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1.
Guidelines on COVID-19 vaccination in patients with immune-mediated rheumatic diseases: a Brazilian Society of Rheumatology task force
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Tavares, Anna Carolina Faria Moreira Gomes
; Melo, Ana Karla Guedes de
; Cruz, Vítor Alves
; Souza, Viviane Angelina de
; Carvalho, Joana Starling de
; Machado, Ketty Lysie Libardi Lira
; Valadares, Lilian David de Azevedo
; Reis Neto, Edgard Torres dos
; Rezende, Rodrigo Poubel Vieira de
; Guimarães, Maria Fernanda Brandão de Resende
; Ferreira, Gilda Aparecida
; Braz, Alessandra de Sousa
; Vieira, Rejane Maria Rodrigues de Abreu
; Pinheiro, Marcelo de Medeiros
; Ribeiro, Sandra Lúcia Euzébio
; Bica, Blanca Elena Gomes Rios
; Baptista, Kátia Lino
; Costa, Izaias Pereira da
; Marques, Claudia Diniz Lopes
; Lopes, Maria Lúcia Lemos
; Martinez, José Eduardo
; Giorgi, Rina Dalva Neubarth
; Mota, Lícia Maria Henrique da
; Loures, Marcos Antônio Araújo da Rocha
; Paiva, Eduardo dos Santos
; Monticielo, Odirlei André
; Xavier, Ricardo Machado
; Kakehasi, Adriana Maria
; Pileggi, Gecilmara Cristina Salviato
.
Abstract Objective: To provide guidelines on the coronavirus disease 2019 (COVID-19) vaccination in patients with immune-mediated rheumatic diseases (IMRD) to rheumatologists considering specific scenarios of the daily practice based on the shared-making decision (SMD) process. Methods: A task force was constituted by 24 rheumatologists (panel members), with clinical and research expertise in immunizations and infectious diseases in immunocompromised patients, endorsed by the Brazilian Society of Rheumatology (BSR), to develop guidelines for COVID-19 vaccination in patients with IMRD. A consensus was built through the Delphi method and involved four rounds of anonymous voting, where five options were used to determine the level of agreement (LOA), based on the Likert Scale: (1) strongly disagree; (2) disagree, (3) neither agree nor disagree (neutral); (4) agree; and (5) strongly agree. Nineteen questions were addressed and discussed via teleconference to formulate the answers. In order to identify the relevant data on COVID-19 vaccines, a search with standardized descriptors and synonyms was performed on September 10th, 2021, of the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and LILACS to identify studies of interest. We used the Newcastle–Ottawa Scale to assess the quality of nonrandomized studies. Results: All the nineteen questions-answers (Q&A) were approved by the BSR Task Force with more than 80% of panelists voting options 4—agree—and 5—strongly agree—, and a consensus was reached. These Guidelines were focused in SMD on the most appropriate timing for IMRD patients to get vaccinated to reach the adequate covid-19 vaccination response. Conclusion: These guidelines were developed by a BSR Task Force with a high LOA among panelists, based on the literature review of published studies and expert opinion for COVID-19 vaccination in IMRD patients. Noteworthy, in the pandemic period, up to the time of the review and the consensus process for this document, high-quality evidence was scarce. Thus, it is not a substitute for clinical judgment.
2.
Sobre gestar e parir uma criança com a Síndrome Congênita do Zika Vírus: um estudo de caso
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Alves, Maria José Cremilda Ferreira
; Melo, Ana Paula Lopes de
; Valongueiro, Sandra
; Santos, Mariana Olívia Santana dos
.
Resumo Este artigo busca analisar o contexto de gestação, pré-natal e parto de uma criança com Síndrome Congênita do Zika (SCZ). É um estudo exploratório qualitativo, tipo estudo de caso único, delineado a partir de entrevista em profundidade realizada com uma mãe de criança diagnosticada com SCZ em Pernambuco. A análise dos dados ocorreu mediante a categorização do conteúdo da entrevista em quatro núcleos temáticos: contexto da descoberta da gestação; condições da assistência ao pré-natal e ao parto; condições de diagnóstico e assistência à criança; e sentimentos envolvidos na descoberta da gestação e do diagnóstico da síndrome. Esse caso sinaliza falhas no planejamento reprodutivo e na assistência ao pré-natal e parto; despreparo dos profissionais de saúde; e mudanças significativas na rotina da família, que implicam escolhas difíceis num contexto de deficitária assistência pública à saúde. A epidemia da SCZ revelou problemas que vão além do controle vetorial do mosquito. O panorama atual escancara vulnerabilidades dessas famílias, intensificadas com o surgimento e as consequências da covid-19, o que tem exposto ainda mais as fragilidades da atenção integral à saúde da mulher e a necessidade de manter uma rede articulada e resolutiva na assistência e vigilância em saúde.
