Submitted in fulfillment of the requirements for the Degree of Master of Health Sciences in Radiography, Durban University of Technology, 2017. / Background The current scope of practice for diagnostic radiographers, does not allow them to administer intravenous contrast media (IVCM) since there are no formal training guidelines accredited by the Health Professions Council of South Africa (HPCSA) (Koch 2014: 26). In selected countries abroad, radiographers are allowed to administer IVCM and have thus received the necessary and accredited training to do so. In view of this, the South African radiographer’s scope of practice is not on par with the selected countries. The radiologists in South Africa (SA) who are currently responsible for the administration of IVCM have issued a position statement which supports, in principle, the idea of radiographers administering IVCM should they receive the necessary and appropriate training to do so (RSSA 2011: 1-2). The aim of this research study was, therefore, to investigate the radiologists’ perspectives regarding the theoretical knowledge, clinical competencies and medico legal responsibilities required by radiographers in order to effectively administer IVCM. This research study provides input for the development of national training guidelines for radiographers to administer IVCM. Research Methodology A quantitative, descriptive study was conducted by targeting qualified radiologists residing and practicing within the province of KwaZulu Natal (KZN). Ethical approval was obtained from the Durban University of Technology’s (DUT) Institutional Research and Ethics Committee (IREC). All the participants were contacted in their personal capacity. The research tool was an online survey administered through SurveyMonkey which included questions and statements relating to the administration of IVCM and was structured so as to meet the study objectives. The research tool was evaluated and amended by an expert focus group to ensure reliability and validity. Confidentiality was maintained and all the data obtained during this research study was password protected. Results and discussion Fifty-nine radiologists (60.8 percent) participated in this study. Twelve respondents, however, were excluded due to incomplete surveys. The final response rate, therefore, was 48.5 percent (n=47) of which 72.3 percent of the respondents were from the private sector. Results illustrated the radiologists’ agreement regarding the theoretical, clinical/practical and medico legal training components for inclusion in the further training of radiographers to administer IVCM. Most respondents supported the inclusion of three assessments: theoretical (87.2 percent), clinical (93.6 percent) and a record of clinical competencies (95.7 percent). The assessments were considered equally important in terms of percentage weighting. The overall results compared favorably to the current international trends and practice standards of radiographers administering IVCM. Conclusion and Recommendations The study, in providing key data for the development of training guidelines for radiographers to administer IVCM, has demonstrated the importance of higher education (HE) and training in addressing transformation in health services with particular reference to professional scopes of practice. Furthermore, it reinforces the need for local research that will inform HE and training and hence a scope of practice that meets local needs. It was recommended that future studies should include those HE institutions offering training in Radiography as well as their stakeholders for the design and transformation of a national curriculum for radiographers to administer IVCM. / M

Background: Insertion of a peripheral intravenous catheter (PVC) is a common procedure performed by nurses. The practical skill is a complex act, which not only requires theoretical and practical knowledge, but also nursing care adjusted to each patient's history and needs. Aim: The aim was to explore the procedure of inserting a peripheral intravenous catheter at a local hospital in Tanzania with focus on nursing care and patient safety. Method: The study was performed as a non-participating observational study and was preceded by a pilot study performed in Sweden. Eight observations were made, which were analysed with a qualitative content analysis. Result: The categories “Execution” and “Respecting patients” with associated sub-categories constituted the results. “Execution” describes how the procedure is performed, while “Respecting patients,” explains the performed nursing care during the practical skill. Conclusion: The Model of Practical Skill Performance was used for interpreting and discussing the result. The model clarified that some components were not fulfilled and the performance can therefore not be considered as well proceeded. One can discuss whether it depends on lack of knowledge, resources and/or culture. Keywords: Peripheral intravenous catheter, nursing care, patient safety, Tanzania, low-income country. / Bakgrund: Insättning av perifer venkateter (PVK) är en vanligt förekommande uppgift för sjuksköterskor. Denna praktiska färdighet kan anses vara komplex, då den inte bara kräver teoretisk och praktisk kunskap, utan också omvårdnad anpassad efter varje patients behov och tidigare erfarenheter. Syfte: Syftet var att undersöka tillvägagångssättet vid insättning av perifer venkateter på ett lokalt sjukhus i Tanzania, med fokus på omvårdnad och patientsäkerhet. Metod: Studien utfördes som en icke-deltagande observationsstudie och föregicks av en pilotstudie utförd i Sverige. Åtta observationer genomfördes som sedan analyserades med kvalitativ innehållsanalys. Resultat: Kategorierna “Utförande” och “Respektera patienter” med tillhörande underkategorier utgjorde resultatet. ”Utförande” beskriver tillvägagångssättet vid insättnig av PVK, samt förberedelser och slutförande. “Respektera patienter” beskriver den givna omvårdnaden under det det praktiska utförandet. Konklusion: Modellen för praktisk färdighetsutövande användes för att tolka och diskutera resultatet. Modellen klargjorde att några komponenter inte uppfylldes och utförandet kan därmed inte anses som väl utfört. Det kan diskuteras om detta beror på bristande kunskap, resurser och/eller kultur. Nyckelord: Perifer venkateter, omvårdnad, patientsäkerhet, Tanzania, låginkomstland.

