A importância da comunicação durante o período de recuperação pós-operatória

Este estudo teve como objetivo conhecer a importância da comunicação durante as orientações pós-operatórias fornecidas pela equipe de enfermagem a pacientes e/ou familiares de uma instituição privada e apreender a percepção destes indivíduos acerca das orientações recebidas. Foi um estudo transversal, descritivo, com abordagem qualitativa, que utilizou o referencial teórico da Comunicação Interpessoal e o referencial metodológico da Análise de Conteúdo. Participaram do estudo 16 pacientes entrevistados no período pós-operatório mediato. Os resultados evidenciaram que a equipe de enfermagem focaliza as orientações nas técnicas instrumentais da profissão, não abordando o indivíduo de forma holística. Também foi possível perceber que, quando o profissional enfermeiro permanece afastado do paciente e/ou não presta informações adequadas gera sentimentos de ansiedade, medo, insegurança e sensação de falta de cuidado. Por outro lado, quando a equipe de enfermagem se fez presente com cuidado e informações coerentes, os clientes relataram um alto nível de satisfação e a sensação de ser bem cuidado

The ethnocategory ''insect'' in the conception of the inhabitants of Tapera County, São Gonçalo dos Campos, Bahia, Brazil

This article deals with the construction of the "insect" ethnozoological dominium by the inhabitants of Tapera County, which is located in the municipality of São Gonçalo dos Campos, Bahia State. Data were obtained from March to May 2005 through open-ended interviews carried out with 23 men and 8 women, whose ages ranged from 6 to 66 years old. Interviewees were asked about how they perceived and defined the animals considered as "insects", which types they knew, and if they used them as food resource. Most of the interviews were tape-recorded, and semi-literal transcriptions are kept at the Ethnobiology Laboratoty of the Universidade Estadual de Feira de Santana. Considering the ethnozoological classification system of the inhabitants of Tapera, the term "insect" is a broad semantic category that brings together animals of different and not systematically related taxonomic groups. Apparently, these animals are culturally perceived and categorized as "insects" because they are usually considered as noxious, disgusting, and disease carrier creatures. True insects can be excluded from this ethnocategory due to the perception people have that such animals do not cause "injuries" or because they are useful. Perceptions toward these animals imply ambiguous behavior and feelings, which range from more positive attitudes (conservative) to more negative (destructive).Este artigo discute a construção do domínio etnozoológico ''inseto'' pelos moradores do povoado de Tapera, localizado no município de São Gonçalo dos Campos, estado da Bahia. Os dados foram obtidos no período de março a maio de 2005 por meio de entrevistas semi-estruturadas realizadas com 23 homens e 8 mulheres, cujas idades variaram de 6 a 66 anos. Os entrevistados foram questionados sobre como percebiam e definiam os animais considerados ''insetos'', quais os tipos que conheciam e se usavam esses animais como fonte alimentar. A maioria das entrevistas foi registrada em micro-fitas; transcrições semi-literais estão no Laboratório de Etnobiologia da Universidade Estadual de Feira de Santana. Considerando o sistema de classificação etnozoológico dos moradores de Tapera, o termo ''inseto'' é uma categoria semântica ampla que reúne animais de diferentes grupos taxonômicas não sistematicamente relacionados. Aparentemente, esses animais são culturalmente percebidos e categorizados como ''insetos'' porque geralmente são tidos como nocivos, nojentos e transmissores de doenças. Os insetos verdadeiros podem ser excluídos da etnocategoria devido à percepção que as pessoas têm de que esses animais não causam danos ou são úteis. As percepções com relação a esses animais implicam comportamento e sentimentos ambíguos que variam de atitudes mais positivas (conservadora) a atitudes mais negativas (destrutiva)

Brazilian green propolis modulates inflammation, angiogenesis and fibrogenesis in intraperitoneal implant in mice

BACKGROUND: Chronic inflammatory processes in the peritoneal cavity develop as a result of ischemia, foreign body reaction, and trauma. Brazilian green propolis, a beeswax product, has been shown to exhibit multiple actions on inflammation and tissue repair. Our aim was to investigate the effects of this natural product on the inflammatory, angiogenic, and fibrogenic components of the peritoneal fibroproliferative tissue induced by a synthetic matrix. METHODS: Chronic inflammation was induced by placing polyether-polyurethane sponge discs in the abdominal cavity of anesthetized Swiss mice. Oral administration of propolis (500/mg/kg/day) by gavage started 24 hours after injury for four days. The effect of propolis on peritoneal permeability was evaluated through fluorescein diffusion rate 4 days post implantation. The effects of propolis on the inflammatory (myeloperoxidase and n-acetyl-β-D-glucosaminidase activities and TNF-α levels), angiogenic (hemoglobin content-Hb), and fibrogenic (TGF-β1 and collagen deposition) components of the fibrovascular tissue in the implants were determined 5 days after the injury. RESULTS: Propolis was able to decrease intraperitoneal permeability. The time taken for fluorescence to peak in the systemic circulation was 20 ± 1 min in the treated group in contrast with 15 ± 1 min in the control group. In addition, the treatment was shown to down-regulate angiogenesis (Hb content) and fibrosis by decreasing TGF-β1 levels and collagen deposition in fibroproliferative tissue induced by the synthetic implants. Conversely, the treatment up-regulated inflammatory enzyme activities, TNF-α levels and gene expression of NOS2 and IFN-γ (23 and 7 fold, respectively), and of FIZZ1 and YM1 (8 and 2 fold) when compared with the untreated group. CONCLUSIONS: These observations show for the first time the effects of propolis modulating intraperitoneal inflammatory angiogenesis in mice and disclose important action mechanisms of the compound (downregulation of angiogenic components and activation of murine macrophage pathways)

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

The last dinosaurs of Brazil: The Bauru Group and its implications for the end-Cretaceous mass extinction

ABSTRACT The non-avian dinosaurs died out at the end of the Cretaceous, ~66 million years ago, after an asteroid impact. The prevailing hypothesis is that the effects of the impact suddenly killed the dinosaurs, but the poor fossil record of latest Cretaceous (Campanian-Maastrichtian) dinosaurs from outside Laurasia (and even more particularly, North America) makes it difficult to test specific extinction scenarios. Over the past few decades, a wealth of new discoveries from the Bauru Group of Brazil has revealed a unique window into the evolution of terminal Cretaceous dinosaurs from the southern continents. We review this record and demonstrate that there was a diversity of dinosaurs, of varying body sizes, diets, and ecological roles, that survived to the very end of the Cretaceous (Maastrichtian: 72-66 million years ago) in Brazil, including a core fauna of titanosaurian sauropods and abelisaurid and carcharodontosaurid theropods, along with a variety of small-to-mid-sized theropods. We argue that this pattern best fits the hypothesis that southern dinosaurs, like their northern counterparts, were still diversifying and occupying prominent roles in their ecosystems before the asteroid suddenly caused their extinction. However, this hypothesis remains to be tested with more refined paleontological and geochronological data, and we give suggestions for future work