Abstract Objective Training a competent physician requires to direct the resident profile of graduate students for practice activities. We sought to identify the doctor-patient relationship orientation and the self-assessment of the core competencies, which they pointed out needed to be developed. Methods All 56 orthopedic residents admitted between 2016 and 2019 participated in the present prospective observational study. The Patient Practitioner Orientation Scale (PPOS) and a self-assessment questionnaire were answered at the beginning and end of the first year of residency (R1) in Orthopedics and Traumatology. We calculated mean and standard deviation for PPOS items and scores and analyzed them through the paired t-test. Self-Assessment Questionnaire answer options were “yes” or “I need to improve it” and skills were classified in decreasing order of the frequency of “I need to improve it” responses with description of absolute number and percentage. We compared frequencies using Fisher Test. P-values < 0.05 were considered statistically significant. GraphPad Prism 8.4.3 (GraphPad Software, San Diego, CA, USA) and Microsoft Excel (Microsoft Corporation, Redmond, WA, USA) were used for statistical analysis. Results In the period between the beginning and the end of R1, the total PPOS mean score significantly decreased from 4.63 to 4.50 (p= 0.024), more biomedical-focused. Around one-third of the residents identified competencies of patient care, practice-based learning and improvement, and interpersonal and communication skills as needed to improve. Conclusions The PPOS and self-assessment activities could promote reflection practices and are possible tools for learner-centered competency assessment. Biomedical guidance tends to prevail as the training of physicians progresses, and periodic self-assessments can be worked on to build a growth mindset.

Resumo Objetivo A formação de um médico competente requer direcionar o perfil de pós-graduação residente para atividades práticas. Buscou-se identificar a orientação de relacionamento médico-paciente e a autoavaliação das competências fundamentais que eles apontaram que precisavam ser desenvolvidas. Métodos Todos os 56 residentes em ortopedia admitidos entre 2016 e 2019 participaram do presente estudo observacional prospectivo. A Escala de Orientação Médico-Paciente (Patient Practitioner Orientation Scale [PPOS, na sigla em inglês]) e um questionário de autoavaliação foram respondidos no início e no final do primeiro ano de residência (R1) em Ortopedia e Traumatologia. Calculamos o desvio médio e padrão para itens e pontuações de PPOS e os analisamos através do teste t emparelhado. As opções de resposta do Questionário de Autoavaliação foram "sim" ou "preciso melhorar" e as habilidades foram classificadas na ordem decrescente da frequência das respostas "preciso melhorar" com descrição de número absoluto e percentual. Comparamos frequências usando o teste de Fisher. Consideramos significativos valores-p < 0,05. Os programas GraphPad Prism 8.4.3 (GraphPad Software, San Diego, CA, EUA) e Microsoft Excel (Microsoft Corporation, Redmond, WA, EUA) foram utilizados para análise estatística. Resultados No período entre o início e o final do R1, a média total de PPOS diminuiu significativamente, de 4,63 para 4,50 (p= 0,024), mais focada em biomédica. Cerca de um terço dos residentes identificou competências do cuidado ao paciente, aprendizagem e melhoria baseadas na prática e habilidades interpessoais e de comunicação, como necessitando melhorar. Conclusões As atividades de PPOS e autoavaliação podem promover práticas de reflexão e são possíveis ferramentas para avaliação de competência centrada no aluno. A orientação biomédica tende a prevalecer à medida que a formação dos médicos progride e as autoavaliações periódicas podem ser trabalhadas para construir uma mentalidade de crescimento.

Abstract Fabry disease (FD) is an X-linked lysosomal storage disorder characterized by reduced or absent activity of the enzyme α-galactosidase A. Due to systemic accumulation of glycolipids, FD phenotype is diverse, and diagnosis may be challenging. Clinical manifestations include small fiber neuropathy, renal dysfunction, cardiac involvement, cerebrovascular disease, among others. In the present study, we describe biopsy proven small fiber neuropathy and subclinical cardiac involvement in two cousins diagnosed with FD secondary to a recently described pathogenic variant, highlighting the importance of diagnostic tools to document organ damage and allow early treatment. (FD Xlinked X linked αgalactosidase α galactosidase A glycolipids diverse challenging dysfunction others study variant treatment

