CUIDADOS DE ENFERMERIA A UNA PACIENTE CON SINDROME DE MIRIZZI

La enfermedad de v\ueda biliar es una de las patolog\uedas m\ue1s frecuentes en el servicio de Cirug\ueda. El S\uedndrome de Mirizzi es una de las complicaciones poco frecuente de estas patolog\uedas, m\ue1s frecuente en pa\uedses en v\uedas de desarrollo, alcanzando en Latinoam\ue9rica entre el 4,7 y 5,7 % de los casos. La presente investigaci\uf3n tiene como objetivo identificar dominios y clases afectadas a un paciente con S\uedndrome de Mirizzi. Estudio de caso en paciente femenina de 45 a\uf1os de edad con antecedentes de ictericia obstructiva secundaria a coledocolitiasis que hab\ueda precisado colocaci\uf3n de pr\uf3tesis pl\ue1stica mediante colangiopancreatograf\ueda retr\uf3grada endosc\uf3pica(CPRE) para asegurar drenaje de la v\ueda biliar, ante la imposibilidad de su extracci\uf3n mediante arrastres con bal\uf3n de Fogarty. Se objetiv\uf3 tambi\ue9n litiasis en conducto c\uedstico que inicialmente no condicionaba obstrucci\uf3n de la v\ueda biliar principal, en una instituci\uf3n de salud del sector p\ufablico de Barquisimeto, Lara, Venezuela. Se administraron los cuidados de enfermer\ueda a trav\ue9s del proceso enfermero, realizando la valoraci\uf3n de enfermer\ueda con la Taxonom\ueda II de Diagn\uf3sticos de enfermer\ueda, se describen los dominios y clases afectadas en el periodo postoperatorio, implement\ue1ndose el plan de cuidados de enfermer\ueda con las interrelaciones diagn\uf3sticos, intervenciones y resultados. Resultados: Despu\ue9s de administrar los cuidados de enfermer\ueda a trav\ue9s del Proceso de Enfermer\ueda durante la estad\ueda hospitalaria de la paciente, evolucion\uf3 favorablemente Conclusiones: Al finalizar la investigaci\uf3n del caso, se observ\uf3 la importancia de llevar a cabo el plan de cuidados de enfermer\ueda con las respectivas interrelaciones para brindar atenci\uf3n de calidad. Palabras clave: S\uedndrome de Mirizzi, Proceso Enfermero, NANDA, NIC-NOC. ABSTRACT Bile duct disease is one of the most common pathologies in the Surgery Department. Mirizzi Syndrome is one of the uncommon complications of these pathologies. It is more frequent in developing countries, reaching in Latin America between 4.7% and 5.7% of the cases. The present investigation aims to identify domains and affected classes to a patient with Mirizzi Syndrome. Case study in a 45-year-old female patient with a history of obstructive secondary jaundice to choledocholithiasis who had required placement of a plastic prosthesis using endoscopic retrograde cholangiopancreatography (ERCP) to ensure drainage of the biliary tract, due to the impossibility of extracting it through trawls with Fogarty's ball. Lithiasis in cystic duct that initially did not condition obstruction of the main biliary tract was also observed in a public health institution in the city of Barquisimeto, Lara State, Venezuela. Nursing care was administered through the nursing process. Nursing assessment was performed with the Nursing Diagnostics Taxonomy II. The domains and affected classes were described in the postoperative period; the nursing care plan was implemented with the diagnostic interrelationships, interventions and results. Results: The patient progressed unfavorably, dying after 60 days due to complications. Conclusions: At the end of the investigation of the case, it was observed the importance of carrying out the nursing care plan with the respective interrelations to provide quality care. Key words: Mirizzi Syndrome, Nurse Process, Nanda, Nic and Noc.<br

Expressão espacial do agronegócio da cana-de-açúcar.

O posicionamento dos empreendimentos industriais e sua caracterização é base para realização de análises que consideram aspectos logísticos e economias regionais. Custos de transação e produção, com arranjos privados que dependem e sofrem interferência da ação estatal, exigem a adequação de elementos em bases espaciais que considerem aspectos como infraestrutura de transportes e logística, oferta de recursos hídricos, aptidão climática, uso e qualidade dos solos. Com o propósito de melhorar essas informações, neste trabalho são apresentados resultados de um esforço de mapeamento das usinas

Sistema de informação para o agronegócio da cana-de-açúcar.

