Voluntary work: an alternative to promote health for the elderly

This article is a thematic reflection. It aims at presenting volunteer work as an alternative for promoting health for elders in Brazil. Having as a starting point the definition of volunteer work, this study contextualizes this type of activity in Brazilian society, explaining it also as an instrument that makes possible for people to experience an active and healthy aging process. The text presents international studies with elders who volunteer and, as a result, have found a relationship between volunteering and satisfaction with their lives and have had less symptoms of depression and a more positive evaluation of life when compared to elderly who do not volunteer. The conclusion emphasizes the importance for health professionals to stimulate and facilitate the access of elders to volunteer work, considering this posture a creative and innovative challenge for the promotion of health for the elderly.     

Benzodiazepine dependence in mice after ingestion of drug-containing food pellets

Diazepam was administered to Swiss-Webster mice for 53 days as a mixture of drug in laboratory chow, leading to consumption as high as 1000 mg/kg/day. Low plasma concentrations of diazepam, but very high levels (generally between 5,000 and 10,000 ng/ml) of the active metabolites nordiazepam and oxazepam, were found. Animals appeared healthy throughout drug administration, but some died because of apparent drug-induced aggression. Withdrawal was precipitated by omitting drug from the food. The behavior and physiological state of each animal were observed in detail during treatment and withdrawal phases. Tests that showed stable results in control animals and changes during abstinence were used to measure the withdrawal syndrome. These changes included piloerection, tremor, pelvic elevation and tail elevation, as well as changes in body tone, abdominal tone and pupil size. A composite withdrawal score was plotted against time; this score increased significantly (P less than .01) 1 day after withdrawal and remained significantly elevated for 17 days. This technique provides a quantitative method to study the effect of withdrawal from benzodiazepines in mice.     

Occurrence of acute cholinergic syndrome in an infant due to donepezil ingestion

Donepezil and acetyl cholinesterase inhibitors are the most commonly prescribed medications for the treatment of Alzheimer''s disease. We describe a 2‐year‐old infant who was referred to the emergency department after developing cholinergic syndrome 6 hours after ingesting 10 mg of his grandmother''s donepezil tablets and was finally discharged in stable condition.     

Stimulation of hematopoiesis as an alternative to transfusion

Optimal parenteral nutritional support, provided concomitantly with extraordinarily large replacement doses of intravenous iron dextran can be safe, effective, and life-saving for severely anemic patients who cannot or will not accept erythrocyte transfusion. Five patients who had sustained massive acute blood loss and two who had severe chronic anemia received as much as 140 ml of iron dextran intravenously. The average initial hemoglobin value in the patients with acute blood loss was 4.7 gm/dl (range 2.6 to 8.4 gm/dl), increasing to an average of 9.8 gm/dl (range 7.5 to 12.8) in 23.4 days (range 17 to 30 days), a 166% increase. The average initial hemoglobin value in the patients with chronic anemia was 3.7 gm/dl, increasing to 10.5 gm/dl over an average period of 121 days, a 182% increase. Total abdominal colectomy, pyloroplasty with truncal vagotomy, and highly selective vagotomy were accomplished without complications in four of the patients. There were no adverse reactions to the therapeutic regimen, and all patients were discharged in good condition.     

Bivalirudin,a bivalent,thrombin specific anticoagulant as an alternative to heparin in interventional procedures as an alternative to heparin in interventional procedures

Among the antithrombotic therapies evaluated to date, the synthetic peptide bivalirudin is unique in its ability to reduce both ischemic and bleeding complications associated with percutaneous coronary intervention (PCI). Bivalirudin is a small peptide consisting of 20 amino acid residues that binds thrombin in a direct, reversible, and bivalent fashion. The agent is approved for use in the United States and New Zealand as an anticoagulant in patients with unstable angina undergoing PCI and may also prove beneficial in patients with acute coronary syndromes (ACS), acute myocardial infarction (AMI) and in patients undergoing coronary artery bypass graft (CABG) procedures. This article examines bivalirudin in more detail.     

Macrophage activation: increased ingestion of IgG-coated erythrocytes after administration of interferon inducers to mice

In vitro phagocytosis of IgG-opsonized sheep erythrocytes (EA) was used to measure the in vivo activation of mouse peritoneal macrophages. Uptake of EA as enhanced by the extraperitoneal administration of Newcastle disease virus, vesicular stomatitis virus, tilorone or polyinosinic-polycytidylic acid. Ingestion of EA was similarly stimulated by lipopolysaccharide or killed Corynebacterium parvum. Dose- response curves relating concentrations of IgG to phagocytosis were parallel for both treated and control animals. This indicates that the heterogeneity of the macrophage populations did not change and that the overall populations were activated with respect to phagocytic ability. Numbers of macrophages were not increased (except in C. parvum-treated mice), suggesting that resident, rather than newly recruited macrophages, were activated by the different agents.     

Q-methodology: an alternative approach to research in nurse education

An understanding of student experiences and perspectives are central to the delivery of quality nurse education programmes; implicit with this is a need to understand the attributes and characteristics of such individuals, their subjectivity. Traditional such inquiry has taken the form of questionnaires or interviews and focus groups. Q-methodology is offered as an alternative approach which provides insight into, and a method for studying, individual subjectivity through the use of factor analysis. Within Q-methodology, individuals are asked to rank-order (Q-sort) statements, which are then intercorrelated and subjected to factor analysis. In this way groups of individuals holding similar expressed subjectivities are identified. The factors are interpreted to provide an understanding of underlying subjectivities. This paper explores the theoretical underpinnings of Q-methodology and its application as a research method in the field of nurse education, providing a brief illustration of its use in mental health nurse education.     

Fatal ingestion of boric acid in an adult.

