Persistent Hypothermia and Excessive Sweating Following Intrathecal Morphine Administration in a Teenage Boy: A Case Report

INTRODUCTION: Opioids are used intrathecally to manage surgical pain. There are few reports of hypothermia after spinal morphine injection, none in the pediatric population. We present a teenager's case of mild hypothermia. CASE PRESENTATION: A 15-year-old boy was scheduled for elective abdominal laparotomy. General anesthesia was combined with spinal anesthesia, using levobupivacaine and morphine. In the recovery room, he presented a decreased tympanic temperature (34.4°C) associated with excessive sweating, hyperglycemia, and complained of feeling hot. All other vital signs were normal. It was decided to maintain clinical vigilance and hourly monitoring of temperature and glycaemia values. Despite active warming, he remained hypothermic for 16 hours, with gradual remission of symptoms and normalization of glycemic values. It is unknown how intrathecal morphine causes hypothermia. The most viable hypothesis is its effect on the hypothalamus. In our case the most probable causes of post anesthesia hypothermia were excluded; therefore, we can admit that the cause of hypothermia was the spinal administration of morphine. Some reports used naloxone and lorazepam successfully. In our report, they disappeared spontaneously 16 hours later, which corroborates our diagnosis. CONCLUSIONS: Children undergoing subarachnoid block with with intrathecal morphine may develop a disruption on thermoregulation, leading to a resistant postoperative hypothermia associated with excessive sweating.info:eu-repo/semantics/publishedVersio

OS CONCEITOS DE MORTE E MORRER NA ENFERMAGEM E AS RELAÇÕES COM O ETHOS DO CUIDADO

 In this study, we analyze the influence of the concepts of death and dying of the nursing staff on the practice of care given in some areas of hospitalization. The data was produced by from a questionnaire containing open ended questions. The subjects of the investigation nurses, technicians and nurses’ auxiliaries who act in the sectors of the medical clinic, the center of intensive care and emergency in public hospitals in the city of Rio de Janeiro, Brazil. After the analysis of the data, two categories emerged: the INFLUENCE and CONFLICT of the concepts about death in the CHOICE and DYNAMICS of ethos of care and death: BEGINNING a new life and END of everything. The results point that the concepts of do not change among the nursing professionals who work in the units studied, and also it seems not to have influenced them when they chose their ethos of care giving. It draws attention that professionals in these units relate a conflict when thinking of death and facing it in their daily care.En este estudio analizamos la influencia de los conceptos de muerte y morir del equipo de Enfermería sobre las prácticas de cuidados en algunos espacios de internación hospitalaria. Los datos se produjeron a partir de la aplicación de un formulario conteniendo preguntas abiertas, siendo los sujetos de la investigación Enfermeros, Técnicos y Auxiliares de Enfermería que actúan en los sectores de Clínica Médica, Unidad de Terapia Intensiva y Emergencia de hospitales de la red pública localizados en el municipio de Rio de Janeiro. Después del análisis de los datos, emergieron dos categorías: la INFLUENCIA y el CONFLICTO de los conceptos acerca de la muerte en la ELECCIÓN y en la DINÁMICA de del ethos del cuidado, y Muerte: INICIO de una nueva vida y FIN de todo.  Los resultados apuntan que los conceptos de muerte no se alteran entre los profesionales de enfermería que actúan en esas unidades investigadas y también parece no haberles influenciado cuando eligieron sus ethos para cuidar. Llama la atención que los profesionales entrevistados relataron conflicto en el pensar la muerte y en encararla en su cotidianidad de cuidar.Neste estudo, analisamos a influência dos conceitos de morte e morrer da equipe de Enfermagem sobre as práticas de cuidar em alguns espaços de internação hospitalar. Os dados foram produzidos a partir da aplicação de um formulário contendo perguntas abertas, sendo os sujeitos da pesquisa, Enfermeiros, Técnicos e Auxiliares de Enfermagem que atuam nos setores de Clínica Médica, Unidade de Terapia Intensiva e Emergência de hospitais da rede pública localizados no município do Rio de Janeiro. Após a análise dos dados, emergiram duas categorias: A INFLUÊNCIA e o CONFLITO dos conceitos acerca da morte na ESCOLHA e na DINAMICA do ethos do cuidado; e Morte: INICIO de uma nova vida e FIM de tudo. Os resultados apontam que os conceitos de morte não se alteram entre os profissionais de enfermagem que atuam nessas unidades pesquisadas e também parece não ter os influenciado quando escolheram os seus ethos para cuidar. Chama atenção que os profissionais entrevistados relataram conflito no pensar a morte, e de encará-la em seu cotidiano de cuidar.

