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Com o objetivo de conhecer p estabelecimento e duração do aleitamento materno total e exclusivo em comunidades rurais do Semi-Árido Baiano, Brasil, foram estudadas 226 crianças de O a 2 anos de idade, filhas de pequenos produtores rurais que vivem numa das regiões mais secas do nordeste brasileiro, de pobreza absoluta. Os dados referem-se a todas as crianças da família que à data do estudo tinham até 2 anos de idade. Os dados foram coletados por meio de formulários aplicados às mães ou responsáveis pelo menor, no período de 1988 a 1989. A tábua de vida foi o recurso estatístico utilizado para o cálculo da duração mediana do evento. Das 226 crianças que integraram o estudo, 91,6 iniciaram a amamentação ao peito. A duração mediana do aleitamento total foi de 90,28 dias e o aleitamento exclusivo apresentou duração mediana de 0,1 dia. Ainda que o estabelecimento da amamentação ao peito possa ser considerado alto, a duração mediana do aleitamento total foi extrememente curta, e o aleitamento exclusivo foi desprezível.

Objective: To understand the experience of men in relation to the process of living with hemophilia., Method: Qualitative study using the theoretical and methodological referential Symbolic Interactionism and the constructivist strand of Grounded Theory. Participated 12 men with hemophilia followed at a Blood Center in the south of Rio Grande do Sul, Brazil. Intensive interviews, genograms and field notes were used for data collection, with concomitant analysis, following the initial, focused, and theoretical coding stages., Results: The theoretical model was built, which has as central category Adapting to (co)exist with hemophilia and the categories Knowing yourself and the illness: knowing how to deal, Adjusting life: taking care of yourself and Getting used to the illness: being almost normal., Conclusion: It was revealed the experience of men who adapt to (co)exist with hemophilia and their actions and behaviors, aiming to preserve them away from bleeding, pain, and the risk of death.

The neurological changes associated with COVID-19 have been frequently described, especially in cases of greater severity, and are related to multifactorial causes, such as endothelial dysfunction, inflammatory mediator release (cytokine storm), endothelial dysfunction and hypoxemia. We report the case of a female patient, 88 years old, with cerebral hemorrhage associated with amyloid angiopathy in the context of SARS-CoV-2 infection.

Objective: To measure the levels of depression among Nursing students from a public institution of higher education and the association with aspects of academic life., Method: Analytical and quantitative study with 203 students from a higher education institution that uses active methodologies. We used Beck's Depression Inventory and the Likert type scale of academic factors., Results: We verified that 19.2% had moderate or severe levels of depression. Higher levels of depression were associated with female gender (p=0.003), working more than 40 hours per week (p=0.047), spending more than 90 minutes to reach academic activities (p=0.043) and with 12 academic factors specific to routines of the studied institution., Conclusion: The results contribute to managers' and professors' reflection and analysis concerning nursing students' mental health, in addition to indicating in which aspects there is a need to provide greater support to these students.

Background: Cardiac remodeling is a specific response to exercise training and time exposure. We hypothesized that athletes engaging for long periods in high-intensity strength training show heart and/or vascular damage., Objective: To compare cardiac characteristics (structure and function) and vascular function (flow-mediated dilation [FMD] and peripheral vascular resistance [PVR]) in powerlifters and long-distance runners., Methods: We evaluated 40 high-performance athletes (powerlifters [PG], n = 16; runners [RG], n = 24) and assessed heart structure and function (echocardiography), systolic and diastolic blood pressure (SBP/DBP), FMD, PVR, maximum force (squat, bench press, and deadlift), and maximal oxygen uptake (spirometry). A Student's t Test for independent samples and Pearson's linear correlation were used (p < 0.05)., Results: PG showed higher SBP/DBP (p < 0.001); greater interventricular septum thickness (p < 0.001), posterior wall thickness (p < 0.001) and LV mass (p < 0.001). After adjusting LV mass by body surface area (BSA), no difference was observed. As for diastolic function, LV diastolic volume, wave E, wave e', and E/e' ratio were similar for both groups. However, LA volume (p = 0.016) and BSA-adjusted LA volume were lower in PG (p < 0.001). Systolic function (end-systolic volume and ejection fraction), and FMD were similar in both groups. However, higher PVR in PG was observed (p = 0.014). We found a correlation between the main cardiovascular changes and total weight lifted in PG., Conclusions: Cardiovascular adaptations are dependent on training modality and the borderline structural cardiac changes are not accompanied by impaired function in powerlifters. However, a mild increase in blood pressure seems to be related to PVR rather than endothelial function.

Objective: To know the advantages and difficulties that people with chronic kidney disease experience after renal transplantation., Methodology: A qualitative and descriptive study with 20 kidney transplant patients in a city in Southern Brazil, from May to July of 2013. Semi-structured interviews were used, analyzed according to the critical incident technique., Results: The main advantages were presented in the similarity to "normal" living: advantages resulting from the kidney transplant category, related to the patient's discharge from dialysis, food and water restriction, among others. The difficulties were presented in the permanent chronic condition and the need for care category., Final Considerations: The advantages and disadvantages depend on each person's experience. The health professionals need to understand and promote health actions that promote the uniqueness and context of renal transplant.

