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Background The morbidity and mortality from severe sepsis depends largely on how quickly and comprehensively evidencebased therapies are administered. As such, a huge opportunity exists. However, optimal care requires not only factual knowledge, but also numerous practical strategies including the ability to recognize a disease, to identify impending crises, to communicate effectively, to run a team, to work under stress and to simultaneously coordinate multiple tasks. Medical simulation offers a way to practice these essential crisis management skills, and without any risk to patients. Methods Following a didactic lecture on the key components of the Surviving Sepsis Campaign Guidelines, we trained 20 emergency medicine residents on a portable Laerdal Patient Simulator. Pre-programmed sepsis scenarios were developed following a needs assessment and modified Delphi technique. To maximize realism, this was performed in the acute care area of the Emergency Department and included a pre-briefed respiratory therapist and nurse. We videotaped resident performance and provided nonpunitive feedback, focusing on the comprehensiveness of therapy (for example, whether broad-spectrum antibiotics were given) and crisis resource management strategies (for example, whether help was asked for and tasks were appropriately allocated). Results Evaluation using a five-point Likert scale demonstrated that participants found this very useful (4.5/5), that lessons were complementary and supplementary to those learned from lectures (4.5/5) and that medical simulation was realistic (4/5). In addition, despite prior sepsis lectures, comparison of pre-tests and posttests showed that more emergency medicine residents would: administer broad-spectrum antibiotics as soon as possible following hypotension (14/20 pre-test, compared with 16/20 posttest), administer low-dose corticosteroids for those with refractory shock (10/20 pre-test, compared with 13/20 post-test), and would favour norepinephrine as a vasopressor (8/20 pre-test, compared with 12/20 post-test). Participants specifically valued the chance to observe and practice crisis resource management skills, which they felt had not been previously addressed (19/20). Conclusion Medical simulation appears to be an effective way to change both knowledge and behaviours in the treatment of severe sepsis. Many education and licensing boards also expect trainees to become not only content experts, but also effective communicators, collaborators, resource managers and advocates. These laudable goals are difficult to capture with traditional lectures but are comparably easy using medical simulation. We hope others will consider medical simulation as a complementary teaching and quality-assurance strategy in the fight against sepsis. P2 Protective potential of 2-chloroadenosine in Klebsiella pneumoniae B5055 induced sepsis in BALB/c mice

O Papilomavírus Humano (HPV) é atualmente a principal causa de virose sexualmente transmissível, sendo sua principal consequência o câncer de colo de útero. Neste contexto, este estudo teve como objetivo avaliar as alterações citológicas em mulheres atendidas em um hospital. Tratou-se de uma pesquisa do tipo quantitativa, de caráter documental, composta por 198 mulheres que apresentaram lesão devido à infecção pelo HPV e atendidas no Hospital Alpheu de Quadros. Os dados foram coletados por meio de registros arquivados no computador do hospital. Das mulheres infectadas pelo HPV, 66,7% tinham entre 20 e 39 anos e das que relataram sua iniciação sexual 61,6% tinham entre 16 e 20 anos. A maioria dessas mulheres foi diagnosticada com lesão intraepitelial de alto grau (HSIL) seja na citologia ou na biópsia. O resultado pós Cirurgia de Alta Frequência apresentou-se positivo, pois houve diminuição de HSIL das mulheres. Ações de saúde pública podem prevenir a incidência e mortalidade pelo câncer de colo de útero quase que totalmente, desde que o planejamento destas ações esteja em concordância com o conhecimento científico atual.

