Warfarin Hipersensitivity. How to Deal with it?

Os autores descrevem um caso clínico de hipersensibilidade à varfarina traduzido por uma elevação acentuada do INR, aquando da introdução do fármaco em doente com antecedentes tromboembólicos. Da pesquisa de polimorfismos para os genes VKORC1 e CYP2C9, utilizando técnicas de amplificação por PCR e hibridização reversa, apurou-se heterozigotia para -1639G>A (gene VKORC1) e homozigotia para 1075A>C (genótipo CYP2C9*3/*3). Os autores fazem uma revisão da farmacodinâmica da varfarina e da sua acção sobre a vitamina K, sugerindo-se indicações para a investigação de algumas variações genéticas, no sentido de obviar potenciais complicações associadas ao fármaco

Cervical Ganglioneuroma in Pediatric Age: A Case Report

Ganglioneuroma is a rare, benign, non-invasive tumor emerging from the sympathetic system. Of these tumors, only 8% occur in the neck. In this report, we present a case of a 13-year-old girl with a 2-year history of enlarging neck mass. Her only complaint, aside from neck swelling, was dysphagia. Physical and radiological examinations revealed a large mass centered in the right carotid space. A transcervical approach was used to excise the tumor emerging from the sympathetic ganglia. The patient developed temporary Horner's syndrome postoperatively. In a few weeks, she was completely asymptomatic. Histological examination was compatible with ganglioneuroma. Surgical excision is the only definite treatment of cervical ganglioneuroma and is also the only way to confirm the diagnosis. Injury during surgery may result in significant morbidity.info:eu-repo/semantics/publishedVersio

Graphene-Based Coating to Mitigate Biofilm Development in Marine Environments

Due to its several economic and ecological consequences, biofouling is a widely recognized concern in the marine sector. The search for non-biocide-release antifouling coatings has been on the rise, with carbon-nanocoated surfaces showing promising activity. This work aimed to study the impact of pristine graphene nanoplatelets (GNP) on biofilm development through the representative marine bacteria Cobetia marina and to investigate the antibacterial mechanisms of action of this material. For this purpose, a flow cytometric analysis was performed and a GNP/polydimethylsiloxane (PDMS) surface containing 5 wt% GNP (G5/PDMS) was produced, characterized, and assessed regarding its biofilm mitigation potential over 42 days in controlled hydrodynamic conditions that mimic marine environments. Flow cytometry revealed membrane damage, greater metabolic activity, and endogenous reactive oxygen species (ROS) production by C. marina when exposed to GNP 5% (w/v) for 24 h. In addition, C. marina biofilms formed on G5/PDMS showed consistently lower cell count and thickness (up to 43% reductions) than PDMS. Biofilm architecture analysis indicated that mature biofilms developed on the graphene-based surface had fewer empty spaces (34% reduction) and reduced biovolume (25% reduction) compared to PDMS. Overall, the GNP-based surface inhibited C. marina biofilm development, showing promising potential as a marine antifouling coating

An evaluation of enteral nutrition practices and nutritional provision in children during the entire length of stay in critical care

<b>Background</b> Provision of optimal nutrition in children in critical care is often challenging. This study evaluated exclusive enteral nutrition (EN) provision practices and explored predictors of energy intake and delay of EN advancement in critically ill children.<p></p> <b>Methods</b> Data on intake and EN practices were collected on a daily basis and compared against predefined targets and dietary reference values in a paediatric intensive care unit. Factors associated with intake and advancement of EN were explored.<p></p> <b>Results</b> Data were collected from 130 patients and 887 nutritional support days (NSDs). Delay to initiate EN was longer in patients from both the General Surgical and congenital heart defect (CHD) Surgical groups [Median (IQR); CHD Surgical group: 20.3 (16.4) vs General Surgical group: 11.4 (53.5) vs Medical group: 6.5 (10.9) hours; p <= 0.001]. Daily fasting time per patient was significantly longer in patients from the General Surgical and CHD Surgical groups than those from the Medical group [% of 24 h, Median (IQR); CHD Surgical group: 24.0 (29.2) vs General Surgical group: 41.7 (66.7) vs Medical group: 9.4 (21.9); p <= 0.001]. A lower proportion of fluids was delivered as EN per patient (45% vs 73%) or per NSD (56% vs 73%) in those from the CHD Surgical group compared with those with medical conditions. Protein and energy requirements were achieved in 38% and 33% of the NSDs. In a substantial proportion of NSDs, minimum micronutrient recommendations were not met particularly in those patients from the CHD Surgical group. A higher delivery of fluid requirements (p < 0.05) and a greater proportion of these delivered as EN (p < 0.001) were associated with median energy intake during stay and delay of EN advancement. Fasting (31%), fluid restriction (39%) for clinical reasons, procedures requiring feed cessation and establishing EN (22%) were the most common reasons why target energy requirements were not met.<p></p> <b>Conclusions</b> Provision of optimal EN support remains challenging and varies during hospitalisation and among patients. Delivery of EN should be prioritized over other "non-nutritional" fluids whenever this is possible.<p></p&gt

