local: Unidades de Saúde Familiar (USF) Novo Cuidar, Centro de Saúde de Fafe. População: Mulheres entre os 18 e os 58 anos utentes da USF Novo Cuidar. Métodos: A uma amostra aleatória de 346 utentes foi aplicado um questionário anónimo e confidencial de autorresposta. Usaram-se os testes Qui-Quadrado ou de Fisher para comparar proporções, o Odds Ratio para determinar a força de associação entre variáveis e os testes t-Student e Mann-Whitney para testar a associação entre variáveis qualitativas e quantitativas (adotou-se um nível de significância de 0,05). Resultados: A taxa de resposta foi de 86,4% e a prevalência de DSF foi de 77,2% (IC95% 72,0-82,7), tendo a perturbação do orgasmo sido o subtipo mais prevalente, 55,8% (IC95% 51,0-63,9). Foi encontrada uma associação entre a contraceção hormonal e a perturbação do desejo (p = 0,003). A aversão sexual foi estatisticamente relacionada com experiências sexuais indesejadas prévias (p = 0,001). Conclusões: A DSF em idade reprodutiva é muito prevalente apesar de apenas metade das mulheres a considerarem um problema. Foram encontradas associações com alguns fatores que podem ter importância na vivência de uma sexualidade feliz pela mulher. Objectives: Sexual dysfunction is believed to exist in 40% to 70% of the population in Portugal. It is defined by pain or alteration of function in the phases of the sexual act. The present study was designed to estimate the prevalence of sexual dysfunction in women of reproductive age, the prevalence of the various subtypes of sexual dysfunction, and the factors associated with female sexual dysfunction. Study design: Observational, cross-sectional and analytic study. Setting: Novo Cuidar Family Health Unit, Fafe. Participants: Women aged between 18 and 58 years attending the Novo Cuidar Health Unit. Methods: An anonymous, self-administered questionnaire was given to a random sample of 346 women. The chi-squared and Fisher tests were used to compare proportions, odds ratio were computed to determine the strength of associations, and t-Student and Mann-Whitney tests were used to compare means and proportions of relevant variables. Results: The response rate was 86.4%. The prevalence of female sexual dysfunction was 77,2% (CI95% 72,0-82,7). Orgasmic disorder was the most prevalent subtype in 55,8% (CI95% 51,0-63,9). An association between hormonal contraception and low sexual desire was found (p = 0,003). Sexual aversion was statistically related with previous unwanted sexual experiences (p = 0,001). Conclusions: Female sexual dysfunction in women of reproductive age is highly prevalent, although only half of the women surveyed considered it to be a problem. Significant associations were found with factors that can influence satisfying sexuality.

A comparative study of the organic acids and phenolics composition and of the total alkaloids content of entire wild edible mushrooms (Russula cyanoxantha, Amanita rubescens, Suillus granulatus and Boletus edulis) and correspondent caps and stipes was performed. All species presented oxalic, citric, malic and fumaric acids, with A. rubescens exhibiting the highest total organic acids content. Organic acids were preferably fixed in the cap. Among phenolics, only p-hydroxybenzoic acid was found in A. rubescens and S. granulatus, in very low amounts. B. edulis was the species that presented the highest total alkaloid amounts. Except for this species, alkaloids mainly accumulated in the cap. All of the species exhibited a concentration-dependent scavenging ability against DPPH . B. edulis revealed the highest antioxidant capacity. The cap seemed to be the part with highest antioxidant potential. Some relationships between chemical composition and antioxidant capacity were considered Fundação para a Ciência e a Tecnologia for a grant (SFRH/BD/22108/2005)

Background: prolonged mechanical ventilation (MV) is synonymous with failure in ventilatory weaning. To identify the risk factors related with prolonged MV in children undergoing cardiac surgery (CS) may contribute for early intervention and a better prognosis. Objective: to identify factors associated with prolonged MV in children undergoing CS in northeastern Brazil. Method: retrospective study of childrenunder MV in the postoperative period of CS in a large hospital located in northeastern Brazil during 2012. Children with immunodeficiency, cystic fibrosis, severe neurological disease or respiratory failure were excluded. Descriptive data analysis was performed, followed by simple and multivariate Poisson regression. Results: Of 136 children undergoing MV in the postoperative period of CS, 125 had congenital heart disease. The most frequent diagnoses were interventricular communication (22.8%) and tetralogy of Fallot (19.9%). Categories 1 and 2 RACHS-1 were the most frequent, with 24.4% and 52.8% respectively. Ages ranged from two months to 17 years old (median 52 months), duration of cardiopulmonary bypass (CPB) 20-205 minutes (median 60 minutes) and duration of MV from one to 192 hours (median 5 hours). The overall mortality rate was 2.2%. Multivariate analysis showed that risk factors for prolonged MV (more than 6 hours) were higher categories RACHS-1, prolonged CPB, and the presence of respiratory complications during surgery. However, higher PaO2 showed a protective factor. Conclusion: The risk factors for prolonged MV were: higher categories RACHS-1, prolonged CPB, and the presence of respiratory complications during surgery. While higher PaO2 showed as a protective factor.