Objective: To analyze the relationship among sports practice, physical education class, habitual physical activity and cardiovascular risk in adolescents., Methods: Cross-sectional study with 120 schoolchildren (mean: 11.7±0.7 years old), with no regular use of medicines. Sports practice and physical education classes were assessed through face-to-face interview, while habitual physical activity was assessed by pedometers. Body weight, height and height-cephalic trunk were used to estimate maturation. The following variables were measured: body fatness, blood pressure, resting heart rate, blood flow velocity, intima-media thickness (carotid and femoral) and heart rate variability (mean between consecutive heartbeats and statistical index in the time domain that show the autonomic parasympathetic nervous system activity root-mean by the square of differences between adjacent normal R-R intervals in a time interval. Statistical treatment used Spearman correlation adjusted by sex, ethnicity, age, body fatness and maturation., Results: Independently of potential confounders, sports practice was positively related to autonomic parasympathetic nervous system activity (β=0.039 [0.01; 0.76]). On the other hand, the relationship between sport practice and mean between consecutive heartbeats (β=0,031 [-0.01; 0.07]) was significantly mediated by biological maturation., Conclusions: Sport practice was related to higher heart rate variability at rest., (Copyright © 2015 Associação de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background and Objectives: Interleukin-6 (IL-6) is a predictor of trauma severity. The purpose of this study was to evaluate the effect of intravenous lidocaine on pain severity and plasma IL-6 after hysterectomy., Method: A prospective, randomized, comparative, double-blind study with 40 patients, aged 18-60 years. G1 received lidocaine (2mg.kg(-1).h(-1)) or G2 received 0.9% saline solution during the operation. Anesthesia was induced with O2/isoflurane. Pain severity (T0: awake and 6, 12, 18 and 24hours), first analgesic request, and dose of morphine in 24hours were evaluated. IL-6 was measured before starting surgery (T0), five hours after the start (T5), and 24hours after the end of surgery (T24)., Results: There was no difference in pain severity between groups. There was a decrease in pain severity between T0 and other measurement times in G1. Time to first supplementation was greater in G2 (76.0±104.4min) than in G1 (26.7±23.3min). There was no difference in supplemental dose of morphine between G1 (23.5±12.6mg) and G2 (18.7±11.3mg). There were increased concentrations of IL-6 in both groups from T0 to T5 and T24. There was no difference in IL-6 dosage between groups. Lidocaine concentration was 856.5±364.1 ng.mL(-1) in T5 and 30.1±14.2 ng.mL(-1) in T24., Conclusion: Intravenous lidocaine (2mg.kg(-1).h(-1)) did not reduce pain severity and plasma levels of IL-6 in patients undergoing abdominal hysterectomy., (Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

This population-based study focused on the validity of the Patient Health Questionnaire-9 (PHQ-9) for screening major depressive episodes in the general population in Pelotas, Rio Grande do Sul State, Brazil. Households were selected by multi-stage sampling, and adults (> 20 years) were invited to participate. The gold standard was the structured diagnostic Mini International Neuropsychiatric Interview (MINI), applied by psychiatrists and psychologists. Both the PHQ-9 and the MINI were applied in the subjects' homes. In a total of 447 participants (191 men and 256 women), the continuous analysis identified > 9 as the cutoff point with the highest sensitivity (77.5%; 61.5-89.2) and specificity (86.7%; 83.0- 89.9). Use of the test's algorithm decreased the sensitivity to 42.5% (27.0-59.1), while the specificity increased to 95.3% (92.8-97.2). The PHQ-9 proved appropriate for screening major depressive episodes. For greater sensitivity, the continuously scored PHQ-9 proved more adequate than the algorithm for screening major depressive episodes in the community.

This study aimed at identifying the performance of Family Health Strategy (FHS) nurses in home care. It consists of an exploratory descriptive study using a qualitative approach. Six FHS nurses from a health district of Porto Alegre, Rio Grande do Sul, Brazil, were interviewed. Data were submitted to thematic content analysis, revealing three categories: home visit (HV) in the FHS, assessment of HV demands and interaction with the health team in home care. Home visits (HV) have allowed the identification of health needs through the recognition of the patients' life context. This approach has been used for chronic, bedridden and elderly patients care, based on information brought by community health agents. All nurses reported to perform HV, and stated they would like to have more time to dedicate to this activity.

This study seeks to identify and reflect on medical strategies used to ensure the systematic use of condoms for the effectiveness of AIDS prevention, in particular, when patients are involved in serodiscordant marital relationship in that only one of the partners is HIV positive. As analytical tools we used the concepts of thinking styles of epistemology (Fleck), the training process (Good), and therapeutics (Sayd, Camargo Jr. and Almeida). Among the findings of the research stood out an invisibility of the serodiscordant couples, for what turns out to be really important is adherence to treatment, which coincides with adherence to medication (ART).

