Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

In developing economies, manufacturing companies play an important role, represent the main source of employment and generate considerable income and export earnings. SMEs in developed and developing economies are defined by many factors and criteria, such as location, size, age, structure, organization, number of employees, sales volume, asset value, ownership through innovation and technology, etc. It is very important to study the mediating role of quality management between business orientation and the performance of manufacturing companies. The intangible capabilities of the company, such as business orientation and quality management, drive the performance of SMEs in a highly competitive market. Keywords: BPM, audit, SMEs, quality management.    

 Abstract: Morgagni Hernia (MH) is a defect between the transverse septum and the sternum, failing the fusion of the sternal and costal parts of the muscle, representing 3 to 4% of the hernia’s diaphragmatic lesions of congenital origin. It is present in 90% of the cases on the right side, 8% on the left side and 2% on the bilateral side. The aim of this article is to report a case on late presentation of MH and to emphasize the importance of this pathology to be analyzed with differential diagnosis in patients with respiratory symptoms. The subject is a patient, male, 62 years old, truck driver, married, with history of dyspnea on medium exertion and mild chest discomfort from 2 years. After 1 year of these symptoms, he evolved with major dyspnea on minor exertion, intense chest pain, without improvement with analgesics or with body positions, making it difficult to perform his usual activities as work and leisure. Multislice Computed Tomography of the Thorax, which showed: diaphragmatic hernia in the left hemithorax, with a ring/diaphragmatic fault located in the anterior and medial pericardial third, and an intrathoracic hernia, notably in the base and middle third in the anterior, lateral and posterior regions, with contents mesenteric and intestinal. The patient underwent thoracotomy in the sixth left intercostal space. A large amount of omentum, transverse colon, stomach, pulmonary atelectasis and small pleural effusion were found. The omentum resection was performed, located hernial ring in the antero-medial portion of the diaphragm, reduction of the hernia, placement of the Malex mesh and apposition of two anterior and posterior thoracic drains. Reports of patients initially diagnosed with pneumonia or treated as chronic dyspeptic, who progressed to intestinal necrosis, respiratory failure or other complications due to late diagnosis, emphasize the relevance of the knowledge of MH as a differential diagnosis of respiratory and gastrointestinal symptoms. 

Abstract: The book ‘Near to The Wild Heart’ was the first novel of the writer Clarice Lispector, it tells the story of Joana, a character that since childhood shows herself provocative, questioner and uncertain of self and from the own world. Lispector’s character reveals, since the first phrases from the book, a suffering for something that her own can’t understand. A silent and constant pain. It remained for the character, in the meantime, to wait. We seek to analyze the descriptions about the suffering of the character, associating with the psychosocial representation of the woman in the work of Clarice as a representative of The Generation of 45. This article followed a method of documentary analysis, using, in addition to Lispector’s masterpiece, bibliographic studies related to the themes of the research. The character Joana faces a discomfort of imprecise location and undefined location. Yet, a suffering that transgress in time. A wild time is drawn in the work, in which Joana lives in streams of events.  The work is a rupture of linearity. The childhood wouldn’t be only a memory of the character, but the own present alive. We highlight as a latent difficulty the reduced amount of research in this methodological line that could contribute to the inferences about the literary work of Lispector. Certainly Joana faces a process until then unrecognizable in Brazilian literature: the pain of the lack of the “I”. Knowing that something is missing and awaiting the revelation of this lack in silence, reverberates in the character a psychic pain. Keywords: Clarice Lispector, Literature, Psychology, Mental health.

