Principais motivos de descarte de córneas para transplante na Paraíba: por que o anti-HBc merece atenção?* / Main reasons for discarding corneas for transplant in Paraíba: why does anti-HBc deserve attention?*

RESUMO Objetivo: Identificar o perfil dos doadores de tecidos oculares humanos na área de atuação do Banco de Olhos da Paraíba, destacando o impacto da sorologia positiva para hepatite B no descarte dos tecidos para transplante. Métodos: O estudo é transversal e utilizou dados do Banco de Olhos da Paraíba entre janeiro de 2013 e dezembro de 2022. Dados sobre procedência, idade, sexo, causa do óbito, tempo entre óbito e enucleação, resultados sorológicos e motivo de descarte das córneas dos doadores foram coletados. Resultados: O maior motivo de descarte foi por sorologia positiva (56,5%), sendo positivadas as sorologias positivas para hepatite B e HBsAg em 11,1% e 4,75% dos pacientes, respectivamente. Conclusão: A sorologia positiva para hepatite B como um critério de descarte absoluto é responsável por grande parcela de descartes, apesar da pouca informação sobre suas repercussões e representação de infectividade nos receptores do transplante.

ABSTRACT Objective: To identify the profile of human ocular tissue donors in the area covered by the Eye Bank of Paraíba (PB), highlighting the impact of positive serology for hepatitis B (anti-HBc) in the disposal of tissues for transplantation. Methods: This is a cross-sectional that uses data from the Eye Bank of Paraíba (PB) between January 2013 and December 2022. Data on origin, age, sex, cause of death, time between death and enucleation, serological results, and reason for discarded donor corneas were collected. Results: The main reason for discarding was due to positive serology (56.5%), with positive anti-HBc and HBsAg serology in 11.1% and 4.75% of patients, respectively. Conclusion: Anti-HBc positive serology as an absolute disposal criterion is responsible for great part of disposals, despite little information about its repercussions and representation of infectivity in transplant recipients.

12 pasos para reducir la incidencia de carbapenemasas / 12 steps to mitigate the incidence of carbapenemases

La resistencia a los antimicrobianos es un grave problema para la salud mundial. Es aún más crítico en los hospitales debido a la aparición de bacterias Gram negativas resistentes a múltiples fármacos, asociadas a una alta mortalidad. Las opciones de tratamiento en estos casos son escasas, en general de alto costo. La alta densidad de consumo de antibióticos y la transmisión cruzada en este entorno amplifican este problema.Hay más evidencia del impacto de las medidas de control de infecciones que de las intervenciones de comités de antimicrobianos para mitigarlo. Además, pocos países cuentan con programas sólidos de control de infecciones para enfrentar este problema. En la presente revisión se propone una serie de 12 pasos a adoptar para mitigar la prevalencia de resistencia antimicrobiana y reducir la incidencia de carbapenemasas en las instituciones de salud. Estas recomendaciones deben interpretase como un ̈bundle ̈o paquete de medidas, en el cual todas son importantes. Aquellas que involucran la prevención de infecciones y/o colonizaciones y su diseminación son las de mayor impacto demostrado hasta ahora. Es esencial que los programas de optimización de uso de antimicrobianos cuenten con el empoderamiento de la conducción de las instituciones donde se lleven a cabo, así como también que estén constituidos por un equipo multidisciplinario eficiente, sólidamente entrenado, con metas y métricas objetivas y auditorias periódicas. También es recomendable que se incluyan recomendaciones para los tratamientos en pacientes en cuidados de fin de vida.

