Living as an oldest old in Rio de Janeiro: the lived experience told

This phenomenological-hermeneutic study was an inquiry into the lived experience of 16 very old persons who were living in their own homes. The nursing perspective was Gadow's existential advocacy for nursing practice. The study findings led to the essence of the phenomenon: pragmatic transition to old age, within a restricted future. Heideggerian concepts were applied and the findings were discussed in relation to the guiding theoretical perspective and related literature. Understanding the meaning of being a very old person is fundamental to developing nursing interventions to help people remain independent, with a sense of self-determination, for as long as possible.     

Profile of HIV-positive women hospitalized in a public maternity ward in Rio de Janeiro

AIDS has been scaring the world population for the last decades. The writers of this article decided to investigate and research into the high incidente of women HIV+ hospitalized in a public maternity in the district of Rio de Janeiro, showing the profile of pregnant women from 1987 to 1996. After a thorough analysis of a total of 102 cases this number was eventually broken down showing that the majority of the female population are single, between the ages of 19 and 33 years, have low schooling, mainly housewives and were sexually contaminated. The results show that the affected groups lack the knowledge as to how they could protect themselves against contamination. It is, therefore, of vital importance to take the necessary measures to help prevent contamination and to focus on health education.     

3种方案治疗新生儿病理性黄疸的临床疗效对比

目的:探讨蓝光照射分别联合白蛋白、妈咪爱、茵栀黄颗粒治疗新生儿病理性黄疸的临床疗效,并观察这3种方案对患儿体质量和细胞免疫功能的影响。方法:选取2017年1月～2018年2月我中心收治84例病理性黄疸新生儿作为研究对象,采用随机数字表法分为观察组、对照A组和对照B组,每组28例。观察组采用白蛋白、妈咪爱、茵栀黄颗粒联合蓝光照射治疗,对照A组采用白蛋白联合蓝光照射进行治疗,对照B组采用茵栀黄颗粒联合蓝光照射治疗,治疗后,统计比较三组的治疗总有效率、体质量和细胞免疫功能。结果:观察组的治疗总有效率、体质量和免疫功能指标均明显优于对照A组和对照B组,差异有统计学意义,P0.05。结论:白蛋白、妈咪爱、茵栀黄颗粒联合蓝光照射治疗新生儿病理性黄疸疗效显著。     

Clonal Dissemination of OXA-370-Producing Klebsiella pneumoniae in Rio de Janeiro,Brazil

Enzymes of the OXA-48 family have become some of the most important beta-lactamases in the world. A new OXA-48 variant (OXA-370) was first described for an Enterobacter hormaechei strain isolated in Rio Grande do Sul (southern region of Brazil) in 2013. Here we report detection of the bla_OXA-370 gene in 24 isolates belonging to three Enterobacteriaceae species (22 Klebsiella pneumoniae isolates, 1 Enterobacter cloacae isolate, and 1 Enterobacter aerogenes isolate) collected from five hospitals in Rio de Janeiro, Brazil, in 2013 and 2014. The isolates showed a multidrug resistance profile, and 12.5% were resistant to polymyxin B. Besides bla_OXA-370, no other carbapenemase genes were observed by PCR, whereas bla_OXA-1 was found in all isolates and 22 isolates (91.6%) possessed bla_CTX-M-15. Molecular typing of the K. pneumoniae isolates by pulsed-field gel electrophoresis (PFGE) showed the presence of two clonal groups, i.e., KpA (21 isolates) and KpB (1 isolate). KpA was characterized as sequence type 16 (ST16) and KpB as ST1041 by multilocus sequence typing (MLST). ST16 has been observed for KPC-producing K. pneumoniae in Rio de Janeiro. Plasmid analysis performed with six representative OXA-370-producing isolates showed plasmids harboring the bla_OXA-370 gene in all strains, ranging from 25 kb to 150 kb. This study suggests that there is an urgent need to investigate the presence of OXA-370 and dissemination of the K. pneumoniae ST16 clone carrying this gene in Brazil.     

