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Objective: To develop and validate a mobile application prototype for nursing shift handover in a hospital inpatient unit., Methods: A methodological study of technological production, carried out from April 2020 to January 2022, for mobile application construction and validity through the Design Thinking methodology. The study involved the stages of prototype development and validity by experts., Results: The application for mobile nursing shift handover obtained a usability score of 79 points and a content validity coefficient of 0.7., Conclusions: The instrument obtained an excellent assessment according to usability and agreement among experts. However, future studies are needed to implement this technology in order to assess effectiveness, time optimization and failures during communication.

Purpose: To analyze the influence of temperature on the flow/texture of different foods, immediately after preparation and after one hour, and 2) To compare the influence of varying the cook in food preparation, in relation to food flow., Methods: This is a quantitative and experimental study. The IDDSI standardized flow test was used to evaluate the remaining volume in the syringe and the levels of foods (porridge, smoothie, liquid soup, and pureed light soup) prepared by different cooks, in triplicate, at time zero (T0) and after one hour (T1)., Results: Differences in temperature were observed in all foods at T0 and T1 (p < 0.05). The IDDSI level changed only in porridge, from level 3 to 4 (p = 0.043). Modifications were observed in the preparation by different cooks for smoothie, on the 2nd and 3rd day (p = 0.049), from level 3 to 4 of IDDSI. In porridge, on the 1st and 3rd day (p = 0.048) and 2nd and 3rd day (p = 0.048), with a change from level 4 to 3 of IDDSI., Conclusion: The temperature of all foods differed within the one-hour interval, with modifications in the flow test and in the IDDSI levels, from level 3 to 4, only for porridge. Different cooks prepared the smoothie and porridge with different characteristics, resulting in changes from level 3 to 4 in both foods.

Objective: To develop and validate a prototype of a mobile application shift handover between nurses in the emergency room using a severity scale., Method: This is a technological tool carried out at the Universidade Estadual de Maringá using design thinking, divided into four phases: discovering, defining, developing, and delivering. To structure the information, a checklist was used based on the Situation Background Assessment Recommendation, and to categorize patients in terms of severity, the National Early Warning Score was used. The validation of the sample was carried out by 10 nurses, specialized in the field of urgency and emergency, using the System Usability Scale questionnaire to assess usability. The content validity coefficient was used for analysis., Results: The application scored 75.75 in usability and had a content validity coefficient of 0.8., Conclusion: The prototype obtained an excellent evaluation of usability and agreement between evaluators. Future studies are needed for implementation in practice, evaluating the practicality, applicability, efficiency and time savings in shift information transfer.

Objective: To evaluate the etiology of and factors associated with pulmonary infection in kidney and kidney-pancreas transplant recipients., Methods: This was a single-center case-control study conducted between December of 2017 and March of 2020 at a referral center for kidney transplantation in the city of Belo Horizonte, Brazil. The case:control ratio was 1:1.8. Cases included kidney or kidney-pancreas transplant recipients hospitalized with pulmonary infection. Controls included kidney or kidney-pancreas transplant recipients without pulmonary infection and matched to cases for sex, age group, and donor type (living or deceased)., Results: A total of 197 patients were included in the study. Of those, 70 were cases and 127 were controls. The mean age was 55 years (for cases) and 53 years (for controls), with a predominance of males. Corticosteroid use, bronchiectasis, and being overweight were associated with pulmonary infection risk in the multivariate logistic regression model. The most common etiologic agent of infection was cytomegalovirus (in 14.3% of the cases), followed by Mycobacterium tuberculosis (in 10%), Histoplasma capsulatum (in 7.1%), and Pseudomonas aeruginosa (in 7.1%)., Conclusions: Corticosteroid use, bronchiectasis, and being overweight appear to be risk factors for pulmonary infection in kidney/kidney-pancreas transplant recipients, endemic mycoses being prevalent in this population. Appropriate planning and follow-up play an important role in identifying kidney and kidney-pancreas transplant recipients at risk of pulmonary infection.

