Resumen ANTECEDENTES: La reanimación cardiopulmonar representa el 1 a 2% de los ingresos a las unidades de cuidados intensivos. En 2018, 17.4 por cada 1000 pacientes embarazadas de Estados Unidos requirieron reanimación cardiopulmonar e ingreso a unidades de cuidados intensivos, con mortalidad del 52% posterior al primer día de puerperio. OBJETIVO: Aportar conceptos indispensables de reanimación cardiopulmonar, causas de paro cardiaco materno y difundir algoritmos de atención y respuesta luego de la activación de un código para probable cesárea de urgencia en los cuatro minutos posteriores al paro cardiorrespiratorio, en casos sin retorno a la circulación espontánea. Esto con la finalidad de aumentar la calidad de atención de salud y disminuir los índices de mortalidad materna. METODOLOGÍA: Primera etapa: búsqueda en PubMed de artículos con antigüedad no mayor a cinco años, publicados en inglés o español, Guías de Práctica Clínica de Perinatología Clínica, revisiones sistemáticas y metanálisis. Segunda etapa: algoritmo de búsqueda (“cardiopulmonary resuscitation “[MeSH-Terms] AND “pregnancy” [MeSH-Terms]) AND ((y_5[Filter]) AND (systemati creview[Filter]) AND (english [Filter]) OR spanish [Filter])). RESULTADOS: Se reunieron 35 artículos o páginas web de los que se seleccionaron 19, incluidos 3 libros de texto relacionados con el tema y 3 páginas web gubernamentales. Además, se analizaron otros artículos para complementar el conocimiento del tema. CONCLUSIONES: El reconocimiento del colapso materno y la oportuna respuesta del personal de salud permitirán una reanimación cardiopulmonar de alta calidad; por esto debe fomentarse la capacitación al personal de salud.

Abstract BACKGROUND: Cardiopulmonary resuscitation accounts for 1% to 2% of intensive care unit admissions. In 2018, 17.4 per 1000 US pregnant patients requiring cardiopulmonary resuscitation were admitted to intensive care units, with mortality of 52% after the first postpartum day. OBJECTIVE: To provide essential concepts of cardiopulmonary resuscitation, causes of maternal cardiac arrest and to disseminate algorithms of care and response after activation of a code for probable emergency cesarean section within four minutes after cardiorespiratory arrest, in case of failure to return to spontaneous circulation. The aim is to increase the quality of health care and reduce maternal mortality rates. METHODOLOGY: First stage: search in PubMed of articles not older than five years, published in English or Spanish, Clinical Practice Guidelines of Clinical Perinatology, systematic reviews, and meta-analyses. Second stage: search algorithm ("cardiopulmonary resuscitation "[MeSH-Terms] AND "pregnancy" [MeSH-Terms]) AND ((y_5[Filter]) AND (systematic creview[Filter]) AND (english [Filter]) OR spanish [Filter])). RESULTS: Thirty-five articles or web pages were collected from which 19 were selected, including 3 textbooks related to the topic and 3 governmental web pages. In addition, other articles were analyzed to complement knowledge of the topic. CONCLUSIONS: Recognition of maternal collapse and timely response by health care personnel will enable high-quality cardiopulmonary resuscitation; therefore, training of health care personnel should be encouraged.

ABSTRACT A 59-year-old male patient with a personal pathological history of smoking, chronic obstructive pulmonary disease and morbid obesity. One month before admission he started with dry cough, left flank pain and marked asthenia; it was interpreted as a community inflammatory pneumopathy, which required several antibiotic treatments. There was no improvement and he went to the “Arnaldo Milián Castro” Hospital for study. The transthoracic echocardiogram performed showed a large pericardial effusion and a tumor image in the left atrium which infiltrated the pericardium. The symptoms worsened, he presented arterial hypotension and bradycardia, fell into cardiorespiratory arrest and was declared dead with the diagnoses of cardiac neoplasia and cardiogenic shock. The findings at necropsy allowed the diagnosis of constrictive pericarditis due to infiltration of moderately differentiated adenocarcinoma of the lung with pleural and pericardial carcinomatosis; he died of cardiogenic shock. The most frequent cardiac tumors are those of metastatic origin, including lung and breast carcinomas, melanomas and leukemias.