Objective To evaluate if dental students with the habit of smoking exhibit alterations in the epithelial cells of the cheek mucosa on the nuclear area (NA), cytoplasmic area (CA) or in the nucleus/cytoplasm ratio (NA/CA), when compared to non-smokers. Methods This is a descriptive, experimental study using a control group. The sample comprised 40 dental undergraduates (20 smokers and 20 nonsmokers). Individuals who smoked at least 5 or 6 cigarettes a day were deemed to be smokers, while non-smokers were those who reported having no experience of any form of smoking. The samples of epithelial cells were obtained from the oral mucosa using the liquid-based exfoliative cytology technique. The slides were processed in the laboratory, stained using the Papanicolau technique and were analyzed via an image analysis system (analySIS getIT). A structured questionnaire was applied with the aim of measuring independent variables related to personal characteristics, health and lifestyle behavior. ResultsThe values obtained in the group of smokers were as follows: NA (169.4 µm² ± 17.0), CA (1240.1 µm² ± 128.9) and NA/CA ratio (0.1375 ± 0.01743). The results did not evidence significant differences when compared to the control group: NA (170.7 µm² ± 20.0), CA (1255.3 µm² ± 174.5) and NA/CA (0.1380 ± 0.01436). Conclusion RESUMOObjetivo Avaliar se os estudantes de odontologia que possuem hábitos tabagistas apresentam alterações celulares nas células epiteliais da mucosa jugal sobre as áreas nucleares (AN), citoplasmáticas (AC) e na relação núcleo/citoplasma (AN/AC) quando comparados a não fumantes. MétodosTrata-se de um estudo experimental, descritivo com grupo controle. A amostra foi composta por 40 estudantes de graduação em odontologia (20 fumantes e 20 não fumantes). Consideraram-se fumantes aqueles indivíduos que fumavam diariamente, no mínimo, cinco a seis cigarros do tipo industrializado; e não fumantes aqueles indivíduos que relataram a não experiência com qualquer tipo de fumo. As amostras de células epiteliais foram obtidas da mucosa oral pela técnica de citologia esfoliativa em meio líquido. As lâminas foram processadas em laboratório, coradas pela técnica de Papanicolau e analisadas através de um sistema de análise de imagens (Analysis getlt). Um questionário estruturado foi aplicado com o intuito de mensurar variáveis independentes referentes às características pessoais, comportamentos em saúde e estilo de vida. ResultadosOs valores obtidos no grupo dos fumantes para a AN (169,4 µm² ± 17,0), AC (1240,1 µm² ± 128,9) e na relação AN/AC (0,1375 ± 0,01743) não apresentaram resultados com diferenças expressivas quando comparados ao grupo controle AN (170,7 µm² ± 20,0), AC (1255,3 µm² ± 174,5) e na AN/AC (0,1380 ± 0,01436). ConclusãoNão foi possível observar alterações celulares significantes nas AN, AC e na relação AN/AC de células epiteliais da mucosa oral. Outros fatores de risco associados ao tabaco devem ser estudados, principalmente o tempo de exposição às propriedades do agente causador. METHODSThis...

Previous studies revealed the presence of LTC(4) synthase in paraventricular vasopressinergic neurons, suggesting a role for leukotrienes (LTs) in certain neuroendocrine system functions. Our aim was to study the effect of an inhibitor of LT synthesis in the release of arginine vasopressin (AVP) following an osmotic stimulus in rats. Male Wistar rats received an intra-cerebroventricular injection of 2 μl of the LT synthesis inhibitor MK-886 (1, 2, or 4 μg/kg), or vehicle (DMSO 5%), 1h before an intraperitoneal injection of hypertonic saline (NaCl 2M) or isotonic saline (NaCl 0.01 M) in a volume corresponding to 1% of body weight. Thirty minutes after the osmotic stimulus, the animals were decapitated and blood was collected for determining hematocrit, plasma osmolality and plasma AVP levels. As expected, the injection of hypertonic saline significantly increased (P<0.05) the hematocrit, plasma osmolality and plasma AVP levels. While inhibiting LT synthesis by central administration of MK-886 did not cause any additional increase in hematocrit or osmolality, plasma AVP levels were augmented (P<0.05). We conclude that central leukotrienes may have a modulatory role in AVP secretion following an osmotic stimulus, this deserving future studies.