Detecção precoce de sepse nos serviços de urgência e emergência: revisão integrativa / Early detection of sepsis in urgent and emergency services: integrative review / Detección temprana de la sepsis en servicios de urgencia y emergencia: revisión integradora

Objetivo: identificar elementos que subsidiam a construção de protocolo clínico para detecção precoce de sepse em serviços de urgência e emergência. Método: revisão integrativa da literatura, do período de 2017 a junho de 2021, nas bases Medical Literature Analysis and Retrieval System Online, National Library of Medicine, Scientific Eletronic Library Online, Scopus e Web of Science. Resultados: foram encontrados 193 artigos e selecionados nove que compuseram a amostra final. Os elementos identificados foram: recomendações da campanha de sobrevivência à sepse; triagem e abertura de protocolo por enfermeiro; treinamentos; sistemas de alerta, uso dos critérios da síndrome da resposta inflamatória sistêmica; times de resposta ou gerente de protocolo; escore de alerta precoce; check-list de verificação; comunicação multiprofissional e lista de antibióticos. Conclusão: os resultados contribuem para assistência ao paciente séptico em serviços de urgência e emergência, favorecendo desfechos positivos, a partir do reconhecimento precoce e aplicação oportuna do tratamento inicial.

Objective: to identify elements that support the construction of a clinical protocol for early detection of sepsis in urgent and emergency services. Method: integrative literature review, from 2017 to June 2021, in the Medical Literature Analysis and Retrieval System Online, National Library of Medicine, Scientific Electronic Library Online, Scopus and Web of Science. Results: 193 articles were found and nine composed the final sample. The elements identified were: recommendations from the surviving sepsis campaign; screening and opening of protocol by nurse; trainings; warning systems, use of systemic inflammatory response syndrome criteria; response teams or protocol manager; early warning score; checklist of verification; multiprofessional communication and antibiotic list. Conclusion: the results contribute to care for septic patients in urgent and emergency services, favoring positive outcomes, based on early recognition and timely application of the initial treatment.

Objetivo: identificar elementos que apoyen la construcción de un protocolo clínico para la detección temprana de sepsis en servicios de urgencia y emergencia. Método: revisión integradora de la literatura, de 2017 a junio de 2021, en las bases de datos Medical Literature Analysis and Retrieval System Online, National Library of Medicine, Scientific Electronic Library Online, Scopus y Web of Science. Resultados: se encontraron 193 artículos de los cuales nueve compusieron la muestra final. Los elementos identificados fueron: recomendaciones de la campaña supervivencia a la sepsis; cribado y apertura de protocolo por enfermero; capacitaciones; sistemas de alerta, uso de los criterios del síndrome de respuesta inflamatoria sistémica; equipos de respuesta o gerente de protocolo; puntuación de alerta temprana; lista de verificación de verificación; comunicación multiprofesional y listado de antibióticos. Conclusión: los resultados contribuyen a la atención de los pacientes sépticos en los servicios de urgencia y emergencia, favoreciendo resultados positivos, basados en el reconocimiento temprano y la aplicación oportuna del tratamiento inicial.

Hernia diafragmática: Un desafío diagnóstico / Diaphragmatic Hernia: A Diagnostic Challenge

Introducción: La hernia diafragmática traumática es una complicación grave del traumatismo abdominal o torácico. Se considera una entidad poco frecuente. El diagnóstico es difícil y, a menudo, puede pasar inadvertido. Objetivo: El propósito de este caso clínico es demostrar la necesidad de sospechar la presencia de hernia diafragmática en los pacientes con trauma toracoabdomial. Presentación del Caso: Paciente de 75 años que sufre accidente de tránsito, con evaluación inicial sin alteraciones clínico-radiológicas, que posteriormente presentan evolución desfavorable con hallazgo radiográfico de una hernia diafragmática traumática. Conclusiones: La hernia diafragmática cuando se presenta constituye un verdadero reto para el diagnóstico por parte del personal médico; pues esta requiere de un alto índice de sospecha y el uso adecuado de las imágenes diagnósticas. Se considera una entidad importante para la evaluación del paciente traumatizado(AU)

Introduction: Traumatic diaphragmatic hernia is a serious complication of abdominal or thoracic trauma. It is considered a rare pathology. The diagnosis is difficult and can often go unnoticed. Objective: The purpose of this clinical case is to demonstrate the need to suspect the presence of diaphragmatic hernia in patients with thoracoabdomial trauma. Case Presentation: Seventy-five-year-old patient who suffers a traffic accident. At initial evaluation no clinical-radiological alterations were observed, but later the patient presented an unfavorable evolution with radiographic finding of a traumatic diaphragmatic hernia. Conclusions: Diaphragmatic hernia, when present, is a real challenge for the diagnosis by the medical staff since it requires a high index of suspicion and an adequate use of diagnostic images. It is considered an important entity in the evaluation of the trauma patient(AU)

