Dos males o menor: representações de universitários sobre o uso das máscaras para prevenção da Covid-19 / The lesser evil: university students representations on the use of masks for Covid-19 prevention / El mal menor: representaciones de universitarios sobre el uso de máscaras para la prevención del Covid-19

Objetivo: conhecer as representações sociais de universitários brasileiros sobre o uso de máscaras para o controle da COVID-19. Método: estudo qualitativo, tipo survey, ancorado na Teoria das Representações Sociais. Participaram 283 universitários brasileiros, selecionados por conveniência. Os dados foram coletados por meio de formulário digital. Para análise, utilizou-se a Análise Temática. Resultados: elaborou-se um tema nomeado "A máscara para prevenção: materialização do medo de contágio", e três subtemas, intitulados respectivamente "A construção de um novo hábito: o mal necessário das máscaras"; "O macrossocial na modificação do eu" e "O uso da máscara no dia-a-dia: a individualização do social". Conclusão: observou-se a compreensão do uso de máscaras como um recurso para prevenção de uma condição ameaçadora à vida. Atitudes favoráveis parecem se organizar em contraposição ao medo causado pelo vírus e suas consequências.

Objective: to know the social representations of brazilian university students about the use of masks to control COVID-19. Method: qualitative survey, based on the Theory of Social Representations. 283 brazilian university students were selected by convenience. Data were collected through digital form. For analysis, the Thematic Analysis was used. Results: a theme named "The mask for prevention: materialization of the fear of contagion" was elaborated, and three sub-themes, respectively titled "The construction of a new habit: the necessary evil of masks"; "The macrosocial in the modification of the self" and "The use of the mask in everyday life: the individualization of the social". Conclusion: the understanding of the use of masks as a resource for preventing a life-threatening condition was observed. These favorable attitudes seem to be organized in contrast to the fear caused by virus and their consequences.

Objetivo: conocer las representaciones sociales de estudiantes universitarios brasileños sobre el uso de máscaras para el control de COVID-19. Método: estudio cualitativo, basado en la Teoría de las Representaciones Sociales. Participaron 283 universitarios brasileños, seleccionados por conveniencia. Los datos fueron recolectados a través de un formulario digital. Para el análisis se utilizó el Análisis Temático. Resultados: se elaboró un tema denominado "La mascarilla para la prevención: materialización del miedo al contagio" y tres subtemas, respectivamente titulados "La construcción de un nuevo hábito: el mal necesario de las máscaras"; "Lo macrosocial en la modificación del yo" y "El uso de la mascarilla en la vida cotidiana: la individualización de lo social". Conclusión: se observó la comprensión del uso de máscaras como recurso para la prevención de una condición potencialmente mortal. Estas actitudes favorables parecen organizarse en contraste con el miedo provocado por el virus y sus consecuencias.

Impacto en la morbimortalidad por COVID-19 según las regulaciones del uso de mascarilla / Impact on COVID-19 morbidity and mortality according to the regulations on the use of face mask

Resumen Introducción: Actualmente, la mascarilla representa un símbolo incomparable cuyo valor pasó del trabajo clínico a impactar en la contención de la propagación del virus SARS-CoV-2; se convirtió en un elemento de discordia en la población general. Objetivo: Establecer el impacto de las políticas de uso de mascarilla en la morbimortalidad por COVID-19. Métodos: Se asociaron las variables de política de uso de cubrebocas, obtenidas de la página web del movimiento científico #Masks4All, con el número de contagios, muertes y aplanamiento de la curva publicados por el centro de recursos de la Universidad Johns Hopkins y EndCoronavirus.org. Resultados: Las políticas de uso de mascarilla fueron de tipo universal (requerido en tiendas, restaurantes, transporte público), parcial (recomendado, requerido en cualquier lugar público) y ausente. Las asociaciones de la política de uso de mascarilla con casos totales (p = 0.01), casos por millón (p = 0.04) y muertes por millón de habitantes (p = 0.02) resultaron estadísticamente significativas. Las asociaciones de las variables con la tendencia de la curva epidemiológica también resultaron estadísticamente significativas (p = 0.00). Conclusión: La recomendación del uso generalizado de mascarilla es una medida con suficiente respaldo científico para reducir el número de contagios y muertes por COVID-19.

