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ABSTRACT Timely and accurate diagnosis is one of the strategies for managing visceral leishmaniasis (VL). Given the specificities of this infection, which affects different vulnerable populations, the local assessment of the accuracy of the available diagnostic test is a requirement for the good use of resources. In Brazil, performance data are required for test registration with the National Regulatory Agency (ANVISA), but there are no minimum requirements established for performance evaluation. Here, we compared the accuracy reported in the manufacturer’s instructions of commercially available VL-diagnostic tests in Brazil, and the accuracies reported in the scientific literature which were obtained after test commercialization. The tests were identified via the electronic database of ANVISA, and their accuracy was obtained from the manufacturer’s instructions. A literature search for test accuracy was performed using two databases. A total of 28 VL diagnostic tests were identified through the ANVISA database. However, only 13 presented performance data in the manufacturer’s instructions, with five immunoenzymatic tests, three indirect immunofluorescence tests, one chemiluminescence test, and four rapid tests. For most tests, the manufacturers did not provide the relevant information, such as sample size, reference standards, and study site. The literature review identified accuracy data for only 61.5% of diagnostic tests registered in Brazil. These observations confirmed that there are significant flaws in the process of registering health technologies and highlighted one of the reasons for the insufficient control of policies, namely, the use of potentially inaccurate and inappropriate diagnostic tools for a given scenario.

https://doi.org/10.1590/0037-8682-0358-2022

Factors associated with the permission for child vaccination in the context of the COVID-19 pandemic
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Santos, Diane Fernandes dos

; Oliveira, Jayane Omena de

; Vieira, Ana Carolina Santana

; Santos, Regina Célia Sales

; Silva, Alanna Michella Oliveira de Albuquerque da

; Costa, Christefany Régia Braz

Revista Gaúcha de Enfermagem

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2023, Volume 44 elocation e20220362

Abstract: En Es Pt | Text: En Es Pt | PDF: En | PDF: Es | PDF: Pt

ABSTRACT Objective: To identify factors associated with permission for child vaccination in the context of the COVID-19 pandemic. Method: Cross-sectional study, with parents/guardians of children aged up to 1 year, 11 months and 29 days, aged 18 years or older, with internet access and residents of the state of Alagoas. The collection was conducted between June 2021 and April 2022, using a structured instrument via Google forms®. Fisher’s Exact and Pearson’s chi-square statistical tests were used. Results: A total of 94 parents/guardians participated. There was an association between permission for child vaccination during the COVID-19 pandemic and higher education level of parents/guardians, with the lack of an educational bond with the child, and between parents/guardians who would allow the application of the COVID-19 vaccine. Conclusion: Permission for child vaccination in the context of the COVID-19 pandemic was associated with higher education level of parents/guardians and the absence of educational bond of the child.

RESUMEN Objetivo: Identificar los factores asociados a permitir la vacunación infantil en el contexto de la pandemia de COVID-19. Método: Estudio transversal, con padres/tutores de niños de hasta 1 año, 11 meses y 29 días, con edad igual o superior a 18 años, con acceso a internet y residentes en el estado de Alagoas. La recolección se realizó entre junio de 2021 y abril de 2022, utilizando un instrumento estructurado a través de Google Forms®. Se utilizaron las pruebas estadísticas Exacto de Fisher y chi-cuadrado de Pearson. Resultados: Participaron 94 padres/tutores. Hubo asociación entre el permiso para la vacunación infantil durante la pandemia de COVID-19 y la escolaridad superior de los padres/tutores, con la falta de vínculo educativo con el niño, y entre los padres/tutores que permitirían la aplicación de la vacuna contra el COVID-19, si disponible. Conclusión: El permiso para la vacunación infantil en el contexto de la pandemia de COVID-19 se asoció con la educación superior de los padres/tutores y la falta de vínculos educativos para el niño.

RESUMO Objetivo: Identificar os fatores associados à permissão da vacinação infantil no contexto da pandemia da COVID-19. Método: Estudo transversal, com pais/responsáveis de crianças com até 1 ano 11 meses e 29 dias, idade maior ou igual a 18 anos, acesso à internet e residentes no estado de Alagoas. A coleta foi realizada entre junho de 2021 e abril de 2022, por instrumento estruturado via Google Forms®. Utilizou-se os testes estatísticos Exato de Fisher e o Qui-quadrado de Pearson. Resultados: Participaram 94 pais/responsáveis. Houve associação da permissão da vacinação infantil durante a pandemia da COVID-19 com uma maior escolaridade dos pais/responsáveis, com a ausência de vínculo educacional da criança e entre os pais/responsáveis que permitiriam a aplicação da vacina da COVID-19, caso estivesse disponível. Conclusão: A permissão da vacinação infantil no contexto da pandemia da COVID-19 foi associada a maior escolaridade dos pais/responsáveis e a ausência de vinculação educacional da criança.

https://doi.org/10.1590/1983-1447.2023.20220362.en

Anxiety, depression, and quality of life in mothers of children with congenital Zika syndrome: Results of a 5-year follow-up study
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Oliveira, Sheila Jaqueline Gomes de

; Tavares, Carolina Santos Souza

; Santos, Victor Santana

; Santos Jr, Hudson P.