This study seeks to examine the influence of key cultural values like machismo, familism, traditionalism, and religiosity on self-efficacy in reducing HIV risk among Mexican-origin IDUs. The purpose of this examination hinges on the importance of including cultural concepts/values not only to facilitate process, but also to add a cultural dimension to an HIV/AIDS intervention that may facilitate attitudinal and behavioral change as well. The findings suggest that culturally innovative approaches can facilitate HIV/AIDS risk reduction among male Mexican-origin drug injectors. The importance of key cultural values like machismo is underscored by its association with HIV risk reduction for both sexual and injection related risks. Intervention programs must identify strategies to incorporate cultural values in their research and evaluation of intervention efficacy. Culturally innovative approaches hold the promise of substantially reducing HIV risk behaviors among Hispanic drug injectors, and may hold promise for other populations affected by HIV/AIDS as well.

<p>In this case study research project I have determined that multidrug sedation in children younger than eight years are possible.<br /> Conscious sedation [or sedation where verbal contact with the patient is possible] can be used successfully to decrease anxiety and fear for unpleasant experiences, like dental procedures.</p> <p><br /> Behaviour therapy in conjunction with one or more drugs can be used to depress the central nervous system in order to decrease the patient&rsquo / s awareness of unpleasant stimuli. This enables treatment to be carried out without patient interference. Extensive literature surveys were done to determine the ideal drugs as well as the ideal route for conscious sedation in dental treatment for children. In this study project drugs like midazolam, propofol, alfentanyl and ketamine were titrated intravenously to achieve conscious sedation.</p>

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / The role of enzyme‐assisted subcutaneous fluid administration (EASFA) in treating mild to moderate dehydration in pediatrics, geriatrics, and palliative care has been studied in developed countries. However, it has historically been underutilized due to widely available health care and alternative treatments, namely peripheral intravenous (IV) fluid administration. Fluid infusions in the subcutaneous tissue have a low risk of infection, are easy to administer, and have wide potential use. The use of EASFA in low resource settings to treat those with difficult IV access or where skilled healthcare workers are not as readily available could prove to be a live saving measure in many situations, including the care of patients in remote areas of the world, mass casualty events, or other disasters. Our objective was to determine if EASFA is a valid and appropriate technique to utilize in pediatric and elderly patients, and evaluate if it could be a safe and efficient way to provide fluid resuscitation in low resource settings. For this systematic review MEDLINE and Cochrane Library were searched from January 1950 to December 2015 to recover all available literature relevant to this topic. Studies that met the inclusion criteria were analyzed using Cohen’s D. This was calculated using the mean difference between intervention and control divided by the pooled standard deviation. For dichotomous outcome of the placement success rate the odds ratios were calculated with 95% confidence intervals. In reviewing 7 articles using Cohen’s D to compare mean differences to determine effect size, we found that catheter placement success rates and infusion rates were similar between EASFA and peripheral intravenous fluid administration. Additionally, it was found that the odds of correct initial needle placement was 7.19 times higher in EASFA versus intravenous administration. EASFA is a comparable alternative to intravenous fluid administration when delivering fluids to pediatric and elderly patients with mild to moderate dehydration. While infusion rates and total volume of fluids administered were similar, the high rate of success with placement of the subcutaneous catheter proves it to be more useful in some situations. Venous cannulation is difficult, even for a trained healthcare provider, and the ease of placement of subcutaneous catheters makes training lay people to administer subcutaneous fluids a possibility. Additionally, this type of fluid administration may lead to less psychological trauma to a child from multiple needle sticks, while still achieving a similar outcome of effective volume replacement. Based on the results of this study, further research is needed to evaluate the effectiveness of utilizing EASFA in low resource settings.