Objective: To analyze and compare the health-related quality of life of adult survivors of acute lymphocytic leukemia and Wilms' tumor amongst themselves and in relation to healthy participants., Methods: Ninety participants aged above 18 years were selected and divided into three groups, each comprising 30 individuals. The Control Group was composed of physically healthy subjects, with no cancer history; and there were two experimental groups: those diagnosed as acute lymphocytic leukemia, and those as Wilms' Tumor. Quality of life was assessed over the telephone, using the Medical Outcomes Study 36-Item Short Form Health Survey., Results: Male survivors presented with better results as compared to female survivors and controls in the Vitality domain, for acute lymphocytic leukemia (p=0.042) and Wilms' tumor (p=0.013). For acute lymphocytic leukemia survivors, in Social aspects (p=0.031), Mental health (p=0.041), and Emotional aspects (p=0.040), the latter also for survivors of Wilms' tumor (p=0.040). The best results related to the Functional capacity domain were recorded for the experimental group that had a late diagnosis of acute lymphocytic leukemia. There were significant differences between groups except for the Social and Emotional domains for self-perceived health, with positive responses that characterized their health as good, very good, and excellent., Conclusion: Survivors of acute lymphocytic leukemia showed no evidence of relevant impairment of health-related quality of life. The Medical Outcomes Study 36-Item Short Form Health Survey (via telephone) can be a resource to access and evaluate survivors.

Severe sepsis and septic shock represent a major healthcare challenge. Much of the improvement in mortality associated with septic shock is related to early recognition combined with timely fluid resuscitation and adequate antibiotics administration. The main goals of septic shock resuscitation include intravascular replenishment, maintenance of adequate perfusion pressure and oxygen delivery to tissues. To achieve those goals, fluid responsiveness evaluation and complementary interventions - i.e. vasopressors, inotropes and blood transfusion - may be necessary. This article is a literature review of the available evidence on the initial hemodynamic support of the septic shock patients presenting to the emergency room or to the intensive care unit and the main interventions available to reach those targets, focusing on fluid and vasopressor therapy, blood transfusion and inotrope administration., (Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

The Paulista Epidemiologic Bulletin (Bepa), created in 2004 is a monthly publication from the Coordinating Office of Diseases Control (CCD), from the State Office of Health of Sao Paulo (SES-SP) responsible for planning and executing actions of health promotion and preventing any risks and diseases throughout the covered areas of the system (SUS-SP). Originally as a proposal of a fast publication of objective informations it suffered transformations along the years and turned out to be an important tool for service actions and health managers. Funded exclusively by public resources it tries hard to maintain the monthly periodicity and disclosure of epidemiologic data, description of programmatic actions, health situation analysis and striking reports concerning the history of public health in Sao Paulo.

Early resuscitation of septic shock patients reduces the sepsis-related morbidity and mortality. The main goals of septic shock resuscitation include volemic expansion, maintenance of adequate tissue perfusion and oxygen delivery, guided by central venous pressure, mean arterial pressure, mixed or central venous oxygen saturation and arterial lactate levels. An aggressive fluid resuscitation, possibly in association with vasopressors, inotropes and red blood cell concentrate transfusion may be necessary to achieve those hemodynamic goals. Nonetheless, even though fluid administration is one of the most common interventions offered to critically ill patients, the most appropriate type of fluid to be used remains controversial. According to recently published clinical trials, crystalloid solutions seem to be the most appropriate type of fluids for initial resuscitation of septic shock patients. Balanced crystalloids have theoretical advantages over the classic solutions, but there is not enough evidence to indicate it as first-line treatment. Additionally, when large amounts of fluids are necessary to restore the hemodynamic stability, albumin solutions may be a safe and effective alternative. Hydroxyethyl starches solutions must be avoided in septic patients due to the increased risk of acute renal failure, increased need for renal replacement therapy and increased mortality. Our objective was to present a narrative review of the literature regarding the major types of fluids and their main drawbacks in the initial resuscitation of the septic shock patients.