The usage of multidisciplinary physical therapies at the Rio de Janeiro 2016 Olympic Summer Games: an observational study

BackgroundThis observational research study analyses the uptake of physical therapies treatments in the Polyclinic during the Rio 2016 Olympic Games.ObjectiveTo describe the usage of physical therapies services – physical therapy, osteopath, chiropractic, and sports massage – by athletes and non-athletes and across different sports.MethodsThe multidisciplinary team of physical therapies recorded treatment modalities, information on provider discipline and reason for attendance, in an Electronic Medical Record system throughout the 32 days of operation of the Olympic Polyclinic. Cold-therapy total immersion ice baths (TIIB) were provided as part of the services, but were reported and analysed separately.ResultsThere were 4993 encounters (4038 athletes, 955 non-athlete encounters). 1395 athletes (12.4% of all athletes) and 393 non-athletes sought treatment. For all four provider disciplines, in addition to TIIB, the primary reason for athlete attendance was for recovery (52% of all encounters), followed by injury treatment (30%), and maintenance (16%). Athletes reported “injury” as the main reason for physical therapy (92% of all encounters, 2.8 encounters per athlete), chiropractic (94%, 1.9) and osteopathy (91%, 1.8) visits. Almost all TIIB visits were used for recovery (98% of all TIIB encounters; 2.1 encounters per athlete). Athletes from handball (37% of all handball athletes), followed by judo (22%), and athletics (21%), presented the largest user groups.ConclusionThis Olympic Polyclinic study evaluates the physical therapies’ activity, and athlete's reason for use of the multidisciplinary physical therapies team, including total immersion ice bath provision. These results emphasise the importance of a multidisciplinary approach.     

甲氨蝶呤不同给药方案治疗未破裂型异位妊娠的效果观察

目的比较甲氨蝶呤(MTX)不同给药方案治疗未破裂型异位妊娠的效果。方法本研究始于2006年1月止于2010年1月,将我院收治的具有保守治疗指征的未破裂型异位妊娠136例按数字随机法分为A组(MTX单次肌内注射)70例和B组(MTX多次肌内注射)66例,比较两组的治愈率及不良反应发生率。结果两组的治愈率相当,差异无统计学意义(P>0.05);但A组的恶心呕吐、口腔溃疡、白细胞下降及丙氨酸转氨酶异常等不良反应发生率明显低于B组,差异有统计学意义(P<0.05)。结论 MTX单次给药不仅能达到与多次给药相当的治愈率,且不良反应发生率明显降低,是保守治疗未破裂型异位妊娠更为理想的给药方案。     

Prognostic Impact of Aortic Stiffness in High-Risk Type 2 Diabetic Patients: The Rio de Janeiro Type 2 Diabetes Cohort Study

OBJECTIVE

The prognostic importance of carotid-femoral pulse wave velocity (PWV), the gold standard measure of aortic stiffness, has been scarcely investigated in type 2 diabetes and never after full adjustment for potential confounders. The aim was to evaluate the prognostic impact of carotid-femoral PWV for cardiovascular morbidity and all-cause mortality in a cohort of 565 high-risk type 2 diabetic patients.

RESEARCH DESIGN AND METHODS

Clinical, laboratory, ambulatory blood pressure (BP) monitoring, and carotid-femoral PWV data were obtained at baseline. The primary end points were a composite of fatal and nonfatal cardiovascular events and all-cause mortality. Multiple Cox survival analysis was used to assess the associations between carotid-femoral PWV, as a continuous variable and categorized at 10 m/s, and the end points.

RESULTS

After a median follow-up of 5.75 years, 88 total cardiovascular events and 72 all-cause deaths occurred. After adjustments for potential cardiovascular risk factors, including micro- and macrovascular complications, ambulatory BP, and metabolic control, carotid-femoral PWV was predictive of the composite end point but not of all-cause mortality both as a continuous variable (hazard ratio 1.13 [95% CI 1.03–1.23], P = 0.009 for increments of 1 m/s) and as categorized at 10 m/s (1.92 [1.16–3.18], P = 0.012). On sensitivity analysis, carotid-femoral PWV was a better predictor of cardiovascular events in younger patients (<65 years), in those with microvascular complications, and in those with poorer glycemic control (HbA_1c ≥7.5% [58.5 mmol/mol]).