Background and Objectives: Transcutaneous electrical nerve stimulation (TENS) is commonly used to treat musculoskeletal pain, but it may also be indicated for postoperative analgesia. The objective of this study was to evaluate the analgesic effects of TENS on post-thoracotomy., Methods: Thirty patients between 18 and 60 years of age undergoing thoracotomy for lung cancer resection on the second postoperative day were included in this study. Patients were divided into two groups (G1 and G2). G1 patients were treated with TENS; and in G2 (without TENS) electrodes were placed but the equipment was not turned on. TENS was maintained for one hour. The visual analogue scale was used to evaluate the analgesic effects on three moments: before TENS (M0), immediately after TENS (M1), and one hour later (M2), with the patient at rest, elevation of the upper limbs, change in decubitus, and coughing., Results: The intensity of pain at rest was higher in G2 immediately after TENS, but not one hour after the procedure. There was no difference between both groups with elevation of the upper limbs, decubitus change, and coughing., Conclusions: With the use of TENS for one hour on the second post-thoracotomy day in patients who received fentanyl (50 μg) associated with bupivacaine (5 mL), a reduction in pain intensity was observed at rest immediately after TENS; with elevation of the upper limbs, change in decubitus, and coughing, a reduction in pain severity was not observed., (Copyright © 2011 Elsevier Editora Ltda. All rights reserved.)

Traditional therapies have the strength to control psychiatric symptoms, but do not offer the necessary conditions to maintain that control. Therefore, untraditional treatments may be used to help with that maintenance. The objective of this study was to survey the feelings that individuals with mental disorders experience while taking part in recreational activities. To do this, 10 users of a Psychosocial Care Center were interviewed after participating in 10 sessions of Recreational Activities Results showed the participants felt pleasure, tranquility, emotion and bonding. Thus, recreation can be considered an important activity in mental health care, as it has a positive effect on psychosocial rehabilitation. The participants showed very positive feelings, which suggest that recreational activities may be of great help in controlling symptoms hence increasing the patients' chances to maintain the symptoms of their disorders under control.

Background and Objectives: Cytokines are necessary for the inflammatory response, favoring proper wound healing. However, exaggerated proinflammatory cytokine production can manifest systemically as hemodynamic instability or metabolic derangements. The objective of this review was to describe the effects of cytokines in pain., Contents: This article reviews the effects of cytokines in pain. In diseases with acute or chronic inflammation, cytokines can be recognized by neurons and used to trigger several cell reactions that influence the activity, proliferation, and survival of immune cells, as well as the production and activity of other cytokines. Cytokines can be proinflammatory and anti-inflammatory. Proinflammatory cytokines are related with the pathophysiology of pain syndromes. Cells that secrete proinflammatory (IL-1, IL-2, IL-6, IL-7, and TNF) and anti-inflammatory (IL-4, IL-10, IL-13, and TGFβ) cytokines, the functions of each cytokine, and the action of those compounds on pain processing, have been described., Conclusions: Cytokines have an important role in pain through different mechanisms in several sites of pain transmission pathways., (Copyright © 2011 Elsevier Editora Ltda. All rights reserved.)

Background and Objectives: Chronic pain is very prevalent and the cost of its treatment can cause a relevant impact on people and society. The objective of this study was to evaluate the monthly cost of drugs used in the outpatient treatment of chronic pain., Methods: In the present study the cost of the drugs used by 233 patients with chronic pain (117 with nociceptive pain, 59 with neuropathic pain, and 57 with mixed pain) followed at the Alpha Center of UNIFESP between January 2004 and January 2008 was evaluated., Results: The mean general cost was R$ 127.74 (from R$ 5.00 to R$ 780.00)., Conclusions: This study showed that the cost of the drugs does not differ significantly taking into consideration the type of pain., (Copyright 2010 Elsevier Editora Ltda. All rights reserved.)

We describe the case of a female patient who presented a condition of dengue hemorrhagic fever that evolved with jaundice and significant coagulation abnormalities. Dengue was diagnosed through the presence of anti-dengue IgM antibodies (MAC-ELISA). This disease needs to be taken into consideration in the differential diagnosis for acute febrile jaundice.

Introduction: This paper show the standardization and use of the immunoenzymatic method using infected cells as antigens (EIA-ICC) for routine serological diagnosing of dengue., Methods: In optimizing the test, a dose of 1,000 TCID50 of dengue type 3 virus (DENV-3) was used, and 100,000 C636 cells infected with 1,000 TCID50 (DENV-3) were used., Results: The results obtained with EIA-ICC were compared with the HUMAN commercial dengue kit. The results were highly concordant. The EIA-ICC showed moderate sensitivity and high specificity. The test was used for serologically diagnosing 1,797 blood samples from suspected dengue cases during the 2006 epidemic in Ribeirao Preto. From the serological evaluation, 228 samples were positive for IgM against DENV-3; 235 samples were positive for IgG against DENV-3; and 35 samples were positive for both IgG and IgM., Conclusions: EIA-ICC was shown to be reliable and simple, and suitable for serologically diagnosing dengue.