SARS-CoV-2/COVID-19: el virus, la enfermedad y la pandemia / SARS-CoV-2/COVID-19: The virus, the disease and the pandemic

El brote de la enfermedad por coronavirus 2019 (COVID-19), causado por el virus del síndrome respiratorio agudo severo tipo-2 (SARS-CoV-2), fue declarado como una pandemia en marzo de 2020. Las tasas de letalidad se estiman entre 1% y 3%, afectando principalmente a los adultos mayores y a aquellos con comorbilidades, como hipertensión, diabetes, enfermedad cardiovascular y cáncer. El periodo de incubación promedio es de 5 días, pero puede ser hasta de 14 días. Muchos pacientes infectados son asintomáticos; sin embargo, debido a que liberan grandes cantidades de virus, son un desafío permanente para contener la propagación de la infección, causando el colapso de los sistemas de salud en las áreas más afectadas. La vigilancia intensa es vital para controlar la mayor propagación del virus, y el aislamiento sigue siendo el medio más efectivo para bloquear la transmisión. Este artículo tiene como objetivo revisar el virus causante de esta nueva pandemia COVID-19 que afecta al mundo, mayor aún que la de influenza A H1N1 en 2009, la cual significó la muerte de cientos de miles de personas en todo el mundo. Se abordan temas como el patógeno, la epidemiología, las manifestaciones clínicas, el diagnóstico y el tratamiento.

The outbreak of coronavirus disease 2019 (COVID 19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a pandemic in March 2020. Fatality rates are estimated to be between 1% and 3%, affecting primarily the aging population and those with comorbidities, such as hypertension, diabetes, cardiovascular disease and cancer. The average incubation period is 5 days but can be as long as 14 days. The majority of infected patients are asymptomatic; however, they release large amounts of viral particles that contribute to the challenges for containing the spread of the infection, and threatening to overwhelm health systems. Intense surveillance is vital for controlling the further spread of the virus, and isolation remains the most effective means of blocking the spread of the disease. This article aims to review the virus and the disease involved in a new pandemic since the appearance of H1N1 flu in 2009, which killed hundreds of thousands worldwide. Topics such as the pathogen, epidemiology, clinical features, diagnosis and treatment will be covered.

Contribución de la prueba rápida NS1 e IgM al diagnóstico de dengue en Colombia en el periodo pre-zika / Contribution of NS1 and IgM based-rapid tests to dengue diagnosis in Colombia before zika emergence

Objetivo: Se considera que el diagnóstico del dengue es fundamentalmente clínico; sin embargo, las pruebas rápidas basadas en la detección de IgM o NS1/IgM están siendo utilizadas en los servicios de salud. Este estudio determinó la contribución de las pruebas rápidas al diagnóstico de dengue en un área endémica antes de la introducción del virus zika. Metodología: Diseño de corte transversal de pruebas diagnósticas realizado a partir del análisis secundario de un estudio previo en 14 instituciones de salud del Valle del Cauca. Se obtuvo información de 632 participantes con resultados de prueba rápida, diagnóstico clínico y pruebas de referencia ELISA NS1, ELISA IgM y RT-PCR. Se compararon la sensibilidad, especificidad, valores predictivos y razones de verosimilitud del uso solo, en serie, y paralelo de los componentes NS1, IgM, NS1/IgM de la prueba rápida y el diagnóstico clínico con las pruebas Q de Cochran y McNemar para datos pareados. Resultados: La sensibilidad del diagnóstico clínico (61,4% IC95% 56%-66,7%) fue superior a la de las pruebas rápidas (37% IC95% 29,6%-44,7%) (P Conclusión: El diagnóstico clínico tiene una mayor sensibilidad que las pruebas rápidas, pero por si solo no es suficiente para confirmar o descartar dengue. Un resultado positivo en pruebas rápidas en pacientes con diagnóstico clínico de dengue es útil para confirmarlo, pero un resultado negativo no lo descarta.

