International Archives of Medicine (E-Journal)
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Anatomical Variation Of The Submandibular Gland Duct. A Unreported Anomaly
Get PDFBackground: The submandibular gland is the second largest major salivary gland and weighs 7–16 gr. The gland is located in both sides of the face, at the same level of the body of the jaw, in the submandibular triangle, The submandibular duct or Wharton’s duct exits anteriorly, coursing deep to the lingual nerve and medial to the sublingual gland, the main excretory duct of the submandibular gland, whose diameter is of 2 to 3mm and approximately 4–5 cm long. It empties lateral to the lingual frenulum through a papilla in the floor of the mouth behind the lower incisor tooth. The purpose of this study is determine the morphologic features and describe an unusual anatomical variation of the path of the submandibular duct.
Methods and Findings: A total of 17 cadavers were used for this study in the Morphology Laboratory at the University of Pamplona. In a cadaver were findings: The excretory duct of the left submandibular gland had an external location that ascends and crosses vertically off the body of the mandible, in its termination it is divided in four ducts that had separate openings into the oral cavity upon a small papillas independent, opposites to the first and second lower molar Crown.
Conclusions: Awareness of potential variations of the excretory ducts of the salivary glands can aid in the accurate diagnosis and treatment of patients with salivary conditions as well as help surgeons avoid further complications or duct lacerations during surgical procedures
Effective Management Of Patients With Amniotic Fluid Embolism In The Intensive Care Unit: Two Case Reports
No full textAmniotic Fluid Embolism (AFE) is a rare complication of the intra- and early post-partum period, which may also be encountered with cesarean delivery and during abortions. Its symptompatology includes respiratory distress with cyanosis, shock and possibly tonic-clonic seizures. Disseminated intravascular coagulation (DIC) frequently occurs and is usually fatal. The aim of this case report is to present the positive outcome and our gained experience from two cases suffering from AFE. Thus, we analyze the case of two patients, in the second trimester of pregnancy who presented symptoms of AFE. Our study reveals that in the case of patients with AFE, early diagnosis, prompt management and proper treatment increase survival rate and may ensure complete recovery in a relatively short period of time. However, DIC is a serious aggravating factor which makes the recovery process slower.
 
Brazilian Program For HIV Point-Of-Care Test Evaluation: A Decade’s Experience
No full textThe point-of-care tests (POCTs) for HIV diagnosis have been widely used in Brazil in order to expand and to allow HIV diagnosis outside health units including remote areas, such as the Amazon region. In order to guarantee the quality of HIV diagnostics based on rapid tests, the Brazilian Ministry of Health (MoH) implemented the HIV POCT Evaluation Program. This study compiles the Brazilian experience acquired over the last 13 years conducting the HIV POCT Evaluation Program.
Methods and Findings
The selection of tests was based on the interest of manufacturers to qualify for the MoH tenders. Each round was performed with fresh whole blood and oral fluid samples, always including HIV positive and negative ones. In addition to the POCT, every sample was submitted to a reference testing protocol, based on an immunoassay followed by Western blot. The POCTs were evaluated for clinical sensitivity, clinical specificity, assay operational characteristics, detection of HIV-2 antibodies, sensitivity to subtypes panels; and sensitivity to seroconversion panels. Since its implementation in 2003, the POCT evaluation protocol has undergone some modifications aiming to improve and simplify the evaluation process, to know: (i) for HIV-positive samples, perform EIA and Western blot only if the POCT is non-reactive; (ii) reduction from 800 to 600 HIV negative samples; (iii) increase from one to three subtype panels (including HIV-2 samples); and (iv) inclusion of seroconversion panel. We evaluated six tests, four of which met the sensitivity criteria of 99.5%: BD Chek™ HIV Multi-test (whole blood), HIV 1/2 Colloidal Gold (whole blood), OraQuick ADVANCE® Rapid HIV-1/2 Antibody Test (whole blood and oral fluid) and TR DPP HIV-1/2 (whole blood, plasma and oral fluid). Regarding other evaluated criteria, all assays met the requirements.
