Internal carotid artery dissection associated with acute dengue virus infection: a case report / Dissecção da artéria carótida interna associada à infecção aguda pelo vírus da dengue: relato de caso

Cervical artery dissections (CAD) can occur spontaneously or as a direct result of significant trauma. Viral infections, such as SARS-CoV2, influenza, and Epstein Barr, are risk factors for spontaneous CAD. Dengue virus infections have dramatically increased in recent decades, and Brazil is one of the endemic areas. The dengue virus can cause headache and neurological complications such as encephalitis, myelitis, Guillain-Barré syndrome, and myositis. No report has yet been found in the literature of dissection of the internal carotid artery secondary to dengue infection. Our objective is to report the case of a patient with dissection of the internal carotid artery associated with acute dengue virus infection.

As dissecções da artéria cervical (DAC) podem ocorrer espontaneamente ou como resultado direto de trauma significativo. Infecções virais, como SARS-CoV2, influenza e Epstein Barr, são fatores de risco para DAC espontânea. As infecções pelo vírus da dengue aumentaram dramaticamente nas últimas décadas, e o Brasil é uma das áreas endêmicas. O vírus da dengue pode causar dor de cabeça e complicações neurológicas como encefalite, mielite, síndrome de Guillain-Barré e miosite. Ainda não foi encontrado na literatura nenhum relato de dissecção da artéria carótida interna secundária à infecção por dengue. Nosso objetivo é relatar o caso de um paciente com dissecção da artéria carótida interna associada à infecção aguda pelo vírus da dengue.

Physical dependence in older adults and job burnout in their informal caregivers in the COVID-19 context, a correlational study / Dependencia física en personas adultas mayores y sobrecarga en sus cuidadores informales en el contexto de la pandemia por COVID-19, un estudio correlacional / Dependência física em idosos e sobrecarga em seus cuidadores informais no contexto da pandemia de COVID-19, um estudo correlacional

Introduction: The functional status of older adults (OA) is usually used as an indicator of their health. Increased dependence raises the need for an informal caregiver (IC), leading to a state of work overload, which was frequently observed during the COVID-19 confinement. Objective: To assess the relationship between physical dependence of OA, job burnout of their IC, and the confinement conditions in the context of the COVID-19 pandemic. Materials and methods: The participants included 77 OA together with their respective IC. The OA filled out a sociodemographic data sheet and a Confinement Conditions Questionnaire. In addition to these two forms, the IC filled out the Zarit Caregiver Burnout Scale and the ABVD Barthel Scale. Results: Statistically significant correlations were found between: physical dependence and job burnout (rho=0.475, p<0.01); physical dependence and confinement degree (rho=0.441, p<0.01); and job burden and confinement degree (rho=0.344, p<0.01). Conclusion: Caregivers develop a greater job burnout as a consequence of the OA's dependence. Furthermore, it seems that this burnout is more related to the confinement conditions experienced by older adults than to the caregiver's own conditions.

Introducción: El estado funcional de las personas adultas mayores (PAM) suele tomarse como indicador de salud; la presencia de dependencia incrementa la necesidad de un cuidador informal (CI) que puede desarrollar sobrecarga, lo cual se agudizó durante el confinamiento por COVID-19. Objetivo: Evaluar la relación de la dependencia física de las PAM, la sobrecarga de su CI y las condiciones de confinamiento en el contexto de la pandemia por COVID-19. Materiales y métodos: Participaron 77 diadas conformadas por una PAM y su CI. Las PAM contestaron una ficha de datos sociodemográficos y Cuestionario de Condiciones de Confinamiento. Los CI, diligenciaron una ficha de datos sociodemográficos, Cuestionario de Condiciones de Confinamiento, Escala de Carga del Cuidador de Zarit y Escala de Barthel de ABVD. Resultados: Se encontró correlaciones estadísticamente significativas entre la dependencia física y la sobrecarga (rho=0,475, p<0,01); la dependencia física y el grado de confinamiento (rho=0,441, p<0,01); y la sobrecarga y el grado de confinamiento (rho=0,344, p<0,01). Conclusión: Los cuidadores de PAM desarrollan mayor sobrecarga frente a su dependencia física; además parece ser que la sobrecarga del cuidador está más relacionada con las condiciones de confinamiento de las personas adultas mayores, que con las propias condiciones de confinamiento del cuidador.

Introdução: O estado funcional do idoso (PAM) é geralmente tomado como um indicador de saúde; A presença de dependência aumenta a necessidade de um cuidador informal (CI) que pode desenvolver sobrecarga, que se agravou durante o confinamento da COVID-19. Objetivo: Avaliar a relação entre a dependência física dos PAM, a sobrecarga do seu CI e as condições de confinamento no contexto da pandemia de COVID-19. Materiais e métodos: Participaram 77 díades compostas por uma PAM e seu CI. O PAM respondeu a uma ficha de dados sociodemográficos e a um Questionário de Condições de Confinamento. Os CI preencheram ficha de dados sociodemográficos, Questionário de Condições de Confinamento, Escala de Sobrecarga do Cuidador de Zarit e Escala Barthel (ABVD). Resultados: Foram encontradas correlações estatisticamente significativas entre dependência física e sobrecarga (rho=0,475, p<0,01); dependência física e grau de confinamento (rho=0,441, p<0,01); e sobrecarga e grau de confinamento (rho=0,344, p<0,01). Conclusão: Os cuidadores do PAM desenvolvem maior sobrecarga diante da dependência física; além disso, parece que a sobrecarga do cuidador está mais relacionada com as condições de confinamento dos idosos do que com as próprias condições de confinamento do cuidador.