Background: ventilator-associated pneumonia (VAP) is a significant infectious complication in Intensive Care Units (ICU) related to increased mortality and hospital expenses. Bundles care has been successful for prevention of VAP, gathering a group of actions that together result in the reduction of infections and period of invasive mechanical ventilation (IMV). Objectives: to evidence the effectiveness of the bundle for prevention of VAP in the ICU of a Brazilian hospital. Methods: this study was carried out in an adult ICU with 20 beds of a general hospital in the city of Recife, northeastern Brazil, from January 2012 to December 2014. Preventive measures included the indication of IMV, oral hygiene with chlorhexidine 0.12%, the supine position (30-45°), cuff pressure between 20-30 cmH2O, prophylaxis of deep vein thrombosis and stress ulcer. The daily application involved ICU interdisciplinary team, audited by the Hospital Infection Control Service. Results: There was a considerable reduction in the incidence density (ID) of VAP, with the beginning of the preventive measures and reduction of VMI utilization rate: View this table: Table 1. Influence of adherence to bundles in reducing ID of VAP and the utilization rate of IMV in an adult ICU in northeastern Brazil, from 2012 to 2014. Conclusion: The bundle application by industry professionals may have been a favorable spot, contributing to patient safety, as they took on the role of actors of this strategy, which requires no increase in workload or costs, being accessible to all realities.

Este estudo tomou como objeto a articulação teoria-prática da disciplina Fundamentos e Práticas da Enfermagem em Saúde Coletiva, do curso de graduação em enfermagem da EEUSP, e como objetivos: identificar a apreensão dos conceitos da disciplina e verificar sua aplicação nas práticas de enfermagem entre esses estudantes de graduação. Utilizou questionário com questões fechadas e abertas para apreensão empírica do objeto, através de análise de conteúdo. Os resultados indicam que a dimensão teórica apenas em parte possibilitou sínteses capazes de fomentar práticas sociais coerentes com o arcabouço teórico-conceitual da Saúde Coletiva. Para superar essa dificuldade faz-se necessário explicitar as diferentes abordagens teórico-metodológicas que fundamentam as práticas e que o educador direcione o educando para elaboração de sínteses, com a finalidade de formar enfermeiros comprometidos com a interpretação da saúde-doença como processo social e da saúde como direito social e, portanto, com a transformação das práticas reiterativas do modelo hegemônico. This study focused on the relationship theory-practice of the discipline Fundamentals and Practices of Collective Health Nursing, offered to undergraduate students of the Nursing School, University of São Paulo, Brazil. The objectives were: to identify and understand the concepts studied in the discipline and to identify its application in nursing practices among these students Data were collected using a questionnaire and analyzed by content analysis. Results: theoretical dimension only partly allowed students to make syntheses potent to develop social practices consistent with the conceptual framework of Collective Health. To overcome this difficulty - and prepare nurses committed to the interpretation of health and disease as a social process and health as social right and, therefore, the transformation of reiterative practices of the hegemonic model -, it is necessary to clarify the different theoretical and methodological approaches underpinning the practices, having teachers directing students to articulate theory and practice. Este estudio tuvo como objeto la articulación teoría-práctica del curso Fundamentos y Prácticas de Enfermería en Salud Colectiva, para alumnos de graduación de la Escuela de Enfermería de la Universidad de Sao Paulo. Se buscó identificar la aprehensión de los conceptos del curso y evaluar su aplicación en las prácticas de enfermería. Se utilizó un cuestionario para aprehender empíricamente el objeto. Las informaciones fueron analizadas con análisis de contenido. Resultados: la dimensión teórica, apenas en parte, posibilitó una síntesis capaz de fomentar prácticas sociales coherentes con la estructura teórica-conceptual de Salud Colectiva. Para superar esa dificultad es necesario explicar los diferentes enfoques teórico-metodológicos que fundamentan las prácticas y que el educador conduzca al educando en la elaboración de síntesis. De esta manera, formar enfermeros comprometidos con la interpretación de salud-enfermedad como proceso social, con la salud como derecho social y con la transformación de las prácticas reiterativas del modelo hegemónico.