RESUMEN Paciente masculino de 59 años, con antecedentes patológicos personales de tabaquismo, enfermedad pulmonar obstructiva crónica y obesidad mórbida. Un mes antes del ingreso comenzó con tos seca, dolor en punta de costado izquierda y astenia marcada; se interpretó como una neumopatía inflamatoria de la comunidad, que requirió de varios tratamientos antibióticos. No hubo mejoría y acudió al Hospital “Arnaldo Milián Castro” para estudio. El ecocardiograma transtorácico realizado mostró un derrame pericárdico de gran cuantía y una imagen tumoral en la aurícula izquierda que infiltraba al pericardio. Hubo empeoramiento de los síntomas, presentó cuadro de hipotensión arterial y bradicardia, cayó en parada cardiorrespiratoria y lo declararon fallecido con los diagnósticos de neoplasia cardíaca y choque cardiogénico. Los hallazgos en la necropsia permitieron el diagnóstico de pericarditis constrictiva por infiltración de adenocarcinoma moderadamente diferenciado de pulmón con carcinomatosis pleural y pericárdica; falleció por cuadro de choque cardiogénico. Los tumores cardíacos más frecuentes son los de origen metastásico y, dentro de ellos, los carcinomas de pulmón y mama, los melanomas y las leucemias.

Neste trabalho, a produção de substâncias antimicrobianas por estirpes de Pseudomonas sp. isoladas de leite pasteurizado e seu potencial de ação contra bactérias associadas a alimentos foram investigados. As amostras de leite pasteurizado foram adquiridas em estabelecimentos comerciais, arbitrariamente escolhidos, da cidade do Rio de Janeiro-RJ, Brasil. Dentre as quatro amostras analisadas, três apresentaram várias colônias típicas de Pseudomonas. Cerca de cem colônias foram escolhidas e submetidas a testes bioquímicos para confirmação da identificação. Dezoito estirpes do gênero Pseudomonas foram identificadas e submetidas aos testes de produção de substâncias antimicrobianas. Doze estirpes (66,7%) foram identificadas como Pseudomonas fluorescens; quatro (22,2%) como P. aeruginosa; uma (5,5%) como P. mendocina, e uma (5,5%) como P. pseudoalcaligenes. Apenas duas estirpes de P. fluorescens não foram capazes de produzir qualquer substância antimicrobiana contra os microorganismos indicadores testados. A maioria das estirpes apresentou um amplo espectro de ação, inibindo estirpes de referência e associadas a alimentos, como Proteus vulgaris, Proteus mirabilis, Hafnia alvei, Yersinia enterocolitica, Escherichia coli e Salmonella Typhi. Cinco estirpes produtoras de substâncias antimicrobianas, que apresentaram o mais amplo espectro de ação, também foram testadas contra estirpes de referência de Staphylococcus aureus e contra 26 estirpes de Staphylococcus sp. isoladas a partir de alimentos, sendo, algumas delas, resistentes a antibióticos. As estirpes produtoras 8.1 e 8.3, ambas P. aeruginosa, foram capazes de inibir todas as estirpes de Staphylococcus testadas. As substâncias antimicrobianas produzidas pelas estirpes 8.1 e 8.3 não parecem ser bacteriocinas típicas, uma vez que foram resistentes às três enzimas proteolíticas testadas. Experimentos envolvendo a caracterização destas substâncias estão sendo realizados, a fim de avaliar a sua aplicação biotecnológica.