Antimicrobial resistance is a serious global health problem. It is even more critical in hospitals due to the emergence of multi-drug resistant Gram negative bacteria, associated with high mortality. The treatment options in these cases are scarce, generally high cost. The high density of antibiotic consumption and cross-transmission in this environment amplifies this problem.There is more evidence of the impact of Infection Control measures than of Antimicrobial Committee interventions to mitigate it. Furthermore, few countries have solid Infection Control programs to deal with this problem.This review proposes a series of 12 steps to adopt to mitigate the prevalence of antimicrobial resistance and reduce the incidence of carbapenemases in health institutions. These recommendations should be interpreted as a ̈Bundle ̈ or package of measures, in which all are important. Those that involve the prevention of infections and / or colonizations and their dissemination are the ones with the greatest impact demonstrated so far. It is essential that antimicrobial use optimization programs have the empowerment of the leadership of the institutions where they are carried out, as well as that they are constituted by an efficient multidisciplinary team, solidly trained, with objective goals and metrics and periodic audits. It is also recommended that recommendations be included for treatments in patients in end-of-life care.

Impacto orçamentário na compra de equipamentos de proteção individual para enfrentamento da Covid-19 / Budgetary impact on the purchase of personal protective equipment for coping with Covid-19 / Impacto presupuestario en la compra de equipo de protección personal para enfrentar el Covid-19

A Covid-19 é causada pelo coronavírus e transmitida por contato próximo, gotículas e aerossóis. Para minimizar o risco de transmissão, profissionais de saúde devem fazer uso de equipamentos de proteção individual, como máscaras ou respiradores, aventais e luvas. Objetivou-se analisar a quantidade consumida destes equipamentos de proteção individual antes e durante a pandemia e também o impacto orçamentário causado para sua aquisição. Estudo retrospectivo, compreendendo os meses de janeiro/fevereiro de 2020 (antes da pandemia Covid ­ 19) e março/abril (durante a pandemia Covid ­ 19), em um hospital público. Realizado avaliação do consumo e custo de aquisição dos insumos considerados equipamento de proteção individual.Os dados foram coletados em sistema de informação próprio da instituição. Todos os itens analisados apresentaram aumento importante na quantidade utilizada e, principalmente, no valor de compra, chegando custar 525% mais caro comparado aos meses sem pandemia. O aumento dos custos estava relacionado à escassez dos produtos tanto no mercado nacional, quanto internacional. Entender os valores pagos e estabelecer controle de dispensação dos equipamentos, favorece o planejamento orçamentário.(AU)

Covid-19 is caused by the coronavirus and transmitted by close contact, droplets and aerosols. To minimize the risk of transmission, healthcare professionals should use personal protective equipment, such as masks or respirators, aprons and gloves. The objective was to analyze the amount consumed of this personal protective equipment before and during the pandemic and also the budgetary impact caused for its acquisition. Retrospective study, comprising the months of January / February 2020 (before the Covid pandemic - 19) and March / April (during the Covid pandemic - 19), in a public hospital. Evaluation of consumption and cost of acquisition of inputs considered as personal protective equipment was performed. Data were collected in the institution's own information system. All the items analyzed showed an important increase in the quantity used and, mainly, in the purchase value, reaching 525% more expensive compared to the months without a pandemic. The increase in costs was related to the scarcity of products both in the national and international markets. Understanding the amounts paid and establishing equipment dispensing control, favors budgetary planning.(AU)

El covid-19 es causado por el coronavirus y se transmite por contacto cercano, gotitas y aerosoles. Para minimizar el riesgo de transmisión, los profesionales de la salud deben usar equipo de protección personal, como mascarillas o respiradores, delantales y guantes. El objetivo fue analizar la cantidad consumida de este equipo de protección personal antes y durante la pandemia y también el impacto presupuestario que ocasionó su adquisición. Estudio retrospectivo, que comprende los meses de enero / febrero de 2020 (antes de la pandemia Covid - 19) y marzo / abril (durante la pandemia Covid - 19), en un hospital público. Se realizó una evaluación de consumo y costo de adquisición de insumos considerados como equipo de protección personal, los datos fueron recolectados en el sistema de información propio de la institución. Todos los artículos analizados mostraron un aumento importante en la cantidad utilizada y, principalmente, en el valor de compra, llegando a ser un 525% más caro respecto a los meses sin pandemia. El aumento de costos estuvo relacionado con la escasez de productos tanto en el mercado nacional como internacional. Conocer los montos pagados y establecer el control de dispensación de equipos favorece la planificación presupuestaria.(AU)