Volatile constituents and behavioral change induced by Cymbopogon winterianus leaf essential oil in rodents

Cymbopogon winterianus Jowitt (‘Java citronella’) is an important essential oil yielding aromatic grass cultivated in India and Brazil and its volatile essential oils extracted from its leaves are used in perfumery, cosmetics, pharmaceuticals and flavoring industries. However, there is no report on any psychopharmacological study of C. winterianus leaf essential oil (LEO) available to date. In this study, the pharmacological effects of the LEO were investigated in animal models and its phytochemical analyses. GC-MS analysis showed a mixture of monoterpenes, as citronellal (36.19%), geraniol (32.82%) and citronellol (11.37%). LEO exhibited an inhibitory effect on the locomotor activity of mice, an antinociceptive effect by increasing the reaction time in the writhing and capsaicin tests. All doses induced a significant increase in the sleeping time of animals not having modified however, the latency. The LEO did not alter the remaining time of the animals on the rota-rod apparatus. These results suggest a possible central effect.Key words: Cymbopogon winterianus, essential oil, CNS, behavioral effects, analgesic

TEORIAS DE ENFERMAGEM: IMPORTÂNCIA DA CORRETA APLICAÇÃO DOS CONCEITOS

Theoretical-reflexive research, whose aim is to analyze the clarity of concept stimulus in the Roy Model, for best comprehension in nursing practice. It was developed in three phases: 1- Search of studies that utilized the Roy Model; 2- Conducted reading for comprehension of the concept stimulus and 3- Analysis of clarity of the concept. The three studies were conducted at master level. The analysis of the studies shows deficiency in the clarity of the concept stimulus, being predominant the ambiguity in the classification and differentiation of the focal and contextual stimuli, without the existence of consistency and uniformity. The need arises to deepen the theories of nursing for adequate application in the areas of research: nursing education and practice, optimizing and improving its use, as well as, enabling the comprehension of determined concepts that are not sufficiently clear. The worries that arise among the nurses will provide a more profound approach to the study, enabling the advance of theories, as well as new findings, leading to necessary changes.  Investigación teórico-reflexiva cuyo objetivo fue analizar la claridad del concepto estímulo según el  modelo de Roy, para mayor comprensión en la práctica de enfermería. Desarrollada en tres etapas: 1ª- Levantamiento de estudios que utilizaron el Modelo de Roy; 2ª - Lectura dirigida hacia la comprensión del concepto estímulo y 3ª - Análisis de la claridad del concepto. Fueron utilizados tres estudios, a  nivel de maestrado. El análisis de los estudios demuestra deficiencia en la claridad del concepto estímulo, predominando ambigüedad en la clasificación y diferenciación de los estímulos focales y contextuales, sin consistencia y uniformidad. Se evidencia la necesidad de profundizar en las teorías de enfermería, para su aplicación adecuada en las áreas de investigación, enseñanza y práctica, optimizando y mejorando su uso, además de posibilitar la comprensión de determinados conceptos no suficientemente claros. Las inquietudes surgidas entre los enfermeros podrán motivar un abordaje más profundo de los estudios, posibilitando el avance de las teorías, así  como nuevos descubrimientos, dirigiendo los cambios necesariosPesquisa teórico-reflexiva, objetivando analisar a clareza do conceito estímulo no modelo de Roy, para maior compreensão na prática de enfermagem. Desenvolvido em três etapas: 1ª- Levantamento de estudos que utilizaram o Modelo de Roy; 2ª - Leitura dirigida para a compreensão do conceito estímulo e 3ª - Análise da clareza do conceito. Foram utilizados três estudos, em nível de mestrado. A análise dos estudos demonstra deficiência na clareza do conceito estímulo, predominando ambigüidade na classificação e diferenciação dos estímulos focais e contextuais, não existindo consistência e uniformidade. Evidencia-se a necessidade do aprofundamento nas teorias de enfermagem, para a aplicação adequada nas áreas de pesquisa, ensino e prática, otimizando e aprimorando seu uso, além de possibilitar a compreensão de determinados conceitos, não suficientemente claros. As inquietações surgidas entre os enfermeiros poderão proporcionar o aprofundamento nos estudos, possibilitando o avanço das teorias, assim como novos achados, direcionando as mudanças necessárias