In this work, the production of antimicrobial substances by strains of Pseudomonas sp. isolated from pasteurized milk and their potential action against food-related bacteria were investigated. Samples of pasteurized milk were purchased from arbitrarily chosen commercial establishments in the city of Rio de Janeiro, Brazil. Of the four samples analyzed, three presented several typical colonies of Pseudomonas. About 100 colonies were chosen and subjected to biochemical tests for confirmation of their identity. Eighteen strains of the Pseudomonas genus were identified and submitted to tests for the production of antimicrobial substances. Twelve strains (66.7%) were identified as Pseudomonas fluorescens, four (22.2%) as P. aeruginosa, one (5.5%) as P. mendocina and one (5.5%) as P. pseudoalcaligenes. Only two P. fluorescens strains were unable to produce any antimicrobial substance against any of the indicator strains tested. Most of the strains presented a broad spectrum of action, inhibiting reference and food-related strains such as Proteus vulgaris, Proteus mirabilis, Hafnia alvei, Yersinia enterocolitica, Escherichia coli and Salmonella typhi. Five antimicrobial substance-producing strains, which presented the broadest spectrum of action, were also tested against Staphylococcus aureus reference strains and 26 Staphylococcus sp. strains isolated from foods, some of which were resistant to antibiotics. The producer strains 8.1 and 8.3, both P. aeruginosa, were able to inhibit all the staphylococcal strains tested. The antimicrobial substances produced by strains 8.1 and 8.3 did not seem to be typical bacteriocins, since they were resistant to the three proteolytic enzymes tested. Experiments involving the characterization of these substances are being carried out in order to evaluate their biotechnological application.

It is important to understand the mechanisms that enable peripheral neurons to regenerate after nerve injury in order to identify methods of improving this regeneration. Therefore, we studied nerve regeneration and sensory impairment recovery in the cutaneous lesions of leprosy patients (LPs) before and after treatment with multidrug therapy (MDT). The skin lesion sensory test results were compared to the histopathological and immunohistochemical protein gene product (PGP) 9.5 and the p75 nerve growth factor receptors (NGFr) findings. The cutaneous neural occupation ratio (CNOR) was evaluated for both neural markers. Thermal and pain sensations were the most frequently affected functions at the first visit and the most frequently recovered functions after MDT. The presence of a high cutaneous nerve damage index did not prevent the recovery of any type of sensory function. The CNOR was calculated for each biopsy, according to the presence of PGP and NGFr-immunostained fibres and it was not significantly different before or after the MDT. We observed a variable influence of MDT in the recovery from sensory impairment in the cutaneous lesions of LPs. Nociception and cold thermosensation were the most recovered sensations. The recovery of sensation in the skin lesions appeared to be associated with subsiding inflammation rather than with the regenerative activity of nerve fibres.

O objetivo deste trabalho foi comparar dados epidemiológicos de pacientes de hanseníase residentes em dois municípios com perfil socioeconômico e nível de endemicidade diferentes e que foram acompanhados em um mesmo centro de referência. Foi realizado um estudo descritivo dos dados de pacientes tratados no ambulatório Souza Araújo, 1986 a 2008, residentes nos municípios do Rio de Janeiro (n = 1353) e Duque de Caxias (n = 336). Entre os pacientes desta cidade, em comparação com os da outra, observou-se maior proporção de casos: com idade inferior a 15 anos, multibalicares, com maior índice baciloscópico (IB) inicial, e detectados através da vigilância de contatos. Os pacientes de Duque de Caxias apresentaram menor renda média e nível de escolaridade. Não foram observadas diferenças estatisticamente significativas quanto ao sexo, grau de incapacidade inicial, reação no diagnóstico, IB final, abandono e regularidade do tratamento. As diferenças encontradas entre os pacientes acompanhados em um mesmo centro de referência poderiam estar, em parte, relacionadas a diferenças contextuais existentes entre os municípios. Por outro lado, observou-se que a oferta de tratamento e acompanhamento podem minimizar o efeito que os fatores contextuais apresentam sobre os desfechos de saúde.