Fever is a nonspecific response to various types of infectious or non-infectious insult and its significance in disease remains an enigma. Our aim was to summarize the current evidence for the use of antipyretic therapy in critically ill patients. We performed systematic review and meta-analysis of publications from 1966 to 2013. The MEDLINE and CENTRAL databases were searched for studies on antipyresis in critically ill patients. The meta-analysis was limited to: randomized controlled trials; adult human critically ill patients; treatment with antipyretics in one arm versus placebo or non-treatment in another arm; and report of mortality data. The outcomes assessed were overall intensive care unit mortality, changes in temperature, intensive care unit length of stay, and hospital length of stay. Three randomized controlled trials, covering 320 participants, were included. Patients treated with antipyretic agents showed similar intensive care unit mortality (risk ratio 0.91, with 95% confidence interval 0.65-1.28) when compared with controls. The only difference observed was a greater decrease in temperature after 24 hours in patients treated with antipyretics (-1.70±0.40 versus - 0.56±0.25ºC; p=0.014). There is no difference in treating or not the fever in critically ill patients.

Objective: To evaluate the rates of mortality and morbidity in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) using routine intraoperative transesophageal echocardiography (ITEE)., Methods: We conducted a retrospective, observational review of medical records of 360 patients from April 2010 to April 2012. We analyzed: age, weight, height, gender, EuroSCORE, diabetes mellitus, ejection fraction and number of diseased vessels. Outcomes were compiled in intraoperative and postoperative (myocardial infarction, stroke, renal failure, hemodialysis, atrial fibrillation, length of stay in the intensive care unit)., Results: 53 patients were included, with 27 receiving monitoring; we excluded 307 individuals, as they were not operated by the same surgical team. The two groups were homogeneous for age, weight and gender. However, the ejection fraction was lower in the group submitted to ITEE (ITEE group 56.3% versus Non-ITEE group 65.9 ± 11%, p = 0.01). In patients not subjected to ITEE, mortality was higher (ITEE group 0% versus Non-ITEE group 7.6%, p = 0.01). There was no significant difference between groups as for the incidence of stroke, myocardial infarction, atrial fibrillation and acute kidney injury., Conclusion: The use of intraoperative transesophageal echocardiography in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass decreased perioperative mortality, warranted the use of inotropic drugs and vasodilators and contributed to a better patient outcome.

Objective of this study was to identify the socio demographic profile and drug use in elderly enrolled in a health unit and to propose nursing actions through identification of diagnoses and prescriptions related, focused on the use of drugs, targeted to these elderly. This descriptive study was conducted in a family health unit, in the state of Rio Grande do Sul, Brazil, with 97 elderly. For data collection it was used a structured form. The data were analyzed by descriptive statistics. it was used Risner's model of diagnostic reasoning for the identification of nursing diagnosis. The elderly used 3.46 drugs and 31.86%, five or more. Seven nursing diagnosis were identified. Those diagnoses were present in at least ten elderly for whom prescriptions related were established. The results of this study may assist in achieving effective action for the resident elderly who uses drugs.

The so-called social technologies have been widely used in many places around the world as a viable alternative for low-income populations to gain access to opportunities for employment and income and other aspects related to quality of life, including basic sanitation. This paper conducts a cost-benefit analysis of using a low cost technology for drinking water used in several countries, namely the SODIS system. The study was conducted in riverside communities living in the island area of Belem municipality, located in the Brazilian Amazon. Data were collected through questionnaires answered by families living on three islands: Jutuba, Nova and Urubuoca. The results were positive, considering the cost-benefit analysis of the project, which demonstrates the economic viability of using the SODIS system in the situation investigated.