Background and Objectives: Neurological evaluation can be done during cervical plexus block for endarterectomy, which also maintains postoperative analgesia. The objective of this study was to compare the analgesic effects of clonidine associated with bupivacaine to those of bupivacaine in cervical plexus block., Methods: A randomized double-blind study was undertaken with 30 patients divided in two groups: G1 received 1.5 mg.kg-1 of 0.375% bupivacaine associated with 150 (1/4)g of clonidine (2 mL), and G2 received 1.5 mg.kg-1 of 0.375% bupivacaine associated with NS (2 mL). The following parameters were evaluated: heart rate and blood pressure at 0 (block), 30, 60, 90, and 120 minutes; the need for anesthetic supplementation; time until the first analgesic supplementation; amount of analgesic used; and pain severity at 0 (end of the surgery), 30, 60, 120, 240, and 360 minutes., Results: Group 1 received 3.8 mL of lidocaine for anesthetic supplementation, while G2 received 3.6 mL of lidocaine, but this difference was not statistically significant. In G1, the time until the first supplementation was 302.6 +/- 152.6 minutes, and in G2 it was 236.6 +/- 132.9 minutes, which was not statistically significant. Differences between the doses of dypirone and tramadol were not observed. Differences in pain severity between both groups were not observed either., Conclusion: The association of 150 (1/4)g of clonidine and bupivacaine in cervical plexus block for carotid endarterectomy did not improve significantly the analgesic effects evaluated by pain severity, time until the first analgesic supplementations and amount of supplementary analgesics.

Background and Objectives: Trigeminal neuralgia is an extremely painful condition characterized by recurrent episodes of sudden, lancinating, shock-like pain lasting from a few seconds to two minutes usually unilateral. It has an annual incidence of approximately 4.3 in 100,000 in the general population and only 3% of those cases present bilateral manifestation. The objective of this report was to describe a rare case of bilateral trigeminal neuralgia., Case Report: A 61 years old housewife from Maranhão, Brazil, married, with a history of hypertension, presented with a six-year history of severe pain in the left V2-V3 regions, lasting 5 to 10 seconds, in the lateral aspect of the nose and mandible, worsening by talking, chewing, and with a decrease in temperature. She had been treated with chlorpromazine (3 mg every eight hours) and carbamazepine (200 mg every eight hours) during six months without improvement. On physical exam, the patient presented thermal and mechanical allodynia in the V2-V3 regions. She was using gabapentin (1,200 mg/day) with partial relief of the pain. The dose of gabapentin was increased to 1,500 mg/day and amitriptyline 12.5 mg at night was added to the therapeutic regimen. The patient evolved with mild and sporadical pain and a reduction in pain severity during 10 months; the dose of gabapentin was progressively reduced to 600 mg/day, and amitriptyline was maintained at 12.5 mg/day. After one year, the patient developed similar pain in the region of the right mandible, which improved with an increase in the dose of gabapentin to 900 mg/day. Head CT and MRI did not show any abnormalities., Conclusions: Carbamazepine is the first choice for the treatment of trigeminal neuralgia; however, the use of gabapentin as the first pharmacological choice or in cases refractory to conventional therapy has been increasing.

The Delphi technique has been used in nursing research, with electronic means as an option. This article has the objective of reporting researchers' experience on the application of this technique in a study about nurses' competencies for the performance of Essential Public Health Functions. Experts were searched on the Lattes Platform of the National Council of Scientific and Technologic Development (CNPq) in Brazil. Two groups with 50 participants each, one with nurses and other with faculty with representation of every geographic region of the country were organized. The competencies validation instrument was sent by electronic means. Although it is reported that this form reduces the time for sending and receiving the questionnaires, difficulties to obtain contact with the experts, lack of return of the participants and a long time to answer the instrument were observed. Health care professionals need to understand the importance of their participation in researches with the utilization of this technique.