; Martins-Filho, Paulo Ricardo

Revista da Sociedade Brasileira de Medicina Tropical

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2022, Volume 55 elocation e0627-2021

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/0037-8682-0627-2021

Taxa de higienização das mãos em uma Unidade de Terapia Intensiva Neonatal
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Oliveira, Edcarla da Silva de

; Cardoso, Maria Vera Lúcia Moreira Leitão

; Bezerra, Carolina Martins

; Barbosa, Lorena Pinheiro

; Nobre, Keline Soraya Santana

; Carneiro, Thaís Aquino

Acta Paulista de Enfermagem

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2022, Volume 35 elocation eAPE00497

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

Resumo Objetivo Avaliar a adesão à higienização das mãos dos profissionais da saúde atuantes em uma Unidade de Terapia Intensiva Neonatal e verificar a associação da adesão entre os cinco momentos preconizados pela Organização Mundial de Saúde. Métodos Pesquisa transversal realizada entre novembro/2017 e abril/2018, com equipe multiprofissional de saúde da Unidade de Terapia Intensiva Neonatal, nos turnos matutino e vespertino, nos dias úteis da semana, por meio de observação direta das oportunidades de higienização das mãos. Os dados foram analisados utilizando-se a Razão de Chance e o Teste Exato de Fisher (p<0,05). Resultados Foram observadas 304 oportunidades de higienização das mãos em 71 profissionais da saúde, mostrando uma taxa de adesão global de 79,9%. A maior adesão à higiene de mãos foi dos fisioterapeutas (91,9%), seguido dos médicos (82,4%) e dos técnicos de enfermagem (82%). As oportunidades com maior adesão à higiene de mãos foram “antes e após tocar o paciente” com 94,4 e 93,9%, respectivamente. A chance de higienizar as mãos antes de tocar o paciente foi 60 vezes maior do que após tocar superfícies próximas ao paciente (p < 0,00001). Conclusão Higienizar as mãos após tocar superfícies próximas ao paciente obteve menor adesão. Já higienizar as mãos antes de tocar o paciente obteve maior adesão por parte dos profissionais observados.

Abstract Objective To evaluate hand hygiene compliance by health professionals working in a Neonatal Intensive Care Unit and verify the association of compliance between the five moments recommended by the World Health Organization. Methods This is cross-sectional research, carried out between November/2017 and April/2018, with a multidisciplinary health staff from a Neonatal Intensive Care Unit, in the morning and afternoon shifts, on weekdays, through direct observation of opportunities for cleaning the hands. Data were analyzed using Odds Ratio and Fisher’s exact test (p<0.05). Results A total of 304 hand hygiene opportunities were observed in 71 health professionals, showing an overall compliance rate of 79.9%. The highest hand hygiene compliance was by physical therapists (91.9%), followed by physicians (82.4%) and nursing technicians (82%). Opportunities with greater hand hygiene compliance were “before and after touching a patient” with 94.4 and 93.9%, respectively. The chance of washing hands before touching a patient was 60 times greater than after touching patient surroundings (p < 0.00001). Conclusion Hygienizing hands after touching patient surroundings had lower compliance. Hygiene hands before touching a patient obtained greater compliance by the professionals observed.

Resumen Objetivo Evaluar la adherencia a la higienización de manos de los profesionales de salud que actúan en una Unidad de Cuidados Intensivos Neonatales y verificar la asociación de la adherencia en los cinco momentos preconizados por la Organización Mundial de Salud. Métodos Investigación transversal realizada entre noviembre/2017 y abril/2018, con un equipo multiprofesional de salud de la Unidad de Cuidados Intensivos Neonatal, en los turnos matutino y vespertino, en días hábiles de semana, por medio de observación directa de las oportunidades de higienización de manos. Se analizaron los datos utilizando la Razón de Oportunidades y la Prueba exacta de Fisher (p<0,05). Resultados Se observaron 304 oportunidades de higienización de manos en 71 profesionales de salud, y se evidenció un grado de adherencia global del 79,9 %. La mayor adherencia a la higiene de manos fue de los fisioterapeutas (91,9 %), seguido de los médicos (82,4 %) y de los técnicos de enfermería (82 %). Las oportunidades con más adherencia a la higiene de manos fueron “antes y después de tocar al paciente” con 94,4 y 93,9 %, respectivamente. La probabilidad de higienización de manos antes de tocar al paciente fue 60 veces más alta que después de tocar superficies próximas al paciente (p < 0,00001). Conclusión Higienizar las manos después de tocar superficies próximas al paciente presentó una adherencia más baja. Por otro lado, higienizar las manos antes de tocar al paciente obtuvo una adherencia más alta por parte de los profesionales observados.

https://doi.org/10.37689/acta-ape/2022ao00497

Adolescents and young adults infected by the Human Papillomavirus (HPV): vulnerabilities and feelings experienced
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Reis, Maria Carolina Oliveira

; Martins, Adenilda Lima Lopes

; Carvalho, Rosely Cabral de

; Moreira, Rita de Cássia Rocha

; Peixoto, Marcelo Torres

; Souza, Sandra Ely Barbosa de

Revista Gaúcha de Enfermagem

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2022, Volume 43 elocation e20210228

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

RESUMO Objetivo: Conhecer as vulnerabilidades vivenciadas por adolescentes e adultas jovens infectadas pelo Papilomavírus Humano atendidas em um centro de referência em Feira de Santana - Bahia. Método: Estudo qualitativo, realizado entrevista semiestruturada com 20 adolescentes e adultas jovens, no período de novembro de 2020 a fevereiro de 2021. Para análise dos dados, utilizaram-se a Análise de Conteúdo proposta por Bardin e o software Iramuteq. Resultados: A descoberta da infecção realça a incompreensão sobre o adoecimento, o medo, o desespero e a culpa, dimensões individuais e coletivas que apontam para o baixo conhecimento sobre o Papilomavírus Humano. Considerações finais: Faz-se necessário a implementação de políticas públicas para minimizar os riscos, pelo conhecimento e enfrentamento às infecções sexualmente transmissíveis, bem como estratégias de promoção da saúde e decisões compartilhadas para o processo de mudança de comportamento em adolescentes e adultas jovens.

ABSTRACT Objective: To know the vulnerabilities experienced by adolescents and young adults infected by the Human Papillomavirus attended at a reference center in Feira de Santana - Bahia. Method: Qualitative study, carried out with a semi-structured interview with 20 adolescents and young adults, from November 2020 to February 2021. For data analysis, the Content Analysis proposed by Bardin and the software Iramuteq were used. Results: The discovery of the infection highlights the misunderstanding about illness, fear, despair and guilt, individual and collective dimensions that point to little knowledge about the Human Papillomavirus. Final considerations: It is necessary to implement public policies to minimize risks, through knowledge and confrontation of sexually transmitted infections, as well as health promotion strategies and shared decisions for the process of behavior change in adolescents and young adults.