Objetivo: O objetivo deste estudo foi avaliar se o uso de uma solução cristaloide balanceada induz menos alterações metabólicas do que o cloreto de sódio 0,9% em crianças submetidas à ressecção de tumor cerebral. Desenho: Estudo fase II, unicêntrico, de superioridade, randomizado e controlado, realizado no Instituto de Oncologia Pediátrica da Universidade Federal de São Paulo, Brasil. População: crianças com idade entre 6 meses e 12 anos submetidas à ressecção de tumor cerebral. Intervenção: O uso de uma solução cristaloide balanceada durante e após (por 24 horas) ressecção de tumor cerebral foi comparado ao uso de cloreto de sódio 0,9%. Eletrólitos séricos e gasometria arterial foram coletados em três momentos: antes da cirurgia (basal); após a cirurgia [pós-operatório imediato (POI)]; e no primeiro dia pós-operatório (1º DPO). Desfecho primário: O desfecho primário deste estudo foi a variação do cloro sérico (pós-préop Cl), definida como a diferença absoluta entre as concentrações plasmáticas medidas no POI e antes da cirurgia. Desfechos secundários: Como desfechos secundários, foram avaliadas as variações (pós-préop) dos outros eletrólitos e do excesso de bases (BE); a incidência de acidose hiperclorêmica; e o escore de relaxamento cerebral (ERC), avaliado pelo neurocirurgião por meio de escala de 4 pontos. Resultados: 53 pacientes foram incluídos no estudo e randomizados; 27 receberam solução balanceada (grupo SB) e 26, cloreto de sódio 0,9% (grupo NaCl 0,9%). O pós-préop Cl mediano foi significativamente menor no grupo SB [0 (-1,0; 3,0)] do que no grupo NaCl 0,9% [6 (3,5; 8,5)], p < 0,01. O pós-préop BE mediano foi menor [-0,4 (-2,7; 1,3) versus -4,4 (-5,0; -2,3), p < 0,01] e acidose hiperclorêmica menos frequente (4% versus 67%, p < 0,01) no grupo SB do que no grupo NaCl 0,9%. O ERC foi comparável entre os grupos. Conclusão: Em crianças submetidas à ressecção de tumor cerebral, o uso de solução cristaloide balanceada reduziu a variação do cloro sérico comparado ao uso de cloreto de sódio 0,9%. Esses achados respaldam o uso de soluções balanceadas em crianças submetidas à ressecção de tumor cerebral. Registro no Clinical Trials: NCT NCT02707549 / Objective: The aim of this study was to determine if the use of a balanced crystalloid induces less metabolic derangements than 0.9% saline solution in children undergoing brain tumor resection. Design: Phase II, single center, superiority, randomized and controlled trial performed at Instituto de Oncologia Pediátrica, Universidade Federal de São Paulo, São Paulo, Brazil. Population: Pediatric patients (age range, 6 months to 12 years) undergoing brain tumor resection. Intervention: Use of a balanced crystalloid solution during and after (for 24 h) brain tumor resection was compared to saline 0.9%. Serum electrolyte and arterial blood gas analyses were performed before surgery (baseline), after surgery, and at postoperative day 1. Primary outcome: The primary trial outcome was the preoperative to postoperative variation in serum chloride (post-preop Cl) measured as the absolute difference between \"after surgery\" and baseline plasma concentrations. Secondary outcomes: As secondary outcomes, we measured the post-preop of other electrolytes and base excess (BE); hyperchloremic acidosis incidence; and the brain relaxation score, a four-point scale evaluated by the surgeon for assessing brain edema. Results: Fifty-three patients were included in the study; twenty-seven were randomized to receive a balanced crystalloid (balanced group) and twenty-six were randomized to receive 0.9% saline solution (saline group). The median post-preop Cl (mmol l-1) was significantly lower in the balanced [0 (-1.0; 