ABSTRACT Background: The pathogenesis of infection triggered by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been intensively investigated, constituting a challenge on a global scale. It is known that the effectiveness and magnitude of both innate and acquired immune responses to SARS-CoV-2 infection determine the severity of the clinical presentation. Literature on the evolution of SARS-CoV-2 infection in patients with X-linked agammaglobulinemia is still scarce. Objective: To report the spectrum of clinical manifestations associated with SARS-CoV-2 infection in patients with X-linked followed in a tertiary hospital. Methods: This is an observational retrospective study of patients with X-linked agammaglobulinemia with SARS-CoV-2 infection diagnosed between March 2020 and July 2022. Results: Among 13 patients under follow-up, nine patients were included, with a mean age of 32 ± 6.1 years. Two patients reported a second SARS-CoV-2 infection during the study. All patients were on polyvalent immunoglobulin G replacement therapy. Seven patients presented risk factors for severe COVID-19 disease: bronchiectasis (n=5), insulin-dependent diabetes (n=1), active smoking (n=1), obesity (n=1), cerebrovascular disease (n=1), immunosuppressive therapy (n=1). COVID-19 infection was mild in most patients (asymptomatic infection n=1, mild n=9, moderate n=1). The most frequently affected systems were the upper (n=6) and lower (n=5) respiratory airways, with fever (n=7) and nasal congestion (n=6) being the most frequent manifestations. Bacterial infection was reported in 4 patients. One patient underwent therapy with convalescent plasma, with tolerance and a favorable clinical course. Conclusion: In this series of patients with X-linked agammaglobulinemia, a high prevalence of SARS-CoV-2 infection is reported, highlighting a mild severity outcome in almost all patients.

RESUMO Fundamentos: A patogénese da infeção por SARS-CoV-2 tem sido extensamente investigada, constituindo um desafio à escala global. É sabido que a eficiência da resposta da imunidade inata e adquirida à infeção por SARS-CoV-2 condiciona a gravidade da apresentação clínica. É ainda escassa a literatura sobre a evolução da infeção por SARS-CoV-2 nos doentes com agamaglobulinemia ligada ao X. Objetivo: Reportar o espetro de manifestações clínicas associadas à infeção por SARS-CoV-2 em doentes com agamaglobulinemia ligada ao X e sua gravidade. Métodos: Estudo observacional retrospetivo dos doentes com agamaglobulinemia ligada ao X em seguimento num hospital terciário e com infeção por SARS-CoV-2, diagnosticada entre março de 2020 e julho de 2022. Resultados: De um total de 13 doentes em seguimento com agamaglobulinemia ligada ao X, foram incluídos 9, com média de idades de 32±6,1 anos, entre os quais se identificaram 2 doentes com uma segunda infeção por SARS-CoV-2 durante o período em estudo. Todos os doentes estavam sob terapêutica de substituição com imunoglobulina polivalente G. Sete doentes apresentavam fatores de risco para doença COVID-19 grave: bronquiectasias (n=5), diabetes insulinodependente (n=1), tabagismo ativo (n=1), obesidade (n=1), doença cerebrovascular (n=1) e terapêutica imunossupressora (n=1). A infeção associou-se a manifestações clínicas de baixa gravidade na maioria dos doentes (infeção assintomática n=1, ligeira n=9, moderada n=1). Os sistemas mais afetados foram as vias áreas superiores (n=6) e inferiores (n=5), sendo a febre (n=7) e a obstrução nasal (n=6) as manifestações mais frequentes. Registou-se sobreinfeção bacteriana em 4 doentes. Um doente apresentou COVID-19 de gravidade moderada e duração prolongada, possivelmente em relação com comorbilidades médicas, tendo apresentado um curso clínico favorável com a administração de plasma de convalescentes. Conclusão: Reporta-se nesta série de doentes com agamaglobulinemia ligada ao X elevada prevalência de infeção por SARS-CoV-2, destacando-se a evolução de gravidade ligeira na quase totalidade dos doentes.