Objective: To develop an experimental model of stable saccular aneurysm in carotid of pigs using the internal jugular vein., Methods: In 12 healthy pigs, weighing between 25 and 5 0kg, five males and seven females, we made a right common carotid artery aneurysm. After elliptical arteriotomy, we carried out a terminolateral anastomosis with the distal stump of the internal jugular vein. Aneurysm volume was calculated so that the value did not exceed 27 times the area of the arteriotomy. After six days angiography and microscopic examination were performed to assess patency of the aneurysm and the presence of total or partial thrombosis., Results: There was a significant weight gain of pigs in the time interval between the manufacture of the aneurysm and angiography (p = 0.04). Aneurysmal patency was observed in ten pigs (83%). Operative wound infections occurred in two animals (16.6%), both with early onset, three days after the making of the aneurysm. Histological analysis showed aneurysm thrombus partially occluding the light in nine pigs (75%). In these animals, it was observed that on average 9% of the aneurysmal diameter was filled with thrombi., Conclusion: It was possible to develop a stable experimental model of saccular aneurysms in pig carotid artery by use of the internal jugular vein.

Background and Objectives: Studies show the importance of monitoring neuromuscular function in preventing the residual block. However, most anesthesiologists in their daily practice base their evaluation of the recovery of neuromuscular function on clinical data. The aim of this study was to assess the degree of neuromuscular blockade in children undergoing general anesthesia at the time of block reversal and the removal of the endotracheal tube., Method: We evaluated children between 3 months and 12 years of age undergoing general anesthesia with the use of atracurium or rocuronium. Monitoring was initiated at the time of reversal of neuromuscular blockade and/or removal of the endotracheal tube. The anesthesiologist was not informed about the T₄/T₁ value; he/she was only alerted when the time was inadequate for the removal of the endotracheal tube. Since the start of the monitoring process, the degree of neuromuscular blockade was registered, as well as the interval of recovery of the T(4)/T₁ ≥ 0.9 ratio, the doses of neostigmine and blocker used, the expired fraction of the inhalational agent, the duration of the anesthesia, and core and peripheral temperatures., Results: Neuromuscular blockade was reversed in 80% of the children of the Rocuronium Group and in 64.5% of the Atracurium Group. The reversal was incorrect in 45.8% of the Rocuronium Group and in 25% of the Atracurium Group. The incidence of T₄/T₁ < 0.9 at the time of the removal of the endotracheal tube was 10% in both groups., Conclusions: When deciding to remove the endotracheal tube based on clinical criteria, 10% of children had T₄/T₁ < 0.9 regardless the blocker received. A considerable number of patients had the neuromuscular blockade incorrectly reversed when the blockade was still too deep or even already recovered., (Copyright © 2011 Elsevier Editora Ltda. All rights reserved.)

This article aims to analyze responses of the population to the influenza epidemic that struck Salvador, capital of Bahia state, Brazil, in early September 1918. From this perspective, we discuss the measures taken by health authorities, the defensive actions of ordinary people, and the adoption of religion-based practices to confront a disease hitherto considered benign and seasonal, which appeared with a surprising virulence at an unusual time of year. We used newspapers published in Salvador during the influenza epidemic as a privileged source for this research.

Carrion breeding insects may be of great utility in crimes briefing. Studies on forensic entomology are restricted to few localities in Brazil and very few of them were done in the cerrado vegetation (a type of Savannah) until now. This work aimed to survey the main species of dipterans associated with the decomposition process of Sus scrofa and the insect succession pattern in carcasses in the Cerrado. The study was carried out in the dry and humid season of the year, in two cerrado vegetation profiles in Uberlândia, MG. Two pig carcasses were placed in each vegetation profile and time period of the year. The decomposition process was slower and insects were more abundant in the dry season. Differences in temperature, air humidity and pluvial precipitation seemed to be the main physical factors responsible for the differences in the time of decomposition of the pig carcasses between the two seasons. Fourteen species of dipterans (59,467 specimens) bred in the decomposing carcasses. Chrysomya albiceps (Wiedemann) was the species more abundantly breed in the two periods. The other species that breed in the carcasses were: C. putoria (Wiedemann), Hemilucilia segmentaria(Fabricius), Lucilia eximia(Wiedemann) (Calliphoridae), Peckia (Pattonella) intermutans(Walker), Peckia (Squamatoides) trivitatta(Curran), Sarcodexia lambens(Wiedemann) (Sarcophagidae), Musca domestica(L.), Ophyra aenescens(Wiedemann), Stomoxys calcitransL. (Muscidae), Fannia pusio(Wiedemann), Fannia sp. (Fanniidae), Hermetia illuscens L. (Stratiomyidae) and Phoridae sp. The Cerrado of this region presents many dipterans potential forensic indicators.