3.0)] than in the saline group [6 (3.5;8.5); p < .01]. Median post-preop BE (mmol l-1) was lower [-0.4 (-2.7; -1.3) versus -4.4 (- 5.0; -2.3); p < .01] and hyperchloremic acidosis less frequent (4% versus 67%; p < .01) in the balanced group than in the saline group. Brain relaxation score was comparable between groups. Conclusions: In children undergoing brain tumor resection, balanced crystalloid solution infusion reduced variation in serum chloride. These findings support the use of balanced crystalloid solutions in children undergoing brain tumor resection

Os esteróides anabólicos androgênicos (EAA) aumentam a massa muscular e o desempenho físico. O uso abusivo de EAA leva a uma grande diminuição da concentração de HDL-C, podendo ocorrer um aumento nas concentrações de LDL-C e triglicérides. Os efeitos dos EAA na cinética plasmática das lipoproteínas que transportam os lípides da dieta, na circulação sanguínea, os quilomícrons e seus produtos de lipólise, os quilomícrons remanescentes, não foram avaliados e podem estar relacionados com o processo aterosclerótico. No presente estudo, foram estudados 12 indivíduos que realizam exercício de força localizada e admitem fazer uso de EAA (grupo Musculação+EAA), 16 indivíduos que também realizam exercício de força localizada, porém não fazem uso de EAA (grupo Musculação) e 18 indivíduos sedentários e normolipidêmicos (grupo Sedentário). A emulsão de quilomícrons artificiais, marcada com triglicérides radioativos (TG-3H) e éster de colesterol radioativo (EC-14C), foi injetada endovenosamente e amostras de sangue foram colhidas durante intervalos de tempo préestabelecidos. As curvas de decaimento plasmático dos lípides radioativos da emulsão foram traçadas e as taxas fracionais de remoção (TFR) foram calculadas por meio de análise compartimental. A TFR-EC do grupo Musculação+EAA apresentou-se diminuída comparando-se aos grupos Sedentário e Musculação (0,0073± 0,0079 min -1, 0,0155± 0,0100 min -1, 0,0149± 0,0160 min -1, respectivamente; p< 0,05), enquanto que as TFR-TG foram similares. As concentrações plasmáticas de LDL-C foram maiores no grupo Musculação+EAA comparando-se com os grupos Sedentário e Musculação (143±54,101±31, 111±52 mg/dL, respectivamente; p=0,047). As concentrações plasmáticas de HDL-C e de apolipoproteína A1 foram menores no grupo Musculação+EAA quando comparados aos grupos Sedentário e Musculação (HDL-C= 22±13; 41±7; 38±13 mg/dL, respectivamente; p<0,001 e apo A1= 88±50; 156±35; 140±24 mg/dL, respectivamente; p<0,001). As curvas de geração de ácidos graxos livres originados pela hidrólise de triglicérides radioativos dos quilomícrons artificiais na circulação sanguínea foram similares entre os grupos estudados. A atividade da lipase hepática foi maior no grupo Musculação+EAA, comparando-se aos grupos Sedentário e Musculação (7243±1822; 3898±1232; 2058±749, respectivamente; p<0,001), enquanto que a atividade da lipase lipoprotéica não diferiu. O diâmetro da HDL e concentração de triglicérides presentes na HDL também foram similares nos três grupos estudados. / Anabolic androgenic steroids (AAS) increase muscle mass and physical performance. Abusive use of AAS has led to a significant reduction of HDL-C concentration in the plasma, which in turn can cause lead to an increase in LDL-C and trigliceride concentrations. The effects of steroids on lipoprotein plasmatic kinetics which transport diet lipids in the blood, the chilomicrons and its lypolisis products, chilomicron reminiscents have not yet been studied and can be contributing factors to the ateroclesrosis process. In this study 12 local weight lifters and admitted steroid users (AAS group), 16 local weight lifters but nonsteroids