Objetivo: analisar o conhecimento da equipe de enfermagem de uma unidade de terapia intensiva adulto sobre sedoanalgesia, descrevendo seu perfil sociodemográfico e experiência profissional. Metodologia: Trata-se de um estudo transversal prospectivo, realizado entre 11 e 17 de maio de 2022 em hospital privado de Manaus, com 54 profissionais (13 enfermeiros e 41 técnicos). Os dados foram coletados por meio de questionário estruturado com dez questões e analisados com estatística descritiva e teste de Mann-Whitney (p<0,05). Resultados: foi evidenciado que a maioria dos profissionais não possuía curso específico em dor ou sedoanalgesia (92,2%), e apenas 46,2% atingiram nível de conhecimento classificado como suficiente ou moderado. A média de acertos foi 3,92 entre enfermeiros e 3,14 entre técnicos, sem diferença estatisticamente significativa. Conclusão: a equipe apresenta conhecimento insatisfatório sobre sedoanalgesia, indicando a necessidade de investimentos em capacitação e educação continuada para aprimorar a assistência em terapia intensiva.
Penile cancer often requires mutilating surgical treatments with significant impacts on the couple’s life, and little is discussed about the effects of this surgery on the patient’s sexual partner. The emotional impact and the anatomical and functional changes in genitalia after partial penectomy can affect the couple’s sexuality, leading to sexual difficulties in the partner that are often overlooked in clinical practice. Evaluate the sexual function in female partners of patients undergoing partial penectomy. This study analyzed female partners of patients who underwent partial penectomy in two tertiary hospitals in Brazil between 2023 and 2025. The presence of sexual dysfunction was assessed using the Female Sexual Function Index, which contains 5 domains that assess arousal, lubrication, orgasm, sexual satisfaction and pain during penetration. The index scores range from 2-36 and patients with scores below 26.5 are classified as having sexual dysfunction. Fourteen women were evaluated. The average age was 55 years. Half of the women analyzed were postmenopausal and were not using hormone replacement therapy. Nine of them had comorbidities and two had already undergone vaginal surgeries. All of them had the post-partial penectomy patient as their only sexual partner. All of the patients analyzed scored below the cutoff and were classified as having sexual dysfunction, with an average of 18 points. The domain with the lowest score was sexual arousal and satisfaction. Sexual dysfunction in the female partner after partial penectomy is an often neglected reality. Post-surgical sexuality requires a comprehensive therapeutic approach that includes not only the patient but also his/her partner. The integration of physical, emotional and relational aspects in multidisciplinary care can promote a satisfactory sex life, even in the face of limitations imposed by the disease and its treatment. No conflict.
Objetivo: analisar os fatores estressores de profissionais enfermeiros do Centro de Terapia Intensiva (CTI) de um hospital privado de Manaus. Metodologia: estudo descritivo, com abordagem quantitativa, realizado no período de abril a maio de 2022. A coleta de dados ocorreu por meio da aplicação de um questionário padronizado e estruturado, aplicado a 15 enfermeiros do CTI. Resultados: a maioria dos participantes era do sexo feminino (78,57%) e do sexo masculino (21,43%), com predominância de idade entre 25 e 30 anos (60,00%). Em relação à autoavaliação dos fatores estressores, observou-se que grande parte dos profissionais relatou a presença de sobrecarga laboral como fator estressante frequente no ambiente de trabalho. Conclusão: observou-se que os profissionais enfermeiros convivem com diferentes fatores estressores no ambiente de trabalho, destacando-se a sobrecarga laboral, aspectos relacionados às relações interpessoais e às demandas do cuidado intensivo, evidenciando a importância da atenção institucional às condições de trabalho desses profissionais.
