Cefaleia e blood patch epidural: revisão de literatura

Fundamentação/IntroduçãoA cefaleia pós-punção da dura-máter é a complicação neurológica mais comum de procedimentos neuroaxiais intervencionistas, sobretudo raquianestesia. Uma das principais opções terapêuticas é o Blood Patch Epidural, no qual se remove pequena quantidade de sangue autólogo e o injeta no espaço peridural. É considerada a terapia padrão-ouro quando ocorre falha do tratamento conservador.Delineamento e MétodosPesquisa descritiva a partir da revisão narrativa de artigos publicados em línguas inglesa e portuguesa nas bases de dados eletrônicos Scielo, PubMed e Medline.ResultadosOs fatores predisponentes mais comuns para cefaleia pós-punção da dura-máter são o grosso calibre das agulhas utilizadas, múltiplas punções realizadas, pacientes jovens, do sexo feminino e gestantes. A maioria das cefaleias após punção lombar desaparece em até seis semanas apenas com uso de analgésicos, cafeína, hidratação e repouso no leito. No entanto, se essas medidas não aliviarem a dor de cabeça, o Blood Patch Epidural deve ser considerado 72 horas após o início da dor, evitando as complicações do escape de líquido cefalorraquidiano, como hematoma subdural e convulsão, que podem ser fatais. O Blood Patch Epidural é um procedimento no qual 10 a 20mL de sangue do próprio paciente é injetado no espaço peridural para interromper o vazamento de líquor, selar o local da punção e controlar a vasodilatação cerebral, fazendo a cefaleia desaparecer entre 48 horas a uma semana. Não obstante, verificou-se que a taxa de sucesso é baixa se for administrada profilaticamente ou dentro de 24 horas após a punção lombar. Os riscos são relativamente pequenos e incluem insucesso, infecção, reação alérgica, sangramento ou dor no local da injeção.ConclusãoEmbora muitas vezes autolimitada, a cefaleia é uma importante complicação pós-punção dural e, às vezes, é associada a distúrbios secundários. O tratamento conservador pode ser recomendado para alguns pacientes, mas produz alívio a curto prazo e pode não ser satisfatório. Por outro lado, o Blood Patch Epidural é uma maneira altamente eficaz e segura para tratar cefaleia moderada a grave que não está respondendo à terapia convencional.

Violence against children in Afghanistan: Concerns and opportunities for positive change

Violence against children (VAC) in Afghanistan is a serious issue in the context of many decades of conflict and poverty. To date, limited studies have explored the extent of VAC in Afghanistan and the settings where VAC takes place. To understand (i) the extent of VAC, (ii) settings where VAC takes place, (iii) parental forms of VAC and (iv) regional differences, an interview administered cross-sectional survey was employed among a community sample of 145 children and 104 parents living within Kabul, Torkham, and Jalalabad. Demographic information was collected as well as items from the International Child Abuse Screening Tool (ICAST-CH). In this study, 71% of children reported experiencing physical violence is some form in the past year. Home was the most likely location of violence. The overwhelming majority of parents reported using physical violence as a discipline method. Parents who attained higher levels of education and had more skilled occupations used violence less as a discipline method. However, consistent with international research, children cited their parents as their preferred source of support in situations of violence. Interestingly, parents did not see violent forms of discipline as more effective than non-violent strategies. The results offer a disturbing yet 'on the ground' insight into VAC in Afghanistan from the experience of children and parents. The results have important implications for programming design and provide a focus for stopping and preventing VAC in Afghanistan and similar contexts.

Optical and transport properties correlation driven by amorphous/crystalline disorder in InP nanowires

Indium phosphide nanowires with a single crystalline zinc-blend core and polycrystalline/amorphous shell were grown from a reliable route without the use of hazardous precursors. The nanowires are composed by a crystalline core covered by a polycrystalline shell, presenting typical lengths larger than 10 μm and diameters of 80-90 nm. Raman spectra taken from as-grown nanowires exhibited asymmetric line shapes with broadening towards higher wave numbers which can be attributed to phonon localization effects. It was found that optical phonons in the nanowires are localized in regions with average size of 3 nm, which seems to have the same order of magnitude of grain sizes in the polycrystalline shell. Regardless of the fact that the nanowires exhibit a crystalline core, any considerable degree of disorder can lead to a localized behaviour of carriers. In consequence, the variable range hopping was observed as the main transport instead of the usual thermal excitation mechanisms. Furthermore the hopping length was ten times smaller than nanowire cross-sections, confirming that the nanostructures do behave as a 3D system. Accordingly, the V-shape observed in PL spectra clearly demonstrates a very strong influence of the potential fluctuations on the exciton optical recombination. Such fluctuations can still be observed at low temperature regime, confirming that the amorphous/polycrystalline shell of the nanowires affects the exciton recombination in every laser power regime tested.