Background and Methods: Proinflammatory cytokines play an important role in the pathophysiology of neuropathic pain syndromes. The objective of this study was to evaluate plasma levels of proinflammatory cytokines before and after treatment with tramadol in patients with herniated intervertebral disks and carpal tunnel syndrome, and to compare them with normal individuals., Methods: Thirty-eight patients with neuropathic pain secondary to herniated intervertebral disks or carpal tunnel syndrome participated in this study. All patients were treated with controlled release tramadol (100 mg every 12 hours) for 10 days. Venous blood (5 mL) was collected in the morning, before treatment and on the 11th day, and stored (-70 degrees C) until analysis. ELISA was used to determine the plasma levels of cytokines (TNF-+/-, IL-1, IL-6) and receptors sTNF-R1 (R & D Systems). Plasma levels of cytokines of 10 healthy volunteers were also determined., Results: The concentration of TNF-+/- before (5.8 +/- 2.8 pg.mL-(1)) was significantly higher than after treatment with tramadol (4.8 +/- 2.1 pg.mL-1; p = 0.04, Mann-Whitney test). The levels of IL-1(2), IL-6, and sTNF-R1 before and after treatment with tramadol showed no significant differences. Plasma levels of TNF-+/- (healthy individuals: 1.4 +/- 0.5; pain patients: 5.8 +/- 2.8 pg.mL-1; p = 0.01) and IL-6 (healthy individuals: 1.2 +/- 0.8; pain patients: 3.5 +/- 2.6 pg.mL-1; p = 0.01) were significantly higher in patients with neuropathic pain, Mann-Whitney Test., Conclusions: In patients with herniated intervertebral disks and carpal tunnel syndrome, plasma levels of TNF-+/- and IL-6 were higher than in healthy volunteers, while differences in the concentrations of sTNF-R and IL-1(2) were not observed. Plasma levels of TNF-+/-, but not of IL-6, sTNF-R, and IL-1(2), decreased after treatment with tramadol (100 mg every 12 hours).

Background and Objectives: Gabapentin has been used as adjuvant in the treatment of postoperative pain with a neuropathic component. It is responsible for the inhibition of central sensitization, decreasing postoperative pain., Contents: All clinical, randomized studies that evaluated the effects of gabapentin on postoperative pain in humans between 2002 and 2007 for a total of 26 studies were selected. In 17 studies, patients received a single preoperative dose, which ranged from 300 to 1,200 mg, 30 minutes to two hours before surgery in the remaining studies, the administration of the drug was initiated one to 24 hours before the procedure and continued for 10 days, in doses that ranged from 1,200 to 1,800 mg.day(-1). To measure pain severity, the Visual Analog or Numeric Rating Scale was used. In 75% of patients who received a single dose of gabapentin, scores were lower, and the same was seen in 55.6% of patients who received the drugs pre- and postoperatively. Opioid consumption was reduced in 82.4% of patients who received a single dose, and in 77.8% of patients who received pre- and postoperative gabapentin. Among the studies using a single dose of gabapentin, four did not describe adverse effects; 52.9% showed no differences, 11.8% detected more nausea or vomiting, 5.9% experienced more dizziness, 5.9% more sedation, less nausea or vomiting in one, and less urinary retention in one. Among the studies with pre- and postoperative administration of gabapentin, four did not describe adverse effects; 22.2% showed no differences, 11.1% had more nausea or vomiting, 22.2% more dizziness, and 11.1% more sedation., Conclusions: Gabapentin, used before as well as before and after surgery, decreased pain severity and the need of analgesic supplementation.

Background and Objectives: Morphine is used frequently to treat oncologic pain. However, tolerance may develop with prolonged use. The association of a NMDA receptor antagonist may reduce or delay the onset of tolerance. S(+) ketamine seems to be more potent and with fewer side effects. The aim of this study was to evaluate the association of S(+) ketamine and morphine in the treatment of oncologic pain., Methods: Thirty patients, randomly divided in two groups, participated in this double-blind study. Patients in G1 received 10 mg of morphine PO every 6 hours and 10 mg of S(+) ketamine PO every 8 hours. Patients in G2 received 10 mg of morphine PO every 6 hours and placebo PO every 8 hours. The dose of morphine was adjusted by 5 mg increments whenever necessary. Pain severity was evaluated through a verbal scale., Results: The percentage of no pain and mild pain was similar in both groups (G1 = 0 and G2 = 0 at M0; G1 = 22.2 and G2 = 53.8 at M1; G1 = 22.2 and G2 = 61.5 at M2; G1 = 44.6 and G2 = 61.5 at M3; and G1 = 44.5 and G2 = 53.8 at M4); Chi-square test. The percentage of moderate relief and complete relief was similar in both groups (G1 = 33.4 and G2 = 53.9 after one week; G1 = 44.4 and G2 = 69.2 after two weeks; G1 = 66.6 and G2 = 69.2 after three weeks; and G1 = 55.6 and G2 = 53.9 after four weeks); Chi-square test. The need to increase the dose of morphine was also similar in both groups (G1 = 2.22 and G2 = 2.15); Mann-Whitney test., Conclusions: We did not observe an increase on the analgesic effects of morphine with the association of 10 mg of S(+) ketamine PO in the treatment of oncologic pain.