A 45-year-old white man ingested approximately two cups of boric acid crystals dissolved in water in a suicide attempt. Nausea, vomiting, greenish diarrhea, and dehydration occurred shortly thereafter. Two days later, he presented to the hospital with hypotension, metabolic acidosis, oliguric renal failure, a generalized erythematous rash, and several superficial skin abrasions. His condition failed to improve despite intravenous fluids and vasopressors. He later developed atrial fibrillation with a rapid ventricular response and could not be converted to a sinus rhythm. This rhythm deteriorated to electromechanical dissociation, and the patient died 17 hours after admission. The urine and whole blood boric acid concentrations approximately 52 hours after ingestion were 160 and 42 mg/dL, respectively. These results are equivalent to urine and blood boron concentrations of 28 and 7 mg/dL, respectively. A postmortem urine boron concentration was 29.4 mg/dL. The autopsy report listed boron toxicity as the cause of death. This is the only adult reported to die from acute boric acid ingestion in recent years and may be atypical since the patient was untreated for 3 days and presented with dehydration and renal function impairment. This case suggests that lack of adequate urine flow and dehydration increases the risk of boron toxicity.     

Submental tracheal intubation is an alternative to tracheostomy in oral surgery

A prospective study was performed in 17 patients who had undergone submental tracheal intubation in facial injury, tumors of the upper jaw, and congenital and acquired deformities of the facial skeleton. The time required for intubation, and the adequacy of gas exchange and ventilation during tracheal intubation and an operation was estimated. Submental intubation was successfully carried out in all the patients. The mean time spent on tracheal intubation was 5-6 min. At surgery, there was no chance extubation or endotracheal tube damage, the parameters of ventilation and gas exchange remained to be within the normal range. A submental scar was minimal. There was inflammation and formation of a bad scar or bleeding at the site of intubation in none case. Submental orotracheal intubation is a safe and simple procedure for airway patency and it may be used as an alternative to tracheostomy in maxillofacial injury, tumors of the upper jaw, and congenital and acquired deformities of the facial skeleton.     

Ultrasound in abdominal trauma: an alternative to peritoneal lavage.

Ultrasonography has been used as an investigation in patients with abdominal signs after blunt injury. Thirty-two patients were examined, of whom 11 had abnormal findings. Free intraperitoneal fluid was demonstrated in eight cases, seven of whom had this confirmed at subsequent laparotomy. The 21 patients with normal scans did not require abdominal intervention. It is suggested that ultrasonography is a reliable method of detecting haemoperitoneum and offers a valuable non-invasive method of investigating blunt abdominal injuries. The hepatorenal pouch is the site where free intraperitoneal fluid can be most easily demonstrated.     

Argatroban as an alternative to heparin in extracorporeal membrane oxygenation circuits

We investigated the anticoagulant effects of argatroban, a direct thrombin inhibitor, versus heparin in extracorporeal membrane oxygenation (ECMO) circuits. Three sham circuits were prepared according to our hospital's standard practice and run for six hours simultaneously. Two circuits were anticoagulated with argatroban (one with heparin in the wet prime and one without). One circuit had heparin in the initial prime and was then anticoagulated with heparin. We measured thrombin generation (prothrombin fragment 1+2, D-dimer and thrombin-antithrombin complexes), activated clotting times (ACTs) and partial thromboplastin times (aPTTs), and monitored thrombus formation using thromboelastography. ACTs were >1000 s in each circuit throughout assessment. No clot initiation was detected by thromboelastography. Thrombin generation was decreased in circuits anticoagulated with argatroban versus heparin, despite aPTTs being less prolonged. These results suggest that argatroban may be more efficacious than heparin for anticoagulation in ECMO. Additional studies are warranted to further evaluate argatroban in this setting.     

Cimetidine as an alternative to N-acetylcysteine in patients with paracetamol poisoning

A 20 year old woman attended the emergency department of Wollongong Hospital 11 hours after a toxic ingestion of paracetamol. After developing a significant anaphylactoid reaction to N-acetylcysteine (NAC), she was treated with cimetidine 40mg/kg intravenously as an alternative. This therapy may be an option when NAC cannot be used.     

The use of microfilters as an alternative to centrifugation in radioimmunoassay.

A microfilter was designed, together with a mechanical filtration apparatus for the separation of "antibody-bound" and "free" antigen in radioimmunoassay. A comparison of the results obtained using both filtration and centrifugation was carried out and the optimum incubation times, reaction conditions and washing volume for use with the microfilter were studied. The use of microfilters in radioimmunoassay gave reproducible results and offered a convenient means of automating the separation procedure.     

Vasopressin as an alternative to norepinephrine in the treatment of milrinone-induced hypotension

OBJECTIVE: To determine whether vasopressin could be effective in treating the hypotension associated with phosphodiesterase III inhibition. Phosphodiesterase III inhibitors are cardiotonic agents that increase myocardial contractility and decrease vascular smooth muscle tone. The vasodilatory effect can be profound, and the resulting hypotension frequently requires the administration of catecholamine pressors. DESIGN: Retrospective analysis of existing data. SETTING: The medical or surgical intensive care unit of Columbia-Presbyterian Medical Center. PATIENTS: Three consecutive patients receiving milrinone and requiring catecholamine pressors to maintain systolic arterial pressure of > or =90 mm Hg. INTERVENTIONS: Vasopressin was administered to the three patients. MEASUREMENTS AND MAIN RESULTS: Vasopressin (0.03-0.07 units/min) increased systolic arterial pressure from 90+/-4.7 to 130+/-2.3 mm Hg while reducing the administration of catecholamine pressors. CONCLUSIONS: Vasopressin at very low doses appears to be an effective vasopressor for milrinone-induced hypotension.