Abstract This study analyzes the context of pregnancy, prenatal care and birth of children with Congenital Zika Syndrome (CZS). A single case exploratory study was conducted with a mother of a child diagnosed with CZS in Pernambuco, Brazil. Data were collected by an in-depth interview and content was categorized into four themes: discovery of pregnancy; conditions of prenatal and childbirth care; conditions of diagnosis and childcare; and feelings involved in the pregnancy discovery and syndrome diagnosis. This case study highlights failures in reproductive planning and in prenatal and childbirth care; unpreparedness of health professionals; and significant changes in the family’s routine, which imply difficult choices under a deficient public health care. CZS epidemic uncovered problems that go beyond mosquito vector control. The current scenario highlights the vulnerabilities of these families, intensified by the emergence and consequences of COVID-19, which has further exposed the weaknesses of women’s comprehensive health care and the need to maintain an articulated and resolute network in health care and surveillance.
3.
Recommendations for evaluation and diagnosis of extra-glandular manifestations of primary sjogren syndrome: results of an epidemiologic systematic review/ meta-analysis and a consensus guideline from the Brazilian Society of Rheumatology (articular, pulmonary and renal)
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Trevisani, Virginia Fernandes Moça
; Pugliesi, Alisson
; Pasoto, Sandra Gofinet
; Lopes, Maria Lucia Lemos
; Guedes, Lissiane Karine Noronha
; Miyamoto, Samira Tatiyama
; Fernandes, Marilena Leal Mesquita Silvestre
; Fialho, Sonia Cristina de Magalhães Souza
; Pinheiro, Aysa César
; Santos, Laura Caldas dos
; Appenzeller, Simone
; Fidelix, Tania
; Ribeiro, Sandra Lúcia Euzébio
; Brito, Danielle Christinne Soares Egypto de
; Libório-Kimura, Tatiana Nayara
; Santos, Maria Carmen Lopes Ferreira Silva
; Cantali, Diego Ustárroz
; Gennari, Juliana D’Agostino
; Civile, Vinicius Tassoni
; Pinto, Ana Carolina Pereira Nunes
; Rocha-Filho, César Ramos
; Oliveira, Fabiola Reis
; Rocha, Aline Pereira da
; Valim, Valeria
.
Abstract Sjogren’s Syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs, associated with sicca syndrome but also with systemic involvement with varying degrees of severity. Despite their importance, these systemic manifestations are not routinely evaluated and there is no homogenous approach to their diagnosis or evaluation. To close this gap, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of epidemiologic and clinical features of these manifestations and made recommendations based on the findings. Agreement between the experts was achieved using the Delphi method. The first part of this guideline summarizes the most important topics, and 11 recommendations are provided for the articular, pulmonary, and renal care of SS patients.
4.
Recommendations for evaluation and diagnosis of extra-glandular manifestations of primary Sjögren syndrome: results of an epidemiologic systematic review/ meta-analysis and a consensus guideline from the Brazilian society of rheumatology (hepatic, gastrointestinal and pancreatic)
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Trevisani, Virginia Fernandes Moça
; Pinheiro, Aysa César
; Fialho, Sonia Cristina de Magalhães Souza
; Fernandes, Marilena Leal Mesquita Silvestre
; Pugliesi, Alisson
; Pasoto, Sandra Gofinet
; Lopes, Maria Lucia Lemos
; Guedes, Lissiane Karine Noronha
; Miyamoto, Samira Tatiyama
; Santos, Laura Caldas dos
; Appenzeller, Simone
; Fidelix, Tania
; Ribeiro, Sandra Lúcia Euzébio
; Brito, Danielle Christinne Soares Egypto de
; Libório-Kimura, Tatiana Nayara
; Santos, Maria Carmen Lopes Ferreira Silva
; Cantali, Diego Ustárroz
; Gennari, Juliana D.’Agostino
; Capobianco, Karina Gatz
; Civile, Vinicius Tassoni
; Pinto, Ana Carolina Pereira Nunes
; Rocha, Aline Pereira da
; Rocha Filho, César Ramos
; Oliveira, Fabiola Reis
; Valim, Valeria
.
Abstract Sjogren's syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs, associated with sicca syndrome but also with systemic involvement with varying degrees of severity. Despite their importance, some systemic manifestations, mainly liver, gastrointestinal, and pancreatic are not routinely evaluated. To address these manifestations, the Sjögren's Syndrome Committee of the Brazilian Society of Rheumatology conducted a broad systematic review of the literature on studies investigating prevalence and diagnosis of these symptoms in Sjogren´s patients and made recommendations based on the findings. Agreement between the experts was achieved using the Delphi method. This is the second part of this guideline, providing 6 recommendations for liver, gastrointestinal, and pancreatic care of SS patients.
5.
Sobre gestar e parir uma criança com a Síndrome Congênita do Zika Vírus: um estudo de caso
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Alves, Maria José Cremilda Ferreira
; Melo, Ana Paula Lopes de
; Valongueiro, Sandra
; Santos, Mariana Olívia Santana dos
.