Resumo A síndrome de quebras de Nijmegen (NBS) é uma doença genética rara que ocorre devido à presença de variantes patogénicas no gene NBN, herdado de forma autossómica recessiva. Esta condição leva à reparação inadequada do DNA e caracteriza-se por imunodeficiência com infeções pulmonares recorrentes, hipersensibilidade à radiação e predisposição para neoplasias, particularmente de origem linfoide. As características fenotípicas principais são a microcefalia grave, que influencia o fenótipo facial, com andar médio da face proeminente e retrognatismo. A perturbação ligeira a moderada do desenvolvimento é frequente e os doentes do sexo feminino geralmente desenvolvem insuficiência ovárica primária. O diagnóstico requer um elevado índice de suspeição e pode ser confirmado por análise genética. São apresentados dois casos de síndrome de quebras de Nijmegen seguidos num hospital terciário.

Abstract Nijmegen breakage syndrome (NBS) is a rare genetic disorder caused by mutations in the NBN gene, which is inherited in an autosomal recessive pattern. The condition results in inadequate DNA repair and is characterized by immunodeficiency with recurrent sinopulmonary infections, increased radiosensitivity, and predisposition to malignancy, particularly of lymphoid origin. The main clinical feature is progressive and severe microcephaly, which affects the facial phenotype, characterized by prominent midface, sloping forehead, and retrognathia. Mild to moderate intellectual impairment is often present and female patients usually develop primary ovarian failure. The diagnosis requires a high index of suspicion and is confirmed by molecular genetic testing. Herein are presented two cases of Nijmegen breakage syndrome followed in a tertiary center.

Abstract Introduction: the Mini Nutritional Assessment Short-Form test (MNA-SF) is valid for malnutrition screening and diagnosis of older adults, but few studies evaluated if it predicts hospital length of stay (LOS) and were conducted in long-term care units. Objective: this study aims to evaluate the criterion and predictive validity of MNA-SF. Methods: a prospective observational study was conducted in older adults from a long-term care unity. MNA Long Form test (MNA-LF) and MNA-SF were applied, at admission and at discharge. Percentage of agreement, kappa and intra-class correlation coefficients (ICC) were determined. Sensitivity and specificity of MNA-SF were calculated. The independent association of MNA-SF with LOS (adjustment for Charlson index, sex, age, education) was assessed by Cox regression analysis [results presented as hazard ratio (HR) and 95 % confidence intervals (CI)]. Results: this sample is composed of 109 older adults (62.4 % women), aged 66-102 years. According to MNA-SF at admission, 7.3 % of participants presented normal nutrition status, 55.1 % were at risk of malnutrition and 37.6 % were malnourished. Agreement, kappa and ICC were 83.5 %, 0.692 and 0.768 at admission, and 80.9 %, 0.649 and 0.752 at discharge. MNA-SF sensitivities were 96.7 % at admission and 92.9 % at discharge; specificities were 88.9 % and 89.5 %, at admission and at discharge. According to MNA-SF at discharge, being at risk of malnutrition (HR = 0.170, 95 % CI: 0.055-0.528) or malnourished (HR = 0.059, 95 % CI:> 0.016-0.223) lowered the odds of being discharged to home or to usual residence. Conclusions: a high agreement was found between MNA-LF and MNA-SF. MNA-SF revealed high sensitivities and specificities. An independent association was found between risk of malnutrition or malnutrition by MNA-SF and LOS. The use of MNA-SF instead of MNA-LF should be considered in long-term care units given its criterion and predictive validity.

