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We describe an infant with Chikungunya virus (CHIKV) infection who developed Horner syndrome. The infant had diagnostic confirmation of CHIKV infection by IgM-ELISA positive in serum and cerebrospinal fluid, and clinical signs of Horner syndrome. Magnetic resonance angiography showed alterations in the cervical and intra cavernous portions of the internal carotid artery. To the best of our knowledge this is the first report of the association of CHIKV infection with Horner syndrome. Keywords: Chikungunya virus, Horner syndrome

OBJETIVO: Analisar o gradiente pressórico residual após cirurgia de troca valvar aórtica realizada no Hospital Universitário Clementino Fraga Filho - UFRJ. CASUÍSTICA E MÉTODOS: Estudo retrospectivo envolvendo pacientes submetidos a operação de troca valvar aórtica isolada em nosso Serviço, no período compreendido entre janeiro de 1988 e dezembro de 1998. Foram incluídos apenas os pacientes com diagnóstico de estenose aórtica isolada, que receberam prótese de tamanho 23 ou menor e que tenham sido submetidos a estudo ecocardiográfico pré e pós-operatório em nossa Instituição. Atenderam aos critérios 44 pacientes. Predominou o sexo masculino com 63,6% dos casos, a média de idade de 53,9 anos e superfície corpórea média de 1,67 m². A prótese utilizada foi biológica em 25 pacientes e mecânica em 19, sendo 8 de monofolheto e 11 de duplo folheto. Antes da operação, 12 pacientes encontravam-se em classe funcional II, 28 em classe III e 4 em classe IV. E o gradiente era em média 95,8 mmHg. RESULTADOS: Seis meses após a operação, 35 (79,5%) pacientes estavam em classe I e os demais (20,5%) em classe II. A variação de gradiente foi em média 62,9 mmHg, chegando-se ao gradiente final de 32,9 mmHg em média. A variação de gradiente não foi influenciada por sexo, idade, superfície corpórea ou tamanho da prótese. Foi, entretanto, influenciada diretamente pelo gradiente pré-operatório. O gradiente pós-operatório foi em média 24,3 mmHg para próteses de duplo folheto, 33,7 mmHg para biopróteses e 42,3 mmHg para as próteses de monofolheto. CONCLUSÃO: A variação de gradiente foi diretamente proporcional ao gradiente pré-operatório. O melhor resultado em termos de gradiente residual foi das próteses de duplo folheto, seguidas pelas biopróteses e, finalmente, pelas próteses de monofolheto. A utilização de próteses de tamanho menor que o recomendado não determinou a ocorrência de gradientes residuais mais elevados.

Objective: To analyze the association of dysglycemia with clinical, laboratory, and radiographic characteristics of patients with pulmonary tuberculosis (PTB), as well as with their tuberculosis treatment outcomes., Methods: This was a longitudinal study involving 140 patients diagnosed with PTB (positive cultures for Mycobacterium tuberculosis or positive Xpert MTB/RIF results from sputum samples). Patients were evaluated at diagnosis (M0), after completing the second month of treatment (M2), and at the end of treatment (MEND). At M0, the patients were classified into three groups: normoglycemia+PTB (NGTB); pre-diabetes mellitus+PTB (PDMTB), and diabetes mellitus+PTB (DMTB), in accordance with glycated hemoglobin levels (< 5.7%, 5.7%-6.4%, and ≥ 6.5%, respectively). Treatment outcomes were classified as favorable (cure or treatment completion) and unfavorable (death, loss to follow-up, or treatment failure)., Results: In our sample, 76 patients (61.4%) had dysglycemia, 20 of whom (14.3%) had DM at M0. The patients with dysglycemia, in comparison with those in the NGTB group, more frequently presented with positive sputum smear microscopy (94.2% vs. 75.9%; p = 0.003); cavities (80.2% vs. 63.0%; p = 0.03); bilateral lesions (67.4% vs. 46.0%; p = 0.02); and higher median of affected thirds of the lungs (3.0 vs. 2.0; p = 0.03) on chest radiography. No significant differences regarding outcomes were found among the groups, but tuberculosis lethality was higher in the DMTB group than in the PDMTB and NGTB groups (20% vs. 2.2%)., Conclusions: PTB patients with dysglycemia had laboratory and radiographic manifestations indicative of more advanced disease, and the risk of death was higher in the DMTB group. These findings reinforce the recommendation for early screening for DM in patients with newly diagnosed tuberculosis in order to reduce the risk of death during treatment.

