INFO IST Setembro 2024 / INFO IST September 2024

Jornal na sua 9ª edição (setembro 2024) com a análise e elaboração de conteúdo pela gerência de IST/AIDS e gerência de Hepatites Virais - SES- RJ.

Co-trimoxazole induced Steven Johnson syndrome in HIV infected patient: things to consider

Co-trimoxazole is a sulfonamide fixed dose combination antibiotic which is effective and widely use in treatment and prevention of opportunistic infections in people living with HIV/AIDS, but can be potentially associated with adverse drug reactions including drug hypersensitivity reactions such as Steven Johnson syndrome. PLWHA individuals have up to a 1000-fold increased risk of drug hypersensitivity reaction compared to the general population, which is associated with drug exposure, immune dysregulation, and concurrent infections. Here we present a case report of a 59-year-old man with HIV who experienced Stevens-Johnson Syndrome after taking co-trimoxazole for 18 days. Therefore, we would like to remind you to be more careful when giving cotrimoxazole to PLWHA because it can take time for a hypersensitivity reaction to occur, also in a few cases, it can occur immediately.

Qualidade do acesso percebida por usuários de serviços especializados em HIV/AIDS da Bahia, Brasil / Quality of access perceived by users of HIV/AIDS specialized services in Bahia, Brazil / Calidad de acceso percibida por los usuarios de servicios especializados en VIH/SIDA en Bahía, Brasil

Este artigo descreve o acesso e a percepção do acesso de usuários a serviços especializados no tratamento do vírus da imunodeficiência humana e da Síndrome da Imunodeficiência Humana (HIV/AIDS) em municípios baianos por meio de um recorte epidemiológico descritivo-analítico, com abordagem quantitativa de dados primários de estudo realizado em cinco serviços localizados na capital e oito no interior do estado da Bahia, Brasil. Participaram deste estudo 475 usuários, de 21 municípios baianos, predominantemente do sexo feminino, com faixa etária entre 25 e 44 anos, negros, cristãos, desempregados, com escolaridade compreendendo o ensino fundamental, renda de até três salários mínimos, heterossexual e cisgênero. O acesso à testagem para HIV e outras Infecções Sexualmente Transmissíveis (IST), profilaxias de pós-exposição e pré-exposição e outros insumos de prevenção não constituíram motivação de inserção no serviço. O tratamento específico e a assistência médica para HIV e outras IST foi motivação para que a maioria dos participantes se direcionassem ao serviço especializado. O deslocamento até o serviço de referência é realizado principalmente por transportes coletivos, e o trajeto casa-serviço tem duração de pelo menos uma hora. O horário de funcionamento da unidade atende às necessidades da maior parte dos participantes, mas parcela dos usuários mencionaram o desejo de funcionamento em horários alternativos. A marcação de consultas é realizada principalmente de forma presencial e por telefone, com possibilidade de agendamento diário, assim a maioria dos usuários avaliaram a organização do serviço para marcação de consultas como boa ou muito boa. O tempo de espera, entre marcação e consulta, mais comum é de uma semana a um mês.

This article describes user access and perception of access to specialized HIV/AIDS services in Bahia municipalities by applying a qualitative epidemiological, descriptive-analytical approach to primary data from research conducted in five services located in the capital and eight in the countryside. A total of 475 users from 21 municipalities in Bahia participated in this study. Most were female, between 25 and 44 years old, Black, Christian, unemployed, with complete primary education, income of up to 3 minimum wages, heterosexual and cisgender. Access to HIV testing and other STIs, post-exposure and pre-exposure prophylaxis and other prevention inputs did not constitute motivation for procuring the service. Specific treatment and medical care for HIV and other STIs motivated most participants to turn to specialized services. Commuting to the reference service is made mainly by public transport and the home-service journey takes at least one hour. The unit's opening hours meet the needs of most participants, but some mentioned the desire for alternative operating times. Appointments are booked mainly in person and over the phone, with the possibility of daily scheduling, so most users rated the service organization for scheduling appointments as good or very good. The most common waiting time between booking and consultation is one week to one month.

Este artículo describe el acceso y la percepción de acceso de los usuarios a servicios especializados en el tratamiento del virus de inmunodeficiencia humana y síndrome de inmunodeficiencia humana (VIH/sida) en municipios de Bahía (Brasil) mediante un enfoque epidemiológico, descriptivo-analítico, y un enfoque cuantitativo de datos primarios de un estudio realizado en cinco servicios ubicados en la capital y ocho en el interior del estado de Bahía. Participaron en este estudio 475 usuarios, de 21 municipios de Bahía, con mayor predominio femenino, con edades de entre 25 y 44 años, negros, cristianos, desempleados, con educación primaria, ingresos de hasta tres salarios mínimos, heterosexuales y cisgénero. El acceso a pruebas de VIH y otras infecciones de transmisión sexual (ITS), profilaxis posexposición y preexposición, y otros insumos de prevención no constituyeron una motivación para ingresar al servicio. El tratamiento específico y la asistencia médica para el VIH y otras ITS fueron la razón para que la mayoría de los participantes buscaran servicios especializados. El desplazamiento al servicio de referencia se realiza principalmente en transporte público, y el trayecto desde el domicilio al servicio tiene una duración mínima de una hora. El horario de atención de la unidad satisface las necesidades de la mayoría de los participantes, pero algunos usuarios mencionaron el deseo de que operase en horarios alternativos. Las citas se realizan principalmente de forma presencial y telefónica, con posibilidad de concertación diaria, por lo que la mayoría de los usuarios valoran como buena o muy buena la organización del servicio de citas. El tiempo de espera más habitual entre la reserva y la consulta es de una semana a un mes.