Resumo Este artigo busca analisar o contexto de gestação, pré-natal e parto de uma criança com Síndrome Congênita do Zika (SCZ). É um estudo exploratório qualitativo, tipo estudo de caso único, delineado a partir de entrevista em profundidade realizada com uma mãe de criança diagnosticada com SCZ em Pernambuco. A análise dos dados ocorreu mediante a categorização do conteúdo da entrevista em quatro núcleos temáticos: contexto da descoberta da gestação; condições da assistência ao pré-natal e ao parto; condições de diagnóstico e assistência à criança; e sentimentos envolvidos na descoberta da gestação e do diagnóstico da síndrome. Esse caso sinaliza falhas no planejamento reprodutivo e na assistência ao pré-natal e parto; despreparo dos profissionais de saúde; e mudanças significativas na rotina da família, que implicam escolhas difíceis num contexto de deficitária assistência pública à saúde. A epidemia da SCZ revelou problemas que vão além do controle vetorial do mosquito. O panorama atual escancara vulnerabilidades dessas famílias, intensificadas com o surgimento e as consequências da covid-19, o que tem exposto ainda mais as fragilidades da atenção integral à saúde da mulher e a necessidade de manter uma rede articulada e resolutiva na assistência e vigilância em saúde.
Abstract This study analyzes the context of pregnancy, prenatal care and birth of children with Congenital Zika Syndrome (CZS). A single case exploratory study was conducted with a mother of a child diagnosed with CZS in Pernambuco, Brazil. Data were collected by an in-depth interview and content was categorized into four themes: discovery of pregnancy; conditions of prenatal and childbirth care; conditions of diagnosis and childcare; and feelings involved in the pregnancy discovery and syndrome diagnosis. This case study highlights failures in reproductive planning and in prenatal and childbirth care; unpreparedness of health professionals; and significant changes in the family’s routine, which imply difficult choices under a deficient public health care. CZS epidemic uncovered problems that go beyond mosquito vector control. The current scenario highlights the vulnerabilities of these families, intensified by the emergence and consequences of COVID-19, which has further exposed the weaknesses of women’s comprehensive health care and the need to maintain an articulated and resolute network in health care and surveillance.
6.
Práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras: uma análise secundária do estudo Fluid-TRIPS
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Freitas, Flavio Geraldo Rezende de
; Hammond, Naomi
; Li, Yang
; Azevedo, Luciano Cesar Pontes de
; Cavalcanti, Alexandre Biasi
; Taniguchi, Leandro
; Gobatto, André
; Japiassú, André Miguel
; Bafi, Antonio Tonete
; Mazza, Bruno Franco
; Noritomi, Danilo Teixeira
; Dal-Pizzol, Felipe
; Bozza, Fernando
; Salluh, Jorge Ibrahin Figueira
; Westphal, Glauco Adrieno
; Soares, Márcio
; Assunção, Murillo Santucci César de
; Lisboa, Thiago
; Lobo, Suzana Margarete Ajeje
; Barbosa, Achilles Rohlfs
; Ventura, Adriana Fonseca
; Souza, Ailson Faria de
; Silva, Alexandre Francisco
; Toledo, Alexandre
; Reis, Aline
; Cembranel, Allan
; Rea Neto, Alvaro
; Gut, Ana Lúcia
; Justo, Ana Patricia Pierre
; Santos, Ana Paula
; Albuquerque, André Campos D. de
; Scazufka, André
; Rodrigues, Antonio Babo
; Fernandino, Bruno Bonaccorsi
; Silva, Bruno Goncalves
; Vidal, Bruno Sarno
; Pinheiro, Bruno Valle
; Pinto, Bruno Vilela Costa
; Feijo, Carlos Augusto Ramos
; Abreu Filho, Carlos de
; Bosso, Carlos Eduardo da Costa Nunes
; Moreira, Carlos Eduardo Nassif
; Ramos, Carlos Henrique Ferreira
; Tavares, Carmen
; Arantes, Cidamaiá
; Grion, Cintia
; Mendes, Ciro Leite
; Kmohan, Claudio
; Piras, Claudio
; Castro, Cristine Pilati Pileggi
; Lins, Cyntia
; Beraldo, Daniel
; Fontes, Daniel
; Boni, Daniela
; Castiglioni, Débora
; Paisani, Denise de Moraes
; Pedroso, Durval Ferreira Fonseca
; Mattos, Ederson Roberto
; Brito Sobrinho, Edgar de
; Troncoso, Edgar M. V.
; Rodrigues Filho, Edison Moraes
; Nogueira, Eduardo Enrico Ferrari
; Ferreira, Eduardo Leme
; Pacheco, Eduardo Souza
; Jodar, Euzebio
; Ferreira, Evandro L. A.
; Araujo, Fabiana Fernandes de
; Trevisol, Fabiana Schuelter
; Amorim, Fábio Ferreira
; Giannini, Fabio Poianas
; Santos, Fabrício Primitivo Matos
; Buarque, Fátima
; Lima, Felipe Gallego
; Costa, Fernando Antonio Alvares da
; Sad, Fernando Cesar dos Anjos
; Aranha, Fernando G.
; Ganem, Fernando
; Callil, Flavio
; Costa Filho, Francisco Flávio
; Dall´Arto, Frederico Toledo Campo
; Moreno, Geovani
; Friedman, Gilberto
; Moralez, Giulliana Martines
; Silva, Guilherme Abdalla da
; Costa, Guilherme
; Cavalcanti, Guilherme Silva
; Cavalcanti, Guilherme Silva
; Betônico, Gustavo Navarro
; Betônico, Gustavo Navarro
; Reis, Hélder
; Araujo, Helia Beatriz N.