Objective: Dengue diagnosis is considered to be mainly clinical; however, rapid tests that detect IgM or NS1/IgM are being used in health services. This study assessed the contribution of rapid tests to dengue diagnosis in an endemic area before the emergence of zika virus in Colombia. Methods: Cross-sectional study of diagnostic tests based on a secondary analysis of a previous study in 14 health care institutions in Valle del Cauca department. Results of dengue rapid test, clinical diagnosis, and reference tests ELISA NS1, ELISA IgM, and RT-PCR were obtained for 632 participants. The sensitivity, specificity, predictive values and likelihood ratios of the use alone, serial and parallel combinations of NS1, IgM, NS1/IgM of the rapid test and clinical diagnosis were compared using Cochran´s Q and MacNemar tests for paired data. Results: The sensitivity of clinical diagnosis (61.4% 95%IC 56-66.7) was higher than the sensitivity of rapid tests (37% 95% IC 29.6-44.7) (P<0.001). The serial used of NS1/IgM rapid test when clinical diagnosis was negative increased the sensitivity to 79.5% and, the serial use when clinical diagnosis was positive increased the specificity (from 66.3% to 98.7%). However, the latter decreased the sensitivity to 32.2%. While all negative likelihood ratios (LR-) were close to 1, the serial use of rapid tests when clinical diagnosis was positive had LR+ higher than 10. Conclusion: The clinical diagnosis is more sensitive than rapid tests, but by itself does not confirm or rule out dengue. A positive result in rapid tests is useful to confirm dengue but a negative result does not rule it out.

Clinical application of combined detection of tumor molecular markers in lung cancer / 肿瘤研究与临床

Objective To explore the values of combined detection of carcino embryonic antigen (CEA),carcinoma antigen 125 (CA 125),cytokerain 19 fragment 21-1 (CYFRA2 1-1),carcinoma antigen Scc-Ag (Scc-Ag) and neuron specific enolase (NSE) for diagnosis and treatment of lung cancer.Methods The concentrations of CEA,CA125,CYFRA21-1,Scc-Ag and NSE in 198 patients with lung cancer (lung cancer group),50 with benign pulmonary disease (benign disease group) and 50 healthies (health control group) were detected by electrochemiluminescence immunoassay (ECLIA).The concentration of Pro-GRP31-98 was detected by enzyme linked immunoassay.Results Six tumor markers in lung cancer group showed significant diffcrence compared with those of benign disease group and health control group (P ＜ 0.01).The concentrations of serum tumor molecular markers were significantly higher in Ⅲ,Ⅳ stage group than those in [,Ⅱ stage group.Before the treatment,the concentrations of serum tumor molecular markers in lymph node metastasis group and lymph node recurrence group were significantly higher than those in no lymph node metastasis group and no lymph node recurrence group after the treatment (P ＜ 0.01).The positive rate of CEA,CA125 in lung adenocarcinoma group,CYFRA21-1 and Scc-Ag in lung squamous cell carcinomas group and NSE and Pro-GRP31-98 in small cell lung carcinoma group were significantly different from the other two kinds of pathological types (P ＜ 0.01).The positive rates of CEA and CA125 combinated detection in lung adenocareinoma,CYFRA21-1 and Scc-Ag combinated detection in lung squamous cell carcinomas,NSE and Pro-GRP31-98 combinated detection in small cell lung carcinoma was significantly higher than the individual detection respectively.The sensitivitv rates of CEA,CA125,CYFRA21-1,Scc-Ag,NSE and Pro-GRP31-98 were 52.52 ％,51.01％,48.99 ％,53.03 ％,49.49 ％ and 50.50 ％,respectively.And the combinated detection sensitivity rate of the six tumor markers was 96.46 ％,which significantly higher than that of a single marker (P ＜ 0.01).Conelusions The tumor molecular markers of CEA,CA125,CYFRA21-1,Scc-Ag,NSE and Pro-GRP31-98 may be the indicators in diagnosis of lung cancer.The combined detection of serum tumor molecular markers would significantly improve the sensitivity of diagnosis for lung cancers.At the same time,it should be valuablc for determination of clinical stage,histological type and follow-up studies of lung cancer.

Revelação do diagnóstico de aids à criança na compreensão de familiares / Disclosure of aids diagnosis to children from the family members' perspective / Revelación del diagnóstico de aids al niño en la comprensión de familiares

Pesquisa fenomenológica que buscou compreender como a familiar cuidadora percebe a revelação do diagnóstico de aids à criança, fundamentado na filosofia de Martin Buber. Realizou-se em um hospital-escola de Porto Alegre com sete familiares de crianças com aids. A coleta das informações ocorreu por meio da entrevista fenomenológica e, para a interpretação, recorreu-se à hermenêutica. Os diálogos para a revelação do diagnóstico ao TU criança com aids demonstram que esta situação está presente no vivido por estas cuidadoras e interfere em sua existencialidade, ao estabelecer relações com o outro, no mundo. A revelação do diagnóstico de aids à criança é um fenômeno complexo e que gera diálogos relacionados às situações cotidianas compartilhadas pelas cuidadoras e crianças. Acredita-se na necessidade de outras pesquisas sobre esta temática, cada vez mais emergente nos serviços de saúde, e que considerem a dinamicidade e singularidade dos rumos tomados por esta epidemia no cenário brasileiro.

