Incorporação da tecnologia da informação na atenção básica do SUS no nordeste do Brasil : expectativas e experiências

A incorporação de tecnologia da informação por meio do registro eletrônico de dados em saúde na atenção básica transforma a organização do trabalho e as práticas profissionais. O objetivo deste estudo é conhecer as expectativas e a experiência da informatização nos serviços de atenção básica do SUS na implantação do Sistema Cartão Nacional de Saúde (SCNS), Cartão SUS. Pesquisa qualitativa, que compara, por meio de 50 entrevistas e 96 questionários, a opinião dos profissionais de saúde sobre a inovação tecnológica, em locais “Sem” e “Com” o SCNS, nos municípios de João Pessoa (Paraíba) e de Aracaju (Sergipe), respectivamente. Há expectativa de que a informatização reduz o tempo para execução do trabalho, o que não foi confirmado pelo local informatizado. A informatização traz melhorias na organização do trabalho, para os usos da informação e possibilita a inserção digital do profissional. A tecnologia “leve” da atividade de cuidado da saúde não é reproduzida pela informatização, a qual aumenta a necessidade de incorporação de saberes aos profissionais, melhora as condições de trabalho, organiza a coleta de dados, aproxima os usos da informação por quem os registrou, e amplia a capacidade de gestão das políticas de saúde.The incorporation of information technology (IT) via an electronic record of health data in primary care is transforming the organization of labor and professional practices in Brazil. The scope of this study is to establish the expectations and experiences of incorporating IT in the primary health care of the Unified Health System (SUS) with the implementation of the National Health Card System (SCNS). It involved qualitative research with 50 interviews and 96 questionnaires comparing the opinion of health professionals about technological innovation in locations with the SCNS and where it has not yet been incorporated in the cities of João Pessoa and Aracaju, respectively. The expectation was that IT would speed up the work schedule, which was not confirmed at the location where the SCNS had been incorporated. IT can improve labor organization, the flow of data and information and enable the digital insertion of the professional. The “light” technology of health care cannot be expedited by IT, as it is necessary to impart knowledge to the professionals. However, it can improve working conditions by data gathering and organization, giving immediate feedback to the professional recording the data and enhance the ability to manage health policies

Toxic Systemic Reaction after Bee Stings in a Bitch

Background: Bee sting poisonings are common in dogs, and toxic systemic presentation may represent a life-threatening condition. Apis mellifera venom is a complex mixture of melitin, apamine, phospholipase, hyaluronidase and degranulating peptides, that causes local injury at the site of inoculation and multiple organ complications, including hemolysis, kidney injury, muscular damage, cardiovascular and respiratory complications. The present work reports a complete and detailed description of a dog’s systemic toxic reaction to bee stings, including history, clinical signs, laboratory findings, emergency care and development, as well as possible association with later immunomediated arthritis. Case: A 6-year-old female German Shepperd suffered multiple bee stings. First care was conducted by a veterinary at the site, where he only received promethazine, meloxicam and dexamethasone. After 24 h and significant progression of symptoms, the animal was forwarded to a specialized veterinary hospital. The patient was evaluated throughout 9 days, and presented intense edema, respiratory distress, tongue necrosis and grade II of acute kidney injury. Extensive laboratory exams were conducted throughout the hospitalization. Main laboratory findings included polycythemia, leukocytosis by neutrophilia and monocytosis, thrombocytopenia and azotemia. Urinalysis evidenced turbid aspect, dark yellow color and intense proteinuria, reinforcing kidney damage. Abdominal ultrasound examination identified blood clots in the bladder, and liver with reduced echogenicity and echotexture, suggesting acute inflammation. Therapy aimed to stabilize the patient, control kidney damage and avoid anaphylaxis. Treatment included intensive care support, promethazine, hydrocortisone, dexamethasone, dipyrone, methadone, metronidazole, ampicillin, clindamycin and tramadol. Following successful treatment, the animal presented immunomediated polyarthritis, possibly associated to both the poisoning and later diagnosed hemoparasitosis (both Erlichia and Babesia). Discussion: Massive bee attacks can cause severe complications, however, data regarding emergency care records are scarce. Based on clinical signs and laboratory findings, the patient presented toxic systemic reaction, including grade II of acute kidney injury and significant cardiorespiratory distress. Another important complication was tongue necrosis, that demanded attention and special supportive care, including feeding tube and specific feed. Treatment also focused in reducing edema and control possible anaphylaxis, providing analgesia and antibiotic therapy. Laboratory findings have been previously described, with evidence of immune-mediated reaction. Follow-up consultations revealed normal parameters, and an unusual presentation of claudication. Investigation concluded that polyarthritis could be responsible for such finding and may be a result of the deposition of immunomediated complexes in the joints, due in this case to the bee poisoning and later positive diagnosis for both Erlichia and Babesia. Systemic reactions to bee stings are complex, and full clinical and laboratory profile aid in both the prognosis and treatment options. Special attention must be given to tongue damage and supportive care is essential for maintaining feeding conditions. Arthritis should be considered as possible complication, reinforcing the importance of follow-up consultations. Keywords: bee attack, dog, envenomation, melittin; poisoning, phospholipase A2