Staphylococcus aureus (S.aureus) infections with Vancomycin resistance in hospital complexes are a concern, a significant increase in the number of these occurrences is observed since it is one of the last available antibiotic therapy routes available for the treatment of infectious processes bacterium. Thus, this work aims to present the main mechanism of resistance induction of S. aureus to Vancomycin. The research used the databases Medline, Scielo, the electronic site of the Google Scholar databases as well as specialized magazines in the area. Thus, the selected articles showed that in the late 1950s almost half of S. aureus strains were resistant to penicillin, and in the 1970s the first cases of methicillin-resistant S. aureus (MRSA) appeared; and thus, Vancomycin became employed in such cases. In 1996, the first case of S. aureus with intermediate resistance to vancomycin (VISA) was found. In 2002, the first case of Vancomycin-resistant S. aureus (VRSA) occurred, the latter being the only known to have the VanA gene until then. It was soon discovered that the emergence of this resistance occurred from the transfer of a plasmid with the transposon of the vancomycin resistant vanA, Tn1546 vancomycin (VRE) gene to an MRSA, which already had a plasmid for resistance to gentamicin and production of beta-lactamase. This new plasmid was disseminated to other S. aureus and thus disseminating a new resistance. Thus, the conclusion is that the cycle repeats itself and previously sensitive bacteria become resistant; thus, in this rhythm of emergence of bacterial resistance against antibiotic therapy is worrying, there will be a moment when there will be no antibiotic capable of acting in the fight against bacteria. This shows the need to understand the mechanism of resistance, the discovery of new antimicrobial drugs and the prevention of the spread of resistant microbes.Key words: Staphylococcus aureus, vancomycin, microbial drug resistance, vancomycin resistance.

Over and over again food-induced exercise-induced anaphylaxis is underdiagnosed by the physician and is reported to be an idiopathic anaphylaxis. In this context, the patient does not receive the proper guidelines for the correct management of his disease. Therefore, you will not know how to act, either to avoid it or to intervene in a possible crisis, so you will be potentially subject to life-threatening situations. Thus the research question was thus outlined: “How should the patient with food-dependent exercise-induced anaphylaxis (AIEDA) act in the face of a likely crisis, particularly in reducing the number of fatal events?” A literature review was performed. on the following bases: Online Medical Literature Search and Analysis System (MEDLINE), Scientific Electronic Library Online (SCIELO). The following controlled descriptors were selected for the location of the studies: “Wheat-Dependent Exercise-Induced Anaphylaxis”, “Impending Anaphylactic Crisis”, “Patients Exposed to Imminent Anaphylactic Crisis” (patients exposed to impending anaphylactic crisis). ). Exercise-induced anaphylaxis (EIA) is believed to be associated with 5-15% of all anaphylaxis cases. AIEDA prevalence data are limited and not reported accurately. Most reported cases have been related to wheat. Reported prevalence ranged from 0.001% to 0.017% worldwide for all foods. In most patients, when there is a mediated IgE reaction, exercise decreases the threshold for mast cell degranulation, giving rise to symptoms even when isolated ingestion is tolerated. Severe food allergy sometimes develops during exercise in association with a specific food (up to four hours after ingestion), characterizing food-dependent exercise-induced anaphylaxis. Proper professional diagnosis and management will help to avoid unnecessary limitations on the patient's diet and exercise. In any situation of anaphylaxis, it is never an exaggeration to stress the importance of educating patients to know how and when to use the self-injecting adrenaline kit, and to convey the notion of ineffective premedication with antihistamines. even mask prodromal symptoms, preventing patients from predicting more severe reactions. Keywords: Wheat-Dependent Exercise-Induced Anaphylaxis;  Impending anaphylactic crisis; Patients exposed to impending anaphylactic crisis

: The elderly people are the group that most use psychotropic drugs, due to psychiatric comorbidity and somatic conditions. In Brazil some benzodiazepines are part of the National List of Essential Medicines (RENAME) being distributed free of charge, facilitating the population access, which can lead to irrational use. Methods: Cross-sectional, descriptive research through a qualitative and quantitative study of benzodiazepine use in patients attended at the Cedro Basic Pharmacy in the city of Cedro-PE. The data collection was done with the application of a semi-structured questionnaire. The pattern of benzodiazepine use has been described through patient-reported symptomatology, therapeutic adherence, medical specialty, dose increase without medical consultation, and adverse effects reported during the drug use. Results: There was a predominance of females (58.33%). The most commonly used benzodiazepine was diazepam (66.67%). The purchase of benzodiazepine without a prescription was reported by 16.67% of the elderly interviewed and an increase in the drug dose without doctor consulting by 25% of the interviewees. Final considerations: The prescription of these drugs for the elderly, as well as the chronic use, should consider the physiological changes caused by aging and the adverse effects of these drugs in order to guarantee a safe treatment. Keywords : Aged; Psychotropic drugs; Drug utilization.