; Hortiz Júnior, Helio Anjos
; Guimaraes, Helio Penna
; Urbano, Hugo
; Maia, Israel
; Santiago Filho, Ivan Lopes
; Farhat Júnior, Jamil
; Alvarez, Janu Rangel
; Passos, Joel Tavares
; Paranhos, Jorge Eduardo da Rocha
; Marques, José Aurelio
; Moreira Filho, José Gonçalves
; Andrade, Jose Neto
; Sobrinho, José Onofre de C
; Bezerra, Jose Terceiro de Paiva
; Alves, Juliana Apolônio
; Ferreira, Juliana
; Gomes, Jussara
; Sato, Karina Midori
; Gerent, Karine
; Teixeira, Kathia Margarida Costa
; Conde, Katia Aparecida Pessoa
; Martins, Laércia Ferreira
; Figueirêdo, Lanese
; Rezegue, Leila
; Tcherniacovsk, Leonardo
; Ferraz, Leone Oliveira
; Cavalcante, Liane
; Rabelo, Ligia
; Miilher, Lilian
; Garcia, Lisiane
; Tannous, Luana
; Hajjar, Ludhmila Abrahão
; Paciência, Luís Eduardo Miranda
; Cruz Neto, Luiz Monteiro da
; Bley, Macia Valeria
; Sousa, Marcelo Ferreira
; Puga, Marcelo Lourencini
; Romano, Marcelo Luz Pereira
; Nobrega, Marciano
; Arbex, Marcio
; Rodrigues, Márcio Leite
; Guerreiro, Márcio Osório
; Rocha, Marcone
; Alves, Maria Angela Pangoni
; Alves, Maria Angela Pangoni
; Rosa, Maria Doroti
; Dias, Mariza D’Agostino
; Martins, Miquéias
; Oliveira, Mirella de
; Moretti, Miriane Melo Silveira
; Matsui, Mirna
; Messender, Octavio
; Santarém, Orlando Luís de Andrade
; Silveira, Patricio Júnior Henrique da
; Vassallo, Paula Frizera
; Antoniazzi, Paulo
; Gottardo, Paulo César
; Correia, Paulo
; Ferreira, Paulo
; Torres, Paulo
; Silva, Pedro Gabrile M. de Barros e
; Foernges, Rafael
; Gomes, Rafael
; Moraes, Rafael
; Nonato filho, Raimundo
; Borba, Renato Luis
; Gomes, Renato V
; Cordioli, Ricardo
; Lima, Ricardo
; López, Ricardo Pérez
; Gargioni, Ricardo Rath de Oliveira
; Rosenblat, Richard
; Souza, Roberta Machado de
; Almeida, Roberto
; Narciso, Roberto Camargo
; Marco, Roberto
; waltrick, Roberto
; Biondi, Rodrigo
; Figueiredo, Rodrigo
; Dutra, Rodrigo Santana
; Batista, Roseane
; Felipe, Rouge
; Franco, Rubens Sergio da Silva
; Houly, Sandra
; Faria, Sara Socorro
; Pinto, Sergio Felix
; Luzzi, Sergio
; Sant’ana, Sergio
; Fernandes, Sergio Sonego
; Yamada, Sérgio
; Zajac, Sérgio
; Vaz, Sidiner Mesquita
; Bezerra, Silvia Aparecida Bezerra
; Farhat, Tatiana Bueno Tardivo
; Santos, Thiago Martins
; Smith, Tiago
; Silva, Ulysses V. A.
; Damasceno, Valnei Bento
; Nobre, Vandack
; Dantas, Vicente Cés de Souza
; Irineu, Vivian Menezes
; Bogado, Viviane
; Nedel, Wagner
; Campos Filho, Walther
; Dantas, Weidson
; Viana, William
; Oliveira Filho, Wilson de
; Delgadinho, Wilson Martins
; Finfer, Simon
; Machado, Flavia Ribeiro
.
RESUMO Objetivo: Descrever as práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras e compará-las com as de outros países participantes do estudo Fluid-TRIPS. Métodos: Este foi um estudo observacional transversal, prospectivo e internacional, de uma amostra de conveniência de unidades de terapia intensiva de 27 países (inclusive o Brasil), com utilização da base de dados Fluid-TRIPS compilada em 2014. Descrevemos os padrões de ressuscitação volêmica utilizados no Brasil em comparação com os de outros países e identificamos os fatores associados com a escolha dos fluidos. Resultados: No dia do estudo, foram incluídos 3.214 pacientes do Brasil e 3.493 pacientes de outros países, dos quais, respectivamente, 16,1% e 26,8% (p < 0,001) receberam fluidos. A principal indicação para ressuscitação volêmica foi comprometimento da perfusão e/ou baixo débito cardíaco (Brasil 71,7% versus outros países 56,4%; p < 0,001). No Brasil, a percentagem de pacientes que receberam soluções cristaloides foi mais elevada (97,7% versus 76,8%; p < 0,001), e solução de cloreto de sódio a 0,9% foi o cristaloide mais comumente utilizado (62,5% versus 27,1%; p < 0,001). A análise multivariada sugeriu que os níveis de albumina se associaram com o uso tanto de cristaloides quanto de coloides, enquanto o tipo de prescritor dos fluidos se associou apenas com o uso de cristaloides. Conclusão: Nossos resultados sugerem que cristaloides são usados mais frequentemente do que coloides para ressuscitação no Brasil, e essa discrepância, em termos de frequências, é mais elevada do que em outros países. A solução de cloreto de sódio 0,9% foi o cristaloide mais frequentemente prescrito. Os níveis de albumina sérica e o tipo de prescritor de fluidos foram os fatores associados com a escolha de cristaloides ou coloides para a prescrição de fluidos.