use (non-user group) and 18 sedentary and normolipidemic individuals (control group) were studied. The artificial chilomicron emulsion, marked with radioactive triglyceride (3H-TG) and radioactive oleate cholesterol (14C-OC) were injected interveneously and blood samples collected during pre-established time intervals. The plasmatic decay curve of the radioactive lipids of the emulsion was traced and fractional clearance rate was calculated (FCR) through compartamental analysis. The FCR-OC of the AAS group when compared to the control and nonuser groups was reduced (0,0073±0,0079 min -1,0,0155±0,0100 min -1, 0,0149± 0,0160 min -1, respectivelly; p< 0,05), while FCR-TG were similar. The LDL-C plasmatic concentration were higher in the AAS group when compared to control and non-user groups (143±54,101±31, 111±52 mg/dL, respectivelly; p=0,047). The HDL-C plasmatic concentration and the apolipoprotein A1 were lower in the AAS group when compared control and non-user groups (HDL-C: 22±13; 41±7; 38±13 mg/dL, respectivelly; p<0,001 e apo A1: 88±50; 156±35; 140±24 mg/dL,respectivelly; p<0,001). No difference was observed of the area under the fatty acid generated curve. Hepatic lipase activity was greater in the AAS group when compared to control and the non-user groups (7243±1822; 3898±1232; 2058±749, respectivelly; p<0,001). However, no difference was observed for lipoproteic lipase activity. The analisys of HDL size and triglyceride concentration in HDL were similar for all three groups.

Hintergrund: Experimentelle Studien konnten zeigen, dass Taurolidin intraperitoneales Tumorwachstum durch lokale intraperitoneale Applikation reduzieren kann. Erste Studien zur tumorstatischen Wirksamkeit nach systemischer Bolus-Applikation zeigten keinen Effekt auf das intra- und extraperitoneale Tumorwachstum. In einem neuen Experiment wurde die Wirkung einer einwöchigen intermittierenden Therapie versus einer Bolus-Therapie mit steigenden Konzentration von Taurolidin bis 3% auf das intraperitoneale und subkutane Tumorwachstum untersucht. Methoden: 80 Ratten (BD IX) wurden einer medianen Laparotomie unterzogen. Anschließend wurden 2 x 104 syngenetische Adenokarzinomzellen (DHD/K12/TRb) intraperitoneal und subkutan am Rücken instilliert. Die Tiere wurden in acht Gruppen randomisiert. Vier Gruppen erhielten postoperativ eine intravenöse (iv) Bolustherapie (Taurolidin 1%, 2%, 3%, Ringer-Lösung), vier Gruppen erhielten die Therapie über eine Woche intermittierend viermal täglich über ein iv Port-System. Nach vier Wochen erfolgte die Obduktion und Auswertung des Tumorwachstums hinsichtlich Tumorgewicht und Anzahl der Tumorknoten. Ergebnisse: Die Anzahl der subkutanen Tumorknoten war unter 3% Taurolidin gegenüber der Kontrollgruppe reduziert (p=0,035). Darüberhinaus war ein Trend der Reduktion des subkutanen Tumorgewichtes unter steigender Taurolidinkonzentration zu verzeichnen (p=0,048). Diskussion: Nur die Langzeittherapie über eine Woche mit 3% Taurolidin-Lösung konnte eine diskrete subkutane Tumorreduktion bewirken. Unerwünschte Arzneimittelwirkungen traten bis auf passagäre vagotone Wirkungen bei zu schneller Applikation nicht auf. Schnelle Injektionen sollten vermieden werden. Die Ergebnisse führen über zu weiteren Studien, die die Wirksamkeit von systemischer Applikation an etablierten, vaskularisierten Tumoren untersuchen. / Background: Experimental studies have shown that taurolidine suppresses intraperitoneal tumor growth following local application in rats. In opposite, a single intravenous therapy affected neither intraperitoneal nor subcutaneous growth of malignancies. Thus, an intravenous bolus and long term therapy with 1%, 2% and 3% taurolidine