Essential oils of aromatic plants represent an alternative to classical pest control with synthetic chemicals. They are especially promising for the alternative control of stored product pest insects. Here, we tested behavioral and electrophysiological responses of the stored product pest Tribolium confusum , to the essential oil of a Brazilian indigenous plant, Varronia globosa, collected in the Caatinga ecosystem. We analyzed the essential oil by GC-MS, tested the effects of the entire oil and its major components on the behavior of individual beetles in a four-way olfactometer, and investigated responses to these stimuli in electroantennogram recordings (EAG). We could identify 25 constituents in the essential oil of V. globosa , with anethole, caryophyllene and spathulenole as main components. The oil and its main component anethole had repellent effects already at low doses, whereas caryophyllene had only a repellent effect at a high dose. In addition, the essential oil abolished the attractive effect of the T. confusum aggregation pheromone. EAG recordings revealed dose-dependent responses to the individual components and increasing responses to the blend and even more to the entire oil. Our study reveals the potential of anethole and the essential oil of V. globosa in the management of stored product pests.

Aim: To evaluate the clinical characteristics, diagnostic approach, and treatment outcomes of tuberculosis (TB) in children living in a high-burden metropolitan area., Methods: This was a retrospective study, based on a medical chart review, involving children under 15 years old treated for TB between 2007 and 2016, in four primary health units (PHU) and three reference centers (RC) in five cities of Rio de Janeiro metropolitan area. Factors associated with TB treatment setting, microbiological diagnosis, and treatment outcomes were evaluated., Results: A total of 544 children were enrolled; 71% were treated in PHU, 36% were under 5 years old, and 72% had pulmonary TB (PTB). The HIV prevalence was 10% (31/322). Fifty-three percent had at least one microbiological test for TB, 68% of them (196/287) had TB confirmed. Among 222 children with previous TB contact, information on LTBI was available for 78 (35%), and only 17% (13/78) were treated. Extrapulmonary TB (56% vs 32%), microbiologically confirmed TB (77% vs 60%), and HIV positivity (18.5% vs 4.0%) were significantly more frequent in RC. Treatment in RC (odds ratio (OR) 3.08, 95% confidence interval (CI) 1.74-5.44) and PTB (OR 2.47, 95% CI 1.34-4.56) were independently associated with a microbiological diagnosis of TB. The treatment success rate was 85%. In the logistic regression analysis, HIV-infected children had a 2.5-fold higher risk of an unfavorable outcome (OR 2.53, 95% CI 1.0-6.38; p = 0.05)., Conclusions: Opportunities for TB prevention and early TB treatment are missed due to suboptimal close contact screening. Microbiological diagnosis of TB and drug susceptibility testing in children should be made available through more sensitive and accessible tests., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: To evaluate the effectiveness of prophylactic, non-invasive ventilation (NIV) on respiratory function in seven- to 16-year-old children in the post-operative phase of cardiac surgery., Method: A randomized, controlled trial with 50 children who had undergone cardiac surgery with median sternotomy. After extubation, patients were randomly assigned to one of two groups: control group (n=26), which received instructions regarding posture, early ambulation, and cough stimulation, and CPAP group (continuous positive airway pressure; n=24), which received the same instructions as the control group and CPAP=10 cmH20 twice daily for 30 minutes from the 1st to the 5th post-operative day (POD). As a primary outcome, lung function was evaluated before and on the 1st, 3rd, and 5th PODs with measures of respiratory rate (RR), tidal volume (TV), slow vital capacity (SVC), inspiratory capacity (IC), minute volume (MV), peak expiratory flow (PEF), and maximal inspiratory pressure (MIP). As secondary outcomes, the time of hospitalization and intensive care were recorded. A mixed, linear regression model and z-test were used to analyze respiratory function, considering p<0.05., Results: All variables, except RR and MV, showed a significant drop on the 1st POD, with gradual recovery; however, only MIP had returned to pre-operative values on the 5th POD in both groups. The RR showed a significant increase on the 1st POD, with a gradual reduction but without returning to baseline. In the intergroup analysis, significant improvement (p=0.04) was observed only in PEF in the CPAP group on the 1st DPO. The length of hospitalization and intensive care showed no significant differences., Conclusion: NIV was safe and well accepted in this group of patients, and the protocol used was effective in improving PEF on the 1st DPO in the CPAP group.