RESUMO: Este trabalho apresenta esforços de organização de informações e de melhoria de ferramentas de difusão pela Embrapa Informática Agropecuária, com foco no sistema agroindustrial da cana-de-açúcar. Apresenta-se a implementação de uma ferramenta WebGIS e os resultados de espacialização e organização das informações sobre empreendimentos do agronegócio. A iniciativa mostra-se promissora para adoção pela Embrapa como referência para análise do agronegócio e difusão de informações.SBIAgro 2011

Immunohistochemical Expression of TLR-4 in Temporomandibular Joint Dysfunction

Objective Toll-like receptor 4 (TLR-4) is a transmembrane protein involved in the innate immune system and has been implicated in the pathogenesis of temporomandibular joint dysfunction (TMD). The purpose of this study was to histologically examine the level of expression of TLR-4 relative to severity of TMD. Methods Thirty-one human TMJ disc samples were immunostained for TLR-4 and evaluated for intensity of stain. Among the samples, 8 were control samples, 16 were from patients with anterior disc displacement with reduction (ADDwR), and 7 were from patients with anterior disc displacement without reduction (ADDwoR). Results There was no statistically significant difference in intensity of stain between groupings (p = 0.673). Conclusions The results indicate a negative correlation between TMD and the expression of TLR-4

Small bowel evisceration in a perforated uterine prolapse

The evisceration of the bowel through the vaginal vault is an extremely rare condition and a surgical emergency with a high-reported mortality rate. Vaginal evisceration most commonly affects menopausal women with a hysterectomy or those with previous vaginal surgery. The most common risk factors include the triad of post-menopausal atrophy, previous vaginal surgery and enterocele. Estrogen deficiency in post-menopausal women leads to weaker pelvic support structures and a thin, atrophic vagina, making it more prone to rupture. Previous vaginal surgery leaves scar tissue with diminished vascularity in the vaginal wall and apex, predisposing it to dehiscence. Post hysterectomy, the axis of the vagina may be changed, making it more vertical or shortened and resulting in the vagina losing its valve-like mechanism. We present a 70-year-old female brought to the emergency department with a vaginal prolapse complicated by bowel evisceration, without any history of vaginal surgery, hysterectomy or trauma. The bowel was inspected and irrigated copiously, then reduced into the abdominal cavity as it was still viable. A total vaginal hysterectomy with an anterior and posterior colporrhaphy was done. The patient had a successful recovery with no complication. We present this case due to its rarity, the absence of previous vaginal surgery, trauma, or hysterectomy and the successful multidisciplinary surgical approach with total recovery

Influence of primary particle density in the morphology of agglomerates

Agglomeration processes occur in many different realms of science such as colloid and aerosol formation or formation of bacterial colonies. We study the influence of primary particle density in agglomerate structure using diffusion-controlled Monte Carlo simulations with realistic space scales through different regimes (DLA and DLCA). The equivalence of Monte Carlo time steps to real time scales is given by Hirsch's hydrodynamical theory of Brownian motion. Agglomerate behavior at different time stages of the simulations suggests that three indices (fractal exponent, coordination number and eccentricity index) characterize agglomerate geometry. Using these indices, we have found that the initial density of primary particles greatly influences the final structure of the agglomerate as observed in recent experimental works.Comment: 11 pages, 13 figures, PRE, to appea

Production of microalgal external organic matter in a Chlorella-dominated culture: influence of temperature and stress factors

Although microalgae are recognised to release external organic matter (EOM), little is known about this phenomenon in microalgae cultivation systems, especially on a large scale. A study on the effect of microalgae-stressing factors such as temperature, nutrient limitation and ammonium oxidising bacteria (AOB) competition in EOM production by microalgae was carried out. The results showed non-statistically significant differences in EOM production at constant temperatures of 25, 30 and 35 °C. However, when the temperature was raised from 25 to 35 °C for 4 h a day, polysaccharide production increased significantly, indicating microalgae stress. Nutrient limitation also seemed to increase EOM production. No significant differences were found in EOM production under lab conditions when the microalgae competed with AOB for ammonium uptake. However, when the EOM concentration was monitored during continuous outdoor operation of a membrane photobioreactor (MPBR) plant, nitrifying bacteria activity was likely to be responsible for the increase in EOM concentration in the culture. Other factors such as high temperatures, ammonium-depletion and low light intensities could also have induced cell deterioration and thus have influenced EOM production in the outdoor MPBR plant. Membrane fouling seemed to depend on the biomass concentration of the culture. However, under the operating conditions tested, the behaviour of fouling rate with respect to the EOM concentration was different depending on the initial membrane state

Crecimiento de lechosa (Carica papaya L.) cv. ´Maradol´ en dos tipos de envase y de sustrato | Growth of papaya (Carica papaya L.) cv. ´Maradol´ in two types of container and of substrate

