A influência do isolamento social devido à covid-19 na saúde mental do público infantil / The influence of social isolation due to COVID-19 on the mental health of children / La influencia del aislamiento social por el covid-19 en la salud mental de los niños

As infecções provocadas pelo coronavírus afetaram todos os países do mundo. Com a pandemia, surgiram muitos desafios a serem enfrentados para superar essa crise global. A quantidade de óbitos, o isolamento social e a incerteza das consequências futuras desse problema têm sido alguns dos principais fatores responsáveis por gerar instabilidade emocional nos indivíduos. Entre os grupos populacionais afetados, as crianças são as vítimas mais vulneráveis devido à prematuridade psicológica e à inabilidade de lidar com crises. Assim, foi realizada uma pesquisa de revisão integrativa nas plataformas Biblioteca Virtual em Saúde (BVS) e PubMed, a fim de investigar quais os efeitos da pandemia na saúde mental do público infantil. A amostra final foi composta de dez artigos. A partir da análise desses textos, pode-se perceber reflexos nas transformações de humor e de comportamento em crianças no contexto de isolamento social. O aumento da permanência em casa, a necessidade de se adaptar a atividades escolares virtuais, a privação do convívio social com outros da mesma idade e a maior exposição a telas nomearam os principais pontos percebidos. A pesquisa mostrou efeitos esperados da pandemia e identificou o despreparo das escolas e dos familiares em promover suporte emocional para esses menores. Dessa forma, é fundamental a realização de estudos sobre a temática com o objetivo de compreender as melhores medidas a serem adotadas para reduzir os efeitos negativos da pandemia na vida desse público.

Coronavirus infections affected all countries worldwide. With the pandemic came many challenges to be faced to overcome this global crisis. The number of deaths, the social isolation, and the uncertainty about the future consequences of this problem have been some of the main factors responsible for generating emotional instability in individuals. Among the affected population groups, children are the most vulnerable due to their psychological prematurity and inability to cope with crises. Thus, an integrative review research was carried out in the Virtual Health Library (BVS) and PubMed databases to investigate the effects of the pandemic on the mental health of children. The final sample comprised 10 studies. The text analysis shows reflexes in the transformations of mood and behavior in children in the context of social isolation. Increased home stay, the need to adapt to virtual school activities, the deprivation of social interaction with peers, and increased exposure to screens were the main points perceived. The research showed the expected effects of the pandemic and identified the unpreparedness of schools and family members to provide emotional support to these minors. Thus, it is essential to carry out further studies on the subject to understand the best measures to be adopted to reduce the negative effects of the pandemic in the lives of childrens.

Las infecciones provocadas por el coronavirus afectaron a todo el mundo. Junto a esta pandemia, han surgido muchos retos a enfrentarse para superar esta crisis global. El número de muertes, el aislamiento social y la incertidumbre de las consecuencias futuras de este problema han sido algunos de los principales factores responsables de generar inestabilidad emocional en los individuos. De los grupos afectados, los niños son las víctimas más vulnerables debido a la prematuridad psicológica y la incapacidad para hacer frente a las crisis. Así, se llevó a cabo una revisión integradora en las bases de datos Biblioteca Virtual en Salud (BVS) y PubMed, con el fin de investigar los efectos de la pandemia en la salud mental de los niños. La muestra final estuvo formada por diez artículos. A partir del análisis de estos textos, es posible notar transformaciones en el estado de ánimo y el comportamiento de los niños en el contexto del aislamiento. La permanencia en casa, la necesidad de adaptarse a las clases remotas, la privación de interacción social y el aumento del tiempo de uso de pantallas nombraron los principales puntos percibidos. La investigación mostró los efectos esperados de la pandemia y también identificó la falta de preparación de las escuelas y los miembros de la familia para promover el apoyo emocional de estos menores. Por tanto, es fundamental realizar estudios sobre el tema para comprender las mejores medidas que se debe tomar para reducir los efectos negativos de la pandemia en la vida de este público.