RESUMEN Objetivo: Conocer las vulnerabilidades vividas por adolescentes y adultos jóvenes infectados por el Virus del Papiloma Humano atendidos en un centro de referencia en Feira de Santana - Bahia. Método: Estudio cualitativo, realizado con entrevista semiestructurada a 20 adolescentes y adultos jóvenes, de noviembre de 2020 a febrero de 2021. Para el análisis de datos se utilizó el Análisis de Contenido propuesto por Bardin y el software Iramuteq. Resultados: El descubrimiento de la infección destaca la incomprensión sobre la enfermedad, el miedo, la desesperación y la culpa, dimensiones individuales y colectivas que apuntan al bajo conocimiento sobre el Virus del Papiloma Humano. Consideraciones finales: Es necesario implementar políticas públicas para la minimización de riesgos, a través del conocimiento y enfrentamiento de las infecciones de transmisión sexual, así como estrategias de promoción de la salud y decisiones compartidas para el proceso de cambio de comportamiento en adolescentes y adultos jóvenes.

https://doi.org/10.1590/1983-1447.2022.20210228.en

Spatial patterns of fetal mortality: scenario before and after the implementation of surveillance
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Silva, Maria Carolina Lyra da

; Oliveira, Conceição Maria de

; Silva, Amanda Priscila de Santana Cabral

; Bonfim, Cristine Vieira do

Revista Brasileira de Saúde Materno Infantil

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jul 2021, Volume 21 N. 3 Pages 889 - 895

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Objetivos: analisar a distribuição espacial dos óbitos fetais, antes e após a implantação da vigilância deste evento, na cidade do Recife, Nordeste do Brasil. Métodos: estudo ecológico utilizando os 94 bairros existentes como unidade de análise espacial. Foram calculados os coeficientes de mortalidade fetal brutos e empregado o estimador bayesiano empírico local para a suavização de flutuações aleatórias desses coeficientes. A autocorrelação espacial foi analisada com a utilização do Índice de Moran Global e agregados espaciais foram identificados pelo Moran Local. Resultados: foram registrados 1.356 óbitos fetais (coeficiente de mortalidade de 9,9 óbitos por mil nascimentos) e 1.325 óbitos fetais (coeficiente de 9,6 óbitos por mil nascimentos), nos períodos anterior e posterior à implantação da vigilância do óbito, respectivamente. Houve diferença estatisticamente significante (p<0,05) entre os índices de Moran Global (I) dos períodos anterior (I=0,6) e posterior (I=0,4) à implantação da vigilância. Identificaram-se agregados espaciais nos bairros das regiões Norte e Leste da cidade, como maior risco de mortalidade fetal. Conclusão: a análise espacial apontou áreas que persistem como prioritárias para o planejamento de ações de vigilância e assistência à saúde para a redução da mortalidade fetal.

Abstract Objectives: to analyze the spatial distribution of fetal deaths before and after implementation of surveillance for this event in the city of Recife, in the Northeast Region of Brazil. Methods: an ecological study whose spatial analysis unit was the 94 neighborhoods. The gross fetal mortality rates were calculated and the local empirical Bayesian estimator was adopted to smooth out random fluctuations of such rates. To analyze the spatial autocorrelation, the Global Moran’s Index was used, and spatial clusters were located by the Local Moran’s Index. Results: during the period before implementation of death surveillance, 1,356 fetal deaths were reported, a coefficient of 9.9 deaths per thousand births. During the second period, 1,325 fetal deaths occurred, a coefficient of 9.6 deaths per thousand births. The Global Moran’s Indexes (I) were I=0.6 and I=0.4 for the first and second periods, respectively, with statistical significance (p<0.05). For both periods analyzed, spatial clusters of high-risk neighborhoods were identified in the northern and eastern regions of the city. Conclusion: the spatial analysis indicated areas that persist as priorities for planning surveillance and health assistance actions to reduce fetal mortality.

https://doi.org/10.1590/1806-93042021000300009 69 downloads

Factors associated with neonatal death among adolescent mothers
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Araujo, Viviane Maria Gomes de

; Silva, Juliana Santana da

; Silva, Carolina Luiza Bezerra

; Costa, Maria do Socorro de Oliveira

; Costa, Emília Chagas

; Frias, Paulo Germano

; Barros, Mauro Virgílio Gomes de

; Correia Junior, Marco Aurélio de Valois

Revista Brasileira de Saúde Materno Infantil

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jul 2021, Volume 21 N. 3 Pages 805 - 815

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Objetivos: analisar fatores associados ao óbito neonatal de mães adolescentes. Métodos: estudo transversal de base hospitalar em instituição terciária, randomizado, com dados do Sistema de Informação sobre Nascidos Vivos (Sinasc), Sistema de Informação sobre Mortalidade (SIM) e de prontuários. A população do estudo compreendeu 1.341 adolescentes de 10 a 19 anos assistidos durante o parto na instituição entre 2012 a 2016. As variáveis independentes foram características sociodemográficas, assistenciais, relacionadas ao pré-natal, parto, nascimento e internamento do recém-nascido, além das características do bebê. Realizou-se análise de regressão logística para avaliar a associação entre óbito neonatal e variáveis explanatórias. Resultados: os fatores associados ao óbito foram municípios do interior e outros estados (OR=2,68; IC95%=1,24-5,81), índices de apgar menor que sete no 1º(OR=9,52; IC95%=4,15-21,81) e no 5º(OR=4,17; IC95%=1,53-11,34) minutos de vida e peso ao nascer menor que 999g (OR=13,37; IC95%= 3,64-49,04) e entre 1500 a 2499g (OR=3,43; IC95%= 1,37-8,58). Conclusões: o apgar e o baixo peso ao nascer se associaram ao óbito neonatal de mães adolescentes além da procedência de municípios do interior e outros estados. Estes achados mostram além de riscos clássicos, potenciais dificuldade das adolescentes em dispor de assistência nos seus lugares de residência. Para reduzir os riscos há necessidade de reorganizar a rede assistencial materno-infantil e garantir uma rede de proteção social a estas meninas.