In this debate, Latin American historians compare the 1918-1919 flu pandemic with the one sweeping the continent in 2009, focusing especially on the experiences in Mexico, Argentina, and Brazil. They analyze the strategies adopted on both occasions, above all isolation measures, port and airport surveillance, and urban interventions. Comparisons are drawn between the actions of federal and local governments, positions taken by doctors and the media, and people's behavior, particularly regarding fear and death. The debaters also analyze the performance of assistance structures, the treatment and prevention measures recommended by public health agencies and private groups with a vested interest in drug sales, and popular and home remedies. The debate extends to how the 1918 experience has influenced the evaluation of today's crisis and what legacy it may leave behind.

Hydrolytic enzymes secreted by fungi play an important role in the pathogenesis of infection. With the aim of evaluating the enzymatic activity, 31 isolates of Acremonium stored in the University of Recife Mycology (URM) Culture Collection were tested. Culture fragments were transferred to glycoside broth for reactivation and further growth in potato dextrose agar medium in order to investigate viability and purity and to confirm the taxonomy through observing the macroscopic and microscopic characteristics. To detect enzymes, milk casein and gelatin were used as substrates for proteinase, starch for amylase and soy lecithin for phospholipase. Among the 31 cultures, 26 (83.9%) remained viable and 24 (92.3%) were confirmed taxonomically. Out of these 24 cultures, 12 (50%) presented proteinase activity, of which two (16.7%) were on milk casein, one (8.3%) on gelatin and nine (75%) on both substrates; 16 (66.7%) degraded starch. None of the cultures presented phospholipase activity. It was concluded that Acremonium species are able to produce enzymes that are involved in the pathogenicity of fungal infections.

The article describes the moment when the medical and health authorities of Bahia state (Brazil) faced the challenge of explaining an illness that was spreading with unexpected virulency throughout the world, provoking much uncertainty and controversy among the global academic and scientific community concerning the diagnosis and etiology of the disease. It analyzes the Bahian medical establishment's stance within these discussions and the scientific knowledge used by medics to explain the epidemic and to recommend therapeutic and prophylactic measures.

Aspects of the population dynamics of Aedes aegypti were investigated from collections over a two-year period in the urban area of Uberlândia, State of Minas Gerais. The population dynamics of this mosquito were influenced by physical factors such as temperature and rainfall. High larval densities also had an influence on mosquito development.

Objective: To analyze adverse events following vaccinations against diphtheria, pertussis and tetanus (AEFV-DPT) and to investigate factors associated with event severity., Methods: A cross-sectional study was carried out with a descriptive and analytical component covering AEFV-DPT that were notified in the State of São Paulo, Brazil, between 1984 and 2001, among children less than seven years old. Cases were defined as used in AEFV-DPT surveillance; the data source was AEFV-DPT passive surveillance. In calculating the rates, the numerator was the number of AEFV-DPT and as denominator was the number of doses applied. The association between severity of AEFV-DPT and the exposures of interest was investigated by means of non-adjusted and adjusted estimates of odds ratios, with their respective 95% confidence intervals, using non-conditional logistic regression., Results: A total of 10,059 AEFV-DPT were identified, corresponding to 6,266 children who presented one or more AEFV-DPT, 29.5% were hospitalized and 68.2% presented contraindications for subsequent DPT doses. Around 75% of the events occurred during the first six hours after vaccination. The most frequent AEFV-DPT were: fever < 39.5 degrees C, local reactions, hypotonic-hyporesponsive episodes and convulsion. Time interval of less than one hour between vaccination and the event (OR = 2.1), first dose applied (OR=5.8) and previous personal (OR=2.2) and family (OR=5.3) neurological histories were independently associated with severe events., Conclusions: Passive surveillance of AEFV-DPT was shown to be useful for monitoring the safety of the DPT vaccine, through describing the characteristics and magnitude of these events, and also enabling identification of possible factors associated with severe forms.