The association between caffeine consumption and various psychiatric manifestations has long been observed. The objective was to assess the behavioral profile in offspring of Swiss mice treated during pregnancy and lactation with caffeine. For this purpose, two groups (n = 6 each and BW ~ 35 g) of female mice were treated during pregnancy and lactation by: tap water and caffeine solution at a concentration of 0.3 mg/mL through oral route. The offspring obtained, by completing 70 days of life, was underwent a behavioral battery test. Statistical analysis was performed by student t test and the different significance adopted was p < 0.05. According to our results, it was not found any significant differences in tail suspension and forced swimming tests. In anxiety related responses however, the mice of caffeine group had greater number of fecal pellets (178 %, p = 0.001) in the open field test, higher number of attempts (51 %, p = 0.03) in light-dark box and decreased percentage of entries in open arms (41 %, p = 0.01) in elevated plus maze test. Moreover, in the marble burying test, there was a significant decrease in the number of buried marbles compared with controls (110 %, p = 0,002). In the meantime, in the von Frey test, it was observed an exacerbation of mechanical allodynia both in basal conditions and after the carrageenan administration (p < 0.001). Furthermore, caffeine treatment during pregnancy and lactation causes long-term behavioral changes in the mice offspring that manifest later in life.

Purpose: To explore the accuracy of preoperative endometrial sampling diagnosis for predicting the final pathology grading in endometrial cancer., Methods: A cross-sectional study was carried out on patients who underwent surgical treatment for clinically early-stage endometrioid carcinoma of uterus at our Centers from March, 1991 to June, 2012. The agreement levels for the histological grading between the preoperative endometrial sampling diagnosis and the final surgical pathology were analyzed by the Kappa (κ) statistics with 95% confidence intervals (CI). The statistical analyses were also based on frequency data and diagnostic agreement of the procedures., Results: We retrospectively selected 79 patients that fit the criteria of this analysis. The overall level of agreement between preoperative and postoperative grading was "fair" according to Kappa (κ) statistics (κ = 0.221; 95%CI = 0.389-0.053; p = 0.01). Accordingly, the overall concordance was 48/79 (60.75%)-39/58 (67.24%) for G1, 7/16 (43.75%) for G2, and 2/5 (40%) for G3 tumors. The preoperative grade 1 diagnosis was upgraded to grade 2 (n = 6) or 3 (n = 1) in 15.2% of patients after hysterectomy. Sensitivity, specificity, NPV, PPV, and accuracy of preoperative endometrial sampling diagnosis to predict grade 1 at the final surgical pathology was 67.2%, 66.7%, 42.4%, 84.8% and 67.1%, respectively., Conclusions: Preoperative endometrial sampling was found to be only a modest overall predictor of postoperative histological grading. A selective staging policy based on predictive models to avoid lymph node dissections in endometrial cancer should take into account additional parameters., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: to analyze the support for learning, in the perspective of patient safety, offered in the work environment, according to health professionals working in primary care., Method: a transversal study, held with 86 health professionals working in primary care. A validated instrument was used, applied via the Internet. Descriptive statistical analysis was undertaken with a presentation of median, mean, standard deviation and coefficient of variation., Results: points which are favorable to supporting learning were evidenced, such as mutual respect, autonomy for organizing the work and valorization of new ideas, which obtained means above 7.0. The variables which hinder the process of learning in the work environment, perceived by the professionals, were: resistance to changes, and excess of work impeding reflection on how to improve the work, with means above 6.0., Conclusion: the study found evidence of indicators related to the process of staff development in the area of health and indicates the influence of support for learning for the improvement of the work processes and of patient safety. It is necessary that a culture involving the systematic assessment of educational interventions in health should be established, the aim being to diagnose actions which are more incisive for changing health professionals' attitude and, therefore, clinical practice.

Selenium is a micronutrient which is part of selenoprotein molecules and participates in a vast number of physiological roles and, among them,we have fetal and neonatal development. Therefore, the aimof this studywas to evaluate possible behavioral changes in offspring of female rats supplemented during pregnancy and lactation with sodium selenite. To address that, we treated two groups of female rats by saline or sodium selenite at a dose of 1mg/kg through oral route and performed neurochemical and behavioral tests. In the offspring, the thyroid profile and hippocampal neurochemistrywere evaluated. Behavioral testswere performed in pups both during childhood and adulthood. We found out that selenium (Se) supplementation increased serum levels of triiodothyronine (25%, p b 0.001) and thyroxine (18%, p b 0.05) and promoted a tryptophan hydroxylase 2 (TPH 2) expression decrease (17%, p b 0.01) and tyrosine hydroxylase (TH) expression increase (202%, p b 0.01) in the hippocampus. The cholinesterase activity was decreased (28%, p b 0.01) in Se supplemented rats, suggesting a neurochemical modulation in the hippocampal activity. During childhood, the Sesupplemented offspring had a reduction in anxiety-like behavior both in elevated plus maze test and in light–dark box test. In adulthood, Se-treated pups had an increase in the locomotor activity (36%, p b 0.05) and in rearing episodes (77%, p b 0.001) in the open field test, while in the elevated plus maze test they also exhibited an increase in the time spent in the open arms (243%, p b 0.01). For the object recognition test, Se-treated offspring showed increase in the absolute (230.16%, p b 0.05) and relative index discrimination (234%, p b 0.05). These results demonstrate that maternal supplementation by sodium selenite promoted psychobiological changes both during childhood and adulthood. Therefore, the behavioral profile observed possibly can be explained by neurochemical changes induced by thyroid hormones during the critical period of the central nervous system ontogeny.