A covid-19 como um analisador do sofrimento de enfermeiras: um ensaio teórico / Covid-19 as a suffering analyzer for female nurses: a theoretical essay / El covid-19 como analizador de sufrimiento de enfermeras: un ensayo teórico

Este ensaio propõe que a Covid-19 pode operar como um analisador, dentro da perspectiva da análise institucional, iluminando um determinado modo de organização social que promove profundas desigualdades e ameaça a vida em diversos níveis e revelando as condições sociais, institucionais e políticas de produção de sofrimento no corpo profissional de Enfermagem. A pandemia desvelou um conjunto de marcas relacionadas à profissão, agravadas pela crise sanitária, reforçando a naturalização das relações de cuidado atribuídas ao feminino, bem como um conjunto de clivagens e hierarquias internas à profissão a partir da sinergia de marcadores da diferença, como gênero, cor/raça, classe e geração. Além disso, este trabalho mostra a presença de uma necropolítica nas respostas à pandemia que banaliza a vida e permite morrer determinados grupos sociais. A ideia de "profissionais de linha de frente" é criticada em suas metáforas bélicas, mas tomada como figura de linguagem em sua potência para afirmar que existem corpos que, pelas marcas sociais e históricas e pela interdependência do cuidado, são mais presentes e exigidos e, portanto, mais vulneráveis à doença e ao sofrimento dela decorrente.(AU)

The essay proposes that Covid-19 can operate as an analyzer, within the perspective of institutional analysis, illuminating a certain mode of social organization that promotes profound inequalities and threatens life at various levels, revealing the social, institutional and political conditions for the production of suffering in the professional nursing body. The pandemic would unveil a set of marks related to the profession, aggravated by the sanitary crisis, reinforcing the naturalization of the care relations attributed to the feminine, as well as a set of cleavages and internal hierarchies to the profession from the synergy of markers of difference as gender, color/race, class and generation. The work shows the presence of necropolitics in responses to the pandemic, which trivializes life and allows certain social groups to die. The idea of "front-line professionals" is criticized in its war metaphors, but taken as a figure of speech in its potency to affirm that there are bodies that by social and historical marks, and by the interdependence of care, are more present and demanded, and therefore more vulnerable to disease and the resulting suffering.(AU)

El ensayo propone que el Covid-19 puede funcionar como analizador, desde la perspectiva del análisis institucional, revelando las condiciones sociales, institucionales y políticas de producción de sufrimiento de enfermeras. La pandemia revela algunas marcas relacionadas con la profesión, agravadas por la crisis de salud, reforzando la naturalización de la atribución del cuidado a lo femenino y un conjunto de jerarquías internas de la profesión. El trabajo también muestra la presencia de una necropolítica en las respuestas a la pandemia. La idea de "profesionales de primera línea" es criticada, pero tomada como una figura del lenguaje en su potencia para afirmar que hay cuerpos que, por las marcas sociales e históricas y por la interdependencia del cuidado, están más presentes y demandados, y por lo tanto más vulnerables a la enfermedad.(AU)

Orientação a pais por chamadas de áudio durante a pandemia de covid-19 / Support for parents via audio calls during the covid-19 pandemic / Orientación de los padres mediante llamadas de audio durante la pandemia de covid-19

O distanciamento social ocasionado pela pandemia de Covid-19 levou a profundas mudanças na rotina das famílias com crianças pequenas, aumentando o estresse no ambiente doméstico. Este estudo analisou a experiência de planejamento e implementação de um projeto de extensão universitária que ofereceu orientação a pais com filhos de 0 a 11 anos por meio de chamadas de áudio durante a pandemia. O protocolo de atendimento foi desenvolvido para atender às necessidades de famílias de baixa renda e listava problemas específicos relacionados ao confinamento em casa e ao fechamento das escolas seguidos por uma variedade de estratégias de enfrentamento. A análise de 223 queixas relatadas pelos usuários em 130 ligações revelou que 94% dos problemas referidos pelos pais foram contemplados pelo protocolo de atendimento e estavam relacionados aos problemas externalizantes (39%) ou internalizantes (26%) das crianças ou ao declínio do bem-estar subjetivo dos pais (29%). Serviços de apoio devem orientar os pais quanto ao uso de práticas responsivas e assertivas que promovam o bem-estar emocional da criança e estabeleçam expectativas comportamentais em contextos estressantes. A diminuição dos conflitos entre pais e filhos resultante do uso dessas estratégias tende a reduzir o sofrimento dos pais, aumentando sua sensação de bem-estar subjetivo. Recomenda-se ampla divulgação dessas iniciativas e seguimento dos casos.(AU)

The social distancing the COVID-19 pandemic entailed has led to profound changes in the routine of families with young children, increasing stress in the home environment. This study analyzed the experience of planning and implementing a university extension program that offered support to parents with children from 0 to 11 years old via audio calls during the COVID-19 pandemic. The service protocol was developed to meet the needs of low-income families and listed specific problems related to home confinement and school closure followed by a variety of coping strategies. The analysis of 223 complaints reported by users in 130 calls revealed that 94% of the problems reported by parents were addressed by the protocol and were related to children's externalizing (39%) or internalizing (26%) problems or to the decline in parents' subjective well-being (29%). Support services should guide parents on the use of responsive and assertive practices that promote the child's emotional well-being and set behavioral expectations in stressful contexts. The reduction in conflicts between parents and children resulting from the use of these strategies tends to reduce parents' suffering, increasing their sense of subjective well-being. Wide dissemination of these initiatives and case follow-up are recommended.(AU)

La distancia social causada por la pandemia de COVID-19 condujo a cambios profundos en la rutina de las familias con niños pequeños, aumentando el estrés en el entorno del hogar. Este estudio analizó la experiencia de planificar e implementar un proyecto de extensión universitaria que ofreció orientación a los padres con niños de cero a 11 años a través de llamadas de audio durante la pandemia COVID-19. El protocolo de atención se desarrolló para satisfacer las necesidades de las familias de bajos ingresos y enumeró problemas específicos relacionados con el confinamiento en el hogar y el cierre de la escuela, seguido de una variedad de estrategias de afrontamiento. El análisis de 223 quejas informadas por los usuarios en 130 llamadas reveló que el 94% de los problemas informados por los padres fueron abordados por el protocolo de atención y estaban relacionados con los problemas de externalización (39%) o internalización (26%) de los niños o la disminución del bienestar subjetivo de los padres (29%). Los servicios de apoyo deberían aconsejar a los padres sobre el uso de prácticas receptivas y asertivas que promuevan el bienestar emocional del niño y establezcan expectativas de comportamiento en contextos estresantes. La reducción de los conflictos entre padres e hijos como resultado del uso de estas estrategias tiende a reducir el sufrimiento de los padres, aumentando su sensación de bienestar subjetivo. Se recomienda una amplia difusión de estas iniciativas y seguimiento de casos.(AU)

Human Papilloma Virus, Risk Factors and Sequelae: How much do Female Adolescents in Port Harcourt Metropolis know?