Criptococosis Meníngea en pacientes viviendo con HIV experiencia en cuidados intensivos / Meningeal cryptococcosis in patients living with HIV. Experience in intensive care

Resumen Introducción : La criptococosis meníngea (CM) es una causa frecuente de meningoencefalitis en personas que viven con HIV (PVHIV) y produce una importante morbi-mortalidad (20-55%). Se describen las características clínicas, la letalidad y las variables de mal pronóstico en PVHIV con CM, en unidades de cuidados intensivos (UCI). Métodos : Estudio observacional y retrospectivo. Pe ríodo 21/11/2006 a 24/05/2023. Población evaluada: 154 PVHIV adultos, admitidos en UCI con diagnóstico de CM. Los porcentajes y valores absolutos, fueron comparados mediante Chi-Cuadrado o test de Fisher y las medianas mediante test de Mann-Whitney. La asociación con mortalidad se evaluó por regresión logística. Se utilizó el programa SPSS 23.0. Un valor p<0.05 fue considerado significativo. Resultados : Los pacientes que fallecieron y los que so brevivieron fueron comparables en edad y sexo (p>0.05). El análisis univariado, observó que un estado funcional y nutricional alterado, falta de tratamiento antirretroviral previo (TARV), CD4 <100 células/μl, APACHE II ≥13 y un score pronóstico de PVHIV ≥8 puntos, requerir ventilación mecánica (VM), sufrir insuficiencia respiratoria, renal, disfunción neurológica o sepsis, podrían estar asociados (p<0.05) con mortalidad. La regresión logística estableció que un estado funcional y nutricional alterado, un score pronóstico PVHIV ≥8, necesitar VM y sufrir sepsis serían variables independientes asociadas a mortalidad. Conclusión : Los resultados indican que el estado funcional y nutricional alterado, un score pronóstico PVHIV ≥8 puntos, requerir VM y sufrir sepsis al ingreso a UCI podrían servir como variables independientes para predecir un mayor riesgo de mortalidad.

Abstract Introduction : Meningeal cryptococcosis (MC) is a frequent cause of meningoencephalitis in people living with HIV (PLHIV), leading to substantial morbidity (20- 55%). Clinical characteristics, lethality and adverse prog nostic factors in PLHIV with MC admitted to intensive care units (ICUs) are described. Methods : A retrospective observational study. Period from 11/21/2006 to 05/24/2023. It involved 154 adult PLHIV diagnosed with MC and admitted to ICUs. Percen tages and absolute values were compared by Chi-Square or Fisher's test and medians by Mann-Whitney test. The association with mortality was assessed by logistic re gression. SPSS 23.0 software was used. A p-value <0.05 was considered significant. Results : Patients who died and those who survived were comparable in age and sex (p>0.05). Univariate analysis showed that impaired functional and nutritio nal status, lack of previous highly active antiretroviral therapy, CD4 <100 cells, APACHE II ≥13 and a PLHIV prognostic score ≥8 points, requiring mechanical venti lation (MV), respiratory failure, renal failure, neurological dysfunction or sepsis could be associated (p<0.05) with mortality. Logistic regression established that impaired functional and nutritional status, a PLHIV prognostic score ≥8, need for MV and presence of sepsis would be independent variables associated with mortality. Conclusion : The results indicate that altered functio nal and nutritional status, a PLHIV prognostic score ≥ 8 points, requiring MV and suffering sepsis on admission to the ICU are more frequent in deceased patients, and they could therefore serve as independent variables to predict a higher risk of mortality.

Uptake of prevention of mother-to-child transmission of human immunodeficiency virus interventions among infected mothers attending health facilities in Mombasa County, Kenya

Background: The study was conducted in Mombasa County, Kenya, and aimed at the uptake of Prevention of Mother-to-Child Transmission interventions among HIV-infected mothers attending health facilities. A hospital-based cross-sectional study was used between May 2021 and October 2021, utilizing a self-administered structured questionnaire to collect data. The collected information was then analyzed using SPSS version 17 and STATA version 9.2. Methods: The study utilized a descriptive cross-sectional research design. Results: 84.8% of respondents exclusively breastfed their babies, and 77.3% received antiretroviral drugs (ARVs). Education level, being a housewife, and religion showed statistically significant associations with PMTCT service uptake (p<0.05). Additionally, 53.7% of participants demonstrated awareness of the importance of enrolling in PMTCT intervention services. The study highlighted high levels of knowledge among participants regarding PMTCT interventions, with 89.9% having correct knowledge of ARVs for children, 83.5% understanding the importance of counselling, 77.3% practicing modified infant feeding, and 85% acknowledging the necessity of delivering in a health facility. Knowledge of PMTCT components such as HIV counselling, ARV usage, facility-based delivery, and early diagnosis was significantly associated with the uptake of PMTCT interventions. Conclusions: Utilization of PMTCT services among postnatal HIV-positive mothers was high among postnatal HIV-positive women who embraced the PMTCT interventions. The respondents had average knowledge concerning PMTCT services. This study suggests supporting and encouraging related stakeholders to provide education about MTCT.