RESUMO Objetivo: Avaliar o ambiente de prática profissional da enfermagem em unidades neonatais e sua relação com os níveis e as principais fontes de estresse ocupacional. Método: Estudo transversal, descritivo, exploratório e correlacional, realizado com profissionais de enfermagem das unidades neonatais de quatro hospitais públicos. Aplicaram-se o questionário sociodemográfico/profissional, Versão Brasileira da Practice Environment Scale e a Escala de Estresse no Trabalho. Na análise, adotaram-se média, desvio padrão e testes qui-quadrado de Pearson, Razão de Verossimilhança e U de Mann Whitney para associação entre variáveis. Resultados: Participaram 269 profissionais. O ambiente de prática foi avaliado como favorável por mais da metade da amostra (63,6%), demonstrando associação estatística significante e inversamente proporcional com o estresse ocupacional (p < 0,001). O número insuficiente de profissionais para um cuidado de qualidade foi a maior fonte de estresse para as técnicas de enfermagem, enquanto o trabalho em equipe com médicos foi fator preponderante na avaliação da qualidade do ambiente e do nível de estresse elevado para as enfermeiras. Conclusão: Ambientes de prática desfavoráveis aumentam o nível de estresse de profissionais de enfermagem em unidades neonatais, podendo comprometer a segurança do paciente.

ABSTRACT Objective: To assess the nurse professional practice environment of neonatal units and its relationship with the levels and main sources of occupational stress. Method: Cross-sectional descriptive, exploratory, correlational study performed with nursing professionals of neonatal units of four public hospitals. A sociodemographic/professional questionnaire, the Brazilian version of Practice Environment Scale, and the Work Stress Scale were applied. In the analysis, mean, standard deviation, and Pearson chi-squared, Likelihood Ratio, and Mann Whitney U tests were adopted for association among variables. Results: Participating professionals amounted to 269. The practice environment was evaluated as favorable by more than half of the sample (63.6%), showing a significant statistical association which was inversely proportional with occupational stress (p < 0.001). The insufficient number of professionals for quality care was the major source of stress for nursing technicians, whereas teamwork with doctors was the predominant factor for the evaluation of environment quality and high stress levels of nurses. Conclusion: Unfavorable practice environments increase the stress levels of nursing professionals in neonatal units and may compromise patient safety.

RESUMEN Objetivo: Evaluar la práctica profesional de enfermería en unidades neonatales y su relación con los niveles y las principales fuentes de estrés ocupacional. Método: Estudio transversal, descriptivo, exploratorio y correlacional conducido con profesionales de enfermería de unidades neonatales de cuatro hospitales públicos. Se aplicaron el cuestionario sociodemográfico/profesional, la versión brasileña de Practice Environment Scale y la Escala de Estrés en el Trabajo. En el análisis, se adoptaron la media, la desviación típica y las pruebas chi-cuadrado de Pearson, Razón de Verosimilitud y Mann Whitney U para la asociación entre las variables. Resultados: Los participantes fueron 269 profesionales. El ambiente de práctica fue evaluado como favorable por más de la mitad de la muestra (63,6%), con una asociación estadística significativa e inversamente proporcional con el estrés ocupacional (p < 0,001). El número insuficiente de profesionales para una atención de calidad fue la mayor fuente de estrés para las técnicas de enfermería, mientras que el trabajo en equipo con los médicos fue el factor predominante en la evaluación de la calidad del ambiente y del nivel de estrés elevado para las enfermeras. Conclusión: Los ambientes de práctica desfavorables aumentan el nivel de estrés de los profesionales de enfermería en las unidades neonatales y pueden comprometer la seguridad del paciente.

Resumo Introdução e objetivo: A contaminação da água utilizada nas unidades de saúde pode induzir consequências adversas individuais e coletivas. O objetivo deste estudo foi avaliar a qualidade da água em clínicas odontológicas de um curso de odontologia de uma universidade no Brasil, através da análise de coliformes totais, coliformes termotolerantes, bactérias heterotróficas e pH. Materiais e métodos: Em cada clínica, amostras de água foram coletadas para análise em diferentes pontos: cisterna externa, torneira clínica, reservatório da cadeira odontológica e seringa tríplice. Após a coleta das amostras, a análise foi realizada: a presença de coliformes totais e coliformes termotolerantes foi determinada pela técnica do substrato cromogênico; a presença ou ausência de Escherichia coli por fluorescência em luz ultravioleta; a contagem de bactérias heterotróficas através do número de colônias e a determinação de pH. Resultados: Em todos os pontos estudados, a presença de coliformes totais, Escherichia coli e coliformes termotolerantes foi observada em pelo menos 26% das amostras. Em relação à UFC/ml, todos os valores médios foram muito superiores ao máximo estabelecido pela legislação (500 UFC/ml). Todas as amostras de pH estavam dentro dos padrões. Conclusão: A análise global mostrou que 100% das amostras foram inadequadas, o que classificou a capacidade de água como fora do padrão em relação à legislação brasileira atual.