Abstract Objective: To describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS. Methods: This was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice. Results: On the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only. Conclusion: Our results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation.
https://doi.org/10.5935/0103-507x.20210028
273 downloads
7.
Relationship between vitamin D deficiency and psychophysiological variables: a systematic review of the literature
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Silva, Mariluce Rodrigues Marques
; Barros, Waleska Maria Almeida
; Silva, Mayara Luclécia da
; Silva, José Maurício Lucas da
; Souza, Ana Patrícia da Silva
; Silva, Ana Beatriz Januário da
; Fernandes, Matheus Santos de Sousa
; Souza, Sandra Lopes de
; Souza, Viviane de Oliveira Nogueira
.
Vitamin D is a fat-soluble vitamin that plays a role not only in calcium homeostasis, but also in several other functions, including cell growth and immune functions, and is considered a neurosteroid. Vitamin D deficiency is highly prevalent worldwide and has been suggested to be associated with an increased risk of emotional disorders. Therefore, the association between vitamin D levels and psychophysiological disorders, such as depression, anxiety, and mood, has been investigated. To list these variables, a bibliographical literature research was conducted in the MEDLINE/PubMed, Web of Science, Scopus, Science Direct and PsycINFO databases, between November and December 2020, with no year limits of publication. The studies involved humans aged between 18 and 59 years without associated diseases. This review presents evidence of the main variables involved in this association, main tools used to verify these variables, and methods used to verify circulating vitamin D levels in populations. Most studies have indicated that the main psychophysiological variables involved with vitamin D levels are depression and anxiety followed by mood, and an association has been observed between increased serum vitamin D levels and reduction in symptoms of depression, anxiety, and mood, and there is a heterogeneity of methods for assessing vitamin D. More studies are clearly needed to improve our understanding of their role in modulating the psychophysiological aspects of vitamin D levels.
https://doi.org/10.6061/clinics/2021/e3155
52 downloads
8.
Perceptions of senior nursing students regarding clinical decision-making
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Marques, Maria de Fátima Mendes
; David, Carlos Lopes Alves Henriques Pina
; Santos, Maria Anabela Ferreira dos
; Neves, Sandra Cristina da Silva
; Pinheiro, Maria Jose Fonseca
; Leal, Maria Teresa Sarreira
.
RESUMO Objetivo: compreender as percepções dos estudantes finalistas de uma escola superior de enfermagem de Lisboa sobre as competências de tomada de decisão clínica adquiridas na formação inicial. Métodos: estudo qualitativo de caráter exploratório e descritivo. A colheita de dados foi realizada por meio de um focus group, com 8 estudantes finalistas do curso de licenciatura em enfermagem. Na aná lise dos dados, recorreu-se à análise de conteúdo pelo software webQDA®. Resultados: os dados foram analisados segundo as quatro dimensões do modelo de tomada de decisão de Tanner, destacando-se a Percepção e a Interpretação como as mais influentes na tomada de decisão clínica. Emergiram como competências mais representativas: o conhecimento teórico e clínico, a validação do planejamento dos cuidados, a priorização e a capacidade de discussão e argumentação sobre as situações. Considerações Finais: os estudantes tomam decisões por meio de um processo complexo usando o conhecimento e as competências adquiridas na formação.
ABSTRACT Objectives: to understand the perceptions of senior students in an undergraduate nursing course at a nursing college in Lisbon regarding skills related to clinical decision-making learned during their initial training. Methods: qualitative study, of an exploratory and descriptive nature. Data collection occurred by carrying out a focus group with eight senior students in an undergraduate nursing course. Data treatment applied content analysis, performed with twebQDA® software. Results: data were analyzed according to the four dimensions of Tanner’s model of clinical judgment, and noticing and interpreting stood out as the most influential in clinical decision-making. Theoretical and clinical knowledge, validation of care planning, prioritization, and capacity to discuss and debate about situations emerged as the most representative skills. Final considerations: students make decisions by means of a complex process by using the knowledge and skills learned during their training.
RESUMEN Objetivo: comprender las percepciones de estudiantes avanzados de una escuela superior de enfermería de Lisboa sobre las competencias de toma de decisiones clínicas adquiridas en la formación inicial. Métodos: estudio cualitativo, exploratorio y descriptivo. Datos recolectados mediante focus group con 8 estudiantes avanzados de la carrera de licenciatura en enfermería. Datos analizados por análisis de contenido, utilizándose software webQDA® . Resultados: los datos fueron analizados según las cuatro dimensiones del modelo de toma de decisiones de Tanner, destacándose la Percepción y la Interpretación como las más influyentes en la toma de decisiones clínicas. Surgieron como competencias más representativas: el conocimiento teórico y clínico, la validación de la planificación de cuidados, la priorización y la capacidad de discusión y argumentación sobre las situaciones. Consideraciones Finales: los estudiantes toman decisiones aplicando un proceso complejo, utilizando el conocimiento y las competencias adquiridas durante su formación.
https://doi.org/10.1590/0034-7167-2020-0921
259 downloads
9.