Abstract Objectives: to analyze factors associated with neonatal death among adolescent mothers. Methods: randomized hospital-based cross-sectional study in a tertiary institution,, data from the Sistema de Informação sobre Nascidos Vivos (Sinasc), (Live Birth Information System), Sistema de Informação sobre Mortalidade (SIM) (Mortality Information System), and medical records. The study population was comprised of 1,341 adolescents aged 10-19 who had assisted childbirth at the institution between 2012 to 2016. The independent variables were sociodemographic characteristics, care, prenatal, childbirth, birth, and newborn’s hospitalization, as well as the baby’s characteristics. Logistic regression analysis was carried out to assess the association between neonatal death and explanatory variables. Results: the factors associated with death were from the countryside or other States (OR=2.68; CI95% =1.24-5.81), Apgar scores lower than 7 in the 1st (OR= 9.52; CI95% = 4.15-21.81) and the 5th (OR=4.17; CI95%=1.53-11.34) minutes of life; and birth weight less than 999g (OR=13.37; CI95% =3, 64-49.04) and between 1,500 to 2,499g (OR=3.43; CI95%=1.37-8.58). Conclusions: apgar and low birth weight were associated with the neonatal death among adolescent mothers, as well as the fact they come from the countryside and other States. These findings show, in addition to classic risks, potential difficulties for adolescents in having access to healthcare services in their hometown. To reduce the risks, there is a need for restructuring the maternal and child healthcare network and ensure a social protection network for these girls.

https://doi.org/10.1590/1806-93042021000300005 141 downloads

Atypical presentation of COVID-19 with multi-organ involvement in a pediatric patient
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Martins-Filho, Paulo Ricardo

; Tavares, Carolina Santos

; Oliveira, Sheila Jaqueline Gomes dos Santos

; Santos, Patrícia Carla Nascimento dos

; Rodrigues, Marlon Brandam Brandão

; Santos, Victor Santana

; Leite, Débora Cristina Fontes

Revista da Associação Médica Brasileira

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jun 2021, Volume 67 N. 6 Pages 785 - 788

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/1806-9282.20200969 36 downloads

Time-restricted feeding in dark phase of circadian cycle and/or westernized diet cause mixed hyperlipidemia in rats
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Alves, Eryka Maria dos Santos

; Melo, Nathalia Caroline de Oliveira

; Costa, Ana Carolina Oliveira

; Barbosa, Humberto de Moura

; Araújo, Nathália Cavalcanti de Morais

; Muniz, Gisélia de Santana

; Nascimento, Elizabeth do

Nutrición Hospitalaria

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apr 2021, Volume 38 N. 2 Pages 281 - 289

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract Background: the dietary pattern that characterizes western diet is strongly associated with metabolic diseases and excess weight, as well as chronic illnesses. Misaligned feeding schedules can lead to or aggravate the development of such conditions. Aim: this study evaluated the influence of dietary composition and/or time-restricted feeding on the anthropometric and biochemical profile of adult rats. Methods: forty male rats, at 60 days of life, were divided into the following groups: Control (C), Restricted Control (RC), Westernized (W), and Restricted Westernized (RW). Results: westernized groups, in spite of a low energy intake (C = 5399 ± 401.2 kcal; RC = 4279.0 ± 476.2 kcal; W = 4302 ± 619.8 kcal; RW = 4081.0 ± 404.4 kcal, p < 0.001), had a higher body weight (C = 404.6 ± 39.1 g; RC = 335.1 ± 36.5 g; W = 488.9 ± 51.2 g; RW = 438.8 ± 36.5 g, p < 0.001) as compared to their paired controls (RC and C) — around 30 % and 20 % more for RW and W, respectively. The westernized diet caused glucose intolerance and mixed hyperlipidemia, characterized by higher concentrations of cholesterol (C = 40.8 ± 7.4 mg/dL; RC = 76.7 ± 10.8 mg/dL; W = 61.3 ± 20.2 mg/dL; RW = 42.2 ± 8.2 mg/dL), LDLc (C = 17.4 ± 7.5 mg/dL; RC = 38.8 ± 7.2 mg/dL ; W = 45.3 ± 15.8 mg/dL; RW = 11.0 ± 5.8 mg/dL), and triacylglycerol (C = 45.2 ± 15.0 mg/dL; RC = 73.2 ± 21.5 mg/dL ; W = 83.6 ± 23.4 mg/dL; RW = 57.5 ± 13.6 mg/dL) in the serum (p < 0.05). Conclusion: the effect of time-restricted feeding on body weight was strongly dependent on diet composition. The glucose tolerance test showed an influence of the circadian cycle phase. Mixed hyperlipidemia varied according to the presence of westernized diet and/or time-restricted food.