A enfermagem e o letramento em saúde no contexto do hiv/aids, tuberculose, hepatites virais e infecções sexualmente transmissíveis / Nursing and health literacy in the context of hiv/aids, tuberculosis, viral hepatitis and sexually transmitted infections / Enfermería y alfabetización en salud en el contexto del vih/sida, tuberculosis, hepatitis viral e infecciones de transmisión sexual

Objetivo: identificar o Letramento em Saúde (LS), relacionados ao HIV/aids, à Tuberculose, às Hepatites Virais e às Infecções Sexualmente Transmissíveis (IST), na área de conhecimento da Enfermagem. Métodos: Pesquisa exploratória, descritiva, com base em materiais documentais, acerca do HIV/aids, tuberculose, hepatites virais e IST, no campo da Enfermagem, considerando as produções de dissertações e teses, até o ano de 2023. Resultados: Elencou-se 62 produções abordando o LS na área de conhecimento em Enfermagem, sendo a primeira em 2012. Após análise, identificou-se nove estudos: três teses (33,3%) e seis dissertações (66,7%), sendo, cinco (55,6%) de HIV/ Aids, um (11,1%) de tuberculose, um (11,1%) de hepatite C e dois (22,2%) de IST. Conclusão: As produções incipientes sobre LS no contexto do HIV/aids, tuberculose, hepatites virais e IST, bem como, na área de Enfermagem, requer o desenvolvimento de novas investigações, visto a proposta de eliminar essas doenças/ infecções como problema de saúde pública até 2030. Faz-se necessário compreender o LS dos indivíduos nessas áreas, como ferramenta para potencializar a atenção prestada, principalmente, no contexto da APS, considerando a atuação da enfermagem como estratégica para o planejamento e a oferta do cuidado e para a promoção do autocuidado. (AU)

Objective: to identify Health Literacy (HL), related to HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections (STIs), around nursing knowledge. Methods: This is an exploratory, descriptive research, based on documentary materials, about HIV/AIDS, tuberculosis, viral hepatitis and STIs, in the field of nursing, considering the production of dissertations and theses, until the year 2023. Results: 62 productions were listed addressing LS around knowledge in Nursing, the first being in 2012. After analysis, nine studies were identified: three theses (33.3%) and six dissertations (66.7%), five (55.6%) of HIV/AIDS, one (11.1%) of tuberculosis, one (11.1%) of hepatitis C and two (22.2%) of STIs. Conclusion: The incipient productions on LS in the context of HIV/AIDS, tuberculosis, viral hepatitis and STIs, as well as, around nursing, requires the development of new investigations, given the proposal to eliminate these diseases/infections as a public health problem by 2030. if necessary, understand the HL of individuals in these areas, as a tool to enhance the care provided, mainly in the context of PHC, considering nursing actions as strategic for planning and offering care and promoting self-care. (AU)

Objetivo: identificar la Alfabetización en Salud (AS), relacionada con VIH/SIDA, Tuberculosis, Hepatitis Virales e Infecciones de Transmisión Sexual (ITS), en el área de conocimiento de enfermería. Métodos: Se trata de una investigación exploratoria, descriptiva, basada en material documental, sobre VIH/SIDA, tuberculosis, hepatitis virales e ITS, en el campo de la enfermería, considerando la producción de disertaciones y tesis, hasta el año 2023. Resultados: 62 producciones. fueron listados abordando LS en el área de conocimiento en Enfermería, siendo el primero en 2012. Luego del análisis, se identificaron nueve estudios: tres tesis (33,3%) y seis disertaciones (66,7%), cinco (55,6%) sobre VIH/ SIDA, uno (11,1%) de tuberculosis, uno (11,1%) de hepatitis C y dos (22,2%) de ITS. Conclusión: Las incipientes producciones sobre LS en el contexto de VIH/SIDA, tuberculosis, hepatitis virales e ITS, así como así como, en el área de enfermería, requiere el desarrollo de nuevas investigaciones, ante la propuesta de eliminar estas enfermedades/infecciones como un problema de salud pública para el año 2030. De ser necesario, entender la AS de los individuos en estas áreas, como una herramienta. potenciar los cuidados prestados, principalmente en el contexto de la APS, considerando las acciones de enfermería como estratégicas para planificar y ofrecer cuidados y promover el autocuidado. (AU)

Tecnologias relacionais e atuação psicológica em HIV/Aids: contribuições da psicologia socioconstrucionista / Relational technologies and psychological action in HIV/AIDS: contributions from socioconstructionist psychology / Tecnologías relacionales y acción psicológica en VIH/SIDA: aportes desde la psicología socioconstruccionista

OBJETIVO: Discutir como se estabelece a indicação de tecnologias relacionais off-line e on-line como recurso de cuidado a Pessoas Vivendo com HIV/Aids (PVHA) por psicólogas/os atuantes em serviços especializados. MÉTODO: Trata-se de uma pesquisa de abordagem qualitativa e exploratória. Utilizamos a perspectiva da psicologia social construcionista, além das noções de tecnologias dura, leve-dura e leve e seu encontro com a perspectiva de tecnologias (materiais e não materiais) como mediadoras inventivas. Realizamos entrevistas semiestruturadas e submetemos os dados à análise categorial temática. RESULTADOS: Foram elaboradas duas categorias: tecnologias relacionais off-line e on-line. Tratam-se dos sentidos construídos em torno de estratégias para o cuidado de PVHA, que não são típicas da clínica psicológica clássica. CONCLUSÃO: Concluímos que o uso de tecnologias relacionais off-line e on-line no acompanhamento de PVHA sugere uma ampliação do repertório profissional das/dos psicólogas/os que trabalham em serviços especializados em HIV/Aids, porém, isso não demonstrou ocorrer de forma tão articulada no campo de atuação psicológica, em comparação às práticas psicológicas clássicas.

