Colite pseudomembranosa : uma casuística de internamentos

Introduction: pseudomembranous colitis (PMC) is an infectious disease that generally begins after antibiotic treatment. Objectives: Characterize the patients with PMC in two Services of a Central Hospital. Material and Methods: we considered the patients admitted in a Medicine (MS) and in a Gastroenterology (GES) Service with primary or secondary diagnosis of PMC, between January/1995 and July/2003 and registered the age, gender, clinical presentation, antibiotics (AB) and other risk factors, diagnostic procedures, complications and treatment. Results: we considered 80 patients (43 - GES and 37 - MS); Mean age - 68,6 ± 17,7 years; 52,5% were male; Antibiotic treatment in the previous 3 months - 85%; Mean time of antibiotic treatment - 10,5 ± 6,1 days. Most Commonly Involved Antibiotics: cephalosporins, amoxicillin/clavulanic acid and quinolones. Associated risk factors: renal insufficiency (22,5%); cardiac insufficiency (22,5%); previously dependent patient ( 36,3%). Diagnostic procedures: toxin search-58 patients ( in 36 ), colonoscopy - 62 ( in 53); culture - 23 (in 17 ). The mortality rate was 18,8% (n = 15); recurrence rate - 10% (n = 8). Therapeutics: metronidazol - 37 patients (46,3%); vancomycin - 24 (30%); metronidazol + vancomycin – 12 (15%). Differences Between Services: mean age (MS - 72,9 and GES - 64,9); admission criteria (GES - intestinal disorders, MS – respiratory infections); diagnostic procedures (colonoscopy more frequent in GES); therapeutic options (MS - metronidazol; GES - vancomycin and metronidazol + vancomycin). Conclusions: PMC is more common in older patients that were generally submitted to previous antibiotic treatment, especially with ß-lactamics. Considering two distinct Services we observed differences concerning age, co-morbility and risk factors that implied distinct diagnostic and therapeutic approaches

Combined tools for Surgical Case Packages contents and cost optimization: a preliminary study

This paper presents a solution proposal based on mathematical and statistical tools to optimize Surgical Case Packages of an Operating Room (OR) in a Portuguese public hospital that it is the most complex environment in a hospital. In this particular hospital, more than 27000 surgeries/year are performed, employing, sometimes, misadjusted composition of standard surgical packages and non-optimized grouping of surgical instruments. Problem consequences are, among others, high transport of various surgical cases packages; high number of open cases and delays in surgical times following surgery. These type of problems are waste that do not add value to the service in the context of Lean Healthcare and must be eliminated using the most suitable tools. After the analysis, different tools were used: combinatorial analysis to optimize surgical cases composition and statistical analysis to identify the instruments usage and surgical basic case patterns. An optimization model was developed which produced a sterilizing initial solution of 135.24€. By identifying the most commonly employed instruments, it was concluded that some instruments have never been used and others rarely and some patterns were identified. The results achieved were based on minor sample and in a form of data collection that needs some adjustment

From Eshu to Obatala: animals used in sacrificial rituals at Candomblé "terreiros" in Brazil

<p>Abstract</p> <p>Background</p> <p>The practice of sacrifice has occurred in several cultures and religions throughout history and still exists today. Candomblé, a syncretical Afro-Brazilian religion, practices the sacrificial ritual called "<it>Orô</it>" by its adherents. The present work aims to document the use of animal species in these sacrificial practices in the cities of Caruaru (PE) and Campina Grande (PB) in Norteastern Brazil, and to further understand the symbolism of these rituals.</p> <p>Methods</p> <p>Semi-structured and unstructured interviews and informal discussions were held with 11 Candomblé priests and priestesses between the months of August 2007 and June 2008. We attended rituals performed at "terreiros" where animals were sacrificed, in order to obtain photographic material and observe the procedures and techniques adopted.</p> <p>Results</p> <p>A total of 29 animal species were used during sacrificial rituals according to the priests and priestesses. These species were classified in 5 taxanomic groups: Molluscs (n = 1), Amphibians (n = 2), Reptiles (n = 2), Birds (n = 10) and Mammals (n = 14). According to Candomblé beliefs, animals are sacrificed and offered to their deities, known as orishas, for the prosperity of all life. There is a relationship between the colour, sex and behaviour of the animal to be sacrificed, and the orisha to whom the animal is going to be offered. The many myths that form the cosmogony of Candomblé can often explain the symbolism of the rituals observed and the animal species sacrificed. These myths are conveyed to adherants by the priests and priestesses during the ceremonies, and are essential to the continuation of this religion.</p> <p>Conclusion</p> <p>Candomblé is a sacrificial religion that uses animals for its liturgical purposes. The principal reason for sacrifice is to please supernatural deities known as orishas in order to keep life in harmony. This is accomplished through feeding them in a spiritual sense through sacrifice, maintaining a perfect link between men and the gods, and a connection between the material world (called <it>Aiyê</it>) and the supernatural world (called <it>Orun</it>).</p

Use and commercialization of Podocnemis expansa (Schweiger 1812) (Testudines: Podocnemididae) for medicinal purposes in two communities in North of Brazil

<p>Abstract</p> <p>Background</p> <p>Throughout Brazil a large number of people seek out reptiles for their meat, leather, ornamental value and supposed medicinal importance. However, there is a dearth of information on the use of reptiles in folk medicine. In North Brazil, the freshwater turtle, <it>Podocnemis expansa</it>, is one of the most frequently used species in traditional medicines. Many products derived from <it>P. expansa </it>are utilized in rural areas and also commercialized in outdoor markets as a cure or treatment for different diseases. Here we document the use and commercialization of <it>P. expansa </it>for medicinal purposes in the state of Pará, Northern Brazil.</p> <p>Methods</p> <p>Data were gathered through interview-questionnaires, with some questions left open-ended. Information was collected in two localities in Pará State, North of Brazil. In the City of Belém, data was collected through interviews with 23 herbs or root sellers (13 men and 10 women). Attempts were made to interview all animal merchants in the markets visited. In fishing community of the Pesqueiro Beach, interviews were done with 41 inhabitants (23 men and 18 women) and during the first contacts with the local population, we attempted to identify local people with a specialized knowledge of medicinal animal usage.</p> <p>Results</p> <p><it>P. expansa </it>was traded for use in traditional medicines and cosmetics. Fat and egg shells were used to treat 16 different diseases. Turtle fat was the main product sold. The demand for these products is unknown. However, the use of this species in folk medicine might have a considerable impact on wild population, and this must be taken into account for the conservation and management of this species.</p> <p>Conclusion</p> <p>Our results indicated that the use and commercialization of <it>P. expansa </it>products for medicinal purposes is common in North of Brazil. More studies regarding the use and commerce of Brazilian turtles are urgently needed in order to evaluate the real impact of such activities on natural populations. We hope that our findings about the trade and use of <it>P. expansa </it>in folk medicine will motivate further studies on the use of animals in folk medicine and its implications for conservation.</p