Abstract Introduction: Currently, the face mask represents an incomparable symbol whose value went from clinical work to impacting the containment of the spread of SARS-CoV-2, although it has become an element of discord in the general population. Objective: To establish the impact of face mask use policies on COVID-19 morbidity and mortality. Methods: Face mask use policy variables, obtained from the website of the #Masks4All scientific movement, were associated with the number of infections, deaths and flattening of the curve published by the Johns Hopkins University resource center and EndCoronavirus.org. Results: Face mask use policies were universal (required in shops, restaurants, public transport), partial (recommended, required in any public place) and absent. Associations of the face mask use policy with total cases (p = 0.01), cases per million (p = 0.04) and deaths per million population (p = 0.02) were statistically significant. Associations of the variables with the epidemiological curve trend were also statistically significant (p = 0.00). Conclusion: The recommendation for face mask widespread use is a measure with sufficient scientific support to reduce the number of COVID-19-related infections and deaths.

Pandemia da COVID-19: adaptação e avaliação psicométrica da "Face Mask Use Scale" / Pandemia de COVID-19: adaptación y evaluación psicométrica de la Face Mask Use Scale / COVID-19 pandemic: adaptation and psychometric assessment of the Face Mask Use Scale

Resumo Objetivo Adaptar culturalmente para o português do Brasil a Face Mask Use Scale e avaliar suas propriedades psicométricas. Métodos Estudo metodológico, transversal, com abordagem quantitativa, que compreendeu as etapas de: tradução; consenso da versão em português; avaliação por comitê de especialistas; retrotradução e comparação com a versão original; teste piloto e avaliação psicométrica da Face Mask Use Scale (FMUS). Resultados A versão original da FMUS foi traduzida para o português do Brasil. A validade de conteúdo foi realizada por um painel de cinco especialistas. O índice de validade de conteúdo para a escala (IVC-S/Ave) foi 0,87 e para os itens (IVC-I) variou de 0,6 a 1,0. A versão para o português do Brasil da FMUS (FMUS-PB) foi aplicada em 4822 adultos com idade média de 30 anos (DP = 11,7). Na consistência interna, o Alfa de Cronbach foi de 0,86. O modelo original de dois fatores da FMUS não se mostrou adequado para a população brasileira pelo uso da análise fatorial confirmatória e exploratória. Assim, realizou-se uma análise fatorial exploratória para investigar a estrutura fatorial da FMUS-PB novamente e um novo modelo potencial da FMUS-PB para melhor explicação. A FMUS-PB apresentou estrutura fatorial diferente do modelo original. Os itens foram alinhados em um único fator, criando um instrumento unidimensional que explicou 59,7% da variância total. A validade de construto por grupos conhecidos foi satisfatória (p <0,001). Conclusão A FMUS-PB é confiável e válida para medir a prática do uso de máscaras entre a população brasileira, sobretudo na pandemia da COVID-19.

Resumen Objetivo Adaptar culturalmente la Face Mask Use Scale al portugués de Brasil y evaluar sus propiedades psicométricas. Métodos Estudio metodológico, transversal, con enfoque cualitativo, que comprendió las siguientes etapas: traducción, consenso de la versión en portugués, evaluación de comité de especialistas, retrotraducción y comparación con la versión original, prueba piloto y evaluación psicométrica de la Face Mask Use Scale (FMUS). Resultados La versión original de la FMUS fue traducida al portugués de Brasil. La validez de contenido fue realizada por un panel de cinco especialistas. El índice de validez de contenido de la escala (IVC-S/Ave) fue 0,87 y el de los ítems (IVC-I) varió de 0,6 a 1,0. La versión en portugués de Brasil de la FMUS (FMUS-PB) fue aplicada a 4.822 adultos de edad promedio de 30 años (DP = 11,7). En la consistencia interna, el Alfa de Cronbach fue de 0,86. El modelo original de dos factores de la FMUS demostró no ser adecuado para la población brasileña mediante el uso del análisis factorial confirmatorio y exploratorio. De esta forma, se realizó un análisis factorial exploratorio para investigar la estructura factorial de la FMUS-PB nuevamente y un nuevo modelo posible de la FMUS-PB para una mejor explicación. La FMUS-PB presentó una estructura factorial diferente al modelo original. Los ítems fueron alineados en un único factor y se creó un instrumento unidimensional que explicó el 59,7 % de la varianza total. La validez del constructo por grupos conocidos fue satisfactoria (p < 0,001). Conclusión La FMUS-PB es confiable y válida para medir la práctica del uso de mascarillas en la población brasileña, sobre todo durante la pandemia de COVID-19.