OBJECTIVE: To discuss how offline and online relational technologies are recommended as a care resource for People Living with HIV/Aids (PLWHA) by psychologists working in specialized services. METHOD: This is research with a qualitative and exploratory approach. We use the perspective of constructionist social psychology, in addition to the notions of hard, soft-hard and soft technologies and their encounter with the perspective of technologies (material and non-material) as inventive mediators. We carried out semi-structured interviews and submitted the data to thematic categorical analysis. RESULTS: Two categories were created: offline and online relational technologies. These are the meanings constructed around strategies for caring for PLWHA, which are not typical of classical psychological clinics. CONCLUSION: We conclude that the use of offline and online relational technologies in monitoring PLWHA suggests an expansion of the professional repertoire of psychologists working in specialized HIV/AIDS services, however, this has not been demonstrated to occur in a so articulated, in the field of psychological action, in comparison to classical psychological practices.

OBJETIVO: Discutir cómo las tecnologías relacionales offline y online son recomendadas como recurso de atención a las Personas que Viven con VIH/SIDA (PVVS) por parte de psicólogos que trabajan en servicios especializados. MÉTODO: Se trata de una investigación con un enfoque cualitativo y exploratorio. Utilizamos la perspectiva de la psicología social construccionista, además de las nociones de tecnologías duras, blandas-duras y blandas y su encuentro con la perspectiva de las tecnologías (materiales y no materiales) como mediadoras inventivas. Realizamos entrevistas semiestructuradas y sometimos los datos a análisis temático categórico. RESULTADOS: Se crearon dos categorías: tecnologías relacionales en línea y fuera de línea. Estos son los significados construidos en torno a estrategias de atención a las PVVS, que no son propias de las clínicas psicológicas clásicas. CONCLUSIÓN: Concluimos que el uso de tecnologías relacionales en línea y fuera de línea en el seguimiento de las PVVS sugiere una expansión del repertorio profesional de los psicólogos que trabajan en servicios especializados en VIH/SIDA, sin embargo, no se ha demostrado que esto ocurra de manera tan articulada en el campo de acción psicológica, en comparación con las prácticas psicológicas clásicas.

Uso de auriculares y la audición en estudiantes de medicina de una universidad pública de Lima, Perú / Headphone use and hearing in medical students at a public university in Lima, Perú

RESUMEN Introducción: La pérdida auditiva afecta a millones globalmente, especialmente a jóvenes que usan auriculares frecuentemente. Objetivo: Establecer la relación entre el uso de auriculares y la audición en estudiantes de medicina en Lima, Perú. Métodos: Se realizó un estudio observacional, analítico y transversal en la Universidad Nacional Federico Villarreal. Participaron 98 estudiantes de medicina (18-32 años) que usaban auriculares regularmente. Se excluyeron aquellos con patologías auditivas previas. La recolección de datos incluyó encuestas sobre el uso de auriculares y audiometrías realizadas en una cabina silente. Los resultados se analizaron mediante estadística descriptiva e inferencial, utilizando el coeficiente de correlación de Rho de Spearman para evaluar la relación entre las variables. Resultados: El 59,2% de los estudiantes eran mujeres. El 39,2% presentó hipoacusia leve a tonos agudos, mientras que el 36,2% tenía audición normal. El 71,4% reportó disminución de la capacidad auditiva y el 56,1% experimentó otalgia. El uso de auriculares mostró una correlación positiva y significativa con la audición (Rho = 0,298, p = 0,003). El tiempo de exposición también fue significativo (Rho = 0,260, p = 0,010), pero la intensidad del sonido no lo fue (Rho = 0,193, p = 0,057). Conclusión: Existe una relación positiva entre el uso de auriculares y la pérdida auditiva en estudiantes de medicina. Se recomienda implementar programas de concienciación sobre el uso seguro de auriculares y realizar evaluaciones auditivas periódicas para prevenir el deterioro auditivo.

ABSTRACT Introduction: Hearing loss affects millions globally, especially young people who frequently use headphones. Objective: To establish the relationship between headphone use and hearing among medical students in Lima, Peru. Methods: An observational, analytical, and cross-sectional study was conducted at the Universidad Nacional Federico Villarreal. Participants included 98 medical students (18-32 years) who regularly used headphones. Those with previous hearing pathologies were excluded. Data collection included surveys on headphone use and audiometries performed in a silent booth. Results were analyzed using descriptive and inferential statistics, employing the Spearman's Rho correlation coefficient to assess the relationship between variables. Results: 59.2% of the students were women. 39.2% had mild hearing loss at high tones, while 36.2% had normal hearing. 71.4% reported decreased hearing capacity, and 56.1% experienced ear pain. Headphone use showed a positive and significant correlation with hearing (Rho = 0.298, p = 0.003). Exposure time was also significant (Rho = 0.260, p = 0.010), but sound intensity was not (Rho = 0.193, p = 0.057). Conclusion: There is a positive relationship between headphone use and hearing loss in medical students. It is recommended to implement awareness programs on safe headphone use and conduct regular hearing evaluations to prevent auditory deterioration.

Can India achieve UNAIDS’ target by 2030?