Abstract Introduction and objective: Contamination of the water used in health care units can induce adverse individual and collective consequences. The objective of this study was to evaluate the water quality in dental clinics of a dentistry program of a university in Brazil, calculating the total coliforms, thermotolerant coliforms, heterotrophic bacteria and pH. Materials and methods: In each clinic, water samples were collected for analysis at different points: external cistern, clinic faucet, dental chair tank and triple syringe. After sample collection, analysis was performed: the presence of total coliforms and thermotolerant coliforms was determined by chromogenic substrate technique, the presence or absence of Escherichia coli by fluorescence in ultraviolet light, the count of heterotrophic bacteria through the number of colonies and the determination of pH. Results: In all studied sites, the presence of total coliforms, Escherichia coli and thermotolerant coliforms was observed in at least 26% of the samples. In relation to CFU / ml, all mean values were much higher than the maximum established by legislation (500 CFU / ml). It was verified a statistically significant difference was found in the external cistern and tap when compared to the chair tank and triple syringe (p < 0.05). All pH samples were within the standards. Conclusion: The global analysis showed that 100% of the samples were inadequate, which classified the water potability as nonstandard in regard to the current Brazilian legislation.

Resumen Introducción y objetivo: La contaminación del agua utilizada en las unidades de salud puede inducir malas consecuencias individuales y colectivas. El objetivo de esta investigación fue evaluar la calidad del agua en clínicas odontológicas de una universidad en Brasil, a través del análisis de coliformes totales, coliformes termotolerantes, bacterias heterotróficas y pH. Materiales y métodos: En cada clínica, las muestras de agua fueron recolectadas para análisis en diferentes puntos: cisterna externa, grifo clínico, reservatorio de la silla odontológica y jeringa tríplice. Después de la recolección de las muestras, el análisis fue realizado: la presencia de coliformes totales y coliformes termotolerantes fue determinada por la técnica del sustrato cromogénico; la presencia o ausencia de Escherichia coli por fluorescencia en luz ultravioleta; el recuento de bacterias heterotróficas a través del número de colonias y de la determinación del pH. Resultados: En todos los puntos estudiados, se observó la presencia de coliformes totales, Escherichia coli y coliformes termotolerantes en al menos el 26% de las muestras. Respecto a la UFC / ml, todos los valores medios fueron muy superiores al máximo establecido por la legislación (500 UFC / ml). Todas las muestras de pH estaban dentro de los patrones. Conclusión: El análisis global mostró que el 100% de las muestras fueron inadecuadas, lo que clasificó la capacidad de agua como fuera del estándar en relación a la legislación brasileña actual.

A novel anti-inflammatory hybrid 3-ibuprofenyl-copalic acid (3-IbuCA) was synthesized from 3-hydroxy-copalic acid isolated from Amazonian copaiba oil (Copaifera multijuga Hayne), and the anti-inflammatory ibuprofen. After full characterization, several assays to verify its anti-inflammatory effects were performed in vitro, in vivo and in silico (molecular docking). Induced fit docking was performed to observe the interactions with the enzymes cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). In vitro tests of cytotoxicity and tumor necrosis factor (TNF)-α inhibition, and in vivo tests of pleurisy, protein expression and gastrocytotoxicity were performed. Molecular docking studies with COX-1 and 2 showed binding free energies (ΔG) of -2.2 and -7.8 kcal mol-1, respectively, while for mofezolac and indomethacin, the binding free energies ΔG presented values of -8.5 and -10.1 kcal mol-1, which makes 3-IbuCA selective for COX-2 inhibition. This hybrid showed no toxicity against human macrophage at concentrations up to 2 µM, and inhibited TNF-α production in lipopolysaccharide (LPS)-stimulated macrophages. In the pleurisy assays, 3-IbuCA reduced the total leukocytes and mononuclear cells, which was followed by reduction of p-IKBα (phosphorylated nuclear factor of kappa light polypeptide gene enhancer in B-cells inhibitor, alpha) protein expression. Compared with ibuprofen alone, the hybrid caused less gastric damage. Thus, the docking, together with in vitro and in vivo studies suggest that this novel hybrid has potential as a new anti-inflammatory agent.