was investigated in rats with intraperitoneal and subcutaneous tumor load. Methods: At the beginning of the operation 10,000 colon adenocarcinoma cells (DHD/K12/TRb) were applied subcutaneously at the back of the rats. Then the animals (n=80, BD IX rats) were randomized into eight groups and underwent a standardized 4 cm midline laparotomy for 30 minutes. At the end of the operation a bolus (1 ml Ringer´s solution) versus a long term intravenous therapy (7 days, eight-hourly 1 ml 1%, 2%, or 3% taurolidine) were performed. For long term therapy a jugularis vein port catheter system was placed and left for one week. The influences on subcutaneous tumor growth, animal growth, general side effects and leukocyte granulocyte counts were analyzed. Total tumor weights were determined four weeks after cell application. Results: The metastatic (subcutaneous) tumor growth showed a dose-dependent reduction of tumor weight (p=0.048) under long term therapy with statistical significancy in solid tumor counts (p=0,035). A slight and temporary depression in animal growth was observed only in long term therapy groups. Independent of the therapeutic agents and the application forms, the operation itself caused a slight leukopenia shortly after the operation compensated by a moderate leukocytosis in the following course. Fast injections of taurolidine led to temporary reduction of breathing rate. Conclusions: Only the intravenous long term therapy of 3% taurolidine led to a slight downregulation in metastatic (subcutaneous) tumor growth. The slight changes of leukocyte counts were not affected by taurolidine. Fast injections have to be avoided. The findings prompted us to start new experiments to determine the influence of increasing doses of taurolidine on progressive tumor growth in rats.

Objetivo: O objetivo deste estudo foi avaliar se o uso de uma solução cristaloide balanceada induz menos alterações metabólicas do que o cloreto de sódio 0,9% em crianças submetidas à ressecção de tumor cerebral. Desenho: Estudo fase II, unicêntrico, de superioridade, randomizado e controlado, realizado no Instituto de Oncologia Pediátrica da Universidade Federal de São Paulo, Brasil. População: crianças com idade entre 6 meses e 12 anos submetidas à ressecção de tumor cerebral. Intervenção: O uso de uma solução cristaloide balanceada durante e após (por 24 horas) ressecção de tumor cerebral foi comparado ao uso de cloreto de sódio 0,9%. Eletrólitos séricos e gasometria arterial foram coletados em três momentos: antes da cirurgia (basal); após a cirurgia [pós-operatório imediato (POI)]; e no primeiro dia pós-operatório (1º DPO). Desfecho primário: O desfecho primário deste estudo foi a variação do cloro sérico (pós-préop Cl), definida como a diferença absoluta entre as concentrações plasmáticas medidas no POI e antes da cirurgia. Desfechos secundários: Como desfechos secundários, foram avaliadas as variações (pós-préop) dos outros eletrólitos e do excesso de bases (BE); a incidência de acidose hiperclorêmica; e o escore de relaxamento cerebral (ERC), avaliado pelo neurocirurgião por meio de escala de 4 pontos. Resultados: 53 pacientes foram incluídos no estudo e randomizados; 27 receberam solução balanceada (grupo SB) e 26, cloreto de sódio 0,9% (grupo NaCl 0,9%). O pós-préop Cl mediano foi significativamente menor no grupo SB [0 (-1,0; 3,0)] do que no grupo NaCl 0,9% [6 (3,5; 8,5)], p < 0,01. O pós-préop BE mediano foi menor [-0,4 (-2,7; 1,3) versus -4,4 (-5,0; -2,3), p < 0,01] e acidose hiperclorêmica menos frequente (4% versus 67%, p < 0,01) no grupo SB do que no grupo NaCl 0,9%. O ERC foi comparável entre os grupos. Conclusão: Em crianças submetidas à ressecção de tumor