Resumen Introducción: la versión corta del test de valoración nutricional (MNA-SF) es válida para la evaluación del riesgo nutricional y de la desnutrición de los adultos mayores, pero pocos estudios han evaluado si predice la duración de la estancia hospitalaria (LOS) y se realizaron en unidades de cuidados de larga duración. Objetivo: evaluar la validez predictiva y de criterio del MNA-SF. Métodos: se realizó un estudio observacional prospectivo en adultos mayores de una unidad de cuidados de larga duración. Se aplicaron el formulario largo del MNA (MNA-LF) y el MNA-SF al ingreso y al alta. Se determinó el porcentaje de concordancia, kappa y coeficientes de correlación interclase (CCI). Se calcularon la sensibilidad y la especificidad del MNA-SF. Se evaluó la asociación independiente del MNA-SF con la LOS (ajustada por: índice de Charlson, sexo, edad y educación) mediante análisis de regresión de Cox (resultados: hazard ratio [HR] e intervalos de confianza [IC] del 95 %). Resultados: esta muestra está compuesta por 109 adultos mayores (62,4 % mujeres), con edades de 66-102 años. Según el MNA-SF al ingreso, el 7,3 % de los participantes estaban bien nutridos, el 55,1 % estaban en riesgo nutricional y el 37,6 % estaban desnutridos. La concordancia, kappa y CCI fueron del 83,5 %, del 0,692 y del 0,768 al ingreso y del 80,9 %, del 0,649 y del 0,752 al alta. Las sensibilidades del MNASF fueron de 96,7 % al ingreso y de 92,9 % al alta; las especificidades fueron de 88,9 % y de 89,5 %, al ingreso y al alta. Según el MNA-SF al alta, estar en riesgo nutricional (HR = 0,170, IC 95 %: 0,055-0,528) o desnutrido (HR = 0,059, IC 95 %: 0,016-0,223) redujo las probabilidades de ser dado de alta al domicilio o la residencia habitual. Conclusiones: se encontró una gran concordancia entre el MNA-LF y el MNA-SF el MNA-SF reveló grandes sensibilidad y especificidad. Se encontró una asociación independiente entre la desnutrición o el riesgo nutricional por MNA-SF y la LOS. El uso de MNA-SF en lugar de MNA-LF debe considerarse en unidades de cuidados de larga duración dada su validez predictiva y de criterio.

ABSTRACT Patient and Public Involvement (PPI) in research should focus on the engagement of patients/carers in every stage of the research cycle. However, the inconsistent level of education and research experience may compromise this involvement and training and support are recommended. In Portugal, consistent training to empower patients in their health decisions, or to be involved in research is neither available nor adapted for the patients and public. Our main goal is to develop and deliver the first high-quality and comprehensive online educational programme for adult patients with asthma and their carers, based on patients’/carers’ needs and preferences. The project includes four tasks. In Task 1, we will identify and organise the most important topics on asthma and health research, based on the identification of educational needs of adult patients/carers with asthma and the expertise of asthma specialists, using Delphi methodology. In Task 2, we will design and implement a high-quality, free, online self-learning programme based on reliable sources of information and on patients’/carers’ preferences. In Task 3, we will assess its feasibility, satisfaction and impact. Finally, Task 4 will be centred on the management and dissemination. Patients and carers will be actively engaged in all stages of this project as co-researchers, including the writing of this protocol. By the end of this project, we expect to have implemented the first high-quality, free-of-charge, online self-learning programme on asthma and health research, adapted for adult patients with asthma and their carers. It will be available for all patients/carers not only from Portugal but also from all Lusophone countries. This programme will empower patients and carers to increase their knowledge about the disease, develop new skills and have the opportunity to learn about research. Ultimately, it will introduce the knowledge patients/carers need to represent themselves and influence health policies in Portugal successfully.

RESUMO O envolvimento dos doentes e cidadãos na investigação (PPI) deve ocorrer em todas as etapas do ciclo de investigação. No entanto, a inconsistência nos níveis educacionais e na experiência de investigação pode ser um entrave significativo de uma participação ativa. Assim, ações de formação e suporte são recomendadas. Em Portugal, não existe formação específica para capacitar os doentes nas suas decisões de saúde, ou para se envolverem em investigação. O objetivo principal é desenvolver e tornar acessível o primeiro programa educacional online de elevada qualidade para doentes adultos com asma e seus cuidadores, com base nas suas necessidades e preferências. O projeto inclui 4 tarefas. Na tarefa 1 iremos identificar os tópicos mais importantes na área da asma e investigação em saúde, a partir da identificação das necessidades educacionais de doentes/cuidadores e da experiência de especialistas em asma, usando o método Delphi. Na tarefa 2 pretendemos desenhar e implementar um programa de elevada qualidade, gratuito e online, baseado em fontes de informação fiáveis e nas preferências de doentes/cuidadores. Na tarefa 3 vamos disseminar o programa e avaliar a sua exequibilidade, aceitabilidade e impacto. A tarefa 4 irá incidir na gestão e disseminação do projeto. Doentes e cuidadores estarão ativamente envolvidos em todas as tarefas do projeto como coinvestigadores, onde se inclui a escrita deste protocolo. No final deste projeto, esperamos ter implementado o primeiro programa de auto-aprendizagem de elevada qualidade, gratuito e online para a asma e investigação em saúde, adaptado para doentes/cuidadores com asma. Este programa irá capacitar doentes e cuidadores para aumentar o seu conhecimento sobre a doença, para desenvolver novas competências, e será uma oportunidade para aprenderem sobre investigação. Este programa permitirá também a introdução a conhecimentos necessários para doentes e cuidadores se fazerem representar e influenciarem as políticas em saúde em Portugal.