The world is embarking on a fast-track strategy to end the AIDS epidemic by 2030. UNAIDS is targeted towards achieving the 95-95-95 strategy by 2025. Scaling up prevention, testing and treatment services towards HIV/AIDS is paramount in achieving these targets. To understand the status of India in achieving these targets, review of trials registered in the CTRI registry was done and found that among the 155 included trials, most (n=45, 29%) of the trials were drug trails, few were vaccine trials (n=6, 3.8%). Out of 155 studies, forty-one (20%) were in line to reach UNAIDS’ targets. The primary focus of those studies was improving CD4 counts and suppression of viral load (third target of UNAIDS’) (n=12, 7.7%), and the minimal focus was on promoting treatment adherence (second target of UNAIDS’) (n=11, 7%) and promotion of HIV testing (first target of UNAIDS’) (n=4, 2.5%). As prevention is always better than care, research should be encouraged towards prevention of HIV, which in turn facilitates achieving UNAIDS’ 2025 and 2030 targets.

Linfoma de células B primario de mama en una paciente con sida. Presentación de un caso y revisión de la literatura / Primary B-cell lymphoma of the breast in an AIDS patient. Case report and literature review

Los LNH constituyen la segunda neoplasia más frecuente en pacientes con VIH. Estas neoplasias están ligadas a la inmunodeficiencia, suelen ser de período de latencia prolongado y más frecuentes en hombres. Más del 95% de estas neoplasias son de fenotipo B, de alto grado de malignidad, extranodales y representan la causa de muerte en un 12% al 16% de los casos. El linfoma no Hodgkin primitivo de mama (LPM) es una entidad infrecuente, que representa el 2,2% de todos los linfomas extranodales y el 0,5% de todas las neoplasias malignas de la mama. Se presenta una mujer con sida y linfoma primario de mama. (AU)

NHL is the second most common neoplasm in patients with HIV. It is linked to immunodeficiency, tends to have a long latency period and is more common in men. More than 95% of these neoplasms are of phenotype B, high-grade, extranodal and are the cause of death in 12% to 16% of cases. Primitive non-Hodgkin lymphoma of the breast is a rare entity, accounting for 2.2% of all extranodal lymphomas and 0.5% of all breast malignancies. A woman with AIDS and primary breast lymphoma is presented. (AU)

Mortality trend due to HIV/AIDS among women in Porto Alegre/RS from 2007 to 2017 / Tendência de mortalidade por HIV/AIDS entre mulheres em Porto Alegre/RS de 2007 a 2017 / Tendencia de mortalidad por VIH/SIDA entre mujeres en Porto Alegre/RS de 2007 a 2017

Background and Objectives: Porto Alegre is among the state capitals of Brazil with the highest magnitude of epidemiological indicators in relation to people living with HIV/AIDS, impacting the mortality indicators of this population. This study aimed to analyze the temporal trend of deaths from HIV/AIDS in women residents of the city of Porto Alegre, Rio Grande do Sul, Brazil, from 2007 to 2017, considering age groups, skin color and education. Method: this is an ecological time series study on the trend of HIV/AIDS mortality rates among women living with HIV residents in the city of Porto Alegre, RS. Unadjusted and standardized mortality rates were calculated according to age group, skin color and education. For trend analysis, Prais-Winsten generalized linear regression was used. Results: 1,603 deaths related to HIV/AIDS were identified in women living in the city during the study period. Mortality coefficients were higher in white, less educated women, with an increasing trend among those over 60 years of age (95%CI 0.044; 0.029) with a decline for those in the age group between 20 and 29 (95%CI - 0.566; - 0.120). Conclusion: changes in the epidemiological scenario of HIV/AIDS draw attention to the care of people over 60 years of age and with less education, requiring efforts from healthcare networks to prevent deaths.(AU)

Jutificativa e Objetivos: Porto Alegre está entre as capitais estaduais do Brasil com maior magnitude de indicadores epidemiológicos em relação às pessoas vivendo com HIV/AIDS, impactando os indicadores de mortalidade dessa população. Este estudo teve como objetivo analisar a tendência temporal de mortes por HIV/AIDS em mulheres residentes na cidade de Porto Alegre, Rio Grande do Sul, Brasil, de 2007 a 2017, considerando grupos etários, cor da pele e educação. Método: trata-se de um estudo de série temporal ecológica sobre a tendência das taxas de mortalidade por HIV/AIDS entre mulheres vivendo com HIV residentes na cidade de Porto Alegre, RS. As taxas de mortalidade não ajustadas e padronizadas foram calculadas de acordo com grupo etário, cor da pele e educação. Para análise de tendência, foi utilizada regressão linear generalizada de Prais-Winsten. Resultados: Foram identificadas 1.603 mortes relacionadas ao HIV/AIDS em mulheres residentes na cidade durante o período do estudo. Os coeficientes de mortalidade foram mais altos em mulheres brancas, menos escolarizadas, com uma tendência crescente entre aquelas com mais de 60 anos de idade (IC95% 0,044; 0,029) com declínio para aquelas na faixa etária entre 20 e 29 anos (IC95% -0,566; -0,120). Conclusão: Mudanças no cenário epidemiológico do HIV/AIDS chamam a atenção para o cuidado de pessoas com mais de 60 anos de idade e com menor escolaridade, exigindo esforços das redes de saúde para prevenir mortes.(AU)