Conclusions
The successful Brazilian policy on POCT use for HIV infection diagnosis includes the evaluation of the POCT itself in addition to appropriate selection of tests to be acquired and nationwide distributed to the public health facilities, control of each test batch distributed by the MoH, proper and easily accessible training to all health professionals involved in rapid testing through distance learning tools, and continued evaluation of POCT use through external quality assessment
Maternal excess weight and nutritional status of preschool children
Get PDFIntroduction: The increasing prevalence and early occurrence of excess weight in childhood suggests an association with the habits and nutritional status of the parents, as preschool aged children are still strongly influenced by the home environment.
Objective: This study sought to evaluate the association between excess weight in parents and the nutritional status of preschool aged children.
Methods: Using a cross-sectional study, the nutritional status of 224 children aged two-six from seven private schools in São Paulo city was classified into two categories: a low or appropriate body mass index (BMI) group called ‘normal weight’ and an overweight or obese group, called ‘excess weight’ according to the World Health Organization. The independent variables were: maternal and paternal nutritional status, sex of the child, family income, maternal education, duration of breastfeeding, age of mother and father and weight and length of the child at birth. A multiple generalised linear regression examined the relation between the independent variables and child excess weight.
Results: Mothers with excess weight presented a prevalence ratio of 1.3 (CI90%: 1.08 to 1.59) of children with excess weight compared to normal weight mothers, but not for fathers. Breastfeeding duration of over 12 months was a protective factor against excess weight of the child, 0.71 (CI90%: 0.51 to 0.99).
Conclusion: The interpretation of the results, even considering the possible limitations, demonstrates that there is an association between excess weight of preschool age children and maternal excess weight, but not with father’s excess weight
Similarity Analysis About The Training Of Family Health Strategy Professionals For The Psychosocial Care Of The Elderly
Get PDFBackground: Elderly mental health is an important topic of discussion to Brazilian public health because it involves factors related to the training of health professionals focused on these demands in the Family Health Strategy.
Objectives: To make a similarity analysis about the training of the Family Health Strategy professionals for psychosocial care for the elderly.
Methodology: Qualitative research carried out with 31 professionals from the Family Health Strategy in the city of Picos, Piauí, Brazil. Data were collected through a semi-structured interview script. The interviews were performed in a reserved room and recorded with the aid of an MP4 player. The data were processed by the IRAMUTEQ software and analyzed through similarity analysis that is based on graph theory.
Results: The study participants were 13 doctors and 18 nurses, 27 (87.09%) were female. The training time of these professionals was comprised between 2 to 32 years of training and the duration of the Health Strategy from 1 year to 16 years. According to the co-occurrence tree, the data indicate that: the word "elderly" is at the heart of the ramifications and expresses how family and professionals can contribute to treatment; another demonstrated representation is that it is difficult for professionals to carry out their activities with the elderly due to lack of training in the specific area of mental health.
Conclusion: the family plays a fundamental role in the elderly care with psychosocial needs and the professionals of the Family Health Strategy present difficulties to carry out comprehensive care due to deficiencies in their training.
Keywords: Mental health. Family Health. Elderly
Unilateral Duplication Of Parotid Duct. A Rare Anatomical Variation
Get PDFBackground: The paired parotid glands are the largest of the major salivary glands and produces mainly serous secretions. The secretion of this gland reaches the oral cavity through single parotid duct (Stensen’s duct). The parotid duct begins at the anterior border of the gland, crosses the masseter muscle, and then pierces the buccinator muscle to reach the mucosa lining the mouth at the level of the cheek. The purpose of this study is determine the morphologic features of the parotid duct and describe an anatomical variation until now unreported.
Methods and Findings: A total of 17 cadavers were used for this study in the Morphology Laboratory at the University of Pamplona. In a cadaver were findings: The main parotid duct originated two conducts: Left superior parotid duct and Left inferior parotid duct, is observed the criss-cross of the ducts, and then perforated the buccinator muscle and entered the oral cavity at a double parotid papilla containing a double opening, separated from each other in 0,98 mm. In the remaining 33 parotid regions (97.06%) the parotid duct is conformed to the classical descriptions given in anatomical textbooks.
Conclusions: The parotid duct anatomy is important for duct endoscopy, lithotripsy, sialography and trans-ductal facial nerve stimulation in the early stage of facial palsy in some cases. The anatomical variations also has clinical importance for parotid gland surgery and facial cosmetic surgery. To keep in mind the parotid duct variation will reduce iatrogenic injury risks and improve diagnosis of parotid duct injury
Perception Of Nursing Middle Managers About The Evidence-Based Management
Get PDFObjective: to comprehend the experience of nursing middle managers of an accredited public hospital, from São Paulo state, about the evidence-based management.