Resumen Antecedentes: el patrón dietético que caracteriza a la dieta occidental está fuertemente asociado con las enfermedades metabólicas, así como con el sobrepeso y las enfermedades crónicas. Los horarios de alimentación desorganizados pueden conducir o agravar el desarrollo de tales trastornos. Objetivo: este estudio evaluó la influencia de la composición dietética y/o la alimentación restringida en el perfil antropométrico y bioquímico de ratas adultas. Métodos: cuarenta ratas macho, a los 60 días de vida, se dividieron en los seguientes grupos: control (C); control restringido (RC); occidentalizado (W) y occidentalizado restringido (RW). Resultados: los grupos occidentalizados, a pesar de la baja ingesta energética (C = 5399 ± 401,2 kcal; RC = 4279,0 ± 476,2 kcal; W = 4302 ± 619,8 kcal; RW = 4081,0 ± 404,4 kcal, p < 0,001), tuvieron mayor peso corporal (C = 404,6 ± 39,1 g; RC = 335,1 ± 36,5 g; W = 488,9 ± 51,2 g; RW = 438,8 ± 36,5 g, p < 0,001) que los respectivos grupos de control (RC y C): alrededor de un 30 % y un 20 % más para RW y W, respectivamente. La dieta occidentalizada provocó intolerancia a la glucosa e hiperlipidemia mixta, caracterizada por una mayor concentración de colesterol (C = 40,8 ± 7,4 mg/dL; RC = 76,7 ± 10,8 mg/dL; W = 61,3 ± 20,2 mg/dL; RW = 42,2 ± 8,2 mg/dL), cLDL (C = 17,4 ± 7,5 mg/dL; RC = 38,8 ± 7,2 mg/dL; W = 45,3 ± 15,8 mg/dL; RW = 11,0 ± 5,8 mg/dL) y triacilglicerol (C = 45,2 ± 15,0 mg/dL; RC = 73,2 ± 21,5 mg/dL; W = 83,6 ± 23,4 mg/dL; RW = 57,5 ± 13,6 mg/dL) en el suero (p < 0,05). Conclusión: el efecto de la alimentación restringida en el tiempo sobre el peso corporal fue muy dependiente de la composición de la dieta. La prueba de tolerancia a la glucosa mostró la influencia de la fase del ciclo circadiano. La hiperlipidemia mixta varió según la presencia de la dieta occidentalizada y/o la comida con restricción de tiempo.

https://doi.org/10.20960/nh.03432

10.

Hematopoietic stem cell transplantation for systemic sclerosis: Brazilian experience
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Henrique-Neto, Álvaro

; Vasconcelos, Marianna Yumi Kawashima

; Dias, Juliana Bernardes Elias

; Moraes, Daniela Aparecida de

; Gonçalves, Maynara Santana

; Zanin-Silva, Djúlio César

; Zucoloto, Talita Graminha

; Oliveira, Marília de Fátima Cirioli de

; Dotoli, Giuliana Martinelli

; Weffort, Luiz Fernando

; Leopoldo, Vanessa Cristina

; Oliveira, Maria Carolina

Advances in Rheumatology

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2021, Volume 61 elocation 9

Abstract: En | Text: En | PDF: En

Abstract Background: In the past 20 years, hematopoietic stem cell transplantation (HSCT) has been investigated as treatment for systemic sclerosis (SSc). The goal of HSCT is to eradicate the autoreactive immune system, which is replaced by a new immune repertoire with long-lasting regulation and tolerance to autoantigens. Here, we describe the clinical outcomes of severe and refractory SSc patients that underwent HSCT at a single Brazilian center. Patients and methods: This is a longitudinal and retrospective study, including 70 adult SSc patients, with an established diagnosis of SSc, and who underwent autologous HSCT from 2009 to 2016. The procedure included harvesting and cryopreservation of autologous hematopoietic progenitor cells, followed by administration of an immunoablative regimen and subsequent infusion of the previously collected cells. Patients were evaluated immediately before transplantation, at 6 months and then yearly until at least 5-years of post-transplantation follow-up. At each evaluation time point, patients underwent clinical examination, including modified Rodnan's skin score (mRSS) assessment, echocardiography, high-resolution computed tomography of the lungs and pulmonary function. Results: Median (range) age was 35.9 (19–59), with 57 (81.4%) female and median (range) non-Raynaud's disease duration of 2 (1–7) years. Before transplantation, 96% of the patients had diffuse skin involvement, 84.2%, interstitial lung disease and 67%, positive anti-topoisomerase I antibodies. Skin involvement significantly improved, with a decline in mRSS at all post-transplantation time points until at least 5-years of follow-up. When patients with pre-HSCT interstitial lung disease were analyzed, there was an improvement in pulmonary function (forced vital capacity and diffusing capacity of lung for carbon monoxide) over the 5-year follow-up. Overall survival was 81% and progression-free survival was 70.5% at 8-years after HSCT. Three patients died due to transplant-related toxicity, 9 patients died over follow-up due to disease reactivation and one patient died due to thrombotic thrombocytopenic purpura. Conclusions: Autologous hematopoietic progenitor cell transplantation improves skin and interstitial lung involvement. These results are in line with the international experience and support HSCT as a viable therapeutic alternative for patients with severe and progressive systemic sclerosis.

https://doi.org/10.1186/s42358-021-00166-8 378 downloads

11.

Identification and characterisation of SARS-CoV-2 and Human alphaherpesvirus 1 from a productive coinfection in a fatal COVID-19 case
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Herlinger, Alice Laschuk

; Monteiro, Fábio Luís Lima

; D’arc, Mirela

; Moreira, Filipe Romero Rebello

; Westgarth, Harrison James

; Galliez, Rafael Mello

; Mariani, Diana

; da Costa, Luciana Jesus

; de Almeida, Luiz Gonzaga Paula

; Voloch, Carolina Moreira

; Melo, Adriana Suely de Oliveira

; Aguiar, Renato Santana de

; dos Santos, André Felipe Andrade

; Castiñeiras, Terezinha Marta Pereira Pinto

; de Vasconcelos, Ana Tereza Ribeiro

; João Filho, Esaú Custódio

; Escosteguy, Claudia Caminha

; Ferreira Junior, Orlando da Costa

; Tanuri, Amilcar

; Higa, Luiza Mendonça

Memórias do Instituto Oswaldo Cruz

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2021, Volume 116 elocation e210176