Antecedentes y Objetivos: Porto Alegre está entre las capitales estatales de Brasil con la mayor magnitud de indicadores epidemiológicos en relación a las personas que viven con VIH/SIDA, impactando los indicadores de mortalidad de esta población. Este estudio tuvo como objetivo analizar la tendencia temporal de muertes por VIH/SIDA en mujeres residentes en la ciudad de Porto Alegre, Rio Grande do Sul, Brasil, de 2007 a 2017, considerando grupos de edad, color de piel y educación. Método: se trata de un estudio de serie temporal ecológica sobre la tendencia de las tasas de mortalidad por VIH/SIDA entre mujeres que viven con VIH residentes en la ciudad de Porto Alegre, RS. Se calcularon tasas de mortalidad no ajustadas y estandarizadas según grupo de edad, color de piel y educación. Para el análisis de tendencia, se utilizó la regresión lineal generalizada de Prais-Winsten. Resultados: Se identificaron 1.603 muertes relacionadas con el VIH/SIDA en mujeres residentes en la ciudad durante el período de estudio. Los coeficientes de mortalidad fueron más altos en mujeres blancas, menos educadas, con una tendencia creciente entre aquellas con más de 60 años de edad (IC95% 0,044; 0,029) con un declive para aquellas en el grupo de edad entre 20 y 29 años (IC95% -0,566; -0,120). Conclusión: Los cambios en el escenario epidemiológico del VIH/SIDA llaman la atención sobre el cuidado de las personas mayores de 60 años y con menor educación, requiriendo esfuerzos de las redes de salud para prevenir muertes.(AU)

Ayudas cognitivas en quirófano. Experiencia del Departamento de Anestesia en el Centro Médico ABC / Cognitive aids in the operating room. Experience of the Anesthesia Department at ABC Medical Center

Resumen: Los manuales de emergencia desarrollados a partir de las ayudas cognitivas son componente esencial dentro de la sala de operaciones para el manejo oportuno de crisis, con la ventaja de disminuir los errores por omisión. El propósito de esta redacción fue retomar la experiencia mundial actualizada con los mismos y compararla con la del Centro Médico ABC. El proceso de recolección de datos se hizo mediante una encuesta a través de Google Forms; los datos obtenidos de la encuesta se convirtieron en porcentajes y se usaron para resumir las variables categóricas. Los resultados mostraron que la mayoría de los médicos tenían conocimiento de esta herramienta en quirófano y más de la mitad en efecto lo utilizaron en situaciones críticas. Las situaciones más descritas fueron: broncoespasmo, choque anafiláctico y sospecha de hipertermia maligna.

Abstract: The emergency manuals based on cognitive aids are an essential component within the operating room for timely crisis management, with the advantage of reducing errors due to omission. The purpose of this writing was to resume the current world experience with them and compare it with the ABC Medical Center. The data obtained from the survey were converted into percentages and used to summarize the categorical variables. The results showed that most doctors were aware of this tool in the operating room and more than a half actually used it in critical situations. The most described situations were: bronchospasm, anaphylactic shock and suspicion of malignant hyperthermia.

Knowledge regarding HIV/AIDS and its prevention among high school students of Anantnag district, Jammu and Kashmir, India: a pre-experimental study

Background: India has become one of the most populous country in the world, and it would be a disaster if our adolescent children fell into the trap of HIV/AIDS, which not only disrupts the healthcare system of any country but also has an impact on the morals of the people. Therefore, the main aim of the study was to understand the knowledge regarding HIV/AIDS and its prevention among high school children. Methods: This was a pre-experimental study in which 60 high school students participated. The knowledge was assessed using demographic characteristics and 30-item knowledge questionnaires. SPSS V16.0 was used for the data analysis. Paired t-test, descriptive statistics, and chi-square analysis were used to check the association. Results: In the study, the majority of the participants, 46 (76.66%), had inadequate knowledge, and only 14 (23.33%) had moderate knowledge regarding HIV/AIDS. The paired “t”-test value was 54.63 at the level of p<0.0001, which was significant. We also found multiple associations between gender, qualification of the mother, occupation of the mother, qualification of the father, occupation of the father, type of family, and source of information. Conclusions: It was observed that there was relatively less knowledge among high school students regarding HIV/AIDS and its prevention. However, after the teaching program, the knowledge improved. Therefore, a multi-dimensional approach should be taken by the school authority to create awareness campaigns for the students.

Assessing accessibility of sexual reproductive health services among adolescents and young people living with HIV/AIDS in Kenya

Background: Sexual and reproductive health rights (SRHR) are fundamental human rights enshrined in national, regional, and international laws and agreements. This study aimed to determine the accessibility of SRHR services among young people living with HIV/AIDS in Kenya. Methods: The study was a cross-sectional study involving a sample of 224 adolescents and young people from Kenya. The study used both qualitative and quantitative methods of data collection and analysis. Before the study commenced, approvals were acquired from the Kenyatta University ethics and review committee, the National Commission for Science, Technology, and Innovation, County Governments, and selected county and sub-county health facilities in Kenya. Results: About 68.2% of adolescents and young people (AYP) living with HIV/AIDS accessed SRH services with a significant difference in proportion between study counties (Nairobi city and Homabay counties) in Kenya (?2=20.553; df=2; p<0.0001). Nevertheless, 33% of them reported that there were challenges that affected access to SRHR services and the unavailability of some services. Therefore, there is a need to ensure enough and constant supply of commodities and supplies for comprehensive care services. Conclusions: The study showed a statistically significant difference in the proportion of AYP living with HIV/AIDS who accessed SRH services in the study counties of Nairobi city and Homabay.