Method: case study and analysis of thematic content in the stages of unity of meaning, condensed meaning unity, interpretation of the underlying meaning, sub-theme and theme. Nine manager nurses participated. The data collection was done through a script with questions that, according to the convenience of the participants, were answered by electronic mail. The data were analyzed in the light of the theoretical reference of the managerial process in nursing and the evidence-based management.
Results: six themes were revealed: Evidence-based management and management process; Evidence-based management strengths; Evidence-based management challenges; the leader and the Evidence-based management; Hospital accreditation and evidence-based management and Experiences with the evidence-based management.
Conclusion: the scientific knowledge and the experiences in the work are sources of evidences that interfere, positively, in the quality and safety of the patient. Leadership training, planning, team empowerment and involvement are essential for the development of this practice. Strategies need to be discussed and implemented so that the management process is based on evidences
Swaziland National Health Research Agenda: The Formulation Process
Get PDFBackground: The objectives of this article are to describe the process followed in development of the Swaziland’s national health research agenda (NHRA); and to provide an overview of the health research priorities that emerged from that process.Discussion: Swaziland followed a fourteen step process to develop it’s NHRA, namely: search and review of the existing health research priority setting guidelines; situation analysis included review of Swaziland’s socio-economic indicators; identification of research stakeholders; identification of the preliminary main broad research themes; development of questionnaire on ranking of main research themes; workshops with each of the eight stakeholders; ranking of major health themes and identification of sub-themes; identification of research gaps under each sub-theme and main research areas; scoring of research areas; research areas were grouped by sub-themes and ranked; collating research areas ranked as number one in each sub-theme; providing content to the agenda; preparation of the zero NHRA draft report; preparation of the first NHRA draft report taking into account critical inputs from stakeholders; and stakeholder’s final validation of the NHRA draft report. The paper provides an overview of communicable diseases, non-communicable diseases, sexual and reproductive health, injuries and health system research gaps under four categories of research: situation (burden and determinants); improvement of existing interventions; effectiveness of interventions; and feasibility of developing new capacities (tools and products).Conclusion: The National Health Research Department, with the support of the National Health Research Review Board, will be responsible for dissemination, preparation of rolling annual action plans to secure government funds for implementation of NHRA, promoting adherence among stakeholders, establishing a registry of R4H, establishing a knowledge translation platform, building of public-private-partnerships for research, mobilization of external resources, coordination and monitoring of the implementation of the NHRA.
KeywordsSwaziland, National Health Research Agenda, Health Research Priorities, Research Stakeholders, Research Gap
Nursing care for mother-to-child transmission of HIV
Get PDFObjective: To evaluate, through the literature, the relevance of neonatal care, through professional training in qualified and humanized care, with a view to reducing child mortality.
Method: An integrative review of the international scientific literature was carried out, in order to answer the following question: "How does neonatal care, through professional training, have the most qualified and humanized assistance in order to reduce infant mortality?" Eight articles were analyzed, which gave rise to three categories: Assistance aimed at HIV + pregnant women; Alternative breastfeeding and The role of Nursing in the prevention of mother-to-child transmission in the puerperal gravid cycle.
Conclusion: Structural actions of promotion and prevention are important measures of health education in the reduction of infant mortality, with nursing having a important role in guaranteeing them
Medical Specialties With Highest Percentages Of Complaints In The State Of Acre, Brazil
Get PDFBackground: The present study had the objective of surveying the medical specialties most commonly involved in complaints reported to the Regional Medical Council (CRM) of the state of Acre, between the years 1993 and 2009.
Method: Data were gathered from the CRM by means of a questionnaire. This yielded 121 complaints. A deductive method was applied, with quantitative analysis. The results indicated that the specialties most susceptible to “medical errors” were general practice and gynecology.
Findings: The results indicated that the specialties most susceptible to “medical errors” were general practice and gynecology.
Conclusion: It is hoped that these data will be useful to the State Health Department for justifying greater investments in these fields of scientific knowledge and for better professional training.
Keywords: Acre; complaints; specialties; ethics