Cannabidiol (CBD) and tetrahydrocannabinol (THC) are the main active principles in the Cannabis extracts. Rich-CBD extracts are indicated to control seizures in epileptic patients, THC is indicated as antiemetic to patients in chemotherapy treatment and extracts with THC and CBD in proportions of approximately 1:1 are indicated to control spasticity in patients with multiple sclerosis. In Brazil epileptic pediatric patients are treated with imported Cannabis extracts registered as food supplement and with national not regulated Cannabis extracts. With the medical Cannabis sanitary regulation in Brazil, quality control methods will be required. A High Performance Liquid Chromatography (HPLC) method was developed and validated for five cannabinoids quantification in oily extracts and resins. The method was applied to 101 Cannabis extracts consumed by patients attended by a risk assessment program. Linearity, selectivity and precision met the validation criteria of national and international sanitary agencies. Cannabis imported oily extracts showed high CBD levels (72.53±60.63 mg mL-1) and low THC levels (1.21±1.32 mg mL-1), while national Cannabis extracts showed mainly two profiles, first composed by negative or cannabinoids traces and the second composed by THC rich extracts (9.81±13.49 mg mL-1). The HPLC method is useful to pharmaceutical production and risk assessment purposes.

Abstract To investigate the simultaneous influence of different non-nutritional factors in production and physical-chemical characteristics of chitosan obtained by Syncephalastrum racemosum we used individually agroindustrial wastes as the only nutritional sources for fungus growth. The growth conditions were evaluated according to Factorial Design, 24 with three central points in order to determine the mainly factors for maximum production of microbiological chitosan in submerged culture. Syncephalastrum racemosum grown in corn steep liquor and yield up to 7.8 g chitosan/kg of substrate in the best condition by factorial design. The microbiological chitosan obtained has deacetilation degree 88.14%, crystallinity rate of 55.96%, mass decomposition process at 304.43 ºC, and low molecular weight. To fast production we performed a kinetic study and confirmed that at 36 h the chitosan production is higher and the physical-chemical characteristics were maintained. This research describes, for the first time, the factorial study of chitosan production by Syncephalastrum racemosum in agroindustrial wastes and its economic potential for commercialization.

ABSTRACT: The contamination of the dental units’ waterlines is a reality, which can develop individual and collective disorders. The aim of this study was to evaluate the prevalence and resistance profile of bacteria on the internal surfaces of waterlines in a dental clinic from a Dentistry school of a Brazilian university. The design was an exploratory, descriptive study with quantitative and qualitative approach. Samples (n=4) were collected for analysis at different points: the portion closest to the water reservoir of the chair, and the portion closest to the triple syringe. After collection the samples were cultured in BHI medium in an oven for 24-48 h at 37 °C. For the quantitative analysis 1 ml of each sample was used for serial dilution up to the dilution value seven. The colonies were counted after pour plate and the results expressed in UFC/cm2. The qualitative analysis was initiated with the cultivation of Agar Blood, EMB-Levine and Cetrimide Agar for 24 h, and the identification of bacteria was performed by microscopic analyses. The resistance profile was verified by classical antibiogram. The internal surfaces of unit waterlines units exhibited a mean of 2.44 x 109 CFU / cm2. Bacillus subtilis and Pseudomonas aeruginosa were identified. The resistance profile of Pseudomonas aeruginosa indicated sensitivity to all tested antibiotics. A large number of microorganisms was quantified from biofilm accumulated in the dental units’ waterlines. However, they were not resistant to classic antibiogram. Better management and application of decontamination protocols for waterlines need to be applied since opportunistic infections may be associated with Pseudomonas aeruginosa.