2021 recommendations of the Brazilian Society of Rheumatology for the gynecological and obstetric care of patients with Sjogren’s syndrome
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Oliveira, Fabiola Reis
; Valim, Valeria
; Pasoto, Sandra Gofinet
; Fernandes, Marilena Leal Mesquita Silvestre
; Lopes, Maria Lucia Lemos
; Souza Fialho, Sonia Cristina de Magalhães
; Pinheiro, Aysa César
; Santos, Laura Caldas dos
; Appenzeller, Simone
; Fidelix, Tania
; Ribeiro, Sandra Lucia Euzébio
; Brito, Danielle Christinne Soares Egypto de
; Libório, Tatiana
; Santos, Maria Carmen Lopes Ferreira Silva
; Tanure, Leandro
; Gennari, Juliana DAgostino
; Civile, Vinicius Tassoni
; Pinto, Ana Carolina Pereira Nunes
; Rocha Filho, César Ramos
; Miyamoto, Samira Tatiyama
; Guedes, Lissiane Karine Noronha
; Pugliesi, Alisson
; Trevisani, Virginia Fernandes Moça
.
Abstract Sjogren’s syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs. Women with SS often experience gynecological symptoms due to the disease and need extra care regarding their sexual activity, reproductive health and during pregnancy, conditions that are not properly conducted in the clinical practice. To cover this gap, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of symptoms, diagnosis, monitoring, prognosis, and treatment of these manifestations. A Focus Group meeting was held and included experts in the field and methodologists, based on a previously developed script, with themes related to the objective of the study. The most important topics were summarized and 11 recommendations were provided.
https://doi.org/10.1186/s42358-021-00208-1
54 downloads
10.
Chronic use of hydroxychloroquine did not protect against COVID-19 in a large cohort of patients with rheumatic diseases in Brazil
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Pileggi, Gecilmara Salviato
; Ferreira, Gilda Aparecida
; Gomides Reis, Ana Paula Monteiro
; Reis Neto, Edgard Torres
; Abreu, Mirhelen Mendes
; Albuquerque, Cleandro Pires
; Araújo, Nafice Costa
; Bacchiega, Ana Beatriz
; Bianchi, Dante Valdetaro
; Bica, Blanca
; Bonfa, Eloisa Duarte
; Borba, Eduardo Ferreira
; Brito, Danielle Christinne Soares Egypto
; Duarte, Ângela Luzia Branco Pinto
; Santo, Rafaela Cavalheiro Espírito
; Fernandes, Paula Reale
; Guimarães, Mariana Peixoto
; Gomes, Kirla Wagner Poti
; Kakehasi, Adriana Maria
; Klumb, Evandro Mendes
; Lanna, Cristina Costa Duarte
; Marques, Claudia Diniz Lopes
; Monticielo, Odirlei André
; Mota, Licia Maria Henrique
; Munhoz, Gabriela Araújo
; Paiva, Eduardo Santos
; Pereira, Helena Lucia Alves
; Provenza, José Roberto
; Ribeiro, Sandra Lucia Euzébio
; Rocha Junior, Laurindo Ferreira
; Sampaio, Camila Santana Justo Cintra
; Sampaio, Vanderson Souza
; Sato, Emília Inoue
; Skare, Thelma
; de Souza, Viviane Angelina
; Valim, Valeria
; Lacerda, Marcus Vinícius Guimarães
; Xavier, Ricardo Machado
; Pinheiro, Marcelo Medeiros
.
Abstract Background: There is a lack of information on the role of chronic use of hydroxychloroquine during the SARS-CoV-2 outbreak. Our aim was to compare the occurrence of COVID-19 between rheumatic disease patients on hydroxychloroquine with individuals from the same household not taking the drug during the first 8 weeks of community viral transmission in Brazil. Methods: This baseline cross-sectional analysis is part of a 24-week observational multi-center study involving 22 Brazilian academic outpatient centers. All information regarding COVID-19 symptoms, epidemiological, clinical, and demographic data were recorded on a specific web-based platform using telephone calls from physicians and medical students. COVID-19 was defined according to the Brazilian Ministry of Health (BMH) criteria. Mann-Whitney, Chi-square and Exact Fisher tests were used for statistical analysis and two binary Final Logistic Regression Model by Wald test were developed using a backward-stepwise method for the presence of COVID-19. Results: From March 29th to May 17st, 2020, a total of 10,443 participants were enrolled, including 5166 (53.9%) rheumatic disease patients, of whom 82.5% had systemic erythematosus lupus, 7.8% rheumatoid arthritis, 3.7% Sjögren’s syndrome and 0.8% systemic sclerosis. In total, 1822 (19.1%) participants reported flu symptoms within the 30 days prior to enrollment, of which 3.1% fulfilled the BMH criteria, but with no significant difference between rheumatic disease patients (4.03%) and controls (3.25%). After adjustments for multiple confounders, the main risk factor significantly associated with a COVID-19 diagnosis was lung disease (OR 1.63; 95% CI 1.03-2.58); and for rheumatic disease patients were diagnosis of systemic sclerosis (OR 2.8; 95% CI 1.19-6.63) and glucocorticoids above 10 mg/ day (OR 2.05; 95% CI 1.31-3.19). In addition, a recent influenza vaccination had a protective effect (OR 0.674; 95% CI 0.46-0.98). Conclusion: Patients with rheumatic disease on hydroxychloroquine presented a similar occurrence of COVID-19 to household cohabitants, suggesting a lack of any protective role against SARS-CoV-2 infection. Trial registration Brazilian Registry of Clinical Trials (ReBEC; RBR - 9KTWX6).
https://doi.org/10.1186/s42358-021-00217-0
22 downloads
11.