Background: Human Papilloma virus (HPV) infection is the most common viral infection of the genital tract; is sexually transmitted with the highest rates observed in young women. This study assessed the level of knowledge of HPV and cervical cancer among adolescent girls in Port Harcourt metropolis, Nigeria. Methodology: A cross-sectional survey among 328 in-school female secondary school students aged 9 - 19 years, selected via multi-stage sampling. Information on socio-demographics, knowledge of HPV and cervical cancer and sexual history were collected using a self-administered, semi-structured questionnaire. Data was analyzed using SPSS version 23 and Chi square test was used to establish associations. Results: Only 38.2% and 30% had heard of cervical cancer and HPV respectively; the media being the most common source. Knowledge of transmission, risk factors, sequelae and prevention of infection was poor (75%). About 20.2% were aware of the causal association between HPV infection and cervical cancer. Some (3.1%) were sexually exposed and practiced unprotected sexual intercourse. Median age at sexual debut was 11 years. Older and private school students (15-19years) had better knowledge Conclusion: The level of knowledge of HPV, cervical cancer, their association and risk factors, among adolescent girls in Port Harcourt metropolis is poor. Some adolescents engage in sexual practices that put them at risk for HPV infection. Social media and upper primary and secondary school-based approach to HPV health promotion should be explored to provide detailed adolescent-friendly information to guide in prevention of HPV infection and cervical cancer.

The impact of the COVID-19 pandemic on theatre use at the rahima moosa mother and child hospital

SARS-COV-2, the viral pathogen that resulted in the COVID-19 pandemic, was first identified by the World Health Organization (WHO) on 31 December 2019. Efforts to curb the spread of this virus, as well as the effects of viral infections and resulting complications thereof, have placed immense strain on healthcare systems throughout the world. In South Africa, a nationwide lockdown was instituted on 27 March 2020 which resulted in the suspension of all elective surgical services. The effect of this suspension of services has not been fully elucidated, but it has been postulated that a significant surgical backlog may have been created due to limited resources and massive pre-existing patient loads. Methods: We conducted a retrospective descriptive review of theatre records at the Rahima Moosa Mother and Child Hospital (RMMCH) for the time period 1 March 2019 to 28 February 2021. Results: A total of 8 176 cases amounting to 9 656 hours and 20 minutes of theatre time occurred from 1 March 2019 to 29 February 2020 (pre-COVID-19). From 1 March 2020 to 28 February 2021 (post-COVID-19), a total of 7 717 cases amounting to 9 148 hours and 2 minutes were conducted. This calculated to a 5.61% reduction in cases and a 5.26% reduction in theatre hours. There was a statistically significant reduction in theatre use both in terms of cases done and hours of theatre time after the onset of the COVID-19 pandemic. Conclusion: The onset of the COVID-19 pandemic significantly reduced the number of cases completed at the RMMCH. It also led to a significant reduction in total theatre use. Both of these findings were most pronounced in elective gynaecology and paediatric surgery services. There was, however, no statistically significant increase in intensive care unit (ICU) and high care (HC) admissions as well as mortalities for the period studied

Analysis of the characteristics of viral infections in children with diarrhea in Beijing from 2018 to 2022 / 中华预防医学杂志

Objective: To explore the characteristics of viral infections in children with diarrhea in Beijing from 2018 to 2022. Methods: Real-time PCR and enzyme-linked immunosorbent assay were used to detect viral nucleic acid of Norovirus (NoV), Sappovirus (SaV), Astrovirus (AstV), Enteric Adenovirus (AdV) or antigen of Rotavirus (RV) in 748 stool samples collected from Beijing Capital Institute of Pediatrics from January 2018 to December 2021. Subsequently, the reverse transcription PCR or PCR method was used to amplify the target gene of the positive samples after the initial screening, followed by sequencing, genotyping and evolution analysis, so as to obtain the characteristics of these viruses. Phylogenetic analysis was performed using Mega 6.0. Results: From 2018 to 2021, the overall detection rate of the above five common viruses was 37.6%(281/748)in children under 5 years old in Beijing. NoV, Enteric AdV and RV were still the top three diarrhea-related viruses, followed by AstV and SaV, accounting for 41.6%, 29.2%, 27.8%, 8.9% and 7.5%, respectively. The detection rate of co-infections with two or three diarrhea-related viruses was 4.7% (35/748). From the perspective of annual distribution, the detection rate of Enteric AdV was the highest in 2021, while NoV was predominant in the other 4 years. From the perspective of genetic characteristics, NoV was predominant by GⅡ.4, and after the first detection of GⅡ.4[P16] in 2020, it occupied the first two gene groups together with GⅡ.4[P31]. Although the predominant RV was G9P[8], the rare epidemic strain G8P[8] was first detected in 2021. The predominant genotypes of Enteric AdV and AstV were Ad41 and HAstV-1. SaV was sporadic spread with a low detection rate. Conclusion: Among the diarrhea-related viruses infected children under 5 years of age in Beijing, the predominant strains of NoV and RV have changed and new sub-genotypes have been detected for the first time, while the predominant strains of AstV and Enteric AdV are relatively stable.