ABSTRACT Chronic kidney disease (CKD) affects more than 10% of the general population worldwide, amounting to more than 800 million individuals. Some important conditions associated with CKD are hypertension, diabetes, dyslipidemia, sedentary lifestyle, and smoking. According to World Health Organization (WHO), regular physical activity helps to prevent and manage non-communicable diseases such as diabetes and hypertension, associated with weight reduction. It is known that a decrease in systolic blood pressure is associated with significant reduction in all causes of mortality and major cardiovascular events. As far as diabetes concerned, beyond first-line medication, healthy lifestyle behaviours should be considered, in which physical activity is included. Training leads to improved skeletal muscle response with increased expression and activity of proteins involved in glucose metabolism and insulin sensitivity. Concerning dyslipidemia, one of the recommended interventions encompasses lifestyle, noting that in patients with low, moderate, or high cardiovascular risk, depending on the LDL value, the treatment involves physical activity and weight loss or its association with pharmacotherapy. CKD patients have some particularities that condition the exercise prescription and the interpretation of its benefits. This review is intended to systematize the importance of exercise in CKD and its determinants.

ABSTRACT INTRODUCTION: Adequate knowledge about food and nutrition can be an important factor in supporting healthier food choices. OBJECTIVES: To evaluate the level of knowledge about food and nutrition of students in the 1st cycle of studies in Health Sciences and its associated factors. METHODOLOGY: An observational cross-sectional study was conducted, which included students of the 1st year of Higher Education in Health Sciences in the 2019/2020 school year (n=150). Data were collected through a structured self-completed questionnaire. Knowledge about food/nutrition was assessed using a scale previously tested in the Portuguese population. Categorical variables were compared using the Chi-square test and quantitative continuous variables with the ANOVA test. RESULTS: The mean percentage of correct answers on the food/nutrition knowledge scale was 77.9% (standard deviation=12.57) (range: 36-100%). When analyzing the factors associated with higher food/nutrition knowledge (>90% correct answers), it was found that this was significantly higher in individuals who reported higher average consumption of fruit and vegetables (4.6 vs. 3.2 portion/ day, p=0.019), particularly soup, among students with more educated mothers (12.7 vs. 11.3 average years of schooling, p=0.039), and among students of the Faculty of Health Sciences compared to those in the Higher School of Health (55.0% vs. 45.0%, p=0.018). CONCLUSIONS: The level of food and nutrition knowledge was relatively high in Health Sciences students. Extreme knowledge was associated with higher consumption of fruit and vegetables, higher maternal education, and the College/School they attended.

RESUMO INTRODUÇÃO: Um nível adequado de conhecimentos sobre alimentação e nutrição pode ser um fator importante para suportar escolhas alimentares mais saudáveis. OBJETIVOS: Avaliar o nível de conhecimento sobre alimentação e nutrição de estudantes do 1.º ciclo de estudos da área das Ciências da Saúde e os seus fatores associados. METODOLOGIA: Foi conduzido um estudo observacional transversal, que incluiu estudantes do 1.º ano do Ensino Superior da área das Ciências da Saúde no ano letivo de 2019/2020 (n=150). Os dados foram recolhidos através de um questionário estruturado de autopreenchimento. Os conhecimentos sobre alimentação/nutrição foram avaliados através de uma escala previamente testada na população portuguesa. As variáveis categóricas foram comparadas através do teste de Qui-quadrado e as variáveis quantitativas contínuas através do teste ANOVA. RESULTADOS: A percentagem média de respostas corretas na escala de conhecimentos sobre alimentação/nutrição foi de 77,9% (desvio-padrão=12,57) (variação 36%-100%). Ao analisarmos os fatores associados a um conhecimento em alimentação/nutrição elevado (>90% respostas corretas), verificou-se que este foi significativamente superior nos indivíduos que reportaram um consumo médio mais elevado de fruta e produtos hortícolas (4,6 vs. 3,2 porções/dia, p=0,019), particularmente de sopa, nos estudantes com mães mais escolarizadas (12,7 vs. 11,3 anos médios de escolaridade, p=0,039) e nos estudantes da Faculdade de Ciências da Saúde comparativamente aos da Escola Superior de Saúde (55,0% vs. 45,0%, p=0,018). CONCLUSÕES: Os estudantes da área das Ciências da Saúde mostraram um nível de conhecimentos sobre alimentação/nutrição relativamente elevado. Um maior conhecimento foi associado a um maior consumo de fruta e produtos hortícolas, uma maior escolaridade da mãe e ao local de Ensino (Faculdade/Escola).