Abstract: En | Text: En | PDF: En

BACKGROUND During routine Coronavirus disease 2019 (COVID-19) diagnosis, an unusually high viral load was detected by reverse transcription real-time polymerase chain reaction (RT-qPCR) in a nasopharyngeal swab sample collected from a patient with respiratory and neurological symptoms who rapidly succumbed to the disease. Therefore we sought to characterise the infection. OBJECTIVES We aimed to determine and characterise the etiological agent responsible for the poor outcome. METHODS Classical virological methods, such as plaque assay and plaque reduction neutralisation test combined with amplicon-based sequencing, as well as a viral metagenomic approach, were performed to characterise the etiological agents of the infection. FINDINGS Plaque assay revealed two distinct plaque phenotypes, suggesting either the presence of two severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains or a productive coinfection of two different species of virus. Amplicon-based sequencing did not support the presence of any SARS-CoV-2 genetic variants that would explain the high viral load and suggested the presence of a single SARS-CoV-2 strain. Nonetheless, the viral metagenomic analysis revealed that Coronaviridae and Herpesviridae were the predominant virus families within the sample. This finding was confirmed by a plaque reduction neutralisation test and PCR. MAIN CONCLUSIONS We characterised a productive coinfection of SARS-CoV-2 and Herpes simplex virus 1 (HSV-1) in a patient with severe symptoms that succumbed to the disease. Although we cannot establish the causal relationship between the coinfection and the severity of the clinical case, this work serves as a warning for future studies focused on the interplay between SARS-CoV-2 and HSV-1 coinfection and COVID-19 severity.

https://doi.org/10.1590/0074-02760210176

12.

Registro Multicêntrico de Takotsubo (REMUTA) – Aspectos Clínicos, Desfechos Intra-Hospitalares e Mortalidade a Longo Prazo
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Almeida Junior, Gustavo Luiz Gouvêa de

; Mansur Filho, João

; Albuquerque, Denilson Campos de

; Xavier, Sergio Salles

; Pontes, Álvaro

; Gouvêa, Elias Pimentel

; Martins, Alexandre Bahia Barreiras

; Nunes, Nágela S. V.

; Carestiato, Lilian Vieira

; Petriz, João Luiz Fernandes

; Santos, Armando Márcio Gonçalves

; Bandeira, Bruno Santana

; Abufaiad, Bárbara Elaine de Jesus

; Pacheco, Luciana da Camara

; Oliveira, Maurício Sales de

; Ribeiro Filho, Paulo Eduardo Campana

; Sampaio, Pedro Paulo Nogueres

; Duque, Gustavo Salgado

; Camillis, Luiz Felipe

; Marques, André Casarsa

; Lourenço Jr, Francisco Carlos

; Palazzo, José Ricardo

; Costa, Cláudio Ramos da

; Silva, Bibiana Almeida da

; Zukowski, Cleverson Neves

; Garcia, Romulo Ribeiro

; Zonis, Fernanda de Carvalho

; Paula, Suzana Andressa Morais de

; Ferrari, Carolina Gravano Ferraz

; Rangel, Bruno Soares da Silva

; Ferreira, Roberto Muniz

; Mendes, Bárbara Ferreira da Silva

; Castro, Isabela Ribeiro Carvalho de

; Souza, Leonardo Giglio Gonçalves de

; Araújo, Luiz Henrique dos Santos

; Giani, Alexandre

Arquivos Brasileiros de Cardiologia

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aug 2020, Volume 115 N. 2 Pages 207 - 216

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento A síndrome de takotsubo (takotsubo) é uma forma de cardiomiopatia adquirida. Dados nacionais sobre essa condição são escassos. O Registro REMUTA é o primeiro a incluir dados multicêntricos dessa condição no nosso país. Objetivo Descrever as características clínicas, prognóstico, tratamento intra-hospitalar e mortalidade hospitalar e em 1 ano de seguimento. Métodos Estudo observacional, retrospectivo, tipo registro. Incluídos pacientes internados com diagnóstico de takotsubo ou que desenvolveram esta condição durante internação por outra causa. Os desfechos avaliados incluíram fator desencadeador, análise dos exames, uso de medicações, complicações e óbito intra-hospitalar e em 1 ano de seguimento. O nível de significância adotado foi de 5%. Resultados Foram incluídos 169 pacientes, em 12 centros no Estado do Rio de Janeiro. A idade média foi de 70,9 ± 14,1 anos e 90,5% eram do sexo feminino; 63% dos casos foram de takotsubo primário e 37% secundário. Troponina I foi positiva em 92,5% dos pacientes e a mediana de BNP foi de 395 (176,5; 1725). Supradesnivelamento do segmento ST esteve presente em 28% dos pacientes. A fração de ejeção do ventrículo esquerdo teve mediana de 40 (35; 48)%. Observamos taxa de 25,7% de ventilação mecânica invasiva e 17,4% de choque. Suporte circulatório mecânico foi utilizado em 7,7%. A mortalidade intra-hospitalar foi de 10,6% e a mortalidade ao final de 1 ano foi de 16,5%. Takotsubo secundário e choque cardiogênico foram preditores independentes de mortalidade. Conclusão Os resultados do REMUTA mostram que takotsubo não se trata de patologia benigna como se pensava, especialmente no grupo de takotsubo secundário que acarreta elevada taxa de complicações e de mortalidade. (Arq Bras Cardiol. 2020; 115(2):207-216)