This phenomenological study aimed at understanding how the care-giving family sees the disclosure of the AIDS diagnosis to the infected child, founded on the philosophy of Martin Buber. This study was performed at a teaching hospital in Porto Alegre, with seven family members of children with AIDS. Data collection was performed through phenomenological interviews and interpreted guided by hermeneutics. The dialogues for disclosing of the diagnosis to YOU child with AIDS show that this situation occurs in the experience lived by those caregivers and interferes in their existentiality, as it when they establish relationships with the other, in the world. The disclosing of the AIDS diagnosis to the child is a complex phenomenon that generates dialogues related to the everyday situations shared by the caregivers and the children. Further studies are needed on this theme that is constantly increasing in health services, which would take into consideration the dynamicity and singularity of the rumors taken by this epidemics in the Brazilian context.

Investigación fenomenológica que buscó entender cómo el familiar cuidador percibe la revelación del diagnóstico de AIDS al niño, fundamentado en la filosofía de Martin Buber. Se realizó en hospital escuela de Porto Alegre con siete familiares de niños con AIDS. Se recolectó información mediante entrevista fenomenológica, interpretada por hermenéutica. Los diálogos para la revelación del diagnóstico al TU niño con AIDS demostraron que esta situación está presente vivencialmente en las cuidadoras e interfiere en su existencialidad, estableciendo relaciones con el otro, en el mundo. La revelación del diagnóstico de AIDS al niño es un fenómeno complejo y que genera diálogos relacionados con las situaciones cotidianas compartidas por cuidadoras y niños. Se coincide en la necesidad de investigaciones enfocadas a cuidadoras y niños. Se cree en la necesidad de otras investigaciones sobre esta temática que consideren la dinámica y singularidad de los rumbos de esta epidemia en Brasil.

Concordância entre diagnóstico clínico e histopatológico de lesões bucais / Agreement between clinical and histopathological diagnoses of oral lesions

Objetivo: Aferir a concordância entre diagnóstico clínico e histopatológico de lesões bucais de pacientes da clínica de Estomatologia da Universidade Estadual de Montes Claros, Minas Gerais, Brasil. Métodos: Realizou-se um estudo retrospectivo, entre março de 2006 e dezembro de 2007, utilizando 200 prontuários clínicos de pacientes atendidos, biopsiados e tratados entre os anos de 2004-2006. As dimensões avaliadas foram: gênero, idade, diagnóstico clínico, realização de biópsias, localização da lesão e diagnóstico histopatológico. A análise estatística foi feita pelo programa SPSS 15.0 e submetidas à estatística descritiva. Resultados: Os sítios anatômicos mais comuns das lesões foram mucosa jugal (16,0%) e gengiva (16,0%), enquanto o mais incomum foi o fundo de vestíbulo (3,5%). O grupo mais comum de lesões foi representado pelos processos proliferativos não neoplásicos (39,0%). Em relação às hipóteses diagnósticas foram aferidas a concordância entre as três primeiras hipóteses clínicas e a histopatologia. Em 78,5% dos diagnósticos finais houve concordância entre uma das três hipóteses clínicas e o diagnóstico microscópico, enquanto em 21,5% dos casos não houve correspondência entre a clínica e a histopatologia. Conclusão: Observou-se uma expressiva concordância (78,5%) entre o diagnóstico clínico e histopatológico, sendo importante a realização de mais estudos para se entender melhor a relação entre estes dois importantes exames de rotina.

Objective: The objective of this study was to measure the agreement between the clinical and histopathological diagnoses of oral lesions in patients seen at the Stomatological Clinic of the State University of Montes Claros, Minas Gerais, Brazil. Methods: A retrospective study was done from March 2006 to December 2007 with 200 medical records of patients that had undergone biopsy and treatment between 2004 and 2006. The assessed parameters were: gender, age, clinical diagnosis, biopsies, lesion site and histopathological diagnosis. Statistical analysis was done by the software SPSS 15.0 and submitted to descriptive statistics. Results: The most common lesion sites were the buccal mucosa (16.0%) and gingiva (16.0%) while the most uncommon was the base of the vestibule (3.5%). The most common group of lesions was represented by the non-neoplastic proliferative processes (39.0%). Agreement occurred between the three first clinical hypotheses and histopathology. In 78% of the final diagnoses, there was agreement between one of the three clinical hypotheses and the microscopic diagnosis and no agreement between the clinical and histopathological diagnoses in 21.5% of the cases. Conclusion: The agreement between clinical and histopathological diagnoses was high (78.5%). More studies are necessary in order to better understand the relationship between these two important routine tests.