Inflammatory granuloma of the trachea: a rare case with Epstin-Barr virus infection / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Epstein-Barr virus (EBV), a double-stranded DNA virus with an envelope, is a ubiquitous pathogen that is prevalent in humans, although most people who contract it do not develop symptoms (Kerr, 2019). While the primary cells EBV attacks are epithelial cells and B lymphocytes, its target range expands to a variety of cell types in immunodeficient hosts. Serological change occurs in 90% of infected patients. Therefore, immunoglobulin M (IgM) and IgG, serologically reactive to viral capsid antigens, are reliable biomarkers for the detection of acute and chronic EBV infections (Cohen, 2000). Symptoms of EBV infection vary according to age and immune status. Young patients with primary infection may present with infectious mononucleosis; there is a typical triad of symptoms including fever, angina, and lymphadenectasis (Houen and Trier, 2021). In immunocompromised patients, response after EBV infection may be atypical, with unexplained fever. The nucleic acid of EBV can be detected to confirm whether high-risk patients are infected (Smets et al., 2000). EBV is also associated with the occurrence of certain tumors (such as lymphoma and nasopharyngeal carcinoma) because it transforms host cells (Shannon-Lowe et al., 2017; Tsao et al., 2017).

Gestión de riesgos aplicado al diseño de un nuevo proceso productivo de un inmunoterapéutico del Centro de Ingeniería Genética y Biotecnología / Risk management applied to the design of a new production process for an immunotherapeutic from the Center for Genetic Engineering and Biotechnology

El estudio expone las acciones dirigidas a la reducción de los riesgos en el diseño de un nuevo proceso de producción del ingrediente farmacéutico activo de un inmunoterapéutico producido en el Centro de Ingeniería Genética y Biotecnología. El análisis modal de fallas y efectos fue conducido por un equipo multidisciplinario del referido centro. La administración de riesgos a la calidad se aplicó a la tecnología de obtención de una proteína recombinante con uso diagnóstico que se proponía transferir a la Dirección de Desarrollo Tecnológico. El riesgo en el diseño de un nuevo proceso de producción evaluó las fallas de mayor influencia en el bajo recobrado y el incumplimiento de las especificaciones de calidad del inmunoterapéutico. Las causas potenciales de estos fallas fueron: la insuficiente cantidad de viales de los bancos de células, el medio de cultivo complejo con componentes de origen bovino, la incorrecta manipulación de las muestras por los operarios, el uso de equipamiento no adecuado, los parámetros de operación (agitación, pH y conductividad) fuera de límites de especificación con efecto sobre la pureza por el alto porcentaje de contaminantes del hospedero; así como, un medio filtrante inadecuado unido a una incorrecta preparación del sistema de filtración redundantes en un producto no estéril. Las acciones llevaron a modificaciones en la tecnología propuesta por la Dirección de Investigaciones Biomédicas que permitió el diseño de un nuevo proceso productivo para un biofarmacéutico destinado al tratamiento de enfermedades virales crónicas(AU)

The study aimed at reducing risks in the design of a new production process for the active pharmaceutical ingredient of an immunotherapeutic produced at the Center for Genetic Engineering and Biotechnology. The failure mode and effects analysis were conducted by a multidisciplinary team from the center. Quality risk management was applied to the technology for obtaining a recombinant protein for diagnostic use that was proposed to be transferred to Technological Development Division. The risk analyses evaluated the greatest influence on low recovery and non-compliance with the immunotherapeutic quality specifications. The potential causes of the failures were: the insufficient number of vials in cell banks, the complex culture medium with components of bovine origin, the samples handling errors by the operators, the use of inappropriate equipment, the parameters of operation (agitation, pH and conductivity) outside specification limits affecting purity due to the high percentage of contaminants from the host; as well as, the inadequate filtering medium together with an incorrect preparation of the redundant filtration system in a non-sterile product. The actions could modify the technology proposed by Biomedical Research Division that allowed the design of a new production process of a biopharmaceutical product for the treatment of chronic viral diseases(AU)

Lactantes febriles menores de tres meses sin foco aparente: ¿es necesario cambiar la estrategia de evaluación?: probamos el step by step / Febrile infants of under three months of age without apparent focus: is it necessary to change the assessment strategy?: we tested the step-by-step approach / Lactentes febris com menos de três meses de idade e sem foco aparente: é necessário alterar a estratégia de avaliação?: tentamos o "passo a passo"

Introducción: la fiebre es un motivo muy frecuente de consulta y hasta en un 20% de los pacientes no se encuentra la causa. En el ámbito de la emergentología pediátrica clásicamente ha existido interés en homogeneizar la forma de evaluar los lactantes febriles menores de tres meses. Contar con un protocolo que permita detectar precozmente el niño que cursa una infección bacteriana invasiva (IBI) sin realizar conductas desproporcionadas es todo un desafío. Objetivo: evaluar y comparar la capacidad para identificar IBI en la pauta actual de fiebre sin foco (FSF) como en la estrategia step by step, en lactantes con FSF valorados en el DEP-CHPR. Material y métodos: estudio observacional, descriptivo, retrospectivo y de pruebas diagnósticas. Criterios de inclusión: lactantes menores de 90 días de vida que consultaron en 2017 y 2018 en DEP-CHPR con diagnóstico de FSF. Resultados: se incluyeron 261 lactantes evaluados con la pauta de FSF actual, en ellos se aplicó la estrategia step by step. El rango de edad fue de 84 días (4-88 días) con una media de 41 días. Sexo masculino 148 niños (56,7%). Se registraron 37 infecciones bacterianas (14,2%) de las cuales 3 fueron IBI (1,1%) y 34 fueron no-IBI (13,1%). La sensibilidad para step by step fue de 0,94% y de 0,89 para la pauta actual, con un VPN de 0,98 para ambas estrategias. Discusión: los lactantes menores de 3 meses son más susceptibles por características fisiológicas a infecciones bacterianas invasivas y cuanto más pequeño aumenta aún más la frecuencia. El step by step discrimina a menores de 1 mes en menores de 21 días y otro grupo de más de 21 días. Nuestra pauta no hace esta discriminación y realiza por igual laboratorio en sangre, orina y líquido cefalorraquídeo; realizando en ocasiones estudios cruentos no necesarios. Conclusiones: ambas estrategias aplicadas en esta población resultaron altamente sensibles para identificar infección bacteriana con un VPN elevado. La aplicación de step by step presenta como beneficio adicional evitar con seguridad la punción lumbar en recién nacidos entre los 21 y 28 días.