The scope of this study was to compare epidemiological data on leprosy patients living in two cities with different socioeconomic and endemic profiles that were monitored in a single center of reference. A descriptive study was made of data from patients in the Souza Araújo Outpatient facility treated in the period 1986-2008, who were resident in the cities of Rio de Janeiro = 1353) and Duque de Caxias (n = 336). Results: Among patients from Duque de Caxias, in comparison with patients from Rio de Janeiro, there was a higher proportion of cases: below the age of 15 years, multibacillary, higher initial bacilloscopic index (BI) and cases detected through surveillance of contacts. Patients in Duque de Caxias had lower average incomes and education levels. There were no statistically significant differences regarding gender, disability level, reaction in the diagnosis, final BI, bandonment and regularity of treatment. The differences found between the patients monitored in a single center of reference, could be partly related to contextual differences between the municipalities. On the other hand, it was observed that the provision of treatment and monitoring can minimize the effect of different contextual factors on health outcomes.

O objetivo deste trabalho foi comparar dados epidemiológicos de pacientes de hanseníase residentes em dois municípios com perfil socioeconômico e nível de endemicidade diferentes e que foram acompanhados em um mesmo centro de referência. Foi realizado um estudo descritivo dos dados de pacientes tratados no ambulatório Souza Araújo, 1986 a 2008, residentes nos municípios do Rio de Janeiro (n = 1353) e Duque de Caxias (n = 336). Entre os pacientes desta cidade, em comparação com os da outra, observou-se maior proporção de casos: com idade inferior a 15 anos, multibalicares, com maior índice baciloscópico (IB) inicial, e detectados através da vigilância de contatos. Os pacientes de Duque de Caxias apresentaram menor renda média e nível de escolaridade. Não foram observadas diferenças estatisticamente significativas quanto ao sexo, grau de incapacidade inicial, reação no diagnóstico, IB final, abandono e regularidade do tratamento. As diferenças encontradas entre os pacientes acompanhados em um mesmo centro de referência poderiam estar, em parte, relacionadas a diferenças contextuais existentes entre os municípios. Por outro lado, observou-se que a oferta de tratamento e acompanhamento podem minimizar o efeito que os fatores contextuais apresentam sobre os desfechos de saúde.

The scope of this study was to compare epidemiological data on leprosy patients living in two cities with different socioeconomic and endemic profiles that were monitored in a single center of reference. A descriptive study was made of data from patients in the Souza Araújo Outpatient facility treated in the period 1986-2008, who were resident in the cities of Rio de Janeiro = 1353) and Duque de Caxias (n = 336). Results: Among patients from Duque de Caxias, in comparison with patients from Rio de Janeiro, there was a higher proportion of cases: below the age of 15 years, multibacillary, higher initial bacilloscopic index (BI) and cases detected through surveillance of contacts. Patients in Duque de Caxias had lower average incomes and education levels. There were no statistically significant differences regarding gender, disability level, reaction in the diagnosis, final BI, bandonment and regularity of treatment. The differences found between the patients monitored in a single center of reference, could be partly related to contextual differences between the municipalities. On the other hand, it was observed that the provision of treatment and monitoring can minimize the effect of different contextual factors on health outcomes.

A trombose venosa é o principal acometimento do sistema vascular na doença de Behçet, sendo uma complicação freqüente na evolução clínica dessa patologia, e está mais associada ao sexo masculino. Os autores relatam o caso de uma paciente do sexo feminino que apresentou início da doença há 3 anos com úlceras orais, além de úlceras genitais, e que vem cursando com episódios recorrentes de trombose venosa, sendo a primeira uma trombose venosa profunda no membro inferior direito; a segunda, de jugular interna esquerda; e, por último, uma trombose da veia cava superior.

Venous thrombosis is the main hazard to the vascular system in Behçet's disease. It is a frequent complication throughout the clinical evolution of this illness, which is more associated with the male gender. The authors report the case of a female patient with disease onset 3 years ago, showing oral and genital ulcers presenting with recurring episodes of venous thrombosis. The first one was a deep venous thrombosis in the right leg; the second was in the left internal jugular vein; and finally a superior vena cava thrombosis.