RESUMEN: La contaminación de líneas de agua en las unidades dentarias es una realidad, generando enfermedades individuales y colectivas. El objetivo de este estudio fue evaluar la prevalencia y resistencia de las bacterias en las zonas internas de las líneas de agua de la Facultad de Odontología de una universidad brasileña. El diseño del estudio fue exploratorio, descriptivo con enfoques cuantitativos y cualitativos. Las muestras para análisis (n=4) fueron selecionadas de distintos lugares: el punto más cercano al sistema de agua del sillón odontológico y el punto más cercano a la jeringa tríplice. Las muestras obtenidas fueron cultivadas en un médio BHI por 24-48 h, en un horno a 37 ºC. Para el análisis cuantitativo, se utilizó 1 ml de cada muestra para dilución hasta el valor siete. Las colonias fueran contadas y los resultados fueron expresados en UFC/cm2. El análisis cualitativo fue iniciado con el cultivo de Agar Sangre, EBM-Levine y Agar Cetrimide por 24 h y la identificación de la bacteria fue realizada por análisis microscópicos. El perfil de resistencia fue verificado por el antibiograma clásico. Las zonas internas de las unidades de líneas de agua mostraron un promédio de 2,44 x 109 UFC/cm2. Bacillus subtilis y Pseudomonas aeruginosa fueron encontrados. El perfil de resistencia de Pseudomonas aeruginosa indicó sensibilidad a todos los antibióticos testados. Un gran número de microorganismos fue cuantificado desde la biopelícula acumulada en las líneas de agua de unidades dentales. Sin embargo, no resistieron al antibiograma clásico. Se requiere una mejor gestión y aplicación de protocolos de decontaminación en las líneas de agua debido a que las infecciones oportunistas puedan estar asociadas a Pseudomonas aeruginosa.

Avaliou-se as características morfogênicas do Capim Tamani (Panicum maximum cv. BRS Tamani), estabelecido com sementes inoculadas ou não com Azospirillum brasilense em função de fontes de fosfato (superfosfato triplo e fosfato natural reativo de bayovar) e doses crescentes de nitrogênio (0, 75, 150, 300 e 600 kg ha-1) em delineamento inteiramente casualizado, organizado em esquema fatorial 2 x 2 x 5 com 4 repetições. A inoculação com Azospirillum brasilense promoveu uma melhoria no aproveitamento dos adubos fosfatados, reduzindo a amplitude de respostas entre eles. Contudo, o melhor desempenho foi observado com a fonte de maior solubilidade (superfosfato triplo) associada aos maiores níveis de adubação nitrogenada.

It was evaluated the morphogenic characteristics of the Capim Tamani (Panicum maximum cv. BRS Tamani) established with seeds either inoculated or not with Azospirillum brasilense as a function of phosphate sources (triple superphosphate and bayovar natural reactive phosphate) and increasing doses of nitrogen (0, 75, 150, 300 and 600 kg ha-1) in a completely randomized design, organized in a 2 x 2 x 5 factorial scheme with 4 replications. The inoculation with Azospirillum brasilense promoted an improvement in the use of phosphate fertilizers, reducing the amplitude of responses between them. However, the best performance was observed with the source of higher solubility (triple superphosphate) associated with higher levels of nitrogen fertilization.

ABSTRACT Objective: to identify Nursing Diagnoses of 5th stage chronic kidney disease patients undergoing hemodialysis. Method: cross-sectional, descriptive and quantitative study carried out with 151 patients undergoing hemodialysis in a clinic specialized in nephrology from the Northwest of the Paraná State. Nursing Diagnoses were determined through Nanda-I in which had the percentage greater than 50%. The analysis used was the simple statistics. Results: 17 Nursing Diagnoses were identified, emphasizing the risks present in 100% of patients: risks for electrolyte imbalance; ineffective kidney perfusion; infection: vascular injuries, adverse response to the iodine-based contrast-enhanced and impaired urinary elimination. Conclusion: the main diagnoses listed reflect the more frequent risks that patients undergoing hemodialysis are exposed to. Being aware of these risks allows the nursing planning with early interventions, in order to prevent complications related to the disease and to promote best life conditions.

RESUMEN Objetivo: identificar los Diagnósticos de Enfermería de portadores de enfermedad renal crónica en estadio 5 hemodialítico. Método: estudio transversal, descriptivo, de abordaje cuantitativo, realizado con 151 individuos en hemodiálisis de una clínica especializada en nefrología en la región Noroeste de Paraná. Se determinaron los Diagnósticos de Enfermería por medio de la Nanda-I que obtuvieron el porcentaje más alta al 50%. El análisis utilizado fue la estadística simple. Resultados: se identificaron 17 Diagnósticos de Enfermería, con destaques para los de riesgos presentes en el 100% de los individuos: riesgos de desequilibrio electrolítico; perfusión renal ineficaz; infección: trauma vascular y respuesta adversa al medio de contraste con yodo y el de eliminación urinaria perjudicada. Conclusión: los principales diagnósticos enumerados reflejan los riesgos más frecuentes a los cuales están expuestos los pacientes en hemodiálisis. El conocimiento de estos riesgos permite la planificación de enfermería con intervenciones tempranas, con miras a la prevención de complicaciones relacionadas con la enfermedad y promoción de mejores condiciones de vida.