Introduction: fever is a very frequent reason for consultation and in up to 20% of patients the cause has not been found. In the field of pediatric emergentology, there has been a traditional interest in homogenizing the way of assessing febrile infants under three months of age. Having a protocol that enables early detection of children with IBIs without engaging in disproportionate procedures is a challenge. Objective: to evaluate and compare the ability to identify IBIs in the present FSF regimen as in the Step-by-Step strategy, in infants with FSF assessed at the Pereira Rossell Pediatric Hospital Center. Material and methods: observational, descriptive, retrospective study and diagnostic tests. Inclusion criteria: Infants under 90 days of age who consulted in 2017 and 2018 at the DEP-CHPR with a diagnosis of FSF. Results: 261 infants diagnosed with FSF regimen were included and they all received a Step-by-Step approach. The age range was 84 days (4 - 88) days with a mean of 41 days. Males 148 children (56.7%). There were 37 bacterial infections (14.2%), of which 3 were IBI (1.1%) and 34 were Non-IBI (13.1%). The sensitivity for the Step-by-Step approach was 0.94% and 0.89 for the current regimen, with a NPV of 0.98 for both strategies. Discussion: infants younger than 3 months-old are more susceptible due to physiological characteristics to invasive bacterial infections, and the younger they are, the higher the frequency. The Step-by-Step Approach splits children of under 1 month of age into those under or over 21 days of age. Our guideline does not make this discrimination and performs the same blood, urine and cerebrospinal fluid laboratory tests sometimes carrying out blood tests is not necessary. Conclusions: both approaches used in this population were highly sensitive to the identification of bacterial infections with a high NPV. The application of the "Step-by-Step" approach has the additional benefit of avoiding lumbar puncture to newborns of between 21 and 28 days of age.

Introdução: a febre é um motivo muito comum de consulta e em até 20% dos pacientes a causa não é encontrada. No campo da emergência pediátrica, tradicionalmente tem havido interesse em homogeneizar a forma de avaliação de lactentes febris menores de três meses de idade. Ter um protocolo que permita a detecção precoce de uma criança com IBI sem realizar procedimentos desproporcionais é um desafio. Objetivo: avaliar e comparar a capacidade de identificação de IBI na atual Diretriz da FSF e na estratégia Passo a Passo, em lactentes com FSF avaliados no DEP-CHPR. Material e métodos: estudo observacional, descritivo, retrospectivo e de testes diagnósticos. Critérios de inclusão: Lactentes com menos de 90 dias de idade que consultaram em 2017 e 2018 no Hospital Pediátrico Pereira Rossell do Uruguai com diagnóstico de FSF. Resultados: Foram incluídos 261 lactentes avaliados com a atual diretriz da FSF, nos quais foi aplicada a estratégia Passo a Passo. A faixa etária foi de 84 dias (4 - 88) dias com média de 41 dias. Sexo masculino 148 crianças (56,7%). Foram registradas 37 infecções bacterianas (14,2%), sendo 3 IBI (1,1%) e 34 Não IBI (13,1%). A sensibilidade para Passo a Passo foi de 0,94% e 0,89 para o esquema atual, com VPN de 0,98 para ambas estratégias. Discussão: crianças menores de 3 meses de idade são mais suscetíveis a infecções bacterianas invasivas devido às características fisiológicas e quanto menores, mais frequentes. O Passo a Passo separa crianças menores de 1 mês em dois grupos: menores de 21 dias e acima de 21 dias. Nossa diretriz não faz essa discriminação e realiza exames laboratoriais de sangue, urina e líquido cefalorraquidiano da mesma forma; às vezes realizando estudos de sangue que não são necessários. Conclusões: ambas as estratégias aplicadas nesta população foram altamente sensíveis para identificar infecção bacteriana com alto VPN. A aplicação do "Passo a Passo" apresenta como benefício adicional evitar a punção lombar em recém-nascidos entre 21 e 28 dias.

Suplementação de probióticos: ferramenta no controle de infecções respiratórias virais ­ uma revisão sistemática / Probiotics supplementation: a tool in the control of viral respiratory infection ­ a systematic review

Infecções respiratórias virais estão entre as principais causas globais de adoecimento de acordo com o estado de saúde e o microbioma do indivíduo. O objetivo dessa revisão foi identificar possíveis efeitos associados à suplementação de probióticos em infecções respiratórias virais. Para tanto, realizou-se uma busca sistematizada nas bases de dados Google Acadêmico, Scopus e PubMed partindo da hipótese de que a intervenção clínica baseada na suplementação de probióticos reduz a gravidade dos sinais/ sintomas de infecções virais. Foram identificados 585 artigos dos quais foram selecionados 16 para compor a síntese descritiva deste artigo. O uso de probióticos como terapêutica na infecção respiratória tem capacidade de melhorar o quadro clínico do paciente por meio de: (i) modulação da resposta imune, (ii) melhora da resposta específica, (iii) produção de bacteriocinas, (iv) melhora na integridade de mucosas, (v) redução do número de cópias virais.

Viral respiratory infections are among the main global causes of illness according to the individual's health status and microbiome. The objective of this review was to identify possible effects associated with probiotic supplementation in viral respiratory infections. Therefore, a systematic search was carried out in the Google Academic, Scopus and PubMed databases, based on the hypothesis that clinical intervention based on supplementation of probiotics reduces the severity of signs/symptoms of viral infections. 585 articles were identified, of which 16 were selected to compose the descriptive synthesis of this article. The use of probiotics as therapeutics in respiratory infection is able to improve the patient's clinical condition through: (i) modulation of the immune response, (ii) improvement of the specific response, (iii) production of bacteriocins, (iv) improvement in mucosal integrity, (v) reduction in the number of viral copies.