Objective: the main aim of this study was to describe the authors' experience with the surgical treatment of endometrial cancer without systematic lymphadenectomy., Methods: a retrospective cohort study was carried out on a subset of patients suffering of clinically early-stage endometrial carcinoma who underwent hysterectomy and salpingo-oophorectomy without systematic (radical) lymph nodes dissection at our centers from June, 2002, to November, 2011. Descriptive statistics were explored as medians (interquartile range) or frequencies (percentages), as appropriated, and the Kaplan-Meier method was applied for survival estimation., Results: eighty-three patients who underwent surgical treatment with no lymph node dissection (n = 20; 24.1%) or with only a sampling procedure (n=63; 75.98%) were selected for analysis. Among these patients, 27 (32.53%) underwent surgery alone and 56 (67.46%) received some adjuvant treatment. Postoperative complications occurred in five patients (6.02%). Over a median follow-up of 27.4 months (Q25 = 13.7 - Q75 = 46.5), 15 (18.07%) patients suffered from relapses and 11 deaths occurred as result of disease recurrence. Cumulative 1, 2 and 3-year disease- free survivals were 97.32, 91.18 and 78.02%, respectively., Conclusion: on a case-by-case basis, the surgical treatment of clinically early-stage endometrial carcinoma without systematic lymphadenectomy did not seem to decrease survival outcomes and presented low rates of surgical morbidity in our experience, but was also related to a high rate use of adjuvant therapy.

Objectives: assess the quality of nursing care, the patients' satisfaction and the correlation between both., Method: cross-sectional study, involving 275 patients hospitalized at a teaching hospital in the Central-West of Brazil. The data were collected through the simultaneous application of three instruments. Next, they were included in an electronic database and analyzed in function of the positivity, median value and Spearman's correlation coefficients., Results: among the nursing care assessed, only two were considered safe--hygiene and physical comfort; nutrition and hydration--while the remainder were classified as poor. Nevertheless, the patients were satisfied with the care received in the domains assessed: technical-professional, confidence and educational. This can be justified by the weak to moderate correlation that was observed among these variables., Conclusion: Despite the quality deficit, the patients' satisfaction level with the nursing care received was high. These results indicate that the institution needs to center its objectives on a continuing evaluation system of the care quality, aiming to attend to the patients' expectations.

The aim of this study was to estimate the prevalence and factors associated with the occurrence of incidents related to medication, registered in the medical records of patients admitted to a Surgical Clinic, in 2010. This is a cross-sectional study, conducted at a university hospital, with a sample of 735 hospitalizations. Was performed the categorization of types of incidents, multivariate analysis of regression logistic and calculated the prevalence. The prevalence of drug-related incidents was estimated at 48.0% and were identified, as factors related to the occurrence of these incidents: length of hospitalization more than four days, prescribed three or more medications per day and realization of surgery intervention. It is expected to have contributed for the professionals and area managers can identify risky situations and rethink their actions.

Objective: To explore how important is the number of pelvic lymph nodes dissected for the nodal staging in FIGO IA2-IB2 cervical cancer, submitted to radical surgical treatment., Methods: A cross-sectional study was carried out on patients who underwent Piver class II radical hysterectomy and pelvic lymphadenectomy, in two centers in the state of Pernambuco, from January, 2001 to December, 2008. The analysis of the area under the ROC curve was adopted as a summary-measure of discriminatory power of the number of nodes dissected in predicting the pelvic nodal status. Additionally, we also confirm our findings using logistic regression and the Fisher's exact test., Results: The postoperative pathological study included 662 pelvic lymph nodes dissected (median per-patient=9, q25=6 - q75=13) from 69 patients. The ROC curve analysis revealed AUC=0.642, for the discriminatory value of the number of nodes dissected in predicting the pelvic nodal status. Similar findings were found after categorization using 10 and 15 lymph nodes as cut-offs (AUC=0.605 and 0.526, respectively). Logistic regression revealed odds ratio of 0.912 (95%CI=0.805-1.032; p=0.125) for the predictive value of the number of nodes dissected, and a number of nodes ≥10 or ≥15 lymph nodes was not significantly associated with the nodal status by the Fischer's exact test (p=0.224 and p=0.699, respectively)., Conclusion: The number of pelvic lymph nodes dissected did not correlate with pelvic lymph node metastatic involvement. This study suggests that dissection of a greater number of lymph nodes does not increase locoregional nodal staging in cervical cancer.