Abstract Objective To culturally adapt the Face Mask Use Scale to Brazilian Portuguese and assess its psychometric properties. Methods This is a methodological, cross-sectional, quantitative study, which comprised the following steps: translation; Portuguese version consensus; assessment by an expert committee; back-translation and comparison with the original version; pilot test; and psychometric assessment of the Face Mask Use Scale (FMUS). Results The original version of FMUS was translated into Brazilian Portuguese. Content validity was performed by a panel of five experts.The Content Validity Index for the scale (CVI-S/Ave) was 0.87 and for the items (CVI-I) it ranged from 0.6 to 1.0. The FMUS - Brazilian Portuguese version (FMUS-BP) was applied to 4822 adults with a mean age of 30 years (SD = 11.7).For internal consistency, Cronbach's alpha was 0.86. The original two-factor model of the FMUS was not suitable for the Brazilian population due to the use of Exploratory Factor Analysis and Confirmatory Factor Analysis. Thus, an Exploratory Factor Analysis was carried out to investigate the factor structure of the FMUS-BP again and a new potential model of the FMUS-BP for better explanation.The FMUS-BP presented a factor structure different from the original model. Items were aligned on a single factor, creating a one-dimensional instrument that explained 59.7% of the total variance. Construct validity by known-groups was satisfactory (p <0.001). Conclusion The FMUS-BP is reliable and valid to measure the practice of using masks among the Brazilian population, especially in the COVID-19 pandemic.

Revisión rápida del uso de cubrebocas quirúrgicos en ámbito comunitario e infecciones respiratorias agudas / Rapid review of the community-wide use of surgical masks and acute respiratory infections

Resumen: Objetivo: Evaluar la efectividad del uso de cubrebocas quirúrgico en ámbitos comunitarios para reducir la probabilidad de contagio por SARS-CoV-2 u otra infección respiratoria aguda viral, en comparación con no usar cubrebocas. Material y métodos: Se utilizó la metodología de revisiones rápidas de Cochrane. La estrategia de búsqueda abarcó una base de datos académica y pre-prints hasta el 1 de abril de 2020. Los títulos y resúmenes fueron revisados por un investigador. La revisión de textos completos fue dividida entre tres investigadores. Los resultados fueron sintetizados de forma narrativa. Resultados: Se identificaron 713 manuscritos, de los cuales 21 cumplieron los criterios de inclusión. De seis revisiones sistemáticas, cuatro no encontraron reducciones en la probabilidad de contagio y seis estudios experimentales en hogares no encontraron diferencias en la probabilidad de contagio asociado con el uso de cubrebocas. Únicamente un estudio de modelaje estimó una reducción de 20% en la incidencia de enfermedad respiratoria, asumiendo que 10 a 50% de la población hace uso correcto de cubrebocas quirúrgicos. Conclusiones: La evidencia científica no es concluyente para recomendar o desalentar el uso de cubrebocas a nivel poblacional. Considerando los potenciales efectos negativos, las recomendaciones gubernamentales deberían esperar a los resultados de los experimentos naturales en países que han recomendado la utilización poblacional de cubrebocas.

Abstract: Objective: To assess the effectiveness of using surgical masks in community settings to reduce the probability of infection by SARS-CoV-2 or other acute viral respiratory infection, compared to not using surgical masks. Materials and methods: We followed the Cochrane rapid review methodology. The search strategy encompasses one academic database and pre-prints until April 1, 2020. Titles and abstracts were reviewed by one investigator. The full text review was divided among three researchers. The results were synthesized in a narrative way. Result: 713 manuscripts were identified, of which 21 met the inclusion criteria. Of six systematic reviews, four found no reduction in the probability of transmission. Experimental home studies found no differences in the probability of contagion associated with the use of mouth masks. Only one modeling study estimated a 20% reduction in the incidence of acute respiratory disease, assuming that 10 to 50% of the population use the surgical masks correctly. Conclusions: The scientific evidence is inconclusive to recommend or discourage the use of surgical masks at the population level. Considering the potential negative effects, official recommendations should await for the results of natural experiments currently occurring in countries that have recommended the use of face masks at the population level.