Clinical education reflective ecological model for health science majors

The clinical education is an integral part of the Health Science majors’ curriculum programs of the University of Aveiro’s School of Health (i.e., Nursing, Physical Therapy, Radiology, Radiotherapy and Speech-Language Pathology) and aims to develop clinical competences in order to generate excellent health care professionals. The organization was based on the Ecological Model of Clinical-Reflective Training, which was characterized by inter-institutional interaction and student’s reflection on actions on a professional setting. This study encompassed two moments of clinical internships in the Nursing, Physical Therapy, Radiology and Radiotherapy majors. The Clinical Internship I provided the 123 students with a global view of the health care professional activities. The Clinical Internship II, with 119 students, developed competences of each health professional. Questionnaires with categorical scales from 1 to 5 evaluated the organization and efficiency of the two internships. The results revealed averages over 3 in all items. In conclusion, the Ecological Model of Clinical-Reflective Training was well accepted by students and clinical supervisors. Applications in the health care area were demonstrated

Validação de um protocolo de treinamento para provas de Marcha da raça Mangalarga Marchador

The Mangalarga Marchador breed is functionally evaluated through marcha contests. The present research aimed to verify the efficacy of a training protocol for conditioning Mangalarga Marchador horses for marcha contests. Eight mares were used in a completely randomized block split-plot design, where each animal was a block, the physical tests (T I, T II, T III, T IV and T V) every 21 days of training were the plots, and the time of evaluation and collection of samples inside each test were the split-plots. The mares were trained for 84 days for one hour a day, five days a week, with rest on Saturdays and Sundays. On Mondays, Wednesdays, and Fridays, the animals warmed up in an oval track by walking for 10 minutes and then marching for a period established individually through a marcha test. Next, the animals were led in walk gait until an hour of exercise was completed. On Tuesdays and Thursdays, the animals were trained outdoors for one hour only walking. The tests consisted of successive 10 minutes stages at marcha, which was interrupted when heart rate reached 150 beats per minute and lactate levels were greater than 4 mmol/L, or after 70 min of the test. Marcha duration, heart rate and blood concentrations of lactate were evaluated. The results were submitted to an analysis of variance and the averages were compared by Fisher’s test at 5% probability. From zero at nine weeks of training, marcha duration increased progressively (p 0.05) between nine and 12 weeks of training. The training protocol used was appropriate to condition Mangalarga Marchador equines to compete in marcha contests following the rules of Brazilian Association of Mangalarga Marchador Breeders.A raça Mangalarga Marchador é avaliada funcionalmente através das provas de marcha. O presente estudo objetivou verificar a eficácia de um protocolo de treinamento para condicionar equinos Mangalarga Marchador visando participação em provas de marcha. Foram utilizadas oito éguas em delineamento de blocos ao acaso com esquema de parcelas subdivididas, onde cada animal constituiu um bloco, as parcelas foram representadas pelos testes físicos (T I, T II, T III, T IV e T V) realizados a cada 21 dias do treinamento e as subparcelas foram constituídas pelos tempos de avaliação e coletas de amostras em cada teste. As éguas foram treinadas durante 84 dias, uma hora por dia, cinco dias por semana, com descanso aos sábados e