Background and Objectives: Osteoarthritis is the most common joint disease among elderly people. This study aimed at comparing the analgesic effects of intra-articular bupivacaine and morphine in knee osteoarthritis patients., Methods: Thirty-nine patients were included in this randomized double-blind study and divided in two groups: G1 (n = 18) patients were given intra-articular 1 mg (1 mL) morphine diluted in 9 mL of 0.9% saline, while G2 (n = 21) received intra-articular 25 mg (10 mL) of 0.25% plain bupivacaine. Pain intensity was evaluated by numerical and verbal scale at 0, 30, 60 minutes and 7 days at rest and in movement. Evaluated parameters were analgesic supplementation requirement with paracetamol (500 mg), total analgesic dose throughout the study, analgesia duration and quality (according to patient)., Results: From 39 patients, 31 have completed the study. There has been no significant difference in pain intensity at rest and in movement between groups in all studied moments. There has been no difference between groups in time between solution administration and need for analgesic supplementation. Mean paracetamol dose in the first day was 796 mg for G1 and 950 mg for G2; supplementation during the week was 3578 mg for G1 and 5333 mg for G2., Conclusions: The analgesic effect of intra-articular 1 mg morphine and 25 mg of 0.25% plain bupivacaine was similar.

Background and Objectives: There are controversies about the efficacy of botulin toxin as compared to local anesthetics for triggering-points infiltration. This study aimed at comparing the analgesic effect of botulin toxin and bupivacaine for triggering-points infiltration in chronic myofascial syndrome., Methods: Participated in this study 20 patients divided in two groups. G1 patients (n = 10) received 25U botulin toxin and G2 patients (n = 10) received 0.25% bupivacaine in one to three triggering-points, being 0.5 mL per point. Patients were weekly evaluated for 8 weeks. Orphenadrine (35 mg) and dipirone (300 mg) were associated every 8 hours and patients were submitted to transcutaneous electrical stimulation twice a week during 1 hour. Pain intensity was evaluated through verbal numeric scale and quality of analgesia was evaluated by patients in moments zero (before injection), 30 minutes after, and at 1, 2, 3, 4, 5, 6, 7 and 8 weeks. Results were submitted to statistical analysis (Mann-Whitney and Fisher Exact tests)., Results: After 30 minutes, 1 and 4 weeks, pain intensity was lower for G1 as compared to G2. After 2, 3, 5, 7 and 8 weeks, there was no significant difference between groups. Quality of analgesia was considered better by G1 patients as compared to G2, except after 2 weeks., Conclusions: Analgesic effect was better with botulin toxin (25U) as compared to 0.25% bupivacaine for triggering-points infiltration.

Objectives: To determine the prevalence of nasopharyngeal pneumococcus colonization in children with sickle cell disease undergoing penicillin prophylaxis, to identify risk factors for colonization and to serotype and determine antibiotic resistance in pneumococci obtained from those children., Methods: Between April 9, 2002 and February 28, 2003, 188 nasopharyngeal swabs were obtained from 98 children with sickle cell disease in follow-up at the Hospital São Paulo-Universidade Federal de São Paulo. Pneumococci were isolated and identified by standard methods. The minimal inhibitory concentration for penicillin was determined by the E-test method. Isolates were serotyped with the use of type-specific antisera for 46 different serotypes (Neufeld-Quellung reaction)., Results: The age of children ranged from 4 months to 17 years (median and standard deviation 6.8-/+4.7 years). Thirteen of the 98 children had nasopharyngeal pneumococcus colonization (13.3% prevalence). There was a significantly greater risk of colonization among children less than 2 years old (p = 0.02). Twenty-one percent of isolates had intermediate penicillin resistance. There were no isolates highly resistant to penicillin. All isolates were susceptible to erythromycin, ceftriaxone, or vancomycin. The most frequently identified serotypes were 18C and 23F., Conclusions: Penicillin prophylaxis reduced pneumococcal nasopharyngeal colonization and did not increase the prevalence of penicillin-resistant pneumococci in children with sickle cell disease. Penicillin can be used not only for prophylaxis, but also in the acute management of febrile states with these children.

Unlabelled: BACKAGROUND AND OBJECTIVES: Since the finding that ketamine blocks NMDA receptors in the neurons of spinal dorsal horn, it has been used to inhibit or decrease central sensitization triggered by nociceptive stimulations. This study aimed at presenting pharmacological aspects of racemic ketamine and its levogyrous compound, as well as its usefulness for preemptive analgesia., Contents: Current preemptive analgesia concepts, pharmacological aspects of ketamine and its levogyrous compound, as well as experimental and clinical trials on ketamine and its use in preemptive analgesia are presented., Conclusions: The efficacy of ketamine in inhibiting or decreasing central sensitization triggered by nociceptive stimulations is not totally confirmed, probably due to different study and statistical analysis methods.