Abstract Objective: The use of parenteral nutrition (PN) formulations that do not contain iodine can contribute to the deficiency of this mineral, potentially leading to hypothyroidism and, ultimately, neurocognitive impairments. This study aimed to evaluate TSH alterations in newborns receiving PN. Methods: Retrospective study of neonatal intensive care unit patients receiving PN for > 15 days. Nutritional, anthropometric, and biochemical variables (TSH, T4, CRP) were analyzed. Hypothyroidism was defined by TSH > 10 mU/L. Results: Two hundred newborns were evaluated [156 (78%) preterm, 31±5 weeks of gestational age, 112 (56%) with very or extremely low birth weight]. The median (IQR) hospital stay was 68 (42-110) days, PN duration was 31 (21-47) days, and 188 (94%) patients also received enteral nutrition. Overall, 143 (71.5%) newborns underwent at least one TSH measurement. The prevalence of hypothyroidism was 10.5%. The Median PN duration in this group was 51 (34-109) days. Among those with hypothyroidism, 10 received Lugol’s solution and six levothyroxine. Thirteen patients received prophylactic Lugol’s solution with a median PN duration of 63 (48-197) days. TSH levels correlated positively with PN duration (r = 0.19, p = .02). Conclusions: The present data suggest that changes in TSH and T4 levels are present in neonates receiving PN for > 15 days, suggesting this population may be at risk for developing hypothyroid-ism. Therefore, the authors suggest that TSH and T4 measurements should be included as routine in neonatal patients receiving PN for > 15 days if PN formulations are not supplemented with iodine, and that iodine supplementation be provided as necessary.

SUMMARY OBJECTIVE: The aim of this study was to measure the reliability, internal consistency, and construct validity of the Kidney Symptom Questionnaire for the Brazilian population. METHODS: This is a cross-cultural adaptation and questionnaire validation study. We included native Brazilians of both sex aged>18 years, as well as hypertensive and/or diabetic patients. All participants were assessed using Screening for Occult Renal Disease, EuroQol 5 Dimensions, 36-Item Short Form Survey, and the Kidney Symptom Questionnaire. We used Spearman’s coefficient (rho) to measure the correlations between the Kidney Symptom Questionnaire and other instruments; Cronbach’s alpha to measure internal consistency; and intraclass correlation coefficient, standard error of measurement, and minimum detectable change to measure test-retest reliability. RESULTS: The sample was formed by 121 adult participants, mostly female, with systemic arterial hypertension and/or diabetes mellitus. We found excellent reliability (intraclass correlation coefficient≥0.978), adequate internal consistency (Cronbach’s alpha≥0.860), and adequate construct validity on the Kidney Symptom Questionnaire domains; besides, we observed significant correlations between the Kidney Symptom Questionnaire and other instruments. CONCLUSION: The Brazilian version of the Kidney Symptom Questionnaire has adequate measurement properties to assess chronic/occult kidney disease in patients who do not require renal replacement therapy.