Desarrollo y resultados de la respuesta institucional dirigida a la comunidad universitaria UIS frente a la pandemia por COVID-19 durante 2020-2021 / Development and results of the institutional response at UIS for the COVID-19 pandemic during 2020 and 2021

Resumen Introducción: La pandemia por COVID-19 ha requerido de la respuesta institucional de las diferentes organizaciones para mitigar sus efectos. Objetivo: Describir el proceso de respuesta institucional dirigida a la comunidad universitaria de la Universidad Industrial de Santander (UIS) frente la epidemia por COVID-19 y analizar los resultados de los procesos implementados durante 2020 y 2021. Metodología: Estudio descriptivo de tipo mixto con un componente cualitativo descriptivo de la organización y desarrollo de la respuesta institucional y un componente cuantitativo descriptivo del análisis de los casos sospechosos y confirmados de COVID-19 en la comunidad universitaria UIS. Resultados: La respuesta institucional UIS comenzó desde marzo de 2020 y comprendió lineamientos y adaptaciones de tipo académico y laboral y un plan de respuesta que incluyó 6 componentes de acción y un retorno gradual a la presencialidad. Durante 2021 se confirmaron 272 casos en funcionarios y docentes y 208 casos en estudiantes, con una tendencia que reflejó la dinámica de transmisión local, pero con menor letalidad. Conclusiones: La respuesta institucional UIS frente a la epidemia por COVID-19 inició tempranamente e incluyó diferentes componentes que permitieron un retorno progresivo con baja transmisión en las sedes. Los aspectos por mejorar estuvieron relacionados con la cobertura, calidad y continuidad del diagnóstico y atención oportunos, conexas a las competencias y fragmentación propias del sistema de salud, y con la visibilidad del plan y sus resultados dentro de la comunidad universitaria.

Abstract Introduction: The COVID-19 pandemic has required the institutional response of different organizations to mitigate its effects. Objective: To describe the institutional response process for the COVID-19 pandemic at the Universidad Industrial de Santander (UIS) and analyze the results of the processes implemented during 2020 and 2021. Methodology: Descriptive mixed study with a qualitative component of the organization and development of the institutional response, and a descriptive quantitative component of the analysis of suspected and confirmed cases of COVID-19. Results: The UIS institutional response began in March 2020. The plan included academic and employment guidelines and adaptations, a response plan that included 6 action components and a gradual return to attendance. During 2021, 272 cases were confirmed in employees and professors, and 208 cases in students with a trend that reflected the dynamics of local transmission, but with lower lethality. Conclusions: The UIS institutional response to the COVID-19 epidemic began early and included different components that allowed for a progressive return with low transmission. The aspects to improve were related to the coverage, quality and continuity of timely diagnosis and care related to competencies and fragmentation of the health system, and the visibility of the plan and its results within the university community.

Knowledge and attitudes of health workers in bouake, Cote d'ivoire on zika virus disease in the context of a global epidemic

Since January, 2012, the Pacific region has faced a heavy burden of concurrent epidemics of dengue, chikungunya, and zika virus infections. In 2016, WHO developed a global response strategic framework to ensure that zika virus is a priority and accelerated area of public health research. This study conducted in Bouaké (Côte d'Ivoire) is part of this framework. The main objective was to assess the knowledge and attitudes of health workers working there on the zika virus disease in order to consider a better preparation and response to a possible epidemic in Côte d'Ivoire. Cross-sectional study covering the period from October 2016 to March 2017 was used here. The sampling was comprehensive and included interviews with 258 persons. Subjects were interviewed using a questionnaire edited and adapted from the CAP questionnaire developed by WHO in 2016. People with prior knowledge of the zika virus disease represented 66.3% of the health workers surveyed. Their level of knowledge was insufficient in 83.5% of cases. Their attitudes were good in 51.5% of cases. In the authors' final model, the exercise structure which was adjusted to the level of education and the corporation significantly influenced health workers' attitudes toward illness. Health workers in public settings appeared to have a better attitude compared to their private colleagues (adjusted OR = 4.88; CI: 2.37-10.03; p-value:0.000). The zika virus disease has attracted the attention of the medical community during the 2014-2016 period. This attention, while mitigated by the West African Ebola virus epidemic, deserves to be highlighted.

"É difícil temer aquilo que não podemos ver": o trabalho representacional da Covid-19 e a pedagogia do medo entre vírus e animações / "It's hard to fear something we can't see": the representational work of Covid-19 and the pedagogy of fear between viruses and animacies

Resumo A mais recente pandemia, caracterizada como SARS-CoV-2, se insere em uma linhagem conhecida de patógenos virais que podem desencadear infecções respiratórias severas. Em que pese a importância de se avançar no conhecimento biomédico como forma de garantir o tratamento e a eficácia na suposta erradicação da doença, não é menos urgente refletir acerca das circunstâncias sociais que modelam essa nova situação epidemiológica. Este ensaio analisa como as representações sobre e contágio e morte imbricadas na díade saúde-doença, como fenômenos tradicionais, se revestiram de proposições morais, particularmente entre os meses de janeiro e março de 2020, quando as definições de surto, epidemia e pandemia se tornaram inextricavelmente misturadas. Naquele contexto, e a partir da criação de um tipo de dispositivo de saúde animado por imperativos afeitos à forma mais mortal da doença, a Covid-19 ganhou materialidade. Constituído na confluência de concepções étnico-racializantes, este dispositivo pedagogizou as primeiras imagens da doença, sedimentadas em uma gramática altamente visual e linguística afeitas a um medo coletivo. Examinamos que o trabalho de recepção, nomeação e enquadramento da Covid-19 dependeu de regimes de visibilidade condicionados por processos tradicionais, relativos à materialização e animação do vírus enquanto uma ameaça não só epidemiológica e social, mas política e moral.