Problem and pro-social behaviour among adolescents living with HIV/AIDS and perception of healthcare workers on available medical and social support in Sokoto, northern Nigeria

Background: Adolescents living with HIV/AIDS (ALHIV) are likely to have behavioural, social, cognitive, and emotional problems. Early detection and treatment of these psychological issues in ALHIV is precarious to comprehensive HIV management. This study aimed to assess problem and pro-social behaviour among and to identify available health facility and social supports for ALHIV in Sokoto State, Nigeria. Methods: A cross sectional study with mixed methods of data collection was conducted among 236 adolescent- caregiver pairs. Key informant interviews were conducted among four health care workers. Quantitative data were analyzed using IBM SPSS version 23 while content analysis along thematic lines was done for qualitative data. Results: Mean age of adolescents was 14.6±2.2 years while mean age of caregivers was 37.9±7.2 years. Prevalence of pro-social behaviour among ALHIV was 6.4% (self- report) and 15.2% (caregiver report). Seventy-eight (33.1%) caregivers reported peer problems and 15 (6.4%) emotional problems among their ALHIV. Based on self-report, 160 (67.8%) ALHIV reported experiencing peer problems and 3 (1.8%) emotional problems. Eleven (4.7%) adolescents reported having low social support, 136 (57.6%) had moderate and 89 (37.7%) high social support. Viral suppression showed significant association with SDQ scores. Conclusions: The Sokoto State Ministry of Health and other organizations supporting HIV programs should ensure community enlightenment programs on HIV in order to reduce stigma associated with the disease.

Validation of care-educational video for patients in postoperative heart surgery / Validación de vídeo educativo de cuidado para pacientes en el postoperatorio de cirugía cardíaca / Validação de vídeo cuidativo-educacional para pacientes em pós-operatório de cirurgia cardíaca

Objective: To develop and validate an educational-care video produced for patients with self-care guidelines in the postoperative period of cardiac surgery. Method: Methodological study, developed in the stages of pre-production, production, and post-production. Content validation was carried out with 13 expert judges, with technical and scientific expertise in the field. Data were tabulated, processed, and analyzed through descriptive analysis. Content validity index (CVI) and Cronbach's alpha tests were performed for reliability. Results: The educational-care video contains information on surgical wound, wound care, alcoho-lic beverages, sexual activity, return to work, physical activity, and diet. Conclusion: The video validated by experts obtained maximum CVI and an attributed reliability of 0.728, indicating it is an educational technology that can be applied in nursing practice to guide patients in the postoperative period of cardiac surgery. (AU)

Objetivo: Construir y validar un video educativo sobre cuidados elaborado para pacientes con instrucciones de autocuidado en el postopera-torio de cirugía cardíaca. Método: Estudio metodológico, desarrollado en las etapas de preproducción, producción y postproducción. La validación del contenido se realizó con 13 jueces expertos, con experiencia técnica y científica en el área. Los datos fueron tabulados, procesados y analizados mediante análisis descriptivo. Se realizaron pruebas de confiabilidad del Índice de Validez de Contenido (IVC) y Alfa de Cronbach. Resultados: El video educativo de cuidado contiene información sobre la herida quirúrgica; cuidados de la herida quirúrgica; consumo de alcohol; actividad sexual; retorno al trabajo; actividad física y nutrición. Conclusión: El video validado por expertos obtuvo un IVC máximo y una confiabilidad asignada de 0,728, lo que indica que es una tecnología educativa que puede ser aplicada en la práctica de enfermería para guiar a los pacientes en el postoperatorio de cirugía cardíaca. (AU)

Objetivo: Construir e validar um vídeo cuidativo-educacional produzido para pacientes com orientações de autocuidado no pós-operatório de cirurgia cardíaca. Método: Estudo metodológico, desenvolvido nas etapas de pré-produção, produção e pós-produção. A validação de conteúdo ocor-reu com 13 juízes especialistas, com expertise técnica e científica na área. Os dados foram tabulados, processados e analisados perante análise descritiva. Realizaram-se os testes de índice de validade de conteúdo (IVC) e de alfa de Cronbach, para confiabilidade. Resultados: O vídeo cuidativo-educacional contém informações quanto a ferida cirúrgica, cuidados com a ferida cirúrgica, bebidas alcoólicas, atividade sexual, retorno ao trabalho, atividade física e alimentação. Conclusão: O vídeo validado pelos especialistas obteve IVC máximo e a confiabilidade atribuída de 0,728, indicando ser uma tecnologia educacional que pode ser aplicada na prática da enfermagem para orientar pacientes no pós-operatório de cirurgia cardíaca. (AU)

Willingness to use HIV self-test kits in Winneba, Ghana

Over the years, many successive governments of Ghana have been making efforts to minimise the transmission of HIV in the country through its agencies such as the Ghana health service and the Ghana AIDS Commission. In an attempt to continue to bring the transmission of HIV under control, the government of Ghana in July 2023, launched the HIV self-test (HIVST) kits for use. However, like new health products such as COVID-19 vaccines, there is a tendency of hesitancy to their use in the country. Using the case study design in connection with the purposive sampling technique, the study sampled 12 participants in Winneba, Ghana and data was analysed using thematic analysis. The study found that majority of the people were aware of the HIVST kits in the country with another indicating that the HIVST kits are yet to be made available in communities. Women were found to be more willing to use the HIVST kits than other population groups. Accessing the HIVST kits on the other hand was met with scarcity and participants identified the pharmacy to be the best place to access the HIVST kits. It is recommended that the municipal health directorate and the Ghana AIDS commission should collaborate to intensify education and publicity on the availability and use of the HIVST kits. Additionally, in order to prevent unforeseen shocks, there is a need for the pharmaceutical society of Ghana to train and equip its members to offer counselling services to users of the HIVST kits.