domingos. Nas segundas, quartas e sextas-feiras, os animais realizavam 10 minutos de aquecimento ao passo em uma pista oval, em seguida marchavam por um tempo individual de marcha, estabelecido em um teste prévio. Depois, caminhavam até completar uma hora de exercício. Na terças e quintas-feiras eram montadas ao passo por uma hora. Os testes foram formados por etapas sucessivas de 10 minutos de marcha, sendo interrompido quando a frequência cardíaca atingia 150 batimentos por minuto e a concentração de lactato era maior que 4mmol/L ou a prova atingisse 70 minutos de duração. Avaliou-se o tempo de marcha, frequência cardíaca e concentração sanguínea de lactato. Os resultados foram submetidos à análise de variância e as médias comparadas pelo teste de Fisher a 5% de probabilidade. De zero a nove semanas de treinamento, o tempo de marcha aumentou progressivamente (p 0,05) entre nove e doze semanas de treinamento. O protocolo de treinamento adotado foi adequado para condicionar equinos Mangalarga Marchador para competir em uma prova de marcha realizada de acordo com a regulamentação da Associação Brasileira de Criadores do Cavalo Mangalarga Marchador.Fil: Abrantes, Renata Guimarães Pequeno. Universidade Federal do Minas Gerais; BrasilFil: Rezende, Adalgiza Souza Carneiro de . Universidade Federal do Minas Gerais; BrasilFil: Santiago, Juliano Martins. Universidade Federal Rural Pernambuco; BrasilFil: Trigo, Pablo Ignacio. Universidade Federal Rural do Rio de Janeiro; Brasil. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Melo, Marília Martins. Universidade Federal do Minas Gerais; BrasilFil: Fonseca, Mayara Gonçalves. Universidade Federal do Minas Gerais; BrasilFil: Lage, Jéssica. Universidade Federal do Minas Gerais; BrasilFil: Moreira, Dalton Colares de Araújo. Universidade Federal do Minas Gerais; Brasi

Surto de neuropatia tardia induzida por organofosforados em búfalos

Forty 1-2-y-old water buffaloes were simultaneously treated with trichlorfon and chlorpyrifos products in the recommended dose for cattle. After a week, 19 animals started presenting clinical signs characterized by apathy, diarrhea, aggressiveness, dehydration, and motor incoordination, followed by flaccid paralysis and permanent lateral recumbency. All affected buffaloes died after a clinical course of 1–4 days. Reduction of serum cholinesterase activity in three cases was indicative of significant exposure to organophosphorus compounds (OPs). Pathological examination of three buffaloes revealed no gross and histological lesions. By thin layer chromatography, chlorpyrifos residues and trace of trichlorfon residues were detected in fresh tissue samples. The epidemiological, clinical, pathological, and toxicological findings were highly compatible with OPs-induced delayed neurotoxicity, a neurological manifestation rarely described in domestic animals.Quarenta búfalos foram simultaneamente tratados com clorpirifós e triclorfom na dose recomendada para bovinos. Após uma semana, 19 animais apresentaram sinais clínicos caracterizados por apatia, diarreia, agressividade, desidratação e incoordenação motora, seguidos por paralisia flácida e decúbito lateral permanente. Todos os búfalos afetados morreram após um curso clínico de 1–4 dias. Redução da atividade da colinesterase sérica em três casos foi indicativa de exposição significativa a organofosforados (OPs). O exame patológico de três búfalos não revelou lesões macroscópicas e histológicas. Por cromatografia em camada delgada, resíduos de clorpirifós e traços de resíduos de triclorfon foram detectados em amostras de tecidos frescos. Os achados epidemiológicos, clínicos, patológicos e toxicológicos foram compatíveis com neuropatia tardia induzida por OPs, uma manifestação neurológica raramente descrita em animais domésticos