Background: Bacteremia seems to increase the morbidity and mortality in clinical and surgical conditions, however the importance and factors associated with it during acute calculous cholecystitis are not well established. The purpose of this study was to determine pre-operative prevalence, associated factors and prognosis of bacteremia in patients with acute calculous cholecystitis submitted to an emergency cholecystectomy., Methods: A prospective study of 51 patients with histological diagnosis of acute calculous cholecystitis was designed. The Bactec System was used to detect bacteremia. Mean results of clinical and laboratory analyses were related to the presence of bacteremia., Results: The pre-operative prevalence of bacteremia was of 15.68%. Age (P=0.024), heart rate (P=0.026), respiratory rate (P=0.028), serum creatinine (P=0.028) and presence of systemic inflammatory response syndrome (P=0.016) were positively associated with bacteremia. Bacteremic patients had statistically higher overall (P=0.045) and infectious (P=0.039) complication rates and longer hospitalization (P<0.005) including one death., Conclusions: Patients with acute calculous cholecystitis have a considerable prevalence of bacteremia in the pre-operative period. It is associated with old age, heart rate, respiratory rate, serum creatinine and systemic inflammatory response syndrome. In patients with acute calculous cholecystitis, presence of bacteremia may be associated to severity of the condition and poor outcome related to pos-operative complications.

Background and Objectives: There are controversies about the action site of lipophylic opioids after epidural injection. Some authors believe that these drugs act at supraspinal level, while others propose a spinal action. This comparative study aimed at answering this question by comparing epidural and intravenous fentanyl for postoperative analgesia of lower limb orthopedic procedures., Methods: This was a randomized double-blind study. At postoperative pain complaint, G1 patients (n = 14) received 5 mL epidural solution (100 microg fentanyl in 0.9% saline) and 2 mL of intravenous 0.9% saline; G2 patients (n = 15) received 5 mL epidural 0.9% saline and 2 mL intravenous fentanyl (100 microg). Analgesic complementation with intravenous tenoxicam (40 mg) and epidural 0.25% bupivacaine (5 mL) (when there was no relief with tenoxicam) has been evaluated. Pain intensity was evaluated by numeric and verbal scales in moments M30, M120 and M240 minutes., Results: Number of patients needing analgesic complementation both with tenoxicam (G1 = 10 and G2 = 15 patients) and bupivacaine (G1 = 2 and G2 = 8 patients) has been higher in G2. There have been no statistical differences in pain intensity between groups in all studied moments., Conclusions: In the conditions of our study, effects of epidural fentanyl were better as compared to intravenous fentanyl.

Background and Objectives: Spinal morphine promotes good pain relief, but is not free from side effects. This study aimed at verifying the correlation between CSF morphine concentration and side effects., Methods: This study involved 4 groups of 7 rats, which were studied 24 hours after spinal catheter insertion via cisterna magna. Groups G1, G2, G3 and G4 received respectively 0.1; 0.3; 0.5 and 1 microg morphine in 10 microl of 0.9% saline solution. CSF samples were collected and side effects were recorded at M15, M30, M60, M120 and M180 minutes after injection., Results: Side effects observed were: mandible tremors, agitation, pruritus, absence of diuresis, sedation, and respiratory changes. The incidence of side effects was higher during early evaluations and progressively decreased with time. Mean CSF morphine concentrations in G1 varied from 72.84 to 1.13 pg; in G2 from 114.26 to 5.68 pg; in G3 from 151.18 to 13.62 pg and in G4, from 561.37 to 18.61 pg., Conclusions: There has been no correlation between CSF morphine concentration and side effects.

Background and Objectives: Spinal morphine promotes adequate pain relief, but is not free from side effects. This study aimed at investigating the effects of different spinal morphine doses., Methods: Five groups of seven rats were studied, 24 h after spinal catheter insertion via cisterna magna under anesthesia with muscular ketamine and xylazine. G1 received 10 microl saline solution; groups G2, G3, G4 and G5 received respectively 0.1; 0.3; 0.5 and 1 microg morphine in 10 microl saline solution. Animals were submitted to tail immersion test in hot water at M0 (prior to injection), and M15, M30, M60, M120 and M180 minutes after the injection., Results: Analgesic effects were observed in groups receiving morphine, in different times, as compared to control and to time before morphine injection. In G1 there was paws weakness in 4 animals. Agitation was observed at M15 in G2 and at M15 and M30 in G3. Mandible tremors were observed at moments M5, M15, M30 and M60 in G2; at M5 and M15 in G3, in M5 in G4, and in M5 in G5. Pruritus was observed at M5, M15, M30 and M60 in G2; at M5, M15, M30, M60 and M120 in G3; at M5, M15, M30, M60, and M120 in G4; and at M5, M15, M30, M60 and M120 in G5. Absence of diuresis was observed at M60 in G2; at M15, M30, M60 and M120 in G3; at M30 and M120 in G4, and at M30, and M60 in G5. Sedation was observed at M15, M30 and M60 in groups 2, 3 and 4; and at M15, M30, M60 and M120 in G5. Respiratory changes were observed at M15, M30 and M60 in G2; at M15, M30 and M60 in G3; at M15 and M30 in groups 4 and 5., Conclusions: In this study all morphine doses below 1 microg have promoted short duration analgesia; all spinal morphine doses have produced side effects.

