Pai syndrome: report of seven South American patients

Frontonasal dysplasia is etiologically heterogeneous and various subsets are known. Pai syndrome is one subset, which is characterized by mild hypertelorism, midline cleft lip, nasal and facial polyps, pericallosal lipoma, ocular anomalies, and normal neuropsychological development. Here, we report seven South American patients and review earlier reported cases. The phenotype is clinically variable and five reported patients were severely affected. The cause of Pai syndrome is unknown to date. Several literature findings have been noted: nondiagnostic and discordant minor signs in a parent of two separate families with an affected child; discordant phenotype in monozygotic twins in one instance; and a de novo reciprocal translocation, 46,X,t(X;16)(q28;q11.2) in one instance.     

Obstacles found in the construction of a democratic and participatory hospital management model

A path leading to management modernization is based on an approach stressing dialog and discussions of the construction of a healthcare enhancement project whose main characteristic is its emphasis on joint management concepts at all levels. This paper assesses almost ten years of management by committee in a public hospital in Rio de Janeiro State, Brazil, seeking impacts on its micro-policies. The intention is to identify and analyze how the nursing staff experienced the implantation of this management model in the hospital. Empirical matters were analyzed at two levels: initially the comments of the players were grouped into themes, followed by cross-theme readings that analyzed the concept of "noise". The remarks made by the respondents indicated that this "noise" functions within the organization, demonstrating that the selected management process and the manner in which it was conducted are not sufficient to penetrate and intervene in institutional micro-policies, leaving gaps between the proposals set forth by this management model and the real situation of the workers.     

Effect of food fortification with iron on childhood anemia: a review study

A systematic review was conducted to identify studies assessing the effect of food fortification with iron on childhood anemia. The MEDLINE, LILACS, and PubMed databases and WHO and PAHO sites were searched with no time limitation, including articles published in Portuguese, English, or Spanish, using the following key words and their combination: food fortification, iron, effectiveness, efficacy, anemia, flour, staple foods, interventions, and children. Of 21 studies reviewed, only one failed to report a positive, favorable effect of iron fortification, indicating the possibility of publication bias. The studies showed important methodological limitations. The two studies with the best methodological scores showed opposite results, highlighting the need for larger trials with better planning to explore this hypothesis.     

Coverage, focus, risk factors associated with participation, and linkage to the National Campaign for Diabetes Detection in a city in Southern Brazil

The objective of this study was to measure coverage, focus, factors associated with participation, and linkage to the National Campaign for the Detection of Diabetes Mellitus in Pelotas, Southern Brazil. 3,100 individuals living within the city limits of Pelotas were interviewed in a cross-sectional study. Coverage was calculated based on different criteria: utilization, coverage among estimated users, and coverage among self-declared users. The focus was the proportion of tests performed in individuals who had met the inclusion criteria. Coverage rates were: utilization, 45.8% (95%CI: 43.0-48.5), among estimated users, 37.7% (95%CI: 35.1-40.5), and among self-declared users, 38.5% (95%CI: 35.2-41.9). Focus was 46.5% (95%CI: 42.8-50.2). Female gender, older age, and lower schooling were associated with adherence to the campaign. A total of 42.4% of individuals with positive screening tests but without prior diagnoses were subsequently examined by physicians, and half of the diagnoses were confirmed. The campaign showed a low coverage and poor focus. Efforts should be concentrated on improving care for individuals who have already been diagnosed, linking them to services by offering regular medication and educational strategies.     