The effectiveness of health services can be evaluated from the quality of life (QOL) standpoint. Thus, this study evaluated rehabilitation services using full conventional dentures (FCD) of Specialized Dental Care Centers (SDCC) in Rio Grande do Norte (RN) regarding daily difficulties associated with these dentures made between 2007 and 2009. A cross-sectional study was conducted with 138 users of these FCD, collecting data by clinical examination and a questionnaire based on the Oral Impacts on Daily Performances index. The Fisher and chi-square tests were used to test the association between the variables. The result was that 42% of users reported difficulties in executing oral activities due to FCDs. These difficulties were more frequent and intense in the activities of eating, speaking and smiling. In general, 58.7% of users did not have functional teeth. In relation to the clinical evaluation of FCDs, 57.2% of upper and 9.2% of lower FCDs were satisfactory. There was an association between difficulty and the absence of functional teeth, but not with inadequate FCDs. Thus, the SDCCs were effective in upper FCD rehabilitation, since the difficulties encountered are within the standard limitations of this type of rehabilitation. On the other hand, the cost-benefit of rehabilitation of lower FCDs must be evaluated.

The study aimed to identify the advantages and constraints in the practices of nurses in Mental Health services. A qualitative descriptive study, was conducted in 22 public mental health services in the state of Goiás, involving 21 nurses as subjects. The evaluation referential of Avedis Donabedian was used for data discussion. Regarding the facilitating aspects, it were cited the availability of physical resources, furniture and materials for the workshops, professional and interpersonal relationships with staff, and coordination with users. Among the constraining aspects also predominated the structure that is offered by the services. It was evident that the structure and interpersonal relations have been conditioning aspects related to the effectiveness of nurses' practice in mental health services within the state of Goiás.

This cross-sectional and quantitative study analyzed the knowledge of nursing professionals regarding Adverse Events (AE) in a hemodialysis unit of a teaching hospital. Data collection was performed between February and April 2011, based on interviews with 25 professionals. Data analysis identified 517 reports of 32 types of adverse events, of which the most commonly cited were: obstructed catheter, accidental withdrawal of the needle; and clotting of the extracorporeal system. Patient-related causes were mentioned in 42.8% of the reports. The main measures adopted were the implementation/ change of protocols and continuing education; the latter is the main suggestion for prevention. The results can contribute to a critical analysis of the quality of care in hemodialysis units, resulting in the development of interventions that help promote patient safety.

The objective of this descriptive, cross-sectional study was to analyze the driving and hindering forces for team work at a Material and Sterilization Center (MSC) of a teaching hospital, through an approximation of Kurt Lewin's Field Theory,in Goiânia, Goiás. Participants were 35 professionals, who answered a self-administered questionnaire based on the referred theory, which establishes that group situations are permeated by forces that have a positive or negative influence on the individuals' movements, and concern the subjects' involvement (I), the groups interaction (Other) and the working environment (Evnironment). The data were submitted to content analysis, and distributed in the predefined dimensions. Results consolidated 1990 registers, with most (59.3%) being categorized as driving forces, mostly in the I dimension. It was observed there was balance between forces in the Other and Environment dimensions. Outlining the force field permitted an objective, concrete view of the strengths and weaknesses of the studied team, and the possibilities to promote changes.

Background: The main aim of this study was describe the author's experience with class II radical hysterectomy and pelvic lymphadenectomy to treat stage I-IIA cervix cancer and reexamine some prognostic factors associated with disease recurrence and patient survival in this data from northeast Brazil., Methods: A cross-sectional study was carried out on patients treated at our Centers from January 2001 to December 2008. Statistical analyses were performed using conventional methods., Results: Eighty-eight patients were selected to analysis. Over the 7.3-year follow-up, 80 (91%) patients were alive and 8 (9%) disease recurrences were observed. Overall 1-, 2-, and 5-year patients survival was 96.5%, 95.3%, and 84%, respectively. Recurrence was associated to tumor size ≥1 cm (P = 0.021) and compromised vaginal margin (P = 0.020). Lower survivals were associated to tumor size ≥1 cm (P = 0.038), compromised vaginal margin (P < 0.001), and lymph node metastasis (P = 0.024). Postoperative complications (n = 11) included wound infection (5.7%), partial wound dehiscence (3.4%), and bladder atony (3.4%)., Conclusions: Class II radical hysterectomy has provided appropriated disease control of cervix cancer with low morbidity in our experience. Furthermore, tumor size and compromised vaginal margin were significantly associated to recurrence. These factors and lymph node metastasis were also associated to lower 5-year survival according to our analysis., (Copyright © 2011 Wiley-Liss, Inc.)