Use of gibberellin in floriculture

This review aimed to show the use of gibberellin in floriculture. In this context, it should be noted that the benefit of the activity of the gibberellins has brought major advances in the field of physiology. Its use is one of the most important tools for the development of agriculture. Thus, the study concluded that the use of gibberellins has been increasingly used by producers and is also a vast important subject that may help in increasing the production of flowers if the farms are dedicated to this purpose.Keywords: Regulators plants, flowers, phenotypic characteristics, postharves

Paradox of life among survivors of bladder cancer and treatments* Paradoxo da vida entre sobreviventes do câncer de bexiga e tratamentos Paradoja de la vida entre supervivientes del cáncer de vejiga y tratamientos

abstract Objective: To interpret the meanings attributed to the experience of bladder cancer among survivors in therapeutic follow-up. Method: Qualitative methodological approach, based on medical anthropology and narrative methodology. After approval by the research ethics committee of a public university hospital, data were collected from January 2014 to February 2015, by means of recorded semi-structured interviews, direct observation and field journal entries on daily immersion with a group of six men and six women, aged between 57 and 82 years, in therapeutic follow-up. Narratives were analyzed by means of inductive thematic analysis. Results: The meanings revealed difficulties with the processes of disease and treatment, such as breakdown of normal life, uncertainty about the future due to possible recurrence of the disease, difficulty with continuity of care and emotional control, relating it to conflicting ways of understanding the present life. Thus, the meaning of this narrative synthesis is paradox. Conclusion: Interpretation of the meaning of experience with bladder cancer among patients provides nurses with a comprehensive view of care, which encompasses biological, psychological and social dimensions, and thereby systematizes humanized care. descriPtOr

DESCRIPTORS: Mental Health Services. Health Manpower. Health Management. Organizational Case Studies

ABSTRACT OBJECTIVE: To analyze work organization in psychosocial healthcare services from the logic of the service management fi eld. METHODS: Organizational analysis was performed, using a case study in a psychosocial healthcare service located in the city of São Paulo, Southeastern Brazil, between 2006 and 2007. A total of fi ve sources of information were analyzed: Ministry of Health documents, research reports made in the service studied, service records, interviews with healthcare workers and managers and simple observation. Interviews dealt with objectives, results and assessment of work process. Each source was treated differently, according to its purpose. A subsequent dialogue about the results obtained aimed to make a set of observations on which the case study was founded. RESULTS: The service proposes to deliver a very intangible result, which views the user in their social context. The intended change in the user's conditions was described as "the person living better". Such condition is diffi cult to be defi ned and understood in terms of the details and limits of this change, thus hindering measurement of results. In addition, the work process involves activities which are not routinary, not predictable and sometimes simultaneous, so that the team fi nds it diffi cult to recognize and legitimize efforts made to perform work, a fact described as "work invisibility" by workers. CONCLUSIONS: The assessment process was found to be a complex aspect of this intangibility, associated with inadequacy and insuffi ciency of the municipal health system's management structure to include a service of this nature. Results enabled better understanding of a fi eld of work where workers' and users' subjectivity is inherent in the service management process

Cerebral tuberculomas in aids patients - A forgotten diagnosis?

The human immunodeficiency virus (HIV) infection epidemics increased the prevalence, multi-drug resistance and disseminated forms of tuberculosis. The central nervous system (CNS) tuberculosis has high mortality and morbidity, and it is usually divided into diffuse (meningitis) and localized (tuberculoma and abscess) forms. We report three cases of cerebral tuberculomas in AIDS patients: one with definitive diagnosis, confirmed with histopathology, and two with probable diagnosis, based on clinical information, radiological images, Mycobaterium tuberculosis isolation out of the CNS and adequate response to antituberculous treatment. Further, we discuss diagnostic, therapeutic and prognostic issues of tuberculomas, with emphasis in the distinction from cerebral tuberculous abscesses. Despite of their infrequent presentation, tuberculomas should be considered in the differential diagnosis of cerebral expansive lesions in patients with AIDS.623B79379

Niche partitioning of a pathogenic microbiome driven by chemical gradients

© 2018 The Authors, some rights reserved. Environmental microbial communities are stratified by chemical gradients that shape the structure and function of these systems. Similar chemical gradients exist in the human body, but how they influence these microbial systems is more poorly understood. Understanding these effects can be particularly important for dysbiotic shifts in microbiome structure that are often associated with disease. We show that pH and oxygen strongly partition the microbial community from a diseased human lung into two mutually exclusive communities of pathogens and anaerobes. Antimicrobial treatment disrupted this chemical partitioning, causing complex death, survival, and resistance outcomes that were highly dependent on the individual microorganism and on community stratification. These effects were mathematically modeled, enabling a predictive understanding of this complex polymicrobial system. Harnessing the power of these chemical gradients could be a drug-free method of shaping microbial communities in the human body from undesirable dysbiotic states