RESUMO Objetivo: identificar os Diagnósticos de Enfermagem de portadores de doença renal crônica em estádio 5 hemodialítico. Método: estudo transversal, descritivo, de abordagem quantitativa, realizado com 151 indivíduos em hemodiálise de uma clínica especializada em nefrologia na região Noroeste do Paraná. Foram determinados os Diagnósticos de Enfermagem por meio da Nanda-I que obtiveram o porcentual maior que 50%. A análise utilizada foi a estatística simples. Resultados: foram identificados 17 Diagnósticos de Enfermagem, com destaques para os de riscos presentes em 100% dos indivíduos: riscos de desequilíbrio eletrolítico; perfusão renal ineficaz; infecção: trauma vascular e resposta adversa ao meio de contraste com iodo e o de eliminação urinária prejudicada. Conclusão: os principais diagnósticos elencados refletem os riscos mais frequentes aos quais os pacientes em hemodiálise estão expostos. O conhecimento desses riscos permite o planejamento de enfermagem com intervenções precoces, com vistas à prevenção de complicações relacionadas à doença e promoção de melhores condições de vida.

RESUMO Objetivo: identificar os Diagnósticos de Enfermagem de portadores de doença renal crônica em estádio 5 hemodialítico. Método: estudo transversal, descritivo, de abordagem quantitativa, realizado com 151 indivíduos em hemodiálise de uma clínica especializada em nefrologia na região Noroeste do Paraná. Foram determinados os Diagnósticos de Enfermagem por meio da Nanda-I que obtiveram o porcentual maior que 50%. A análise utilizada foi a estatística simples. Resultados: foram identificados 17 Diagnósticos de Enfermagem, com destaques para os de riscos presentes em 100% dos indivíduos: riscos de desequilíbrio eletrolítico; perfusão renal ineficaz; infecção: trauma vascular e resposta adversa ao meio de contraste com iodo e o de eliminação urinária prejudicada. Conclusão: os principais diagnósticos elencados refletem os riscos mais frequentes aos quais os pacientes em hemodiálise estão expostos. O conhecimento desses riscos permite o planejamento de enfermagem com intervenções precoces, com vistas à prevenção de complicações relacionadas à doença e promoção de melhores condições de vida.

ABSTRACT Objective: to identify Nursing Diagnoses of 5th stage chronic kidney disease patients undergoing hemodialysis. Method: cross-sectional, descriptive and quantitative study carried out with 151 patients undergoing hemodialysis in a clinic specialized in nephrology from the Northwest of the Paraná State. Nursing Diagnoses were determined through Nanda-I in which had the percentage greater than 50%. The analysis used was the simple statistics. Results: 17 Nursing Diagnoses were identified, emphasizing the risks present in 100% of patients: risks for electrolyte imbalance; ineffective kidney perfusion; infection: vascular injuries, adverse response to the iodine-based contrast-enhanced and impaired urinary elimination. Conclusion: the main diagnoses listed reflect the more frequent risks that patients undergoing hemodialysis are exposed to. Being aware of these risks allows the nursing planning with early interventions, in order to prevent complications related to the disease and to promote best life conditions.

RESUMEN Objetivo: identificar los Diagnósticos de Enfermería de portadores de enfermedad renal crónica en estadio 5 hemodialítico. Método: estudio transversal, descriptivo, de abordaje cuantitativo, realizado con 151 individuos en hemodiálisis de una clínica especializada en nefrología en la región Noroeste de Paraná. Se determinaron los Diagnósticos de Enfermería por medio de la Nanda-I que obtuvieron el porcentaje más alta al 50%. El análisis utilizado fue la estadística simple. Resultados: se identificaron 17 Diagnósticos de Enfermería, con destaques para los de riesgos presentes en el 100% de los individuos: riesgos de desequilibrio electrolítico; perfusión renal ineficaz; infección: trauma vascular y respuesta adversa al medio de contraste con yodo y el de eliminación urinaria perjudicada. Conclusión: los principales diagnósticos enumerados reflejan los riesgos más frecuentes a los cuales están expuestos los pacientes en hemodiálisis. El conocimiento de estos riesgos permite la planificación de enfermería con intervenciones tempranas, con miras a la prevención de complicaciones relacionadas con la enfermedad y promoción de mejores condiciones de vida.