Effect of Metabolic Syndrome on Parkinson's Disease: A Systematic Review
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Souza, Ana Patrícia da Silva
; Barros, Waleska Maria Almeida
; Silva, José Maurício Lucas
; Silva, Mariluce Rodrigues Marques
; Silva, Ana Beatriz Januário
; Fernandes, Matheus Santos de Sousa
; Santos, Maria Eduarda Rodrigues Alves dos
; Silva, Mayara Luclécia da
; Carmo, Taciane Silva do
; Silva, Roberta Karlize Pereira
; Silva, Karollainy Gomes da
; Souza, Sandra Lopes de
; Souza, Viviane de Oliveira Nogueira
.
Evidence shows that metabolic syndrome (MS) is associated with a greater risk of developing Parkinson's disease (PD) because of the increase in oxidative stress levels along with other factors such as neuroinflammation and mitochondrial dysfunction. However, because some studies have reported that MS is associated with a lower risk of PD, the relationship between MS and PD should be investigated. This study aimed to investigate the effect of MS on PD. Two authors searched five electronic databases, namely, MEDLINE, PubMed, Scopus, PsycINFO, Web of Science, and Science Direct, for relevant articles between September and October 2020. After screening the title and abstract of all articles, 34 articles were selected for full-text review. Finally, 11 articles meeting the eligibility criteria were included in the study. The quality of articles was critically evaluated using the Joanna Briggs Institute. Overall, we evaluated data from 23,586,349 individuals (including healthy individuals, with MS and PD) aged 30 years or more. In cohort studies, the follow-up period varied between 2 and 30 years. MS contributed considerably to the increase in the incidence of PD. In addition, obesity, a component of MS, alone can increase the probability of developing neurodegenerative diseases. However, despite few studies on MS and PD, changes in cognitive function and more rapid progression of PD disease has been documented in patients with MS using methods commonly used in research.
12.
Guideline of the Brazilian Society of Cardiology on Telemedicine in Cardiology - 2019
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Lopes, Marcelo Antônio Cartaxo Queiroga
; Oliveira, Gláucia Maria Moraes de
; Ribeiro, Antonio Luiz Pinho
; Pinto, Fausto J.
; Rey, Helena Cramer Veiga
; Zimerman, Leandro Ioschpe
; Rochitte, Carlos Eduardo
; Bacal, Fernando
; Polanczyk, Carisi Anne
; Halperin, Cidio
; Araújo, Edson Correia
; Mesquita, Evandro Tinoco
; Arruda, José Airton
; Rohde, Luis Eduardo Paim
; Grinberg, Max
; Moretti, Miguel
; Caramori, Paulo Ricardo Avancini
; Botelho, Roberto Vieira
; Brandão, Andréa Araújo
; Hajjar, Ludhmila Abrahão
; Santos, Alexandre Fonseca
; Colafranceschi, Alexandre Siciliano
; Etges, Ana Paula Beck da Silva
; Marino, Bárbara Campos Abreu
; Zanotto, Bruna Stella
; Nascimento, Bruno Ramos
; Medeiros, Cesar Rocha
; Santos, Daniel Vitor de Vasconcelos
; Cook, Daniela Matos Arrowsmith
; Antoniolli, Eduardo
; Souza Filho, Erito Marques de
; Fernandes, Fábio
; Gandour, Fabio
; Fernandez, Francisco
; Souza, Germano Emilio Conceição
; Weigert, Guilherme de Souza
; Castro, Iran
; Cade, Jamil Ribeiro
; Figueiredo Neto, José Albuquerque de
; Fernandes, Juliano de Lara
; Hadlich, Marcelo Souza
; Oliveira, Marco Antonio Praça
; Alkmim, Maria Beatriz
; Paixão, Maria Cristina da
; Prudente, Maurício Lopes
; Aguiar Netto, Miguel A. S.
; Marcolino, Milena Soriano
; Oliveira, Monica Amorim de
; Simonelli, Osvaldo
; Lemos Neto, Pedro A.
; Rosa, Priscila Raupp da
; Figueira, Renato Minelli
; Cury, Roberto Caldeira
; Almeida, Rodrigo Coelho
; Lima, Sandra Regina Franco
; Barberato, Silvio Henrique
; Constancio, Thiago Inocêncio
; Rezende, Wladimir Fernandes de
.
https://doi.org/10.5935/abc.20190205
5274 downloads
13.