The pathophysiology and pathology of SARS-CoV-2 infection

SARS-CoV-2 infection is a major pandemic that has involved all continents in the world. It has caused almost seven million deaths since its onset. SARS-CoV-2 commonly enters cells by binding to angiotensin-converting enzyme 2 (ACE2) molecules on the surface of cells in the human body. SARS-CoV-2 infection, although mild in many patients, has the potential to cause dysfunction of many organ systems in the body. The body response to the internalisation of the virus in the epithelial cells of the lungs can lead to alveolar epithelial inflammation, commonly referred to as the exudative phase of acute respiratory distress syndrome (ARDS). Cardiac symptoms shown by patients infected with SARS-CoV-2 include chest tightness/pain and palpitations. These features can be because of newly developed or worsening ischaemic heart disease and arrythmias, respectively. SARS-CoV-2 infection is known to cause a clinical condition known as COVID-19-associated nephropathy (COVAN), a disease quite similar to HIV-associated nephropathy (HIVAN). Like HIVAN, COVAN is relatively more common in people of African descent and is associated with the APOL1 variant gene. Researchers have not identified unique morphological changes that could be used to identify the infection in tissues. Hence, the use of RT-PCR for diagnosis is still very important.

Application value of ultrasonic measurement of optic nerve sheath diameter and cerebral blood flow parameters in intracranial hypertension caused by AIDS cryptococcal meningitis / 重庆医学

Objective To explore the application value of ultrasonic measurement of optic nerve sheath diameter(ONSD)and cerebral blood flow parameters in intracranial hypertension caused by AIDS cryptococ-cal meningitis.Methods A total of 27 patients with cryptococcal meningitis diagnosed by Chongqing Public Health Medical Center from February to July,2022 were included.All patients were examined with ultrasound measurement of ONSD and ultrasound measurement of cerebral blood flow of intracranial middle cerebral ar-tery(MCA),including peak systolic velocity(PSV),end diastolic velocity(EDV),peak systolic velocity/end diastolic velocity(S/D)and resistance index(RI),and then lumbar puncture was performed and intracranial pressure(ICP)was recorded.The ICP≥200 mmH2O was defined as the ICP increased group,ICP＜200 mmH2O was defined as the ICP normal group,and 17 AIDS patients without complications were selected as the control group.The baseline data,ONSD and MCA cerebral blood flow parameters of the three groups were compared,and the statistically significant indexes were correlated with ICP,and the receiver operating charac-teristic(ROC)curve of the subjects was drawn to analyze the diagnostic efficacy of ONSD value in predicting intracranial hypertension caused by AIDS cryptococcal meningitis.Results There were no significant differ-ences in gender,age,systolic blood pressure or diastolic blood pressure among the ICP increased group,the ICP normal group and the control group(P＞0.05).There were no significant differences in PSV,EDV,S/D and RI among the three groups of MCA(P＞0.05),but there was significant difference in ONSD among the three groups(P＜0.05).There was a positive correlation between ICP and ONSD in the patients with AIDS cryptococcal meningitis(P＜0.01,r=0.736).The ROC curve analysis showed that when the ONSD cutoff value was 3.965 mm,it predicted the highest efficacy of intracranial high pressure in the patients with AIDS cryptococcal meningitis.The area under the ROC curve was 0.90(95％CI:0.714-1.000,P=0.001),the sensitivity was 90％,and the specificity was 100％.Conclusion Ultrasonic measurement of ONSD can effec-tively predict ICP in patients with AIDS cryptococcal meningitis and guide clinical decompression measures in time,which is worthy of clinical application.

Impact analysis of emergency intervention on 120 ambulance dispatchers in Chongqing city with regression discontinuity designs / 中华急诊医学杂志

Objective:To explore the impact of emergency response to public health emergencies on the efficiency of pre-hospital emergency work, and study the degree of impact on 120 ambulance dispatchers in Chongqing city during pre-periods and post-periods of the emergency intervention.Methods:Taking 120 phone answering and ambulance operation efficiency as the research subjects, we collected pre-hospital emergency case data from a city's emergency medical center, covering the period from November 10, 2021 to January 6, 2023. The cases were divided into groups according to the time periods of emergency response. A regression discontinuity design method was employed to compare the response of emergency intervention to the predictions (virtual cases) without the emergency intervention, obtaining the average intervention effect.Results:During the study period of 27 days, the number of 120 calls picked up within 10 seconds increased from 11 000 to 19 000, but the answering rate slightly decreased within 10 seconds. The vacancy rate of 120 ambulances during emergency response decreased from 0.39% to 0.20%, but the completion rate within 18 minutes decreased from 72% to 30%. In this particular emergency response period, the number of patient complaints (such as high fever and difficulty breathing) increased compared to the pre-period of emergency response.Conclusion:Emergency response significantly impacts pre-hospital emergency work such as emergency phone answering and ambulance operation efficiency. This study provides empirical research results and decision-making support for urban emergency medical services to respond to public health emergencies.