Introduction: Tracheostomy is probably the most common surgical procedure in critically ill patients and is generally performed to facilitate mechanical ventilation weaning. Evidence-based guidelines have confirmed the benefits of tracheostomy weaning protocols and of the physiotherapists engagement in this process; however, no consensus decannulation criteria are currently available. Therefore, this study aimed to evaluate the influence of peripheral muscle strength and other indicators on decannulation success., Methods: This was an observational retrospective study that analyzed the medical records of patients admitted to the medical and surgical intensive care unit of Hospital Agamenon Magalhães between March 2007 and August 2009. Respiratory and peripheral muscle strengths were evaluated in decannulated patients., Results: Overall, 1,541 patients were evaluated, 143 of which had been tracheostomized, and only 57 of which had been decannulated. Forty-six patients had a satisfactory decannulation outcome, while 11 had decannulation failure, requiring the return to an artificial airway within 2 weeks. The calculated Medical Research Council peripheral muscle strength score was significantly lower for the failure group than for the successful decannulation group (28.33 ± 15.31 vs. 41.11 ± 11.52; P = 0.04). Scores above or equal 26 had 94.4% sensitivity and 50.0% specificity for the decannulation outcome, with an area under the ROC curve of 0.7593. In addition, white blood cell counts were higher in decannulation failure group patients (14,070 ± 3,073 vs. 10,520 ± 3,402 cells/μL; P = 0.00)., Conclusion: This study has shown that peripheral muscle strength and blood leucocyte counts evaluated on the day of decannulation may influence the tracheostomy decannulation success rate.

Traditional retinal projections target three functionally complementary systems in the brain of mammals: the primary visual system, the visuomotor integration systems and the circadian timing system. In recent years, studies in several animals have been conducted to investigate the retinal projections to these three systems, despite some evidence of additional targets. The aim of this study was to disclose a previously unknown connection between the retina and the parabrachial complex of the common marmoset, by means of the intraocular injection of cholera toxin subunit b. A few labeled retinal fibers/terminals that are detected in the medial parabrachial portion of the marmoset brain show clear varicosities, suggesting terminal fields. Although the possible role of these projections remains unknown, they may provide a modulation of the cholinergic parabrachial neurons which project to the thalamic dorsal lateral geniculate nucleus.

The object of this study was to characterize the process of insertion in the Centros de Material e Esterilização - Center of Material and Sterilization (CME) of workers who have no specific formation in the area of Nursing. Seventy-five workers of two public hospitals took part in the study. After the observation of the legal ethical aspects, data was obtained through a questionnaire previously validated and tested. The study found 15 workers without specific formation, who came from different intra- and extra-hospital services. They had not been submitted to selection processes nor to training, and had learned the work routine with co-workers. This is worrisome, considering the worker's occupational risk, the risks this situation represents for the quality of the reprocessing of hospital items and the conformity to the legislation that governs professional practice.

The comprehension of the real meaning of team is fundamental, and even necessary for a good and efficient quality in healthcare with, requiring collective involvement of the nursing team. The present article aims to identify and to analyze the national scientific production in Nursing area about team work over the period from 1992 to 2002. It is a literature review proceeded using seven nursing journals. Twenty-four articles concerning the subject were identified and analyzed, with major occurrence in the year of 1997. In the remaining years production is linear and less expressive regarding to publication by year. The issue most emphazised by authors as an estrategic tool and essential in team interaction, was communication.

Nowadays, myths and superstitions are present in spite of scientific and technological developments, especially when trying to solve problems that escape human understanding. This study was aimed at determining the existence of superstitions and myths in the university community, investigating their origins, influences, adoption and credibility, correlating them with people's level of knowledge. It is a descriptive/analytical research conducted at Teaching Units in the Area of Health of the Federal University of Goiás. The technique of content analysis was utilized for data analysis. Two categories have been created: Personal Attitudes related to Superstitions and Influences and Destruction of Superstitions. It was found out that there is a clash between popular and scientific knowledge, either leading to the exclusion of popular wisdom, to its 'veiled' maintenance, or even to an alliance between the two types of knowledge.

This article is aimed at presenting endomarketing as a tool for nurses in the management process, taking into account the current context of changes in the healthcare sector, which also requires the development of skills that are directly related to the introduction of new technologies and ways of work organization. Our reflection leaves some important points to be analyzed by nurses and educators in the search for better ways and alternatives for educating nurses who will have greater professional satisfaction and competence to manage the healthcare services. The big challenge of endomarketing is, therefore, to combine the aims and interests of the internal public with the needs and expectations of the external public in the organization.