CONCLUSIONS

Carotid-femoral PWV provides cardiovascular risk prediction independent of standard risk factors, glycemic control, and ambulatory BPs and improves cardiovascular risk stratification in high-risk type 2 diabetes.In the past decade, knowledge of the importance of arterial stiffness in the pathogenesis of cardiovascular diseases grew (1,2). Arterial stiffness depends on the structural and geometric properties of the arterial wall and on the distending pressure, and aging and blood pressure (BP) are its main determinants (1,2). The measurement of carotid-femoral pulse wave velocity (PWV) is considered the gold standard evaluation of central aortic stiffness (1). Furthermore, aortic stiffness has been demonstrated to predict cardiovascular morbidity and mortality above and beyond other traditional cardiovascular risk factors in patients with end-stage renal disease (3) and hypertension (4), elderly individuals (5), and general population-based samples (6,7). This prognostic importance has also been recently confirmed in a meta-analysis (8).Type 2 diabetic patients have increased arterial stiffness (9–11) and are at particular risk for augmented cardiovascular morbidity and mortality. This high cardiovascular risk is not completely explained by clustering of traditional risk factors, and increased arterial stiffness may be one pathophysiological mechanism that links diabetes to increased cardiovascular morbidity and mortality (12). Nevertheless, only one previous study investigated the prognostic impact of increased aortic stiffness for cardiovascular outcomes in type 2 diabetes (13), but because of a smaller sample size (397 diabetic individuals), the study could not completely adjust for traditional cardiovascular risk factors, chronic diabetes complications, or metabolic control parameters. Therefore, we aimed to investigate in a prospective follow-up cohort of high-risk type 2 diabetic patients the prognostic impact of increased aortic stiffness for cardiovascular morbidity and mortality and for all-cause mortality. In particular, we evaluated whether aortic stiffness was able to add prognostic information beyond traditional cardiovascular risk markers and whether there were interactions between aortic stiffness and other important covariates, such as age, sex, presence of diabetes complications, and glycemic control.     

三种方式治疗输卵管妊娠的疗效及妊娠结局比较

[目的]探讨腹腔镜、开腹手术及药物治疗输卵管妊娠的疗效及妊娠结局.[方法]选择确诊为输卵管妊娠患者130例,其中腹腔镜组56例（Ⅰ组）,开腹组45例（Ⅱ组）,药物治疗组29例（Ⅲ组）,比较三组在治疗后β绒毛膜促性腺激素（β-HCG）下降至正常所需时间、有效率、治疗后患侧输卵管通畅度及1年内妊娠结局的差异.[结果]Ⅰ组和Ⅱ组治疗后血β-HCG值下降至正常所需时间显著短于Ⅲ组,有效率显著高于Ⅲ组（P〈0.05）;Ⅰ组术后输卵管通畅度显著高于Ⅱ组及Ⅲ组（P〈0.05）;Ⅰ组术后1年内的宫内妊娠率、异位妊娠率与Ⅱ组及Ⅲ组比较有显著性差异（P〈0.05）.[结论]腹腔镜下治疗异位妊娠可提高术后再次妊娠率,能维持妇女正常生育功能,值得临床推广应用.     

Staphylococcus haemolyticus disseminated among neonates with bacteremia in a neonatal intensive care unit in Rio de Janeiro,Brazil

Oxacillin-resistant Staphylococcus haemolyticus (ORSH) was found as the most prevalent (77.5%) species of coagulase-negative staphylococci associated with bacteremia in neonates making use of intravenous catheters in an intensive care unit of a Brazilian teaching hospital. Thirty-one blood isolates were confirmed as S. haemolyticus by sequencing of the 16S and clustered in 6 pulsed-field gel electrophoresis types (with 58% of the strains belonging to 2 predominant types B and D). S. haemolyticus was mostly oxacillin-resistant (90.3%) displaying multiresistance profiles (70.4%). However, the mecA gene was undetected in 22.6% strains. ORSH exhibited slime production on Congo-Red agar (67.7%), adherence to polystyrene (96.7%), and glass (87%) surfaces. Interestingly, ica-operon was detected in 58% strains, mostly belonging to the B, D, and F genotypes, which is a significantly higher percentage when compared to other studies conducted at different parts of the globe. Data indicated that ica operon and biofilm-forming ORSH are endemic in Brazilian nosocomial environment.     