Abstract The most recent pandemic, characterized as SARS-CoV-2, is part of a known lineage of viral pathogens that can trigger severe respiratory infections. Despite the importance of advancing biomedical knowledge as a way to guarantee treatment and effectiveness in the supposed eradication of the disease, it is no less urgent to reflect on the social circumstances that shape this new epidemiological situation. This essay analyzes how the representations of contagion and death imbricated in the health-disease dyad, as traditional phenomena, took on moral propositions, particularly between the months of January and March 2020, when the definitions of outbreak, epidemic and pandemic became inextricably mixed. In that context, and from the creation of a type of health apparatus animated by imperatives related to the deadliest form of the disease, Covid-19 gained materiality. Constituted at the confluence of ethnic-racializing conceptions, this apparatus formed the first visual and linguistic images of the disease. Finally, this article examines that the work of reception, appointment and framing of Covid-19 depended on visibility regimes conditioned by traditional processes, related to the materialization and animation of the virus as a threat not only epidemiological and social, but political and moral.

Relación entre obesidad y enfermedades crónicas no transmisibles e infecciosas / Relationship between obesity and chronic non-communicable and infectious diseases

Introducción: la obesidad aumenta el riesgo a padecer de enfermedades crónicas no transmisibles (ECNT) y afecta el curso de enfermedades de origen infeccioso. Objetivo: examinar la literatura sobre cómo influye la obesidad en la gravedad del cuadro clínico de algunas de las enfermedades no transmisibles y transmisibles de mayor impacto en el Perú. Métodos: investigación documental. Se hace un análisis de contenidos de artículos y documentos de estudios desarrollados en diversos contextos asociados a la presencia de obesidad junto con infecciones o ECNT y en base de datos. Resultados: la condición de obesidad alcanzada por malos hábitos de consumo y baja actividad física, es la principal responsable del elevado índice de las ECNT y por consecuente de las tasas de mortalidad. Conclusiones: el exceso de peso afecta al sistema inmunológico, contribuyendo específicamente en los fenómenos exacerbados de respuesta inflamatoria sistémica, determinada por el aumento de secreción de adipocitoquinas, que predispone al organismo a desarrollar y contraer ECNT y enfermedades infecciosas. (AU)

Introduction: Obesity increases the risk of chronic non-communicable diseases (NCDs) and affects the course of diseases of infectious origin. Objective: Reviewing the literature on how obesity influences the severity of the clinical picture of some of the non-communicable and communicable diseases of greatest impact in Peru. Methods:Documentary research, from studies developed in various contexts associated with the presence of obesity along with infections or NCDs. Results: The condition of obesity reached by bad consumption habits and low physical activity is the main responsible for the high rate of NCDs, consequently, mortality. Conclusions: Excess weight affects the immune system, contributing specifically to exacerbated phenomena of a systemic inflammatory response, determined by increased secretion of adipocytokines, which predisposes the body to develop and contract NCDs and infectious diseases. (AU)

Aspectos históricos, clínicos y epidemiológicos de la poliomielitis en México (1946 - 1960) / Historical, clinical and epidemiological aspects of poliomyelitis in Mexico (1946-1960)

La poliomielitis emergió en Europa como enfermedad epidémica a finales del siglo XIX. Durante los años treinta del siglo XX alcanzó gran intensidad en los Estados Unidos y Canadá, pero fue tras la Segunda Guerra Mundial cuando la enfermedad se convirtió en un grave problema de salud pública mundial que castigó terriblemente a varios países del mundo, incluyendo a México. La poliomielitis es una enfermedad viral muy contagiosa que invade el sistema nervioso central (destruye las neuronas motoras) que atemorizó a la población mexicana en la primera mitad del siglo XX, no tanto por las altas cifras de mortalidad y morbilidad sino por sus secuelas paralíticas, como la invalidez, y por el hecho de que afectó a uno de los grupos poblacionales más vulnerables: los niños. La enfermedad afectaba principalmente a los niños menores de cinco años, siendo poco frecuente en los primeros meses de vida del recién nacido debido al efecto protector de la inmunidad que le transfiere la madre al hijo a través de la leche materna; después de ocho meses, al término de la alimentación, el infante podía ser infectado por el poliovirus invadiendo la medula espinal y produciendo la parálisis, más comúnmente de las piernas o tronco. Asimismo, ocasionaba una parálisis en los músculos respiratorios (diafragma) de los niños, a quienes había que auxiliarlos a respirar ya que, si no, se asfixiaban, por lo que se les introducía en unas máquinas conocidas comúnmente como pulmones de acero o pulmotores de tipo Emerson (máquina que permite a una persona respirar cuando esta perdió el control de sus músculos respiratorios, como el diafragma, inventada en 1928 por el ingeniero estadounidense Philip Drinker).

Poliomyelitis emerged in Europe as an epidemic disease at the end of the 19th century. During the thirties of the twentieth century it reached great intensity in the United States and Canada, but it was after the Second World War when the disease became a serious world public health problem, which punished several countries of the world, including Mexico. Poliomyelitis is a very contagious viral disease that invades the central nervous system (destroys motor neurons) that frightened the Mexican population in the first half of the twentieth century, not so much by high mortality and morbidity figures but by its paralytic sequels, like the disability, and by the fact that it affected one of the most vulnerable population groups: children. The disease mainly affected children under five years of age, being rare in the first months of life of the newborn due to the protective effect of immunity that the mother transfers to the son through breast milk; After eight months, at the end of the feed, the infant could be infected by poliovirus by invading the spinal cord and producing paralysis, most commonly of the legs or trunk. Likewise, it caused a paralysis in the respiratory muscles (diaphragm) of children, who had to help them to breathe since, if not, they were suffocated, so they were introduced in machines commonly known as steel lungs or lungs of Emerson type (machine that allows a person to breathe when he lost control of his respiratory muscles, such as the diaphragm, invented in 1928 by the American engineer Philip Drinker).

