Value of transesophageal echocardiography in the diagnosis of acute aortic dissection]

We describe our experience of six patients with clinical suspicion of acute aortic dissection (AAD) who were studied consecutively by transesophageal echocardiography (TEE) from April to July of 1991. All of them were previously submitted to transthoracic echocardiogram. The diagnosis was correctly established by TEE in five cases, confirmed by aortography and/or surgery (four cases), or by autopsy (one case). In one patient the diagnosis of AAD was excluded by TEE, and posteriorly by nuclear magnetic resonance. Four patients had a Stanford type A, and one patient a type B dissection. The site of entry was identified in three cases; the intimal entry tear of the type B dissection, not observed by TEE, was localized in the aortic arch by aortography. In three of the four type A dissection cases, a thrombus in the false lumen and an aortic regurgitation were found. No other noninvasive methods were used after the diagnosis of AAD by TEE. The surgical repair was successful in three cases, one of which, without previous necessity of aortography. In our experience, TEE increased extraordinarily the diagnosis efficacy of AAD, making possible an earlier therapeutic approach, and probably contributing to the improvement of the prognosis of this pathology.     

Molecular characterization of the <Emphasis Type="Italic">env</Emphasis> gene from Brazilian field isolates of Bovine Leukemia Virus

Molecular characterization of Bovine leukemia virus (BLV) isolates from Brazil using the env gene sequences revealed a high conservation of this gene. In most cases the substitutions corresponded to silent transitions. In addition, cystein residues, potential glycosylation sites, neutralization domains and other critical residues involved with the envelope structural domains and viral infectivity were conserved. Most of the substitutions found in the aminoacid sequences of the gp51 protein were localized in the G and H epitopes. Using the SIFT software, it was predicted that they should not alter the protein functions. Phylogenetic analyses showed that partial or complete env gene sequences grouped in three or four phylogenetic clusters, respectively. The sequences from the Brazilian isolates had similar mutation rates as compared to samples from other countries, and belonged to at least two phylogenetic clusters.     

The "oligoanalgesia problem" in the emergency care

INTRODUCTION: Pain is a common occurrence in trauma victims that provokes harmful effects on the body. However, there is a gap in the literature about this problem, which is still underevaluated and undertreated in Brazil, especially concerning the use of opioids. OBJECTIVES: To estimate pain intensity and the use of analgesia in traffic accident victims. MATERIALS AND METHODS: A prospective study, involving 100 accident victims (traffic accidents), who were interviewed at 2 separate posttraumatic moments, in a reference hospital of the city of S?o Paulo. All the medications used for these victims were recorded. All patients displayed a Glasgow Coma Scale (ECGl) of 15, had stable hemodynamic parameters, and were brought directly from the scene of the accident. RESULTS: Pain of moderate and severe intensity (in 90% of cases) was the most noted. After a 3-hour period, a significant number of patients with pain (48%) continued without analgesia, and few opioids were used. CONCLUSION: Pain is a common event associated with trauma. It is still undertreated and underevaluated in Brazil, and the use of opioids for admittedly very severe pain is not frequently employed in the Emergency Service even in hemodynamically stable patients and with a Glasgow Coma Scale of 15.     

Use of mycelial-phase Sporothrix schenckii exoantigens in an enzyme-linked immunosorbent assay for diagnosis of sporotrichosis by antibody detection

An enzyme-linked immunosorbent assay (ELISA) was developed for specific antibody detection in serum specimens of patients with sporotrichosis. The assay was made with mycelial-phase Sporothrix schenckii exoantigens and was tested against 90 sera from patients with different clinical forms of sporotrichosis. Potential cross-reactions were analyzed with 72 heterologous sera from patients with paracoccidioidomycosis, cryptococcosis, aspergillosis, histoplasmosis, tuberculosis, and American tegumentary leishmaniasis, as well as 76 sera from healthy controls. We found a sensitivity of 97% and a specificity of 89% in this assay. Some cross-reactions were seen, as observed in other immunoassays for the diagnosis of sporotrichosis. The ELISA appears to be especially useful for cutaneous forms of disease, since these are not promptly diagnosed with available immunoprecipitation or agglutination techniques. These results suggest that the ELISA using mycelial-phase S. schenckii exoantigens is a very sensitive diagnostic tool for the serodiagnosis of sporotrichosis and can be used in conjunction with conventional methods of diagnosis, particularly in cases where cross-reactions or false-positive results are experienced with the serodiagnosis.     

Aesthetics of the grotesque and audiovisual production for health education: segregation or empathy? The case of leishmaniasis in Brazil

In order to understand audiovisual production on health and disease and the pedagogical effects of health education mediated by educational videos, this article analyzes the audiovisual production on leishmaniasis in Brazil. Fourteen educational videos showed the hegemony of TV aesthetics, particularly a journalistic paradigm with constant use of voice-over, inducing the fixation of meanings. Rather than stimulating critical reflection on the social circumstances of leishmaniasis, the videos' discourse and images promote a banal, non-critical, stigmatized representation of the disease. Individuals with the disease are subjected to visual exposure rather than being involved critically and sensitively as protagonists in prevention and treatment. The article thus presents approaches based on studies of visual and health anthropology, arguing in favor of an innovative approach to the production and utilization of educational videos in health education, mediated through audiovisuals. Health education should respect and engage in dialogue with various cultures, subjectivity, and citizenship, developing an audiovisual aesthetics (in terms of narrative and image) that fosters an educational praxis in the field of collective health.     

Group therapy with nursing students during the theory-practice transition

This study aimed to verify whether the intervention of short term groups could provide nursing students means to cope with stress, typical of the transition process from the theoretical to the practical learning. Participant observation was used, allowing 12 students in the discipline Fundamentals II, to express their anxieties and anguish towards the new and future role of taking care of other people's health. Results suggest that higher nursing education institutions should consider the group technique not only as a support resource, but also as a didactical resource in their curricula. At a time when educational reforms are discussed, is important to bear in mind that any planned changes will have an effect not only in technical terms but will also affect the human being.     

The PICO strategy for the research question construction and evidence search

Evidence based practice is the use of the best scientific evidence to support the clinical decision making. The identification of the best evidence requires the construction of an appropriate research question and review of the literature. This article describes the use of the PICO strategy for the construction of the research question and bibliographical search.