This article presents reflections about the necessity to include the development of interpersonal competence in the process of the nurse manager formation. It points up a trend of contemporary management and the importance of the construction of interpersonal relationships as base for the actions of a manager. The inclusion of interpersonal competence in this way can influence in the transformation of the nurse manager practice and in the formation of a leader who can evaluate and measure the problems in a global way and perform her/his role with security and transparency.

Development occurs in a proper rhythm as result of genetic inheritance and environment factors. This study had the aim to identify some environmental risk factors for the motor development in two groups of healthy children. 100 pre-school aged (five years children) from two day-care centers and a private school were evaluated, in Recife-PE. All the children underwent to a motor skills assessment and their parents answered a questionnaire. The children from the public nursery remained behind in fine motor skills. The results showed that the biologically healthy children development can suffer negative influence of the environmental risk factors. In this research these factors were: the father absence, improper toys use to the correct age, the place were the child was kept in the early childhood, the lack of pedagogical guidance and extra-parental socialization and low familiar socioeconomic status.

Purpose: Gold standard treatment for invasive penile carcinoma remains amputation and lymphadenectomy. This procedure has high morbidity and new prognostic factors on the incidence of metastasis would help select candidates to lymphadenectomy. Mutations in the p53 gene common in several neoplasms can be related to the prognosis. We studied 82 patients with penile carcinoma staged according to the 1978 TNM system who underwent amputation and bilateral lymphadenectomy to evaluate the prognostic value of immunohistochemical p53 staining in the primary tumor., Materials and Methods: Immunoreactivity of p53 was studied with other clinicopathological variables, including patient age, stage, histological grade, tumor thickness, lymphatic and venous embolization, corpora cavernosa, corpus spongiosum and urethral infiltration, and human papillomavirus (HPV) status. We also determined its association with lymph node metastasis, the survival rate and the risk of death. In addition, we studied the association of p53 and HPV DNA with prognosis. All slides were reviewed by 1 pathologist. HPV DNA was detected by polymerase chain reaction using GP5/6+ generic primers. p53 expression was measured by immunohistochemical testing with monoclonal Clone DO-7 mouse anti-human p53 protein antibody (Dako A/S, Glostrup, Denmark). The Cox regression hazards method was used for multifactorial analysis., Results: Nuclear accumulation of p53 was detected in 34 of 82 samples (41.5%). Clinical lymph node N stage (p = 0.045), lymphatic (p <0.001) and venous (p = 0.04) embolization by neoplastic cells, p53 positivity (p = 0.012) and p53 grade (p = 0.004) were significantly associated with lymph node metastasis. Followup was 0.1 to 453 months (mean 88.7). Multivariate analysis revealed that only lymphatic embolization (relative risk 9.4, 95% confidence interval [CI] 2.8 to 31.6) and p53 positivity (relative risk 4.8, 95% CI 1.6 to 14.9) were independent factors for lymph node metastasis. Patients with negative p53 had significantly better 5 and 10-year overall survival than those in whom tumors stained positive for p53 (64.5% and 54.6% versus 30.2% and 26.4%, respectively, p = 0.009). When tumors were p53 positive and HPV DNA positive, overall survival was worse. Multivariate analysis revealed that only age (relative risk 2.9, 95% CI 1.6 to 5.1) and lymph node metastasis (relative risk 3.2, 95% CI 1.8 to 5.8) were independent risk factors for death., Conclusions: Immunoreactivity of p53 is an independent factor for lymph node metastasis. The association of positive p53 with positive HPV DNA was related to a worse prognosis.

Background: Many studies have tried to identify prognostic factors to guide the selection of patients at high risk for metastases in penile carcinoma. The authors evaluated human papillomavirus (HPV) status with respect to clinical features, incidence of metastases, and prognosis of penile carcinoma., Methods: Human papillomavirus DNA was detected using the polymerase chain reaction on paraffin embedded material from 82 patients with penile carcinoma. The following variables were recorded: age, marital status, clinical staging, tumor surgery extension, histologic grade, tumor thickness, lymphatic and venous embolization, corpora cavernosa and corpus spongiosum infiltration, urethral infiltration, mononuclear and eosinophilic infiltrate, and lymph node spread. Follow-up ranged from 0.1 to 453 months., Results: Human papillomavirus DNA was detected in 30.5% (25 of 82) of samples. HPV-16 was the most frequent type detected (13 of 25, 52%). Human papillomavirus DNA positive tumors had less lymphatic embolization by neoplastic cells than HPV negative ones (P = 0.007). The logistic regression revealed that only lymphatic embolization was related to HPV status. There was no difference, however, between HPV DNA negative and HPV DNA positive patients according to presence of lymph node metastases (P = 0.386). No difference was found in the 10-year survival rate (68.4% vs. 69.1%; P = 0.830) between the two groups., Conclusions: These data suggest that HPV status does not influence prognosis in invasive penile carcinoma., (Copyright 2001 American Cancer Society.)