BACKGROUND The massive use of insecticides in public health has exerted selective pressure resulting in the development of resistance in Aedes aegypti to different insecticides in Venezuela. Between 2010 and 2020, the only insecticides available for vector control were the organophosphates (Ops) fenitrothion and temephos which were focally applied. OBJECTIVES To determine the state of insecticide resistance and to identify the possible biochemical and molecular mechanisms involved in three populations of Ae. aegypti from Venezuela. METHODS CDC bottle bioassays were conducted on Ae. aegypti collected between October 2019 and February 2020 in two hyperendemic localities for dengue in Aragua State and in a malaria endemic area in Bolívar State. Insecticide resistance mechanisms were studied using biochemical assays and polymerase chain reaction (PCR) to detect kdr mutations. FINDINGS Bioassays showed contrasting results among populations; Las Brisas was resistant to malathion, permethrin and deltamethrin, Urbanización 19 de Abril was resistant to permethrin and Nacupay to malathion. All populations showed significantly higher activity of mixed function oxidases and glutathione-S-transferases (GSTs) in comparison with the susceptible strain. The kdr mutations V410L, F1534C, and V1016I were detected in all populations, with F1534C at higher frequencies. MAIN CONCLUSION Insecticide resistance persists in three Ae. aegypti populations from Venezuela even in the relative absence of insecticide application.

Abstract This study aims to evaluate the residual effect of different lipid sources in the diet of Japanese quails (Coturnix japonica) in the rearing phase on the performance and egg quality in the initial phase of egg-laying. In the first stage, 400 Japanese quails aged 21 days were used, being distributed in a completely randomized experimental design, with five treatments and ten replicates of eight birds/replicate Treatments consisted of basal ration (BR) with 2.5% soybean oil; BR with 2.5% corn oil; BR with 2.5% cottonseed oil; BR with 2.5% sunflower oil; and BR with 2.5% canola oil. At 42 days, maintaining the initial design, all quails received a basal ration with soybean oil, in order to evaluate the residual effect of the previous phase on the performance and egg quality in the initial phase of egg-laying (43 - 84 days). The different lipid sources did not affect the performance of quails in the initial phase of production. For egg quality, yolk height, yolk diameter, yolk index, gravity, and Haugh unit (HU) showed better results in the treatment using sunflower oil. There was a residual effect of the use of lipid sources of vegetable origin in the rearing phase diet of Japanese quails on egg quality traits. Lipid sources from soybean, corn, cottonseed, canola, and sunflower seeds can be used as energy sources in the rearing diet of egg-laying quails for not being harmful to their initial performance. The longevity in egg production of quails fed with different lipid sources in the rearing phase was similar.

Resumo A pesquisa foi conduzida com objetivo de avaliar o efeito residual de diferentes fontes lipídicas na dieta de codornas japonesas (Coturnix japonica) na fase de recria sob o desempenho e a qualidade de ovos na fase inicial de postura. Na primeira etapa foram utilizadas 400 codornas japonesas com idade de 21 dias, as aves foram distribuídas em tratamentos seguindo um delineamento inteiramente casualizado com dez repetições, de oito aves, em cinco tratamentos: ração basal (RB) com 2,5% de óleo de soja, RB com 2,5 % de óleo de milho, RB com 2,5% de óleo algodão, RB com 2,5% de óleo de girassol e RB com 2,5% de óleo de canola. Aos 42 dias mantendo o delineamento inicial, todas aves receberam ração basal com óleo de soja, para que fosse avaliado o efeito residual da fase anterior sobre o desempenho e a qualidade dos ovos na fase inicial de postura (43 - 84 dias). As diferentes fontes lipídicas não afetaram o desempenho das aves na fase inicial de produção. Para a qualidade dos ovos, os parâmetros de altura, diâmetro e índice de gema, gravidade e UH foram melhores no tratamento com utilização de óleo de girassol. Houve efeito residual da utilização de fontes lipídicas de origem vegetal na dieta em fase de recria de codornas japonesas sobre as características da qualidade dos ovos. As fontes lipídicas oriundas das sementes de soja, milho, algodão, canola e girassol podem ser utilizadas como ingredientes energéticos na dieta de recria de codornas poedeiras por nâo serem prejudiciais ao desempenho inicial das aves. A longevidade na produção dos ovos das aves alimentadas com diferentes fontes lipídicas na fase de recria foi semelhante.