Abstract Introduction Revision surgeries for inflatable penile prosthesis (IPP) implants are expected in up to 30% of cases within the first 10 years. Given the increasing life expectancy of the male population, and considering that IPP can be considered in the treatment of erectile dysfunction in younger patients, it is likely that many of these patients will require revision surgery at some point in their lives. In addition to a higher likelihood of postoperative infection, revision surgeries carry greater risk due to changes in surgical and anatomical planes, which can make it difficult to replace the entire device rather than just the malfunctioning component. Objective To present a case of replacement of an inflatable penile prosthesis in a 45-year-old man with excessive penile filling volume performed for aesthetic purposes. Methods A patient who underwent an IPP implant eight years ago for the treatment of premature ejaculation presented with mechanical failure of the prosthesis, unable to inflate it. He had undergone penile filler surgery for aesthetic purposes with hyaluronic acid approximately one year earlier. Physical examination of the genital region revealed a penis with a large volume of filler material, several nodules, deformities, and irregularities on its shaft, but with a free scrotum and an easily palpable pump. Pelvic resonance imaging described an apparently empty retropubic reservoir, while high-resolution ultrasound described between the Dartos and Buck fasciae, throughout the penis, a large quantity of anechoic deposits with suspended debris, certainly related to hyaluronic acid deposits, and in the dermis, areolar tissue and dissecting Buck's fascia, throughout the penis, a hyperchromic area was identified with a large amount of oily substance probably corresponding to silicone oil. Two applications of hyaluronidase were performed with a one-week interval in the penile filling region, and we scheduled the surgery to replace the IPP for 15 days after the second application of hyaluronidase. Results The surgical approach was performed through a transverse penoscrotal incision, allowing for easy access to the pump and connections. The location of the prosthesis' mechanical failure was quickly identified, resulting in a ruptured connection between the pump and one of the cylinders. On the ventral surface of the corpora cavernosa, there was significant anatomical dysmorphism of the subdermal planes, with an apparent local inflammatory reaction. However, with the Foley urethral catheter for identification and protection of the urethra, and through the connections to the cylinders, the ventral surface of the corpora cavernosa could be identified without major difficulties. After bilateral cavernosotomy, we removed the penile prosthesis cylinders from within the corpora cavernosa. The prosthesis reservoir, which had been positioned through the right external inguinal ring in the space of Retsius, was left in place. We positioned a new reservoir with 125 ml in the space of Retsius by dissection through the left external inguinal ring, which was easily identified and accessed. Conclusions There are few reports in the literature on aesthetic penile filling procedures in patients with IPP. Despite the anatomical alterations, IPP replacement in patients with penile filling was shown to be feasible through the penoscrotal approach. Disclosure No
As neoplasias gastrointestinais configuram um relevante problema de saúde pública, em razão de sua elevada incidência, mortalidade e marcada heterogeneidade biológica. Nos últimos anos, a compreensão da carcinogênese tem avançado além das alterações genéticas isoladas, incorporando o papel dinâmico do microambiente tumoral, especialmente da matriz extracelular (MEC). Este estudo teve como objetivo revisar evidências recentes acerca de proteínas e fragmentos derivados da MEC como potenciais biomarcadores no diagnóstico, prognóstico e monitoramento clínico dessas neoplasias. Trata-se de uma revisão integrativa da literatura, com busca sistematizada nas bases PubMed/MDLINE, Scopus, Web of Science e BVS, contemplando publicações entre 2015 e 2025. A análise de 26 estudos evidenciou que a clivagem enzimática de componentes da membrana basal, sobretudo com liberação do fragmento C4M, associa-se ao estadiamento avançado e ao potencial metastático no adenocarcinoma colorretal. Além disso, alterações na rigidez da MEC e no arranjo das fibras elásticas atuam como estímulos mecânicos da transição do epitélio-mesenquimal. A detecção de fragmentos circulantes da MEC, integrada a Exossomos e DNA livre circulante aponta para o avanço da biópsia líquida multimodal. Apesar dos desafios analíticos, essa abordagem pode aprimorar o diagnóstico precoce e a terapêutica personalizada.