Objectives: To describe the prevalence of hypertensive pseudocrisis in patients treated in emergency rooms with substantially elevated blood pressure levels. To compare this prevalence in private and public hospitals. To describe the frequency of wrong treatment for this condition. To identify, during triage, independent predictors of pseudocrisis. To evaluate the prognosis of patients with pseudocrisis., Methods: Patients above the age of 18, admitted to the Emergency Rooms of two hospitals (private and public) during a 6 month timeframe, with diastolic blood pressure > or = 120 mmHg were included in the study. Hypertensive pseudocrisis was determined when none of the criteria for hypertensive crisis were present (Guidelines of the Brazilian Society of Cardiology(1))., Results: In the 110 patients studied, the prevalence of hypertensive pseudocrisis was 48% (95% CI = 39%-58%) and prevailed in the private hospital (59% vs 37%, p=0.02). The frequency of wrong treatment was similar between the two hospitals (94% vs 95%, p=0.87). After multivariate analysis, the presence of headache upon admission (Odds Ratio=5.4; 95% CI = 5.1-13; p< 0.001) and diastolic BP levels (Odds Ratio=0.93; 95% CI = 0.89-0.97; p=0.002) were independent predictors of pseudocrisis. The 5 month mortality rate was lower in the pseudocrisis group than the hypertensive crisis group (0% vs 21%, p=0.0004)., Conclusions: There is a high prevalence of hypertensive pseudocrisis in patients when hypertensive crisis is suspected, particularly in the private hospital. The frequency of wrong treatment was similar for both the private and public hospitals. Headaches and diastolic BP levels are independent predictors for this clinical condition. Hypertensive pseudocrisis has a low rate of lethality.

Background: The Burnout syndrome can be characterized by abnormalities in three domains: emotional exhaustion (EE), depersonalization (DP) and lack of personal realization (PR). In the medical profession, oncologists are especially prone to this syndrome. This study evaluates its prevalence among cancer physicians in Brazil correlating it to their demographic, work related variables and seeks possible solutions to prevent burnout., Methods: We mailed three questionnaires (Maslach burnout inventory, general and opinion questionnaires) to all 645 members of the Brazilian Cancer Society and received 136 responses after 10 weeks., Results: The response rate was of 21%. The burnout syndrome was present at moderate or severe levels in all three domains analyzed in 15.7% of the physicians. For each of these the frequency of moderate or severe dysfunction was analyzed and found to be present in 55.8% for EE, 96.1% for DP and 23.4% for RP. Practicing physical activity or having a hobby correlated significantly with lower levels of EE (p = 0.008) while working only for the private sector correlated with higher DP scores (p = 0.021). Cancer physicians pointed out that less paper work (73.5%) and a lower patient load (72.7%) were the most important factors for prevention of this syndrome., Conclusion: Burnout syndrome is frequent among Brazilian cancer physicians and further studies should be conducted to evaluate its prevalence and prevention among other sub specialists.

The article investigates the Spanish flu epidemic that hit the city of Salvador and the state of Bahia, reaching its height between September and December of 1918. The local press is a primary source in this analysis of power politics, sanitary conditions in the state capital, some economic issues, the material conditions for survival in Salvador, and the fragility of public health and assistance policies-- all features of a complex, unequal society made visible by the epidemic.