Manifestaciones clínicas y evolución de seis primeros casos reportados de COVID-19 en personal médico de Perú / Clinical manifestations and course of the first six reported cases of COVID-19 in the medical doctors of Peru

INTRODUCCIÓN: El personal de salud, entre ellos los médicos, es parte fundamental en primera línea de defensa ante la pandemia de COVID-19, causada por SARS-Cov-2. OBJETIVO: Caracterizar la clínica y evolución de los primeros casos de contagio por coronavirus en médicos de Perú. METODOLOGÍA: Se presentan una serie de seis casos de médicos infectados por coronavirus, con positividad confirmada para COVID-19, mostrando la evolución diaria desde el diagnóstico de la enfermedad, sus principales signos y síntomas, la evolución de los mismos y hasta el desenlace en cada caso. RESULTADOS: De los casos estudiados, cinco fueron hombres, tenían una mediana de edad de 28 años (rango intercuartílico: 27 a 33). Tres de ellos trabajaban más de 12 horas al día en servicios de hospitalización y emergencia; y tres no contaban con mascarilla como método de protección personal. Los síntomas más frecuentes fueron la temperatura axilar superior a 38 grados Celsius, el malestar general, la tos seca y la odinofagia (este último en tres pacientes). En cuanto al diagnóstico con la prueba molecular, tuvo una mediana de tres días de demora (con rango: de 2 a 6 días). Los síntomas que más persistieron fueron la tos seca (presente durante 10 días en cuatro médicos), y la disgeusia como síntoma único, que tuvo la mayor duración (15 días en un solo médico). En los seis casos la evolución fue favorable. Sin embargo, aún se tienen deficiencias para la definición de reincorporación laboral a sus centros hospitalarios. DISCUSIÓN: A pesar de ser un número pequeño de casos, es el primer reporte en personal de salud y que detalla día a día la evolución de los síntomas de COVID-19. Esto puede servir para la salud ocupacional, e incluso como base para la vigilancia y monitorización de los casos en una población mayor.

INTRODUCTION: Health personnel, including physicians, are a fundamental part of the first line of defense against the SARS-CoV-2 pandemic. OBJECTIVE: To characterize the clinical manifestations and course of the first cases of contagion by SARS-CoV-2 in doctors of Peru. METHODOLOGY: We present a series of six cases of doctors infected by SARS-CoV-2, with confirmed positivity for COVID-19, showing the daily evolution from the diagnosis of the disease, its main signs and symptoms, evolution, and until the outcome in each case. RESULTS: Five were men. The median age was 28 years (interquartile range: 27 to 33). In three cases the physician worked more than 12 hours a day in emergency and hospitalization services and not wear a mask at all times. The most frequent symptoms were axillary temperature above 38°C, malaise, dry cough, and odynophagia (the latter in three of the cases). The diagnosis was made at a median of 3 days (interquartile range: 3 to 4 days). The symptoms that persisted the most were dry cough (present during ten days in four doctors). Dysgeusia was the only symptom with the most extended duration (15 days in only one doctor). In the six cases, the course was favorable. However, these doctors found it difficult to return to functions in their hospital centers adequately. DISCUSSION: Despite a small number of cases, it is the first report detailing the evolution of symptoms day by day, which can help for occupational health and even for case surveillance and monitoring.

Reduction of contractility and reactivity in isolated lymphatics from hemorrhagic shock rats with resuscitation

PURPOSE: To evaluate the changes of contractility and reactivity in isolated lymphatics from hemorrhagic shock rats with resuscitation. METHODS: Six rats in the shock group suffered hypotension for 90 min by hemorrhage, and resuscitation with shed blood and equal ringer's solution. Then, the contractility of lymphatics, obtained from thoracic ducts in rats of the shock and sham groups, were evaluated with an isolated lymphatic perfusion system using the indices of contractile frequency (CF), tonic index (TI), contractile amplitude (CA) and fractional pump flow (FPF). The lymphatic reactivity to substance P (SP) was evaluated with the different volume of CF, CA, TI and FPF between pre- and post-treatment of SP at different concentrations. RESULTS: The CF, FPF, and TI of lymphatics obtained from the shocked rats were significantly decreased than that of the sham group. After SP stimulation, the ∆CF (1×10-8, 3×10-8, 1×10-7, 3×10-7 mol/L), ∆FPF (1×10-8, 3×10-8, 1×10-7 mol/L), and ∆TI (1×10-8 mol/L) of lymphatics in the shock group were also obviously lower compared with the sham group. In addition, there were no statistical differences in CA and ∆CA between two groups. CONCLUSION: Lymphatic contractility and reactivity to substance P appears reduction following hemorrhagic shock with resuscitation. .