This article aims to evaluate the effectiveness and use of laparoscopy in penetrating abdominal trauma, thus providing a better definition of the role of laparoscopic approach in patients with PAD.  A systematic review was performed by searching indexed articles in the Virtual Health Library and the Medical Literature Analysis and Retrieval System Online database (MEDLINE / PubMed), in which analysis after final analysis included 07 articles.  In this study we identified seven articles that evaluated the use and contributions of the laparoscopic approach in patients with TAP, in which it was identified that the use as a diagnostic approach is widely used due to its benefits and safety.  Regarding its therapeutic approach it was determined that in the largest of the studies there is indication, usefulness, reliability and accuracy of its use, however, for better results is essential experience of the surgical team in laparoscopic technique.Keywords: Abdominal trauma;  Laparoscopy and Penetrating Trauma;  Abdominal injury;  Laparoscopy;  Penetrating wound.

Suicide is a huge public health problem, which needs more attention. One doctor commits suicide in the U.S. every day -- the highest suicide rate of any profession. According to the American Foundation for Suicide Prevention, physicians are at a higher risk than the general population for suicide. Methods: A Brief Communication that focus on the starkest sign of the crisis gripping medicine: the number of physicians who commit suicide every year. Include: discovery or development of new information’s, novelty in modeling  scientific, elucidation of mechanisms editorials and channels of information. Results: The medical profession has proven to have one of the highest risks of death by suicide among professions. About 15-30% of students and residents screen positive for depression. Studies also show that 1 in 16 trainees report suicidal ideation. The researchers also suggest that psychiatry help is still a taboo among doctors. Limitations: As Short Communications are expected to have higher than average impact on the field rather than report on incremental research, they will receive prioritized and rapid publication. Conclusion: Strategies to reduce preventable deaths should include preventive and treatment service. We should all strive to help usher in a new era of medical culture that promotes sustainable medical careers. Excessive pressures and expectations at work, may entail   to a loss of meaning of work and of self for physicians. Key-words: Suicide; Doctors; Medicine; Mental Health

Mental health in the interface with social psychiatryis a constantly evolving field. Psychiatry faces major challenges. The therapeutic relationship remains paramount. Methods: A Short Communication that focus the informational spaces of professional interests, many new ideas and concepts what are issued under the banner of "social psychiatry.". Include: discovery or development of new information’s, novelty in modeling  scientific and channels of information. Results: The evidences emphasize that Mental illness and interventions in psychiatry should be considered in the of social context where patients live and factors they face on a daily basis. There’s a need for greater numbers of psychiatrists. Limitations: As Short Communications are expected to have higher than average impact on the field rather than report on incremental research, they will receive prioritized and rapid publication. Conclusion: Social values and concepts have played a central role in the history of mental health care, allowing more focus on possible environmental causes or factors. Keywords: Social Psychiatryis; Mental Health; Therapeutic Relationship.

This article aims to evaluate the epidemiological determinants of TBI in pediatric patients. An integrative review was performed by searching indexed articles in the Virtual Health Library, in which analysis after final analysis included 08 articles. For better elucidation, two categories were formulated: Epidemiological profile of children with TBI and Epidemiological determinants and the clinical implications of TBI in children. It was possible to verify that there is a male predominance, the fall is considered the main mechanism for the condition and TBI, in addition, age groups under 5 years have a worse prognosis. Keywords: Craniocerebral Trauma; Child; Epidemiologic Factors.