Recommendations from the Brazilian society of rheumatology for the diagnosis of Sjögren's syndrome (Part I): glandular manifestations (systematic review)
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Trevisani, Virginia Fernandes Moça
; Pasoto, Sandra Gofinet
; Fernandes, Marilena Leal Mesquita Silvestre
; Lopes, Maria Lucia Lemos
; Fialho, Sonia Cristina de Magalhães Souza
; Pinheiro, Aysa César
; Santos, Laura Caldas dos
; Appenzeller, Simone
; Fidelix, Tania
; Ribeiro, Sandra Lucia Euzébio
; Brito, Danielle Christinne Soares Egypto de
; Libório, Tatiana
; Santos, Maria Carmen Lopes Ferreira Silva
; Tanure, Leandro
; Gennari, Juliana D Agostino
; Civile, Vinicius Tassoni
; Pinto, Ana Carolina Pereira Nunes
; Oliveira, Fabiola Reis
; Sousa, Jaqueline Martins de
; Miyamoto, Samira Tatiyama
; Valim, Valeria
.
Abstract Background: Primary Sjögren's syndrome (pSS) is a systemic immune-mediated disease whose main characteristic is exocrine gland inflammation and, subsequent reduction in tear and saliva production. A delayed diagnosis is common due to the nonspecific clinical manifestations of disease. The aim of the present study was to develop recommendations for the diagnosis of glandular manifestations of pSS based on evidence and expert opinion. Main body of the abstract: We conducted a systematic literature review to retrieve the best evidence available on the accuracy of diagnostic tests for pSS. We also held two in-person meetings with experts (rheumatologists, pathologists, ophthalmologists and dentists) to establish their level of agreement using the Delphi method. Ultimately, we generated 18 recommendations that aim to facilitate the diagnosis of the glandular manifestations of pSS. Conclusion: The diagnosis of glandular manifestations of pSS is complex and multidisciplinary. It requires specific knowledge in the field of ophthalmology, immunology, pathology and imaging, making it compulsory for the rheumatologist to work with professionals from these different areas in order to improve accuracy and early diagnosis. Glandular dysfunction tests, ANA, RF, Anti-Ro, protein electrophoresis, urinalysis, blood count, C-Reactive protein, complement, testing for syphilis and viruses (HCV, HIV) and SGUS should be investigated when dryness or systemic manifestation are present. Minor salivary gland biopsy is recommended for all anti-Ro negative or incomplete criteria cases.
https://doi.org/10.1186/s42358-019-0102-8
878 downloads
14.
Physicochemical characterization and comparison of labels of beef bouillon cubes
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VASCONCELOS, Anderson Maciel de
; SANTOS, Sandra Maria Lopes dos
; DAMACENO, Marlene Nunes
; CAVALCANTE, Antonio Belfort Dantas
.
Abstract This study aimed at determining the centesimal composition, the energy value and the sodium content in beef bouillon cubes and compare them with the nutritional information by the manufacturer. Beef bouillon cube samples were collected in supermarkets in of the city of Limoeiro do Norte/CE, and the levels of nutrients were determined by official analysis methods. The physicochemical analyses carried out were moisture, lipids, proteins, fixed mineral residue, total carbohydrates and sodium content. The beef bouillon cubes analyzed showed a low moisture content (3.23 – 4.23 g/100 g) and high levels of lipids (19.72 – 20.05 g/100 g) and fixed mineral residue (53.24 – 57.61 g/100 g). When compared to the data reported on their labels, all the parameters were in smaller amounts than the ones declared in all analyzed brands. The average sodium content found in the samples ranged from 758.5 to 815.5 mg/serving of the product. Considering that the results were based on a portion of broth and that these amounts are related to half a cube of beef bouillon, it becomes quite alarming the amount of sodium available in this type of product, since the food prepared with this ingredient is usually eaten alongside other foods, which also contain sodium in their composition.
https://doi.org/10.1590/fst.11017
1379 downloads
15.
Shelf life of artisanal demi-glace sauce
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HOLANDA, Natálya Vidal de
; GOMES, Joyciane da Silva
; SANTOS, Sandra Maria Lopes dos
; DAMACENO, Marlene Nunes
.
Abstract The objective of this study was to elaborate and evaluate the shelf life of the liquid artisanal demi-glace sauce considering sensory, microbiological and lipid oxidation characteristics during 75 days of storage compared to commercial hydrated demi-glace sauce. Sensory aspects (visual and olfactory), counts of coliform and Staphylococcus aureus, determination of Salmonella sp. and lipid oxidation were evaluated every 15 days. The artisanal demi-glace sauce was homogenous, without sensory alteration during the storage period, with olfactory alteration only at the end. The commercial demi-glace sauce remained unchanged until t3 (30 days), from t4 (45 days) presented turbid appearance, followed by phase separation and with unpleasant odor in t6 (75 days). The lipid oxidation showed an increased concentration of malonaldehyde at every evaluated time. The artisanal and commercial demi-glace sauces showed a significant difference at t1, t2, t4 and t5, when the artisanal sauce had lower contents of malonaldehyde (18, 23, 36 and 11%, respectively), only at the 30th and 75th days of storage there was significant similarity. The sauces were within the microbiological standards required by the law. Although the artisanal demi-glace sauce does not contain conservatives, its shelf life was similar to the hydrated commercial product.
https://doi.org/10.1590/1678-457x.37416
1633 downloads
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