ABSTRACT Urinary tract infection is an important cause of hospitalization, morbidity and mortality, being responsible for an important fraction of health expenses. The main risk factors are urine flow obstruction, urinary catheters, immunosuppression and diabetes mellitus. We present a case of pyelonephritis that culminated in nephrectomy, finally unravelling an unexpected diagnosis. A 52-year-old male presented in the emergency department with two weeks of pain in the left iliac fossa that irradiated to the lumbar region and cloudy urine. Lab work revealed severe anaemia (4.9 g/dL), inflammatory markers elevation, leucoerythrocyturia, serum creatinine of 4.33 mg/dL and metabolic acidosis. Computed tomography scan showed a swollen left kidney with a staghorn calculus and intraparenchymal hypodensities. After a failed trial of large spectrum antibiotics, he was submitted to left radical nephrectomy with significant clinical improvement. Gross examination showed a markedly dilated pyelocalicial tree, filled with several staghorn calculi and purulent secretions with associated parenchymal atrophy. Histopathologic evaluation revealed exuberant chronic pyelonephritis with an acute inflammatory infiltrate that extended into the perinephric fat and multiple Schistosoma ova, predominantly calcified. The authors describe the case of a severe pyelonephritis with exuberant clinical and imagiological features and rare microbiological findings, suggesting previous genitourinary Schistosomiasis that predisposed to nephrolithiasis and chronic pyelonephritis.

Abstract Objectives To evaluate neonatal autopsy rates at a tertiary hospital in southern Brazil ascertain the level of agreement between premortem and postmortem diagnosis. Methods The authors reviewed all neonatal autopsies performed over a 10-year period and described the percentage of neonates who died and underwent autopsy. The authors tested for agreement between autopsy findings and the cause of death as defined by the neonatologist. Agreement between clinical diagnosis and autopsy findings was classified using the modified Goldman criteria. Additional findings at autopsy were grouped by organ system. Linear regression and multiple comparisons were used for statistical analyses. Results During the study period, 382 neonates died at the Neonatal Intensive Care Unit (NICU). Consent to perform an autopsy was obtained for 73 (19.1%). The complete agreement between autopsy findings and the neonatologist's premortem diagnosis was found in 48 patients (65.8%). Additional findings were obtained at autopsy in 25 cases (34.2%). In 5 cases (6.9%), the autopsy findings contributed to subsequent genetic counseling. Seven autopsies (9.6%) revealed a diagnosis that would have changed patient management if established premortem. The autopsy rate increased by an average of 1.87% each year. Conclusion Despite a high level of agreement between clinical diagnosis and pathological findings, autopsies provided relevant data regarding the cause of death, providing additional clinical information to neonatologists and allowing genetic counseling of family members.

Resumo Introdujo: Delirium é uma disfundo cerebral aguda, associado ao aumento da mortalidade e morbilidade, que atinge frequentemente o paciente adulto/idoso crítico. O enfermeiro tem um papel determinante na preven^áo/controlo do delirium, através da implementa^áo de intervendes náo farmacológicas. Objetivo: Conhecer as intervendes de enfermagem na identificado, prevendo e controlo do delirium no paciente adulto/idoso crítico. Materiais e Métodos: Realizada uma Revisáo Integrativa da Literatura de artigos publicados entre 2014 e 2018, que identificaram intervendes de enfermagem dirigidas a prevendo e controlo do delirium no paciente adulto/idoso crítico. Foram realizadas quatro pesquisas, nas bases de dados electrónicas da EBSCOhost e na B-on. Resultados: Identificaram-se 13 estudos, que apresentam intervendes de enfermagem, maioritariamente náo farmacológicas, para prevendo e controlo do delirium no paciente adulto/idoso crítico. Destas, evidenciam-se intervendes relacionadas com o ambiente, promodo do sono, intervendo terapéutica precoce, avaliacáo cognitiva e orientado dos pacientes, interven^óes sistematizadas em protocolos, bem como intervendes direcionadas a participado dos familiares, a formado dos enfermeiros e ao ensino dos pacientes. Foram também identificados fatores de risco para o desenvolvimento do delirium e instrumentos de avaliacáo. Discussao: A prevendo do delirium é importante e imperativa, já que nos pacientes críticos a sua ocorréncia está associada ao aumento da mortalidade, morbilidade, do tempo de internamento e a um elevado custo hospitalar. A identificacáo dos fatores de risco para a ocorréncia do delirium devem estar incluídos nos protocolos de abordagem do delirium. Conclusao: As evidéncias demonstraram que o enfermeiro é fundamental na identificacáo precoce, prevencáo e controlo do delirium, evitando a progressáo da doenca, contribuindo para a diminuicáo da morbilidade e mortalidade. A intervencáo de enfermagem deve incluir a identificacáo de fatores predisponentes e/ou precipitantes de modo a contribuir para a diminuicáo da ocorréncia e/ou resolucáo do quadro de delirium.