Instrument to screen cases of pervasive developmental disorder: a preliminary indication of validity / Instrumento para rastreamento dos casos de transtorno invasivo do desenvolvimento: estudo preliminar de validação

OBJECTIVE: To translate into Portuguese, back-translate, culturally adapt and validate a screening instrument for pervasive developmental disorder, the Autism Screening Questionnaire, for use in Brazil. METHOD: A sample of 120 patients was selected based on three groups of 40: patients with a clinical diagnosis of pervasive developmental disorder, Down syndrome, or other psychiatric disorders. The self-administered questionnaire was applied to the patients' legal guardians. Psychometric measures of the final version of the translated questionnaire were tested. RESULTS: The score of 15 had sensitivity of 92.5 percent and specificity of 95.5 percent as a cut-off point for the diagnosis of pervasive developmental disorder. Internal validity for a total of 40 questions was 0.895 for alpha and 0.896 for KR-20, ranging from 0.6 to 0.8 for both coefficients. Test and retest reliability values showed strong agreement for most questions. CONCLUSIONS: The final version of this instrument, translated into Portuguese and adapted to the Brazilian culture, had satisfactory measurement properties, suggesting preliminary validation proprieties. It was an easy-to-apply, useful tool for the diagnostic screening of individuals with pervasive developmental disorder.

OBJETIVO: Tradução, retro-versão, adaptação cultural e validação do Autism Screening Questionnaire para a língua portuguesa e para o seu uso no Brasil. MÉTODO: Foi selecionada uma amostra inicial de 120 pacientes, encaminhados de duas clínicas privadas e uma pública, divida em três grupos de 40 pacientes distintos: pacientes com diagnóstico clínico de transtornos globais do desenvolvimento ou transtornos invasivos do desenvolvimento; de síndrome de Down e de outros transtornos psiquiátricos. O questionário foi aplicado aos responsáveis legais dos pacientes seguindo os padrões de um questionário auto-aplicável. As medidas psicométricas do questionário traduzido, na sua versão final, foram testadas. RESULTADOS: Valores de sensibilidade de 92,5 por cento e especificidade de 95,5 por cento foram encontrados para uma pontuação de 15, como sendo um valor discriminativo para os sujeitos com características de transtornos globais do desenvolvimento/transtornos invasivos do desenvolvimento. A validade interna para o total das 40 questões foi de 0,895, com uma variação entre 0,6 a 0,8. Os valores de confiabilidade obtidos pelo teste e re-teste demonstraram que a maioria das questões obteve alta concordância. CONCLUSÕES: A versão final do instrumento de pesquisa, traduzido e adaptado à cultura brasileira, apresentou propriedades de medida satisfatórias, sugerindo adequadas propriedades preliminares de validação. É um instrumento de fácil aplicação e uma ferramenta útil para a realização de um screening diagnóstico em indivíduos com transtornos globais do desenvolvimento/transtornos invasivos do desenvolvimento.

CT assessment of the correlation between clinical examination and bone involvement in oral malignant tumors

Oral cancers have a tendency to invade the surrounding bone structures, and this has a direct influence on the treatment management and on outcomes. The objective of this study was to correlate the clinical parameters (location, clinical presentation and TNM staging) of oral malignant tumors that can be associated with a potential of bone invasion and determine the accuracy of clinical examination to predict bone involvement, using computed tomography (CT). Twenty five patients, with oral malignant tumors were submitted to clinical and CT examinations. CT was considered the standard parameter to evaluate the presence of bone involvement. Clinical assessment of location, presentation form and TNM staging of the tumors were then compared to the CT findings in predicting bone involvement. Bone involvement was observed in 68 percent of the cases. It was predicted that tumors located in the retromolar trigone and hard palate, with a clinical aspect of infiltrative ulcer or nodule and classified in stage IV had a high potential to cause bone involvement. The clinical examination assessment of these tumors showed to be a valuable tool to predict bone invasion, with high sensitivity (82 percent) and specificity (87.5 percent), based on the results found in the CT images. No statistical significance was found between the CT and clinical examinations regarding bone involvement. The identification of some clinical parameters such as location, clinical presentation, and TNM stage, associated with a detailed clinical examination, was considered a valuable tool for the assessment of bone destruction by oral malignant tumors.