A study on the impact of pain in patients with temporomandibular joint disorder (TMD) was carried out. Twenty two patients (20 women, two men, 28 years of age on average) with TMD who looked for specialized physiotherapy care were submitted to a brazilian version of McGill Pain Questionnaire (Br-MPQ), which includes questions about life quality, as follows: 1) social loss; 2) daily life activities; 3) third party’s perception; 4) pain tolerance; 5) sensation of being sick; 6) sensation of being useless; 7) life satisfaction. The results showed that pain related to the TMD significantly affected work activities (59.09%), school activities (59.09%), sleeping (68.18%) and appetite/feeding (63.64%). The authors conclude that pain from TMD has a negative impact on the patients’ life quality and that, although unspecific, the questionnaire used allowed for an adequate evaluation of the impact.

Purpose: To describe the use of myocardial reperfusion strategies (percutaneous transluminal coronary angioplasty-PTCA and intravenous trombolysis) whenever it is possible to use emergency cinecoronariography in acute myocardial infarction (AMI)., Methods: The records of patients admitted with initial diagnosis of AMI, until six hours after the beginning of symptoms, were reviewed retrospectively, between March/92 and December/93., Results: One hundred forty-three patients were admitted with suspected AMI. Eighty-one (57%) presented definitive criteria for this diagnosis. Fifty-two patients (64%) were admitted in the first six hours from the beginning of symptoms. Thirty-eight (73%) were male and the mean age was 59 +/- 12 years. Cinecoronariography was indicated immediately in 36 of 52 (69%) patients, with purpose to use PTCA. That was done in 30 (58%). Two (4%) patients were submitted to emergency surgical myocardial revascularization. Intravenous thrombolysis was used in 11 (21%) patients. At admission, the conservative treatment was chosen for five out of nine left patients, based on clinical grounds., Conclusion: The availability of emergency cinecoronariography made an early reperfusion strategy possible in 83% of patients admitted with AMI in the first six hours after the beginning of symptoms.

Clinical manifestation of carcinoide syndrome are often difficult to control with medical treatment and so present a large problem for doctors. In the majority of cases, such manifestations are seen in patients with hepatic metastases. In such cases the control of the problem can be achieved by local hepatic treatment. A 57 year old patient with carcinoide syndrome for a year, with extensive hepatic tumor from a carcinoide tumor, whose origins were not lokted, had a urinary excretion 5-hidroxi-indolacetic = 73 mg in 24 hours, he used cyproheptadin, loperamida and metisergida without showing improvement. In light of the failure of medical treatment and the impossibility of surgery he was given into hepatic chemoembolization (QEH) with lipiodol, doxorrubicin (1.0 mg/Kg) and mitomicin (10.0 mg) twice. Clinical control with absolute recovery of "flushing" and diarrhea were achieved, a dose of 5-HIAA U (5.5 mg) after the first application. Transitory alterations of the aminotransferasis alkaline phosphates and leucocytosis. Besides the post embolization syndrome that regressed in 20 days, there were no complications recurring after treatment. The period of recovery was more than 9 months. We can then conclude that hepatic chemoembolization is an efficient treatment to control carcinoid syndrome.

Today, epidemiology is no longer confined to the study of outbreaks of infectious-contagious diseases, but is shifting its focus to the chronic-degenerative diseases, and it is becoming increasingly necessary to train the clinician to apply its principles and methods in his medical practice. In his argument to this effect, the writer stresses the importance of bedside clinical work as a means to discovery and to the confirmation--or refutation--of hypotheses propounded in the experimental laboratory and in public health studies. As the prescriber of procedures for diagnosis and treatment, the clinician, it is asserted, is better placed than the epidemiologist to provide guidance for the solution of salient health problems. While of value in clinical research and the choice and analysis of preventive and curative methods, clinical epidemiology is also important for elucidating the natural history and causative factors of diseases, determining the effectiveness of new procedures, assessing the benefits to be gained from them, and evaluating the efficiency of the very health services that make them available to the population. Giving the clinician a basic understanding of epidemiology as an analytical instrument for the selection of methods of diagnosis and treatment, it is maintained, is the way to enhance his capacity for critical evaluation.