Abstract Introduction: Delirium is an acute brain dysfunction, associated with increased mortality and morbidity, which often affects critically ill adult/elderly patients. Nurses have a crucial role in the prevention/control of delirium, through the implementation of non-pharmacological interventions. Objective: To know the nursing interventions in the identification, prevention and control of delirium in adult/critical elderly patients. Materials and Methods: An Integrative Literature Review of articles published between 2014 and 2018 was carried out, which identified nursing interventions aimed at the prevention and control of delirium in adult/ critical elderly patients. Four searches were carried out, in the electronic databases of EBSCOhost and B-on. Results: 13 studies were identified, which present nursing interventions, mostly non-pharmacological, for the prevention and control of delirium in adult/critical elderly patients. Of these, interventions related to the environment, sleep promotion, early therapeutic intervention, cognitive assessment and patient orientation, interventions systematized in protocols, as well as interventions aimed at the participation of family members, the training of nurses and the teaching of patients are evident. Risk factors for the development of delirium and assessment tools were also identified. Discussion: The prevention of delirium is important and imperative, since its occurrence in critically ill patients is associated with increased mortality, morbidity, length of stay and a high hospital cost. The identification of risk factors for the occurrence of delirium should be included in delirium management protocols. Conclusions: Evidence has shown that nurses are essential in the early identification, prevention and control of delirium, preventing the progression of the disease, contributing to the reduction of morbidity and mortality. The nursing intervention must include the identification of predisposing and/or precipitating factors to contribute to the reduction of the occurrence and/or resolution of delirium.

Resumen Introducción: El delirio es una disfunción cerebral aguda, asociada con un aumento de la mortalidad y la morbilidad, que afecta con frecuencia a pacientes adultos/ancianos críticamente enfermos. Las enfermeras tienen un papel crucial en la prevención/control del delirio, a través de la implementación de intervenciones no farmacológicas. Objetivo: Conocer las intervenciones de enfermería en la identificación, prevención y control del delirio en pacientes adultos/ancianos críticos. Materiales y Métodos: Se realizó una Revisión Integrativa de la Literatura de artículos publicados entre 2014 y 2018, que identificaron intervenciones de enfermería dirigidas a la prevención y control del delirio en pacientes adultos/ancianos críticos. Se realizaron cuatro búsquedas, en las bases de datos electrónicas de EBSCOhost y B-on. Resultados: Se identificaron 13 estudios que presentan intervenciones de enfermería, en su mayoría no farmacológicas, para la prevención y control del delirio en pacientes adultos/ ancianos críticos. De estas, se evidencian intervenciones relacionadas con el medio ambiente, la promoción del sueño, la intervención terapéutica temprana, la evaluación cognitiva y la orientación del paciente, intervenciones sistematizadas en protocolos, así como intervenciones dirigidas a la participación de los familiares, la formación de enfermeras y la enseñanza de los pacientes. También se identificaron factores de riesgo para el desarrollo de delirio y herramientas de evaluación. Discusión: La prevención del delirio es importante e imperativa, ya que su ocurrencia en pacientes críticos se asocia con aumento de la mortalidad, morbilidad, estancia hospitalaria y alto costo hospitalario. La identificación de factores de riesgo para la aparición de delirio debe incluirse en los protocolos de manejo del delirio. Conclusión: La evidencia ha demostrado que los enfermeros son esenciales en la identificación temprana, prevención y control del delirio, previniendo la progresión de la enfermedad, contribuyendo para la reducción de la morbimortalidad. La intervención de enfermería debe incluir la identificación de factores predisponentes y/o precipitantes para contribuir a la reducción de la ocurrencia y/o resolución del delirio.