Abstract Background Takotsubo syndrome (TTS) is an acquired form of cardiomyopathy. National Brazilian data on this condition are scarce. The Takotsubo Multicenter Registry (REMUTA) is the first to include multicenter data on this condition in Brazil. Objective To describe the clinical characteristics, prognosis, in-hospital treatment, in-hospital mortality, and mortality during 1 year of follow-up. Methods This is an observational, retrospective registry study including patients admitted to the hospital with diagnosis of TTS and patients admitted for other reasons who developed this condition. Evaluated outcomes included triggering factor, analysis of exams, use of medications, complications, in-hospital mortality, and mortality during 1 year of follow-up. A significance level of 5% was adopted. Results The registry included 169 patients from 12 centers in the state of Rio de Janeiro, Brazil. Mean age was 70.9 ± 14.1 years, and 90.5% of patients were female; 63% of cases were primary TTS, and 37% were secondary. Troponin I was positive in 92.5% of patients, and median BNP was 395 (176.5; 1725). ST-segment elevation was present in 28% of patients. Median left ventricular ejection fraction was 40 (35; 48)%. We observed invasive mechanical ventilation in 25.7% of cases and shock in 17.4%. Mechanical circulatory support was used in 7.7%. In-hospital mortality was 10.6%, and mortality at 1 year of follow-up was 16.5%. Secondary TTS and cardiogenic shock were independent predictors of mortality. Conclusion The results of the REMUTA show that TTS is not a benign pathology, as was once thought, especially regarding the secondary TTS group, which has a high rate of complications and mortality. (Arq Bras Cardiol. 2020; 115(2):207-216)

https://doi.org/10.36660/abc.20190166 1217 downloads

13.

Influência da cardiopatia congênita no desenvolvimento neuropsicomotor de lactentes
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Paula, Ítalo Ribeiro

; Oliveira, Janaína Carla Silva

; Batista, Ana Carolina Ferreira

; Nascimento, Lizandra Caroline Santana

; Araújo, Lúcio Borges de

; Ferreira, Márcia Berbert

; Gomes, Miria Benincasa

; Azevedo, Vivian Mara Gonçalves de Oliveira

Fisioterapia e Pesquisa

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jan 2020, Volume 27 N. 1 Pages 41 - 47

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

RESUMO As cardiopatias congênitas (CC) estão entre as principais causas de morbimortalidade na primeira infância e os lactentes com essa condição podem apresentar atrasos no desenvolvimento neuropsicomotor (DNPM). O objetivo deste estudo foi avaliar a influência da CC no DNPM de lactentes. Trata-se de um estudo observacional com avaliação do desenvolvimento neuropsicomotor realizada pela Bayley Scales of Infant and Toddler Development (BSID-III). As condições maternas e clínicas dos lactentes foram verificadas no relatório de alta médica e na caderneta de saúde da criança, e a condição socioeconômica das famílias pelo Critério da Classificação Econômica Brasil. Para associar as variáveis clínicas e o DNPM foram utilizados o coeficiente de correlação de Spearman e o teste de razão de verossimilhança. Foram avaliados 18 lactentes, com predomínio do sexo feminino (72,2%). A maioria das mães (47,1%) possuía ensino médio completo ou superior incompleto, com média da idade de 27,2±5,5 anos. Houve correlação das escalas do BSID-III com as variáveis quantitativas analisadas: escala motora com o peso (p=0,02 e r=0,54) e com uso de oxigenoterapia (p=0,009 e r=−0,591); já para as variáveis qualitativas as associações foram entre: escala motora e condição socioeconômica (p=0,015), escala motora e comunicação interatrial - (CIA) (p=0,023) e escala da linguagem e CIA (p=0,038). A CC influenciou o DNPM, principalmente no aspecto motor. Além disso peso, diagnóstico de CIA, uso de oxigenoterapia e condição socioeconômica foram considerados como principais fatores de risco para o atraso no DNPM.

ABSTRACT Congenital heart defects (CHD) are among the main causes of morbidity and mortality in infants who has this impairment may present delays in neuropsychomotor development (NPMD). This study assesses the influence of CHD on NPMD of infants. This is an observational study assessing neuropsychomotor development performed by Bayley Scales of Infant and Toddler Development - BSID-III. The Brazilian Economic Classification Criteria was used to verify the socioeconomic status of the families and also the maternal and infants’ clinical conditions were verified in the medical discharge report and in the child’s health handbook. For the association between the quantitative and qualitative variables with the NPMD, the Spearman’s correlation coefficient and the likelihood ratio test were used. A total of 18 infants were assessed, with a predominance of females (72.2%). Most mothers (47.1%) had complete high school or incomplete higher education, with a mean age of 27.2±5.5 years. There was a correlation between the BSID-III scales and the quantitative variables analyzed: motor scale with weight (p=0.02 and r=0.54) and oxygen therapy (p=0.009 and r=−0.591); besides that, the qualitative variables correlation were: motor scale and socioeconomic condition (p=0.015), motor scale and Interatrial Communication - IAC (p=0.023) and language with IAC scales (p=0.038). CHD influences the delay of NPMD, mainly for motor aspect. Furthermore, weight, diagnosis of IAC, use of oxygen therapy and socioeconomic status were considered the main risk factors for the delay in NPMD.

RESUMEN Las cardiopatías congénitas (CC) se encuentran entre las principales causas de morbimortalidad en la primera infancia, y los lactantes con esta afección pueden tener retrasos en el desarrollo neuropsicomotor (DNPM). El presente estudio tuvo el objetivo de evaluar la influencia de las CC en el DNPM de los lactantes. Este es un estudio observacional en el cual se evaluó el desarrollo neuropsicomotor utilizando la Bayley scales of infant and toddler development (BSID-III). Las condiciones maternas y clínicas de los lactantes se obtuvieron en el informe de alta médica y en la libreta de salud del niño, y el estado socioeconómico de las familias en el Criterio de Clasificación Económica de Brasil. Para asociar las variables clínicas y el DNPM, se utilizaron el coeficiente de correlación de Spearman y la prueba de razón de probabilidad. Se evaluaron a 18 lactantes, con un predominio del sexo femenino (72,2%). La mayoría de las madres (47,1%) tenían la secundaria completa o la educación superior incompleta, con una edad promedio de 27,2±5,5 años. Hubo una correlación entre las escalas BSID-III y las variables cuantitativas analizadas: escala motora con el peso (p=0,02 y r=0,54) y con el uso de oxigenoterapia (p=0,009 y r=−0,591); para las variables cualitativas, las asociaciones fueron entre: escala motora y estado socioeconómico (p=0,015), escala motora y comunicación interauricular (CIA) (p=0,023) y escala de lenguaje y CIA (p=0,038). Las CC influyeron en el DNPM, principalmente en el aspecto motor. Además, el peso, el diagnóstico de CIA, el uso de oxigenoterapia y el estado socioeconómico fueron considerados los principales factores de riesgo para el retraso en el DNPM.

https://doi.org/10.1590/1809-2950/18039627012020 3231 downloads

14.