Cardiopulmonary resuscitation in an average brazilian intensive care unit: should we perform less or better?

Abstract Introduction: Few data can be found about cardiac arrest in the intensive care unit outside reference centers in third world countries. Objective: To study epidemiology and prognostic factors associated with cardiac arrest in the intensive care unit (ICU) in an average Brazilian center. Methods: Between June 2011 and July 2014, 302 cases of cardiac arrest in the intensive care unit were prospectively evaluated in 273 patients (age: 68.9 ± 15 years) admitted in three mixed units. Data regarding cardiac arrest and cardiopulmonary resuscitation were collected in an "Utstein style" form and epidemiologic data was prospectively obtained. Factors associated with do not resuscitate orders, return of spontaneous circulation and survival were studied using binary logistic regression. Statistical package software used was SPSS 19.0 (IBM Inc., USA). Results: Among 302 cardiac arrests, 230 (76.3%) had their initial rhythm recorded and 141 (61.3%) was in asystole, 62 (27%) in pulseless electric activity (PEA) and 27 had a shockable rhythm (11.7%). In 109 (36.1%) cases, cardiac arrest had a suspected reversible cause. Most frequent suspected cardiac arrest causes were hypotension (n=98; 32.5%), multiple (19.2%) and hypoxemia (17.5%). Sixty (19.9%) cardiac arrests had do not resuscitate orders. Prior left ventricle dysfunction was the only predictor of do not resuscitate order (OR: 3.1 [CI=1.03-9.4]; P=0.04). Among patients that received cardiopulmonary resuscitation, 59 (24.4%) achieved return of spontaneous circulation and 12 survived to discharge (5.6%). Initial shockable rhythm was the only return of spontaneous circulation predictor (OR: 24.9 (2.4-257); P=0.007) and survival (OR: 4.6 (1.4-15); P=0.01). Conclusion: Cardiopulmonary resuscitation rate was high considering ICU patients, so was mortality. Prior left ventricular dysfunction was a predictor of do not resuscitate order. Initial shockable rhythm was a predictor of return of spontaneous circulation and survival.

Birt-Hogg-Dubé syndrome / Sindrome de Birt-Hogg-Dube

A 45-year-old woman with a history of renal carcinoma was observed for facial, cervical and truncal flesh-colored papules. Relatives had similar skin findings and a brother had repeated episodes of pneumothorax. The computerized tomography scan revealed multiple cysts on both lungs. A skin biopsy revealed a perifollicular fibroma. The clinical diagnosis of Birt-Hogg-Dubé syndrome (BHDS) was corroborated by identification of a novel frameshift c.573delGAinsT (p.G191fsX31) mutation in heterozygosity on exon 6 of the folliculin gene. The presence of multiple and typical benign hair follicle tumors highlights the role of the dermatologist in the diagnosis of this rare genodermatosis that is associated with an increased risk of renal cell cancer and pulmonary cysts, warranting personal and familial follow-up and counseling.

Uma mulher de 45 anos com história de carcinoma renal foi observada por pápulas cor da pele, faciais, cervicais e tronculares. Referia história familiar de achados cutâneos semelhantes e irmão com episódios repetidos de pneumotórax. Identificaram-se múltiplos quistos pulmonares por tomografia computorizada. Uma biópsia cutânea revelou fibroma perifolicular. O diagnóstico clínico de síndrome de Birt-Hogg-Dubé (BHDS) foi contudo corroborado pela identificação de uma nova mutação frameshift c.573delGAinsT (p.G191fsX31) em heterozigotia no exão 6 do gene da foliculina. A presença de múltiplos e típicos tumores benignos do folículo piloso, realça o papel do dermatologista no diagnóstico desta rara genodermatose, que está associada a um risco aumentado de tumores de células renais e cistos pulmonares, exigindo seguimento e aconselhamento pessoal e familiar.