cerebral, o uso de solução cristaloide balanceada reduziu a variação do cloro sérico comparado ao uso de cloreto de sódio 0,9%. Esses achados respaldam o uso de soluções balanceadas em crianças submetidas à ressecção de tumor cerebral. Registro no Clinical Trials: NCT NCT02707549 / Objective: The aim of this study was to determine if the use of a balanced crystalloid induces less metabolic derangements than 0.9% saline solution in children undergoing brain tumor resection. Design: Phase II, single center, superiority, randomized and controlled trial performed at Instituto de Oncologia Pediátrica, Universidade Federal de São Paulo, São Paulo, Brazil. Population: Pediatric patients (age range, 6 months to 12 years) undergoing brain tumor resection. Intervention: Use of a balanced crystalloid solution during and after (for 24 h) brain tumor resection was compared to saline 0.9%. Serum electrolyte and arterial blood gas analyses were performed before surgery (baseline), after surgery, and at postoperative day 1. Primary outcome: The primary trial outcome was the preoperative to postoperative variation in serum chloride (post-preop Cl) measured as the absolute difference between \"after surgery\" and baseline plasma concentrations. Secondary outcomes: As secondary outcomes, we measured the post-preop of other electrolytes and base excess (BE); hyperchloremic acidosis incidence; and the brain relaxation score, a four-point scale evaluated by the surgeon for assessing brain edema. Results: Fifty-three patients were included in the study; twenty-seven were randomized to receive a balanced crystalloid (balanced group) and twenty-six were randomized to receive 0.9% saline solution (saline group). The median post-preop Cl (mmol l-1) was significantly lower in the balanced [0 (-1.0; 3.0)] than in the saline group [6 (3.5;8.5); p < .01]. Median post-preop BE (mmol l-1) was lower [-0.4 (-2.7; -1.3) versus -4.4 (- 5.0; -2.3); p < .01] and hyperchloremic acidosis less frequent (4% versus 67%; p < .01) in the balanced group than in the saline group. Brain relaxation score was comparable between groups. Conclusions: In children undergoing brain tumor resection, balanced crystalloid solution infusion reduced variation in serum chloride. These findings support the use of balanced crystalloid solutions in children undergoing brain tumor resection

Objetivo: Comparar as relações de custo-efetividade de duas terapias, Imunoglubulina Intravenosa (IgIV) e Plasmaferese (PE), no tratamento da Síndrome de Guillain-Barré sob a perspectiva do sistema público (SUS). O objetivo secundário foi avaliar a adesão às recomendações da Comissão de Medicamentos do HCPA Métodos: estudo transversal com análise econômica de pacientes tratados por Síndrome de Guillain-Barré no período de junho de 2003 a junho de 2008 no Hospital de Clínicas de Porto Alegre (HCPA). Foi realizada análise de custo-efetividade do emprego de IgIV e de PE nestes pacientes, pelo método de minimização de custos, considerando-se somente os custos diretos sanitários, fornecidos pelo sistema gerencial da instituição . Foram excluídos os pacientes que usaram outro tipo de tratamento associado ou isolado. Coletaram-se os dados através da revisão dos prontuários. A gravidade da doença na internação foi classificada como: doença leve, quando caminhar foi possível; doença moderada, quando caminhar foi impossível; doença grave, quando os pacientes necessitaram de ventilação assistida. A incapacidade na alta foi estabelecida pela escala de sete pontos de Hughes. A adesão às recomendações da Comissão de Medicamentos do HCPA, objetivo secundário, foi avaliada através da dose e o esquema de prescrição da IgIV. Resultados: Vinte e cinco participantes (2 a 70 anos) foram incluídos no estudo, cinco tratados com PE, empregando-se Albumina Humana como substituto do plasma, e 20 tratados com IgIV. O custo total do tratamento de um paciente com PE foi R$10.603,88 (± 2.978,12) e o de um que recebeu IgIV foi R$ 32.103,00 (± 21.454,24). O custo total da internação foi de R$45.027,14 (± 32.750,45) para os tratados com PE e de R$ 60.844,28 (±48.590,52) para os que receberam IgIV. Em relação ao desfecho clínico principal, melhora na escala de incapacidade de sete pontos, após o tratamento com uma das alternativas escolhida, a mediana dos pacientes que internaram com grau de gravidade 3 e que foram tratados com PE foi igual a dos que receberam IgIV. Em relação à permanência hospitalar, permanência em UTI e dias de Ventilação Mecânica, não houve diferença estatisticamente significativa entre os dois tratamentos. Conclusões: Quando comparados os custos médios das duas opções terapêuticas, uma delas aparece claramente com menor custo. Quando comparados os desfechos, após o emprego de cada opção terapêutica, estes não revelam diferença. Concluímos que, no HCPA, a opção pelo procedimento Plasmaferese é mais custo efetiva do que o emprego da IgIV. / Objectives: To compare the cost-effectiveness of two distinct therapies, Intravenous Immunoglobulin (IVIg) and Plasma Exchange (PE) in the treatment of Guillain-Barré Syndrome, concerning the public health care system. Compliance to the guidelines of the Pharmacy and Therapeutics Committee of the Hospital de Clínicas de Porto Alegre was a secondary objective. Methods: A cross-sectional, economical analysis was conducted, including patients treated for GBS in the period from June, 2003 through June, 2008 in Hospital de Clínicas de Porto Alegre (HCPA). The cost-effectiveness of the use of IVIg and PE in such patients was studied through the cost minimization method, considering direct medical costs only (2008 currency), yield by the management of the institution. Patients receiving treatments other than PE or IVIg were excluded. Data were collected by chart reviews. Severity of disease on admittance was classified as follows: mild disease, when the patient was able to walk; moderate disease, when the patient was unable to walk, and severe disease, when assisted ventilation was required. Disability on discharge was established by the 7-point scale of Hughes. Compliance to the guidelines of the Pharmacy and Therapeutics Committee was evaluated through the dose and prescription scheme of IVIg. Results: Twenty-five participants (2 to 70 years of age) were included in the study, 5 were submitted to treatment with PE, using human albumin as replacement for plasma, and 20 were treated with IVIg. The total treatment cost for PE in a single patient was US$6,058.85 (±1,701.78 SD), and the same expense for IVIg was US$18,344.57 (± 12,259.56 SD) (p = 0.035). Total inpatient cost was US$25,729.79 (± 18,714.54 SD) in the PE group, and US$34,768.16 (±27,766.01 SD) (p=0.530) in the IVIg group. The main clinical outcome was improvement in the 7-point disability grade scale. The median of that measure in patients admitted with a severity grade 3 treated either with PE and IVIg was the same. Secondary outcomes, such as in-hospital stay, ICU stay, and number of days on mechanical ventilation revealed no statistically significant difference between treatments. Conclusions: As the mean expenses of both therapeutic options are compared, one clearly stands-out as less onerous. Clinical outcomes, when compared, reveal no statistical difference after each treatment. We concluded that, in HCPA, plasma exchange is more cost-effective than intravenous immunoglobulin.