Spontaneous Poisoning by Blutaparon portulacoides in a Horse

Background: In the Rio Grande do Norte state, Northeastern Brazil, several outbreaks of poisoning affecting horses, cattle and sheep have been attributed by a number farmers to the consumption of the leaves of Blutaparon portulacoides, a plant from family Amaranthaceae, known as “pirrixiu”, “bredo-de-praia” and “capotiraguá”. However, the spontaneous poisoning was reported in the literature exclusively in sheep. Thus, the present study aims to report the clinical signs found in a spontaneous poisoning by B. portulacoides in a horse.Case: A 8-year-old mixed-breed mare, weighing 268 kg, was referred to veterinary care showing loss of appetite and diarrhea. The clinical evolution was reported by the owner as for six days. During the physical examination, the animal presented slight apathy, pale mucous membranes, tachypnea, dehydration, intestinal hypermobility, and watery diarrhea. The predominant plant in the paddock where the mare was maintained was B. portulacoides. According to the owner, the poisoning by this plant is common in the neighborhood of the farm and has already occurred in other species (cattle and sheep). After the origin of poisoning was identified, the access to the plant was restricted and it was established fluid therapy to treat the dehydration. After three days, the animal returned to eat normally and the diarrhea ceased.Discussion: The exclusive feeding of sheep with B. portulacoides is responsible for disorders in the digestive tract, characterized by softening of feces and intestinal epithelial lesions (intestinal villi epithelium detachment, goblet cell hyperplasia, submucosal inflammatory cells infiltrate and infiltration of the lamina propria by mononuclear cells). Given the similarity of the frame displayed by the horse, described in the present report, it is believed that the sensitivity to poisoning by B. portulacoides is not exclusive to sheep, but also occurs in horses. Taking into account that B. portulacoides is found widespread through the Atlantic coast of Brazil, it is feasible to speculate that several other cases of poisoning might occur without accurate diagnosis. A plant that promotes similar poisoning is Portulaca elatior Mart. (family Portulacaceae), described in the literature affecting goats, sheep, and cattle. However, the poisoning by P. elatior is typically acute, showing clinical evolution within 48 hours after ingestion of the plant, whereas B. portulacoides poisoning occurs after a few days of consumption. Phytochemical analysis of B. portulacoides leaves revealed the occurrence of a number compounds, including three steroids, one flavone, one isoflavone and two flavonoids. However, the toxic principle of the plant is still unknown. The possible mechanism of poisoning is the osmotic imbalance in the digestive tract promoted by scarcity of sodium and excess of magnesium, potassium and calcium in the plant. Future studies are desirable to determine the toxic principle present in B. portulacoides and the exact mechanism of poisoning. In conclusion, the clinical presentation of the referred mare is similar to that described in sheep that ingested Blutaparon portulacoides, thus this plant can be considered as responsible for toxic effects in the digestive system of horses

Anemia infecciosa equina afeta o desempenho atlético de equinos da região do Pantanal brasileiro