Background and Objectives: Methods to promote knee pain analgesia without impairing motor function have been widely researched. This study aimed at comparing intra-articular morphine, bupivacaine, and fentanyl analgesic effects (as compared to saline solution), after knee video-arthroscopy., Methods: Participated in this study 60 patients who were randomly distributed in four groups: GI (n = 15) 10 ml saline solution; GII (n = 15) 2 mg morphine diluted in 10 ml saline solution; GIII (n = 15) 10 ml of 0.25% bupivacaine; GIV (n = 15) 100 microg fentanyl diluted in 10 ml saline solution, injected at surgery completion. All patients received spinal anesthesia with 15 mg hyperbaric bupivacaine. Pain intensity was evaluated by a visual analog scale (VAS) (at surgery completion, and 6, 12, 18 and 24 hours later). The need for analgesic complementation (1 g intravenous dipirone) was also evaluated. Side effects were recorded., Results: There were no statistical differences in pain intensity among groups in almost all moments studied. There was a statistic difference up to 6 hours, when the fentanyl group had significantly lower pain. The morphine group needed more dipirone complementation. Side effects were minor, without statistical significance., Conclusions: There were no statistical differences among solutions analgesic effects in almost all moments studied.

Background and Objectives: In spite of the frequent use of high doses of fentanyl for major surgeries, the correlation of its residual plasma concentration to postoperative analgesia deserves further investigation. This study aimed at evaluating the residual analgesic effect of fentanyl in the first and second postoperative days of myocardial revascularization, as well as quantifying its concentration., Methods: Participated in this study 11 patients undergoing myocardial revascularization with cardiopulmonary bypass under general anesthesia with 50 microg.kg-1 intravenous fentanyl. Analgesia was evaluated by a numeric verbal scale at moments zero (extubation), 70 min, 3, 5, 8 and 12 hours in the first day; and moments zero (24 h after extubation), 70 min, 3, 5, 8 and 12 hours in second post-operative day. Pain intensity to vigorous cough and respiratory physical therapy was evaluated. At every measurement, patients were asked about the need for analgesic complementation. Plasma samples were collected in moments zero (extubation), 70 min, 3, 5, 8 and 12 hours during the first and second postoperative days for fentanyl radioimmunoassay., Results: Mean pain intensity varied from 1.9 to 3.7 in the first day and from 2.1 to 3.8 in the second postoperative day. Fentanyl plasma levels (> 1 ng/ml) evidenced its contribution to post-operative analgesia during the first postoperative day., Conclusions: In spite of the lack of correlation between residual fentanyl plasma concentration and pain intensity, patients referred only mild pain during the whole investigation period.

Purpose: To determine the frequency, associate factors and clinical features of bacteremia in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP), with or without therapeutic procedures., Methods: Prospectively, 42 consecutives patients undergoing 46 endoscopic retrograde cholangiopancreatographies (ERCPs) from August to December 1994 were analyzed. The search for bacteremia was done by drawing 6 blood samples for cultures from peripheral blood. Two blood samples were collected before the ERCP and 4 of them after. The bottles used for cultures were Bactec bottles. The bottles were incubated in the Bactec 9240 system, and eventual bacteria detect were identificated by the manual routine of the laboratory and also with the autoScan/Microscan system., Results: All blood cultures obtained before the ERCPs were negatives. Bacteremia were detected after 7 endoscopic procedures. In two episodes of bacteremia, the microorganism identified (Staphylococcus epidermidis) was considered to be a contaminant. The other 5 episodes of bacteremia were considered true bacteremia (frequency- 10.9%), and the microorganisms identified were: Streptococcus viridans, Corynebacterium sp., Enterobacter cloacae, Klebsiello oxytoca and Enterobacter aerogenes. This episodes were more frequent in the blood cultures obtained immediately after the ERCPs (p < 0.05), and occurred exclusively in the patients who were not receiving antibiotics (p = 0.0192). Clinical manifestation of the episodes of bacteremia were not detected., Conclusion: The episodes of bacteremia occurred exclusively in the patients who were not receiving antibiotics, were transient and completely no symptomatic.

Coagulase-negative staphylococci (CNS) are an important cause of nosocomial bacteremia and they are frequently considered as contaminants of blood-cultures. From October 1990 to September 1992, 300 positive blood-cultures for CNS at the Hospital São Paulo were studied and 141 CNS bacteremias were characterized as nosocomial bacteremias. Clinical and microbiological criteria were defined to differentiate between true CNS bacteremia and contaminated cultures. Only 20.6% of the CNS nosocomial bacteremia were considered as true bacteremia. Most of the CNS true nosocomial bacteremia were detected among newborns admitted to the neonatal intensive care unit; the presence of intravascular catheter and parenteral nutrition were significant findings. We did not detect significant difference between true nosocomial bacteremia and contaminated cultures regarding to resistance to oxacillin and SLIME production. The clinical criteria and the positivity of the blood-cultures up to 48 hours after incubation, utilized in our definitions, were useful parameters to characterize the CNS true nosocomial bacteremia.