Computer-Assisted Pacemaker Management Systems: Three Years of Clinical Experience

The implantation of large numbers of cardiac pacemakers and the increasing sophistication in engineering techniques has resulted in the demand for computer-assisted pacemaker management systems to remain on top of the available programmable features of the pacers as well as being able to access the follow-up data of pacemaker patients. A pacemaker patient management systems is introduced (PATIENTLOG™) that has been used in the clinical environment for a number of years. The menu-guided program is easy to handle and features a patient card for administration data, an implantation card for the technical data of the pacer, and a follow-up card where a large number of follow-ups can be stored side by side which are easily graphically displayable. An extensive statistical program, letter functions, automatic back-up and on-line communication with external equipment through an RS 232C interphase and a parallel adapter are available. The data base in Frankfurt holds 8,000 patients, 10,000 interventions and more than 30,000 follow-ups, the existing data base needs 20 M bytes storage space. Up to 96 different pacer types with their specific features can be introduced into the system. Software and hardware design complies with the recommendation of the NASPE Computer Committee.     

输卵管间质部妊娠腹腔镜诊断及手术的探讨

目的:探讨输卵管间质部妊娠腹腔镜诊断及患侧子宫角部楔形切除术的可行性和安全性。方法:分析91例输卵管间质部妊娠病例的临床资料,其中腹腔镜诊治术43例为研究组,剖腹手术48例为对照组,比较两组围手术期情况。结果:腹腔镜诊、治组输卵管间质部妊娠破裂发生率显著低于剖腹手术组(P<0．01);腹腔内出血量及术中出血量均显著少于剖腹手术组(P<0．01);手术时间显著长于剖腹手术组(P<0．01)。腹腔镜手术均获成功,无中转剖腹手术病例。结论:腹腔镜术用于输卵管间质部妊娠的诊断并同时在镜下进行患侧子宫角部楔形切除术,可显著减少子宫破裂、腹腔内大量出血发生率。只要手术方法得当,在腹腔镜下进行该手术是可行、安全的。     

甲氨喋呤联合米非司酮治疗宫外孕的临床疗效观察

将自愿接受保守治疗并符合保守治疗要求的31例宫外孕患者,随机分成A(单用甲氨喋呤)、B(单用米非司酮)、C(甲氨喋呤联合米非司酮),比较3组患者的临床疗效。结果 A组与B组患者相比,临床疗效差异不大(P>0.05),C组患者临床疗效明显提高(P<0.05)。甲氨喋呤联合米非司酮治疗宫外孕疗效确切,值得临床推广。     

Poisoning Due to Illegal Use of Carbamates as a Rodenticide in Rio De Janeiro

Abstract

Carbamate insecticides (mainly aldicarb) are illegally commercialized as rat poisons and commonly used by the population of Rio de Janeiro for this purpose. A retrospective study concerning 189 cases (80 men, 109 women) of carbamate poisoning referred to the Poison Control Center of Rio de Janeiro throughout 1993 is described. The causes of carbamate poisoning were suicide attempts (65%) and accidental ingestions (35%). The main signs and symptoms found (86%) were those related to the SLUDGE syndrome (increased salivation, lacrimation, urinary incontinence, diarrhea, gastrointestinal cramping and emesis) which were more commonly seen in adults than in children. Despite treatment with atropine, the case-fatality was 4%. It is concluded that there is a widespread risk of carbamate poisoning in Rio de Janeiro due to its clandestine use as a rodenticide. Effective measures by the government authorities should be implemented to stamp out the illicit commercialization of these compounds.     

三种子宫肌瘤剔除术的临床疗效评估

[目的]探讨三种不同途径子宫肌瘤剔除术的临床效果,以选择合适的手术方式.[方法]回顾性分析腹式子宫肌瘤剔除术92例,阴式子宫肌瘤剔除术41例,腹腔镜下子宫肌瘤剔除术78的临床资料,比较各组患者术中及术后情况.[结果]三组比较手术时间腹腔镜组最长,有统计学意义（P〈0.05）,腹式组和阴式组间差异无统计学意义（P〉0.05）;术中出血量,腹腔镜组多于阴式组和腹式组（P〈0.05）,腹式组和阴式组间差异无统计学意义（P〉0.05）;术后排气时间和住院天数腹式组最长,术后病率高,有统计学意义（P〈0.05）,而腹腔镜组和阴式组间差异无统计学意义;腹腔镜组和阴式组间剔除的肌瘤单个平均重量无统计学意义（P〉0.05）,但轻于腹式组（P〈0.05）.[结论]不同途径的子宫肌瘤剔除术各有优劣,且不能完全替代,应综合考虑患者的情况、手术医生技能经验、医院的设备条件而定,选择最合适的手术途径.