Infecções virais na prática odontológica: riscos e prevenção / Viral infections in dental practice: risks and prevention

Objetivo: revisar a literatura sobre as principais patologias virais associadas à área odontológica, tais como varicela, herpes zoster, sarampo, mononucleose infecciosa, síndrome da imunodeficiência adquirida (Aids), hepatites virais e infecções associadas ao herpes-vírus simples (HSV) e ao papilomavírus humano (HPV), com o intuito de descrever as manifestações orais relacionadas a essas patologias e informar e esclarecer aos profissionais da área odontológica os riscos e os cuidados durante a prática clínica. Métodos: foi realizada uma busca nas bases de dados Google Acadêmico, SciELO, LILACS e PubMed sobre o tema infecções virais na prática odontológica. Foram incluídos nesta revisão 31 artigos, publicados no período de 2000 a 2020. Também foram utilizados como fonte bibliográfica 4 livros que abordavam o assunto em questão. Revisão de literatura: o consultório odontológico é um local propício à propagação de agentes biológicos patógenos causadores de infecção, nos quais se incluem os vírus. O profissional da área deve adotar medidas de biossegurança para evitar possíveis infecções. As precauções universais eficazes na redução do risco ocupacional baseiam-se no uso de equipamentos de proteção individual (EPIs), na prevenção da exposição a sangue e fluidos corpóreos, na prevenção de acidentes com instrumentos perfurocortantes e no descarte adequado dos resíduos contaminados. Considerações finais: as infecções virais representam um assunto relevante para o odontólogo, pois, além de serem transmissíveis por vários meios, também apresentam manifestações orais. Dessa forma, o cirurgião-dentista deve ter conhecimento suficiente sobre o tema para nortear a sua conduta clínica.(AU)

Objective: the present study aims to review the literature regarding the main viral pathologies associated with the dental field, such as chickenpox, herpes zoster, measles, infectious mononucleosis, acquired immunodeficiency syndrome (AIDS), viral hepatitis, and infections associated with herpes simplex virus (HSV) and human papillomavirus (HPV), in order to describe the oral manifestations related to these pathologies, and inform and clarify to the dental professionals the risks and care during clinical practice. Methods: a search was performed using Google Scholar, SciELO, LILACS and PubMed databases on the topic of viral infections in dental practice. This review included 31 articles, published from 2000 to 2020. Four books on the subject were also used as a bibliographic source. Literature review: the dental office is a place susceptible to the spread of pathogenic biological agents that cause infection, including viruses. The professional must adopt biosafety measures to avoid possible infections. Universal precautions that are effective in reducing occupational risk are based on the use of personal protective equipment (PPE), the prevention of exposure to blood and bodily fluids, the prevention of accidents with sharps, and the proper disposal of contaminated waste. Final considerations: viral infections represent a relevant issue for the dentist, because in addition to being transmissible through various means, they also present oral manifestations. Thus, the dentist must have sufficient knowledge on the subject to guide his clinical conduct.(AU)

Seropositivity for Bovine Viral Diarrhea and Enzootic Bovine Leukemia viruses in Blanco Orejinegro cattle in Colombia and infection associated-factors / Soropositividade para o vírus da diarréia viral bovina e leucemia bovina enzoótica em bovinos Blanco Orejinegro na Colômbia e fatores associados à infecção

ABSTRACT Serological controls for diseases of viral origin in animal production systems and the identification of factors associated with infections are decisive elements to establish prevention and control measures. The aim of this study was to establish the serological status for Bovine Viral Diarrhea (BVD) and Enzootic Bovine Leukemia (EBL) viruses in Blanco Orejinegro (BON) cattle from Colombia, and to identify the factors associated with seropositivity. A cross-sectional study was conducted with a total of 498 animals of all age groups and physiological states of the BON breed were selected, belonging to 14 herds located in 6 states of Colombia, in which a survey with 27 questions was conducted. By means of the chi-square test, possible factors associated with seropositivity against the 2 viruses were identified. A sample of 4 ml of blood was taken from each animal to extract plasma and make indirect Elisa tests to detect antibodies against both pathogens. General seropositivity of 27,1% was obtained for EBL, finding as factors associated with seropositivity the inadequate disposition of placental tissues after delivery of the cows and the non-performance of serological tests on new animals entering the herd. For BVD, seropositivity obtained was 50,6%, and the factors associated with seropositivity identified were having had a history of the disease in the herd, and using semen from bulls that are not known to be free for the infection. We suggest establishing control measures considering the factors associated with each viral infection to limit their expansion in the BON cattle production systems of Colombia.

RESUMO Os controles sorológicos para doenças de origem viral nos sistemas de produção animal e a identificação de fatores associados à infecção são elementos decisivos para estabelecer medidas de prevenção e controle. O objetivo deste estudo foi estabelecer o status sorológico dos vírus da Diarréia Viral Bovina (BVD) e da Leucemia Bovina Enzoótica (EBL) em bovinos Blanco Orejinegro (BON) da Colômbia e identificar os fatores associados à soropositividade. Foram selecionados 498 animais de todas as faixas etárias e estados fisiológicos da raça BON, de 14 rebanhos localizados em seis regiões da Colômbia, nos quais foi realizada uma pesquisa para identificar possíveis fatores associados à soropositividade contra os dois vírus. Foi retirada uma amostra de 4 ml de sangue de cada animal para extrair plasma e fazer testes ELISA indiretos para detectar anticorpos contra os dois patógenos. Obteve-se soropositividade geral de 27,1% para EBL, encontrando como fatores associados à soropositividade a disposição inadequada dos tecidos placentários após o parto das vacas e a não realização de testes sorológicos em novos animais que entraram no rebanho. Para a BVD, a soropositividade obtida foi de 50,6%, e os fatores associados à soropositividade identificados foram: histórico de doença no rebanho e uso de sêmen de touros que não são reconhecidos como livres da infecção. Sugerimos o estabelecimento de medidas de controle considerando os fatores associados a cada infecção viral para limitar sua expansão nos sistemas de produção de gado BON da Colômbia.