The objective of this work was to evaluate the effects of equine infectious anemia (EIA) on the physical performance of equines from the Brazilian Pantanal region. A total of 16 males were evaluated, divided into two groups: 8 seronegative (G1) and 8 seropositive (G2) for EIA. Two graded exercise tests were carried out before (T1) and after (T2) 42 days of training. Heart rate, lactate concentration, distance covered, and hematocrit level were recorded. In both tests, G1 covered a greater distance. In T2, G2 had lower hematocrit levels and lower speeds reached at different lactate concentrations and heart rates. The athletic performance of the evaluated equines is affected by equine infectious anemia.O objetivo deste trabalho foi avaliar o efeito da anemia infecciosa equina (AIE) no desempenho físico de equinos da região do Pantanal brasileiro. Foram avaliados 16 machos, divididos em dois grupos: 8 soronegativos (G1) e 8 soropositivos (G2) para AIE. Dois testes de esforço progressivo foram realizados, antes (T1) e após (T2) 42 dias de treinamento. Foram registrados frequência cardíaca, concentração de lactato, distância percorrida e níveis de hematócrito. Em ambos os testes, o G1 percorreu uma distância maior. No T2, o G2 apresentou menores níveis de hematócrito e menor velocidade obtida a diferentes concentrações de lactato e frequências cardíacas. O desempenho atlético dos equídeos avaliados é afetado pela anemia infecciosa equina.Instituto de Genética Veterinari

Anemia infecciosa equina afeta o desempenho atlético de equinos da região do Pantanal brasileiro

The objective of this work was to evaluate the effects of equine infectious anemia (EIA) on the physical performance of equines from the Brazilian Pantanal region. A total of 16 males were evaluated, divided into two groups: 8 seronegative (G1) and 8 seropositive (G2) for EIA. Two graded exercise tests were carried out before (T1) and after (T2) 42 days of training. Heart rate, lactate concentration, distance covered, and hematocrit level were recorded. In both tests, G1 covered a greater distance. In T2, G2 had lower hematocrit levels and lower speeds reached at different lactate concentrations and heart rates. The athletic performance of the evaluated equines is affected by equine infectious anemia.O objetivo deste trabalho foi avaliar o efeito da anemia infecciosa equina (AIE) no desempenho físico de equinos da região do Pantanal brasileiro. Foram avaliados 16 machos, divididos em dois grupos: 8 soronegativos (G1) e 8 soropositivos (G2) para AIE. Dois testes de esforço progressivo foram realizados, antes (T1) e após (T2) 42 dias de treinamento. Foram registrados frequência cardíaca, concentração de lactato, distância percorrida e níveis de hematócrito. Em ambos os testes, o G1 percorreu uma distância maior. No T2, o G2 apresentou menores níveis de hematócrito e menor velocidade obtida a diferentes concentrações de lactato e frequências cardíacas. O desempenho atlético dos equídeos avaliados é afetado pela anemia infecciosa equina

Anemia infecciosa equina afeta o desempenho atlético de equinos da região do Pantanal brasileiro

The objective of this work was to evaluate the effects of equine infectious anemia (EIA) on the physical performance of equines from the Brazilian Pantanal region. A total of 16 males were evaluated, divided into two groups: 8 seronegative (G1) and 8 seropositive (G2) for EIA. Two graded exercise tests were carried out before (T1) and after (T2) 42 days of training. Heart rate, lactate concentration, distance covered, and hematocrit level were recorded. In both tests, G1 covered a greater distance. In T2, G2 had lower hematocrit levels and lower speeds reached at different lactate concentrations and heart rates. The athletic performance of the evaluated equines is affected by equine infectious anemia.O objetivo deste trabalho foi avaliar o efeito da anemia infecciosa equina (AIE) no desempenho físico de equinos da região do Pantanal brasileiro. Foram avaliados 16 machos, divididos em dois grupos: 8 soronegativos (G1) e 8 soropositivos (G2) para AIE. Dois testes de esforço progressivo foram realizados, antes (T1) e após (T2) 42 dias de treinamento. Foram registrados frequência cardíaca, concentração de lactato, distância percorrida e níveis de hematócrito. Em ambos os testes, o G1 percorreu uma distância maior. No T2, o G2 apresentou menores níveis de hematócrito e menor velocidade obtida a diferentes concentrações de lactato e frequências cardíacas. O desempenho atlético dos equídeos avaliados é afetado pela anemia infecciosa equina.Instituto de Genética Veterinari