RESUMO Objetivo Conhecer as modificações do padrão do sono em insones usuários crônicos de benzodiazepínicos (BZDs) após introdução da trazodona. Métodos Em um grupo de 11 pacientes, foi estabelecido esquema para retirada gradual do BZD com introdução progressiva da trazodona. Foram realizadas duas polissonografias, sendo a primeira com dose de BZD habitual do paciente e a segunda após supensão do BZD e com 150 mg de trazodona de liberação prolongada. Questionários de qualidade do sono (Pittsburgh), sonolência diurna (Epworth) e sintomas depressivos (Hamilton) e ansiosos (Beck) foram aplicados. Resultados Cinco indivíduos concluíram o estudo, tendo sido acompanhados por pelo menos seis semanas. Nesses pacientes, a trazodona aumentou significativamente a eficiência do sono e sono REM e diminuiu o tempo desperto após início do sono. Houve melhora da qualidade do sono, porém não houve alteração dos sintomas depressivos e ansiosos. Conclusão Trazodona de liberação prolongada demonstrou ser uma opção terapêutica para insones usuários crônicos de BZDs com retirada eficaz do ansiolítico. Houve melhora na qualidade do sono por questionário e polissonografia. Maior número de pacientes será necessário para determinar os benefícios da trazodona nesse tipo de intervenção.

ABSTRACT Objective To know the modifications of the sleep pattern in chronic benzodiazepine users after the introduction of trazodone. Methods In a group of 11 patients, a gradual withdrawal of benzodiazepine (BZD) was introduced with progressive introduction of trazodone. Two polysomnograms were performed, the first with BZD usual dose of the patient and the second after BZD suppression and with 150 mg of prolonged release trazodone. Sleep quality questionnaires (Pittsburgh), daytime sleepiness (Epworth) and depressive (Hamilton) and anxious (Beck) symptoms were applied. Results Five subjects completed the study and were followed up for at least six weeks. In these patients, trazodone significantly increased sleep efficiency and REM sleep and decreased wakefulness after sleep onset. There was an improvement in sleep quality, but there was no change in depressive and anxious symptoms. Conclusion Prolonged release trazodone has been shown to be a therapeutic option for chronic insomnia patients with benzodiazepines with effective withdrawal of the anxiolytic drug. There was improvement in sleep quality by questionnaire and polysomnography. More patients will be needed to determine the benefits of trazodone in this type of intervention.

Abstract Mechanized operations on soils with inadequate moisture cause compaction and are deleterious to soil quality. The aim of this study was to evaluate the influence of different oilseed crop successions on the structural quality of a clayey Rhodic Hapludox. Sunflower (Helianthus annuus L.), canola (Brassica napus L. and Brassica rapa), safflower (Carthamus tinctorius L.), crambe (Crambe abyssinica Hochst.), and niger (Guizotia abyssinica) were sown in autumn/winter in a no-tillage system in succession to corn grown in the summer and soybean/corn grown in summer/autumn-winter. When the autumn-winter crops began to grow, soil samples were collected in metallic cylinders at 0.0–0.05 m and 0.05–0.10 m depths. Analyses of the optimal water interval in each crop succession at the 0.0–0.05 m layer indicated that the corn/safflower and corn/crambe successions reduced the structural quality of the soil. The autumn-winter niger crop in succession to summer corn improved the soil structure at 0.0–0.05 m and 0.05–0.10 m when compared with the soil cultivated with the soybean/corn succession. The niger crop is an effective crop rotation alternative that improves the physical quality of the soil under no-tillage systems.

Resumen Las operaciones mecanizadas en suelos con humedad inadecuada causan compactación y son perjudiciales para la calidad del suelo. El objetivo de este estudio fue evaluar la influencia de diferentes sucesiones de cultivos de semillas oleaginosas sobre la calidad estructural de un hapludo rubio arcilloso. Se sembraron girasol (Helianthus annuus L.), canola (Brassica napus L. y Brassica rapa), cártamo (Carthamus tinctorius L.), crambe (Crambe abyssinica Hochst.) Y niger (Guizotia abyssinica) en otoño/invierno Sistema de labranza cero en sucesión al maíz cultivado en verano y soja/maíz cultivado en verano/otoñoinvierno. Cuando comenzaron a crecer los cultivos de otoño-invierno, se recogieron muestras de suelo en cilindros metálicos de 0.0-0.05 m y 0.05-0.10 m de profundidad. Los análisis del intervalo óptimo de agua en cada sucesión de cultivos en la capa 0.0-0.05 m indicaron que las sucesiones de maíz/cártamo y maíz/crambe redujeron la calidad estructural del suelo. La cosecha niger de otoño-invierno en sucesión al maíz de verano mejoró la estructura del suelo a 0.0-0.05 m y 0.05-0.10 m en comparación con el suelo cultivado con la sucesión soja/maíz. El cultivo de níger es una alternativa eficaz de rotación de cultivos que mejora la calidad física del suelo bajo sistemas de labranza cero.