Intraoperative lactate levels and postoperative complications of pediatric cardiac surgery

Objectives: Correlate arterial lactate levels during the intraoperative period of children undergoing cardiac surgery and the occurrence of complications in the postoperative period. Aim: Arterial lactate levels can indicate hypoperfusion states, serving as prognostic markers of morbidity and mortality in this population. Background: Anesthesia for cardiac pediatric surgery is frequently performed on patients with serious abnormal physiological conditions. During the intraoperative period, there are significant variations of blood volume, body temperature, plasma composition, and tissue blood flow, as well as the activation of inflammation, with important pathophysiological consequences. Methods/Materials: Chart data relating to the procedures and perioperative conditions of the patients were collected on a standardized form. Comparisons of arterial lactate values at the end of the intraoperative period of the patients that presented, or not, with postoperative complications and frequencies related to perioperative conditions were established by odds ratio and nonparametric univariate analysis. Results: After surgeries without cardiopulmonary bypass (CPB), higher levels of arterial lactate upon ICU admission were observed in patients who had renal complications (2.96 vs 1.31 mm ) and those who died (2.93 vs 1.40 mm ). For surgeries with CPB, the same association was observed for cardiovascular (2.90 mm × 2.06 mm ), renal (3.34 vs 2.33 mm ), respiratory (2.98 vs 2.12 mm ) and hematological complications (2.99 vs 1.95 mm ), and death (3.38 vs 2.40 mm ). Conclusion: Elevated intraoperative arterial lactate levels are associated with a higher morbidity and mortality in low‐ and medium‐risk procedures, with or without CPB, in pediatric cardiac surgery.     

The nursing work process in care for healthy children at a social security institution in Mexico

We aimed to analyze the nursing work process directed at care in the Nutrition, Growth and Development Surveillance and Control Program (VNCD) for children under five years at a social security institution in Mexico. The study adopted a qualitative approach and was based on the work category, on conceptions of the work process in health and on institutional analysis. We carried out direct systematic observations and interviews with a group of nurses and their assistants and with mothers who attended nursing appointments with their children. The care process was identified as procedure-centered and based on care protocols, with rapid appointments and little room for interaction between nurses and mothers. However, on some occasions, nurses were capable of producing live work as a result of their self-government, which allowed them to establish a mother/child-centered care nucleus.     

Allogeneic acute rejection on fetal small-bowel graft: role of gangliosides

In previous work, it was shown that gangliosides (Gang) have an inhibitory effect on lymphocyte proliferation as well as on delayed-type hypersensitivity response and mixed lymphocyte reaction. Therefore, we decided to examine the effect of gangliosides in acute allorejection after fetal intestinal transplantation. We used two female C57BL/6 mice on pregnancy day 19 as a source of fetal intestine. All animals were anesthetized with ketamine (70 mg/kg) and xylazine (10 mg/kg), intramuscularly. We harvested intestinal segments of 1 cm to transplant into BALB/c and C57BL/6 mice (male, weighing around 20 g) used as recipients. They were divided into groups of six animals each: isogeneic and allogeneic without treatment, or treated with tacrolimus 1 mg/kg/day, or gangliosides 3 and 9 mg/kg/day, during 7 days posttransplantation, intramuscularly. On postoperative day 7, intestinal grafts were collected and fixed in 10% formalin solution. Using an anesthetic overdose as euthanasia, we removed the intestinal grafts. Tissue samples were stained with hematoxylin-eosin for histological analysis regarding grafts development (D) and rejection (R) aspects. Data were analyzed by the Kruskal-Wallis test, considering P < or = 0.05 as significant. In the isogeneic and tacrolimus groups, we observed a very good degree of development (D = 9 +/- 0.5; D = 9 +/- 0.4, respectively), but a severe degree of rejection (R = 15 +/- 1.3) and a low degree of development (D = 1 +/- 0.8) in animals without treatment. The ganglioside groups showed D = 5 +/- 1.6 and R = 13 +/- 3.3, and D = 7 +/- 2.9 and R = 9 +/- 1.9, for the 3-mg and 9-mg groups, respectively. There was a statistically significant difference between the ganglioside groups and allogeneic groups without treatment. Based on the above data, we conclude that avascular fetal intestine transplantation is a good experimental model for studying immunological events, and that gangliosides only partially modulate the allorejection response, allowing intestinal development, mainly at the highest ganglioside dose. Maybe immunomodulation would be better observed by using isolated types of gangliosides or association with other immunosuppressive drugs.