Tamba

Dentre as principais recomendações para a segurança do paciente, com o intuito de mimetizar erros na assistência ao paciente, inclui o protocolo de identificação adequada do paciente. Esse protocolo quando utilizado de forma correta, é capaz de prevenir danos ao paciente. A literatura traz que, sempre que ocorre um incidente é de suma importância que seja notificado, para que seja possível, numa análise futura, ter uma noção dos problemas ocorridos, investigar a natureza deles, para que os incidentes futuros sejam evitados. Tendo a ótica que o erro não é simplesmente individual, sendo necessário que haja uma transferência de responsabilidade, que se passe a ver de outra forma os processos de assistência, aderindo a uma sistematização que previna erros, para que os mesmos possam ser evitados.

A tuberculose pulmonar é uma doença infecciosa grave que representa um desafio para a saúde pública. O diagnóstico precoce e o tratamento adequado são fundamentais para o seu controle. O presente artigo tem como objetivo avaliar os avanços científicos e tecnológicos no diagnóstico da tuberculose pulmonar, bem como sua relação com a terapêutica precoce e prevenção da disseminação da bactéria. Para tal, foi encontrado 130 artigos onde foram escolhidos 60 artigos para os resultados, obtidos através dos bancos de dados: National Library of Medicine (PubMed); Scientific Eletronic Library Online (SCIELO) e Biblioteca Virtual de Saúde (BVS), dos quais 13 se enquadraram nos critérios de inclusão. Em conclusão, verificou-se que o melhor protocolo para o diagnóstico rápido de casos de tuberculose é o método GeneXpert MTB/RIF por tratar-se de uma metodologia com alta sensibilidade e especificidade o que contribui para uma terapêutica precoce do paciente. Assim, métodos tradicionais como baciloscopia e cultura, são importantes para auxiliar na confirmação do diagnóstico, bem como no acompanhamento do tratamento do paciente, por apresentarem custo menor quando comparado ao TRM. Quanto a terapêutica, a combinação de rifampicina, isoniazida, pirazinamida e etambutol se mostraram eficazes, todavia a adesão dos pacientes é um desafio importante no tratamento, o que torna necessário o tratamento diretamente observado (TDO).

背景：粘液線維肉腫（MFS）は中高年四肢に好発する代表的な粘液性肉腫の一つであるが，細胞診断での鑑別に苦慮する．今回，high-grade MFS の 1 例を経験したので，その細胞像を中心に文献的考察を加え報告する．

BackgroundMamushi bites are the most common venomous snake bites in Japan, with known complications including rhabdomyolysis and acute kidney injury; however, adrenal insufficiency as a result of snake bites has not been previously reported. We report a case of empty sella with transient adrenal insufficiency during hospitalization for a Mamushi bite.Case presentationAn 84-year-old man was admitted to our hospital with a Mamushi bite on the right fifth finger. Serum sodium (Na) level remained in the normal range. On the ninth day of admission, he developed hyponatremia, with a serum Na level of 114 mEq/L and serum cortisol level of 4.0 μg/dL (reference value 4.5–21.1 μg/dL). His serum Na level was restored within the normal range after administration of corticosteroids with 3% NaCl solution. Both rapid adrenocorticotrophin and corticotropin-releasing hormone loading tests showed low cortisol response. Based on the results of the hormone loading tests, a diagnosis of pituitary adrenal insufficiency was made. Contrast-enhanced pituitary magnetic resonance imaging (MRI) showed primary empty sella. After discontinuation of corticosteroids, the hyponatremia did not recur, and the patient was discharged on the 24th day of hospitalization. After discharge, the patient visited an outpatient clinic, but hyponatremia recurrence was not observed.ConclusionsThis is the first report of hyponatremia due to pituitary adrenal insufficiency during hospitalization for a Mamushi bite in a patient with empty sella. When hyponatremia occurs during hospitalization for a Mamushi bite, cortisol measurement, hormone loading test, and head MRI should be performed to search for pituitary lesions because of the possibility of adrenal insufficiency caused by snake venom.

BackgroundSelective fetal growth restriction in monochorionic twin pregnancies is associated with an increased risk of perinatal mortality and morbidity and represents a clinical dilemma. Interventions include expectant management with early preterm delivery if there are signs of fetal compromise, selective termination of the compromised twin, fetoscopic laser coagulation of the communicating placental vessels or termination of the whole pregnancy. Previous studies evaluating interventions have reported many different outcomes and outcome measures. Such variation makes comparing, contrasting, and combining results challenging, limiting ongoing research on this uncommon condition to inform clinical practice. We aim to produce, disseminate, and implement a core outcome set for selective fetal growth restriction research in monochorionic twin pregnancies.MethodsAn international steering group, including professionals, researchers, and lay experts, has been established to oversee the development of this core outcome set. The methods have been guided by the Core Outcome Measures in Effectiveness Trials Initiative Handbook.Potential core outcomes will be developed by undertaking a systematic review of studies evaluating interventions for selective fetal growth restriction in monochorionic twin pregnancies. Potential core outcomes will be entered into a three-round Delphi survey and key stakeholders including clinical professionals, researchers, and lay experts will be invited to participate. Repeated reflection and rescoring of individual outcomes should encourage group and individual stakeholder convergence towards consensus outcomes which will be entered into a modified Nominal Group Technique to finalize the core outcome set. Once core outcomes have been agreed, we will establish standardized definitions and recommend high-quality measurement instruments for each outcome.DiscussionThe development, dissemination, and implementation of a core outcome set for selective fetal growth restriction should ensure that future research protocols select, collect, and report outcomes and outcome measures in a standardized manner. Data synthesis will be possible on a broad level and rigorous implementation should advance the quality of research studies and their effective use in order to guide clinical practice, improve patient care, maternal, short-term perinatal outcomes, and long-term neurodevelopmental outcomes.Trial registrationCore Outcome Measures in Effectiveness Trials (COMET) registration number: 998.International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42018092697. 18th April 2018.

The experiences and needs of mothers who lose a newborn twin were explored by sending semistructured questionnaires to 14 bereaved mothers. All mothers continued to think of the surviving child as a twin. Six had feelings of resentment towards the survivor. All felt their loss had been underestimated. Support could be improved by acknowledging the mother's grief and encouraging her to talk about the dead baby. Zygosity should be determined and reminders, such as photographs (of the babies together) and ultrasound scans, provided. All parents should be offered counselling and the opportunity to meet similarly bereaved parents.