Durometry as an alternative tool to the modified Rodnan's skin score in the assessment of diffuse systemic sclerosis patients: a cross-sectional study
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Oliveira, Marília de Fátima Cirioli de

; Leopoldo, Vanessa Cristina

; Pereira, Karla Ribeiro Costa

; Moraes, Daniela Aparecida de

; Dias, Juliana Bernardes Elias

; Gonçalves, Maynara Santana

; Ramalho, Leandra Naíra Zambelli

; Santos, Bruna Nogueira dos

; Oliveira, Maria Carolina de

; Silveira, Renata Cristina Campos Pereira

Advances in Rheumatology

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2020, Volume 60 elocation 48

Abstract: En | Text: En | PDF: En

Abstract Background The reproducibility and reliability of the modified Rodnan's Skin Score (mRSS) are debated due to investigator-related subjectivity. Here, we evaluate if durometry correlates with mRSS in patients with diffuse systemic sclerosis (SSc). Methods This cross-sectional study was conducted from December 2018 to June 2019, including 58 diffuse SSc patients. Two certified researchers, blind to each other's scores, performed the mRSS, followed by durometry at 17 predefined skin sites. For durometry and mRSS, individual scores per skin site were registered. Durometry and mRSS results measured by each researcher, as well as scores from different researchers, were compared. Skin thickness measurements from forearm skin biopsies were available in a subset of the patients, for comparisons. Statistical analyses included Cohen's Kappa Coefficient, Intraclass Correlation Coefficient, Kendall's Coefficient and Spearman's test. Results Mean (standard deviation, SD) patient age was 44.8 (12.9) years, and 88% were female. Inter-rater agreement varied from 0.88 to 0.99 (Intraclass correlation coefficient) for durometry, and 0.54 to 0.79 (Cohen's Kappa coefficient) for mRSS, according to the specific evaluated sites. When data were compared with skin thickness assessed in forearm biopsies, durometry correlated better with skin thickness than mRSS. Conclusion Durometry may be considered as an alternative method to quantify skin involvement in patients with diffuse SSc. The strong inter-rater agreement suggests that the method may be useful for the assessment of patients by multiple researchers, as in clinical trials.

https://doi.org/10.1186/s42358-020-00152-6 273 downloads

15.

CONSTRUÇÃO DE CARTILHA EDUCATIVA SOBRE CUIDADOS COM CRIANÇAS FRENTE À PANDEMIA COVID-19: RELATO DE EXPERIÊNCIA
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Silva, Rita de Cássia Ramires da

; Raimundo, Adrielly Cristina de Lima

; Santos, Camila Thayná Oliveira dos

; Vieira, Ana Carolina Santana

Revista Baiana de Enfermagem

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2020, Volume 34 elocation e37173

Abstract: En Es Pt | Text: En Es Pt | PDF: En | PDF: Es | PDF: Pt

Objective to report the experience of producing and disseminating technology as an educational booklet, to inform and guide about the childcare before the COVID-19 pandemic. Methodology this is an experience report on the construction of an online and free booklet, targeting children from two years of age, parents or guardians and the community. The construction was carried out by nursing students in May 2020. Results the construction of the booklet allowed integrating researchers, educators and the community. The product was widely disseminated and there was a positive return of the provided guidelines in a playful, reliable and accessible way. Conclusion the experience allowed for the dissemination of safe information, with reliable sources and scientific basis, in addition to integrating researchers into the community. It expanded the extramural bond of the University, an indispensable factor for working with the population.

Objetivo informar la experiencia de la producción y difusión de tecnología, en forma de folleto educativo, para informar y orientar sobre el cuidado de los niños frente a la pandemia de COVID-19. Metodología este es un informe de experiencia sobre la construcción de un folleto en línea y gratuito, dirigido a niños a partir de dos años de edad, padres o tutores y la comunidad. La construcción fue llevada a cabo por estudiantes de enfermería en mayo de 2020. Resultados la construcción del folleto permitió la integración entre investigadores, educadores y la comunidad. El producto fue ampliamente difundido y hubo un retorno positivo de las orientaciones anteriores de una manera lúdica, fiable y accesible. Conclusión la experiencia permitió la difusión de información segura, con fuentes fiables y base científica, además de la integración de los investigadores en la comunidad. Amplió el vínculo extramuros de la Universidad, un factor indispensable para trabajar con la población.

Objetivo relatar a experiência da produção e divulgação de tecnologia, em forma de cartilha educativa, para informar e orientar sobre os cuidados com as crianças frente à pandemia da COVID-19. Metodologia trata-se de relato de experiência sobre a construção de uma cartilha on-line e gratuita, tendo como público-alvo crianças a partir de dois anos de idade, os pais ou responsáveis e a comunidade. A construção foi realizada por estudantes de enfermagem, em maio de 2020. Resultados a construção da cartilha possibilitou a integração entre pesquisadoras, educadores e comunidade. O produto foi amplamente divulgado e houve retorno positivo das orientações passadas de forma lúdica, fidedignas e acessíveis. Conclusão a experiência oportunizou a disseminação de informações seguras, com fontes confiáveis e embasamento científico, além da integração das pesquisadoras à comunidade. Ampliou o vínculo extramuros da Universidade, fator imprescindível para atuação junto à população.

https://doi.org/10.18471/rbe.v34.37173 303 downloads

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