The re-humanization of the executive nurse's job: a focus on the spiritual dimension

This work synthesizes the authors' views on the damages to the development of human capital in health services, which are caused by the disregard to the human spiritual dimension. New administration paradigms related to the development of spirituality are pointed out. Considering that the spiritual dimension has a systemic nature and that, by means of ethics and esthetics, it harmonizes all of man's dimensions in his relationships with others, the authors aim at approaching the spiritual value as fundamental for the re-humanization of the managing nurse's job. They recommend the integration of the spiritual dimension to the daily work of such professional as a determinant factor for a new performance as well as an inductor for nurses' better personal and professional life quality.     

Bereavement-related cognitive impairment in an oldest-old community-dwelling Brazilian sample

As it is already known that depression can cause a demonstrable impact on cognition in elderly subjects, the objective of this study was to determine whether also the mourning process is associated with any cognitive impairment in this age range. A random and representative sample (a sample with 77 subjects/total county population of oldest-old with 219 subjects = 35%) aged 80 years or more was selected from the county of Veranópolis in the Brazilian rural southern region. Of this group, the cognitive function of subjects without grief and of subjects with the presence of grief were compared. Five neuropsychological tests (the Buschke-Fuld Selective Reminding Test, the word-list from the CERAD battery, the Verbal Fluency Test, and two subtests of the Wechsler memory scale), the Mini-Mental State Examination (MMSE) and two self-perceived memory impairment questionnaires were used. Presence of depressive symptomatology was identified by the Yesavage Geriatric Depression Scale (GDS). The prevalence rates of some psychiatric diagnoses (syndromic general anxiety disorder, major and minor depression) were compared between the bereaved group and the control group. There was not a statistically significant difference between the scores of controls and subjects with grief in the GDS. The frequency of affective disorders in both groups did not differ. However, the recently bereaved elderly subjects presented a mild cognitive impairment when evaluated with the MMSE, with the digit span test and with Word-list neuropsychological memory test. Likewise these bereaved octogenarian subjects presented more frequently a diagnosis of 'aging-associated cognitive decline' when compared with non-bereaved oldest-old. These results suggest that the normal sadness and/or the chronic stress of the grieving process, even without the presence of an identifiable syndromal-level depression, are associated with memory and cognitive differences among the bereaved oldest-old. Cause-effect relationships, however, cannot be established from this cross-sectional correlational study: Grief may influence cognitive functioning in the elderly, but mildly cognitively compromised elderly persons may be more likely to experience strong grief reactions after loss.     

Stereotactic fibrinolysis of spontaneous intracerebral hematoma using infusion of recombinant tissue plasminogen activator

PURPOSE: The authors present a prospective study on 10 patients with stereotactic infusion of tissue plasminogen activator (rtPA) intraparenchimal hemorrhage. METHODS: Between 1999 and 2000, 10 patients with deep seated hematomas in the basal ganglia were selected for stereotactic infusion of rtPA and spontaneous clot drainage. RESULTS: All cases had about 80% reduction of the hematoma volume in the CT scan at the third day. The intracranial pressure was normalized by the third day too. There were no local or systemic complications with the use of this thrombolytic. The results were shown by the Glasgow Outcome Scale with six patients in V, three in IV and one in III after 3 months. CONCLUSION: Early treatment and drainage with minimally invasive neurosurgery, can make these patients with deep-seated hematomas recover the consciousness and they can be rehabilitated earlier avoiding secondary complications.     

The Impact of Lupus Erythematosus Cutaneous on the Quality of life: The Brazilian–Portuguese Version of DLQI

Objective: To translate into Brazilian–Portuguese, culturally adapt and validate the DLQI. Patients and Methods: The DLQI was translated into Brazilian–Portuguese and cultural adaptation was performed following the methodology proposed by Falcão. Inter-observer reliability and validity were assessed. Seventy-one patients with lupus erythematosus with cutaneous lesions selected from the outpatient dermatology clinic had their quality of life assessed by DLQI and SF-36. The validity of the Brazilian–Portuguese version of the DLQI was evaluated by the correlation of DLQI scores with SF-36 component scores and other outcome measures. Results: In the translation and cultural adaptation process the basic structure of DLQI was kept. Very few questions have very slightly modifications. Of the 71 patients, 83% were women and the median (SD) age was 38 (12) years. The patients had a mean (SD) disease duration of 8(6) years. There were 46 patients with active cutaneous lesions and 37 patients with alopecia. The DLQI inter-observer reliability coefficient was 0.96 (p<0.001). The DLQI mean (SD) score was 6.5 (5.6) and most of the SF-36 domains were between 60 and 70. The domains that had the lowest scores were ‘general health’ (62) and ‘mental health’ (62). The Pearson correlation coefficient between DLQI and each SF-36 component score were highly statistically significant (p<0.001), despite of being only moderate. As expected there was no correlation between DLQI or each one of the SF-36 components and age, disease duration or number of ACR criteria. Patients with active cutaneous lesions presented statistically significant lower scores of DLQI and SF-36 when compared to patients without active cutaneous lesions. Patients with alopecia presented a statistically significant lower score in DLQI when compared to patients without alopecia. Conclusions: The results suggest that the Brazilian–Portuguese version of the DLQI is a reliable and valid outcome measure to be used in LE clinical studies.     

Cerebral venous thrombosis and homocystinuria: case report

Homocystinuria presenting as cerebral venous thrombosis is not usual. We report on a 13-year-old boy who was admitted to the hospital due to severe headache, nausea, vomiting and fever (38 degrees C). The patient was Marfan like and presented left hemiparesis and meningeal irritation sings. He was mentally retarded, had severe myopia, and had right lens dislocation one month before. Cranial CT scan was suggestive of cerebral venous infarct. MRI and magnetic resonance angiography showed venous infarcts more prominent in the right thalamic projection with hemorrhagic transformation and multiple foci of cortical (occipital and parietal bilaterally) deep parietal and left capsular bleeding, secondary of thrombosis of the transverse and sigmoid venous sinuses. High levels of homocysteine were detected in the blood and urine. Homocystinuria is an autosomal recessive inborn error of methionine metabolism caused by cystathionine-beta-synthase defect in most cases. We discuss the clinical and radiological findings in this patient, analyzing the pathophysiology of the thrombotic events related to homocystinuria.     

Amiloride Relaxes Rat Corpus Cavernosum Relaxation In Vitro and Increases Intracavernous Pressure In Vivo

Introduction

The antihypertensive effects of thiazide diuretics such as hydrochlorothiazide are commonly associated with erectile dysfunction. The association of hydrochlorothiazide/amiloride is not associated with erectile dysfunction. The hypothesis is that amiloride has beneficial effect in penile erection and, therefore, counterbalances the hydrochlorothiazide-induced disruptive effect.