Objectives: It was aimed to verify the prevalence of work-related musculoskeletal disorders (WRMSD) of dentists from the primary health care network in Recife, Brazil. Material and Methods: The Nordic Musculoskeletal Symptom Questionnaire was used having as goal to identify the presence of pain, discomfort or dormancy in different body areas. Results: The musculoskeletal symptoms associated with the practice of Dentistry were mentioned by 97.3% of the interviewees. Neck (56.75%); fist/hands/fingers (54.06%); shoulders (51.35%) and lumbar region (48.65%) were the most affected locations. When measuring the association between WRMSD and the “5” extra-professional variables studied, only physical activity was associated with symptoms in the fist / hands / fingers area (p <0.05). Conclusions: A high prevalence of WRMSD was observed in dentists of Recife. The practice of regular physical activity showed to be a possible protective factor for the fist/hands/fingers lesions.

Objetivos: Verificar la prevalencia de los trastornos musculoesqueléticos asociados con el trabajo (TMEAT) de los dentistas de la red de atención primaria de salud en Recife, Brasil. Material y Métodos: Se utilizó el Cuestionario nórdico de síntomas musculoesqueléticos con el objetivo de identificar la presencia de dolor, incomodidad o latencia en diferentes áreas del cuerpo. Resultados: El 97,3% de los entrevistados mencionaron los síntomas musculoesqueléticos asociados con la práctica de la Odontología. El Cuello (56,75%); el puño / manos / dedos (54.06%); los hombros (51.35%) y la región lumbar (48,65%) fueron los lugares más afectados. Al medir la asociación entre TMEAT y las “5” variables extraprofesionales estudiadas, solo la actividad física se asoció con síntomas en la región de puño / manos / dedos (p <0,05). Conclusiones: se observó un alta prevalencia de TMEAT en dentistas de Recife. La práctica de actividad física regular demostró ser un posible factor de protección para las lesiones puño / manos / dedos.

Resumo: O objetivo deste trabalho foi determinar valores de referência para avaliação do estado nutricional de laranjeiras 'Pêra' em diferentes estádios de frutificação, com uso do método de diagnose da composição nutricional (CND). Foram utilizadas 243 amostras foliares, provenientes de 81 glebas, com coletas em plantas com frutos de três e seis meses de idade e, também, na colheita principal (nove meses). Glebas com produtividade superior a 30 Mg ha-1 foram selecionadas para o estabelecimento dos padrões de referência. Foram avaliadas três faixas normais para cada nutriente, na população de referência, abrangidas entre o intervalo de confiança (IC) das médias dos teores foliares, a média±desvio-padrão (±DP) e a média±⅔DP. Independentemente da faixa normal de nutrientes utilizada, a época de amostragem foliar interferiu no estado nutricional da laranjeira 'Pêra'. As faixas normais obtidas a partir dos critérios IC e ±⅔DP dos teores nutricionais observados na população de referência proporcionaram diagnósticos nutricionais frequentemente semelhantes. Zn, Ca e Fe são os elementos que mais frequentemente limitam a produção da laranja 'Pêra' no Amazonas.

Abstract: The objective of this work was to determine reference values for evaluating the nutritional status of 'Pêra' orange trees in different fruiting stages, using the compositional nutrient diagnosis (CND) method. The study used 243 leaf samples from 81 plots, with samplings performed in plants bearing fruits with three and six months of age, and also in the main harvest (nine months). Plots with productivity higher than 30 Mg ha-1 were selected for the establishment of reference standards. Three normal ranges were evaluated for each nutrient in the reference population, comprehended by the confidence interval (CI) of the foliar content averages, by the mean±standard deviation (±SD), and by the mean±⅔SD. Regardless of the normal range of nutrients used, the leaf sampling periods interfered with the nutritional status of 'Pêra' orange tree. The normal ranges obtained from the criteria CI and ±⅔SD of the nutrient contents observed in the reference population frequently provided similar nutritional diagnoses. Zn, Ca, and Fe are the elements that most often limit the production of 'Pêra' orange in the state of Amazonas, Brazil.