Squamous cell carcinoma (SCC) accounts for 95% of penile malignant neoplasms. A subtype of SCC, named warty carcinoma (WC), is a morphologically distinct verruciform tumor with features of human papillomavirus (HPV)-related lesions. Descriptions of the behavior and histologic features of this tumor are scarce in the literature. The aim of this report is to analyze the clinicopathologic features and HPV deoxyribonucleic acid status in 60 SCCs and 11 WCs. The mean patient age was 46.5 +/- 15.9 years for WC and 52.6 +/- 12.4 years for SCC. No significant differences in age (p = 0.154) and clinical staging (T, p = 0.649; N, p = 0.497) between the two groups of tumors were found. When compared with SCCs, WCs exhibited less lymphatic embolization (p = 0.001), nodal metastasis (p = 0.019), and corpora cavernosa and corpus spongiosum infiltration (p = 0.040). Lymph node metastases were found in 34 of 60 SCC patients (56.7%) and in two of 11 WC patients (18.2%). No patients with WC tumors died of the disease compared with 19 of 60 (5-year specific survival, 66.0%) in the SCC group (p = 0.032). HPV deoxyribonucleic acid was more likely to be associated with WC (five of 11, 45.5%) than SCC (16 of 60, 26.7%), although significance was not reached (p = 0.209). The results suggest that WC is less aggressive and confers a better prognosis than typical SCC of the penis.

Objective: To evaluate survival in patients with metastatic iliac nodal involvement from carcinoma of the penis., Patients and Methods: Thirteen patients with metastases to the iliac nodes were selected from 68 with squamous cell carcinoma of the penis who had undergone amputation and bilateral ilio-inguinal lymphadenectomy. The 1978 Tumour-Nodes-Metastasis system was used for staging. Deep and superficial lymph nodes were removed during the inguinal procedure. Lymph nodes below the common iliac artery (external and obturator) were removed and histologically evaluated for the presence of metastases., Results: The mean (median, range) follow-up was 55.5 (8. 8, 0.3-235) months, at the end of which five patients were free of cancer, seven had died from cancer or treatment-related complications and one was lost to follow-up. Four of the five survivors had metastases to only one iliac lymph node., Conclusion: Ilio-inguinal lymphadenectomy may have a significant role in increasing the survival of patients with metastases to only one iliac lymph node.

This study was done to evaluate nurses postures and gestures when patient and family orientation was being done in an Intensive Care Unit. Data were colected using filming of nurse, patient and family interaction. Gestures were classified as by Ekman and Friesen. It was seen predominance of ilustrative gestures, wich was positive, as those types of gestures reinforce the object of the nurse talk and enhance comprehension by families.

A complete inactivation is observed after a 3 min pre-incubation at 70 degrees C with mitochondrial F0F1-ATPase complex depleted of the ATPase natural inhibitor protein (ammonium-Sephadex submitochondrial particles) and activated MgATP-submitochondrial particles (particles that after a 4 h-pre-incubation at 42 degrees C released the endogenous inhibitor protein). However, latent MgATP-submitochondrial particles (particles containing the inhibitor protein) pre-incubated under the same conditions are totally inactivated only after 15 min of pre-incubation. When ammonium-Sephadex particles are reconstituted with 20 micrograms/ml of purified ATPase inhibitor protein there is an increase of 15-fold in the half-time for thermal inactivation (t0.5), showing that the inhibitor protein protects the mitochondrial F0F1-ATPase complex against thermal inactivation.

This study was done in a Sao Paulo city hospital with 54 nurses who required for dismissal from January, 1995 to January, 1996. All of them at the dismissal interview provided information on how long they had worked for the hospital, reasons for leaving and their frank opinions about the hospital itself, nurse department directors and personal suggestions. The study goal was to evaluate the reasons for high turnover of institutions nurses in order to draw adequate administrative intervention strategies. An exploratory study of retrospective character with data quantitative qualitative analysis has been used. Data analysis considered that 74% of the nurses had left the institution in 12 months but 35.3% until the third month. The nurses emphasized work conditions specially the staff, benefits and interpersonal communication. The results came towards our perception on the institution nurses turnover causes.

The nursing activities--diagnosis, intervention and client outcome-have several synonyms, different meanings and antagonistic frame-works. Although the study results can be considered as potential barriers to the Classification for Nursing Practice project in Brazil, or anywhere else, they also indicate a high number of references related to this theme, leading us to conclude that there is motivation for defining and classifying nursing phenomena.