El establecimiento y manejo de la planta en el vivero es una de las etapas más importantes del proceso productivo de los cultivos frutícolas. El objetivo del trabajo fue analizar el efecto de dos tipos de envase y dos sustratos, sobre el desarrollo vegetativo de plántulas de lechosa. La investigación se efectuó de junio a agosto de 2006. El diseño experimental utilizado fue completamente al azar, se usaron dos tipos de envase y dos sustratos, que generaron cuatro tratamientos (T1: Bolsas de polietileno negro (730 ml) y turba de musgo; T2: Bolsas de polietileno negro y suelo franco limoso; T3: Bandejas deplástico negro de 200 cavidades (20 ml por cavidad) y turba de musgo y T4: Bandejas de plástico negro y suelo franco limoso), se emplearon tres repeticiones por tratamiento. Las variables estudiadas fueron: altura de plántula, diámetro de tallo, número de hojas fotosintéticamente activas y biomasa seca de las partes aérea y radical de las plántulas. Los datos se analizaron mediante varianza y comparación de medias Tukey 5 %. La altura de plántula varió de 5,10 a 21,29 cm, diámetro de tallo de 3,23 a 6,87 mm, número de hojas de 4 a 7, masa seca aérea de 0,01 a 0,69 gramos y masa seca radical de 0,01 a0,48 gramos. El T2 fue superior a los demás tratamientos en todas las variables evaluadas. Con base en los resultados se recomienda el uso de bolsas plásticas y suelo franco limoso, para la propagación de plántulas de lechosa en vivero.Palabras clave: Medio de propagación, altura de plántula, bolsas de polietileno, bandejas plásticas, biomasa.ABSTRACTNursery is a stage most important in the productive process of fruit crops. A trial was conducted for analyzed the effect of two types of pack and two substrates on vegetative growth of papaya seedlings. The experiment was made from June to August 2006. The experimental design was randomized completely, four treatments and three replicates. T1 plastic bags (730 ml) and lime loam soil, T2 plastic bags and peat moss, T3 plastic trays of two hundred cavities (20 ml per cavity) and lime loam soil and T4 plastic trays and peat moss. The variables studied were: seedling height, stem diameter, number of leaves photo synthetically active and dry biomass of roots and stem plus leaves of seedlings. Statistical analysis was variance analysis and test Tukey 5 %. Medium values of seedlings height varied from 5.10 to 21.29 cm, stem diameter 3.23to 6.87 mm, number of leaves 4 to 7, dry biomass stem plus leaves 0.01 to 0.69 g and dry biomass roots 0.01 to 0.48 g. T2 was the highest in all studied variables. Results showed that plastic bags and lime loam soil were more adequate for propagation of papaya seedlings at nurseryKey words: propagation medium, seedling height, plastic bags, plastic trays, biomas

Usability Evaluation of a Web Academic Software Developed to Measure

University requires agility in accordance to the needs arising from technological innovation and the reform of the regulations that govern higher education, which is why the present project arises to model and implement a web application that allows the entry and visualization of qualifications, and online registration under the academic regulations that govern the Technical University of Cotopaxi. For the development of this web application, Metric V3 methodology was used, with its five stages within the life cycle of software development. Once the application was developed, it was submitted to a usability evaluation with four computer users who issued their assessments respect to ten questions related to the usability principles of Jakob Nielsen. The result was 86.5% favorable of the application for which it was necessary to previously analyze the options of ”packaged” software and customized development. &nbsp; &nbsp; Keywords: web application, usability, Metrica V

Intracameral dexamethasone reduces inflammation on the first postoperative day after cataract surgery in eyes with and without glaucoma

Purpose: To evaluate whether dexamethasone injected intracamerally at the conclusion of surgery can safely and effectively reduce postoperative inflammation and improve surgical outcomes in eyes with and without glaucoma. Methods: Retrospective chart review of 176 consecutive eyes from 146 patients receiving uncomplicated phacoemulsification (PE) (n = 118 total, 82 with glaucoma), glaucoma drainage device (GDD) (n = 35), combined PE/GDD (n = 11) and combined PE/endoscopic cyclophotocoagulation (n = 12). Ninety-one eyes from 76 patients were injected with 0.4 mg dexamethasone intracamerally at the conclusion of surgery. All eyes received standard postoperative prednisolone and ketorolac eyedrops. Outcomes were measured for four to eight weeks by subjective complaints, visual acuity (VA), slit-lamp biomicroscopy, intraocular pressure (IOP) and postoperative complications. Results: Dexamethasone significantly reduced the odds of having an increased anterior chamber (AC) cell score after PE (p = 0.0013). Mean AC cell score ± SD in nonglaucomatous eyes was 1.3 ± 0.8 in control and 0.8 ± 0.7 with dexamethasone; scores in glaucomatous eyes were 1.3 ± 0.7 in control and 0.9 ± 0.8 with dexamethasone. Treated nonglaucomatous eyes had significantly fewer subjective complaints after PE (22.2% vs 64.7% in control; p = 0.0083). Dexamethasone had no significant effects on VA, corneal changes, IOP one day and one month after surgery, or long-term complications. Conclusions: Intracameral dexamethasone given at the end of cataract surgery significantly reduces postoperative AC cells in eyes with and without glaucoma, and improves subjective reports of recovery in nonglaucomatous eyes. There were no statistically significant risks of IOP elevation or other complications in glaucomatous eyes. © 2009 Chang et al, publisher and licensee Dove Medical Press Ltd