Compliance with the use of personal protective equipment among dentists working at the royal medical services

The assessment of compliance with using personal protective equipment among a group of military dentists. A self-administered questionnaire was distributed to a total of 100 military dentists. The questionnaire comprised of two parts. The first included five general questions related to the duration of dental experience, gender, professional rank, frequency of recording medical history of patients, in addition to the availability of infection control policy in their departments. The second part was further subdivided into four sections concerned with the use of different personal protective equipment including masks, white coat, gloves and protective glasses. Of the total 100 questionnaires, the response rate was 87%. The majority of the dentists were male general practitioners. Only 57 [65.5%] of them recorded the medical history routinely and only 12 [13.7%] had an infection control policy in their department. The majority of the above mentioned dentists [94.2%] always wore gloves but only 81.6% of them changed their gloves after each patient. About 67.8% of the dentists always wore masks while treating their patients but only 10.3% of them changed the mask after each patient. Most of the dentists [97.7%] wore white coats and approximately half of them [50.57%] never used eyeglasses or protective face shields. Military dentists show good compliance with the use of personal protective equipment; however, some dentists do not utilize the full range of infection control procedures. The development of an infection control manual, in addition to continuous education with adequate supplies of personal protective equipment are necessary to reduce the risk of cross infection in dental clinics

Severe neck burns and laryngeal mask airway for frequent general anesthetics

Securing the airways in a patient suffering from severe neck burns or its sequalae may present a challenge to the most experienced anesthesiologist. We investigate the utility of the Laryngeal Mask Airway [LMA] in this situation. We report on success, failure or complications of LMA insertion at the induction of general anesthesia in 23 patients of a Major Burns Unit and compare our results to our records of patients intubated endotracheally in the Unit. 14 out of 15 patients with neck burns had a LMA inserted with no difficulty or complications, while difficult endotracheal intubations in patients with neck burns were more frequent with statistical significance compared to patients with intact necks. LMA insertion seems to ignore the difficulties met with endotracheal intubation in this context

Use of the laryngeal mask for closed circuit anesthesia

We examined whether the laryngeal mask could be used effectively in 70 patients breathing spontaneously during closed-circuit anesthesia. After administration of oxygen 101 min[-1], anesthesia was induced and the laryngeal mask inserted. After 6 min of denitrogenation [3.51 min[-1] nitrous oxide and 1.51.min[-1] oxygen], the fresh-gas flow was decreased to the minimum required to maintain refilling of a ventilator bellows [Carden Ventmasta]; nitrous oxide was turned off. A vaporiser outside the breathing system was set either by observing an end-tidal agent monitor or at 3-5 times greater than the required end-tidal concentration. The total fresh gas flow, hemodynamics and respiratory variables were monitored. Several types of operations were performed and lasted 9-126 min [mean 37 min]. The average total fresh gas flow during the closed circuit period was 340 ml. min[-1] [range 200-500 ml. min[-1]]. Blood pressure, heart rate and respiration were stable throughout anesthesia and there were no major side effects attributable to the technique. We believe that closed-circuit anesthesia in patients breathing spontaneously through the laryngeal mask, as described here, can be used safely, conveniently and effectively. This technique is suitable for surgical operations of short duration

Estudo e avaliaçäo dos meios de biossegurança para o cirurgiäo-dentista e auxiliares contra doenças infecto-contagiosas no consultório odontológico / Evaluation of the methods for protection of dental team and prevention from infectious diseases

O presente trabalho visa alertar os cirurgiöes-dentistas para os perigos de transmissäo das doenças infecto-contagiosas no consultório odontológico e corrigir suas técnicas operatórias, visando o controle da infecçäo cruzada. Foram avaliados dispositivos de biossegurança, como máscaras faciais, máscaras retangulares e ovais, óculos e luvas existentes no comércio nacional. As luvas foram avaliadas com relaçäo à incidência de micro-perfuraçöes e localizaçäo dessas por horas de trabalho, e os outros dispositivos foram avaliados em relaçäo à eficiência, visibilidade e comodidade. Todos os dispositivos testados foram aprovados e indicados por serem eficientes