Opinión de estudiantes de kinesiología relacionado con precauciones estándar, vista de enfermería / Opinion of kinesiology students related to standard precautions, nursing view

INTRODUCCIÓN: Las precauciones estándar corresponden a un grupo de prácticas de prevención de infecciones que se aplican en la atención a todos los pacientes, tiene como objetivo prevenir la transmisión cruzada de microorganismos entre pacientes. OBJETIVO: Develar la opinión de las/os estudiantes de Kinesiología de la Universidad Mayor-Temuco con relación a las Precauciones Estándar. METODOLOGÍA: Estudio cualitativo, descriptivo y exploratorio, estudio intrínseco de caso, la muestra no probabilística, intencionada: 12 sujetos estudiante de kinesiología 2018; criterio de inclusión: haber aprobado la asignatura de Cuidados Básicos del Enfermo; recogida de datos: entrevistas en profundidad, se utilizaron notas de campo y se manejó el método de comparación constante, además esquema de la reducción progresiva. RESULTADOS: Para la categoría de significado de precauciones estándar surge medida de protección y seguridad para usuario y tratante; para precauciones estándar utilizadas en prácticas clínicas emerge las subcategorías de elementos y técnicas de barrera en forma análoga nace como categoría aplicabilidad de precauciones estándar de ella se desprenden campos clínicos, eventos clínicos del usuario y técnicas y procedimientos; para la categoría factores facilitadores: docente y estudiantes; en tanto factores obstaculizadores: curriculum. CONCLUSIONES: En los estudiantes existe un conocimiento deficiente y conceptos aislados sobre PE, utilizan principalmente guantes y lavado de manos; menor grado uso de mascarilla y pechera. Destaca positivamente conocimiento docente; factores obstaculizadores: aspectos teóricos deficientes curriculares; considerar modificaciones curriculares en aspectos conceptuales y procedimentales.

BACKGROUND: the standard precautions correspond to a group of infection prevention practices that are applied in the care of all patients, it aims to prevent the cross-transmission of microoganisms between patiens. OBJETIVE: to reveal the opinion of Kinesiology students at the Universidad Mayor-Temuco regarding standard precautions. METHODOLOGY: Qualitative, descriptive, and exploratory study, intrinsic case study, non-probabilistic sample, intentional: 12 subjects, kinesiology student of the year 2018; For data collection, in-depth interviews were used, field notes and the constant comparison method were used, in addition to the progressive reduction scheme. RESULTS: 173 units of meaning emerge, for the category of meaning of standard precautions, protection and security measure for user and trafficker arises; For standard precautions used in clinical practices, the subcategories of barrier elements and techniques emerge, the most mentioned, in an analogous way, the applicability of standard precautions is born as a category of clinical fields, clinical events of the user and techniques and procedures; for the category facilitating factors: teacher and student are the least mentioned; as impeding factors: curriculum. CONCLUSIONS: There is a deficient knowledge and isolated concepts about SP, mainly use gloves and hand washing; less degree the use of masks and scrubs. It is positively highlighted teacher's knowledge, and some of the hindering factors are the lack of theoretical aspects of the curriculum and the consideration for curriculum modifications to compensate conceptual and procedural aspects.

The role of Environmental Health in preventing antimicrobial resistance in low- and middle-income countries

Antimicrobial resistance (AMR) is increasingly becoming a threat to global public health, not least in low- and middle-income countries (LMICs) where it is contributing to longer treatment for illnesses, use of higher generation drugs, more expenditure on antimicrobials, and increased deaths attributed to what should be treatable diseases. Some of the known causes of AMR include misuse and overuse of antimicrobials in both humans and animals, unnecessary use of antimicrobials in animals as growth promoters, and lack of awareness among the public on how to protect antimicrobials. As a result, resistant organisms are circulating in the wider environment, and there is a need to consider the One Health approach to minimise the continuing development of AMR. Environmental Health, specifically water, sanitation and hygiene (WASH), waste management, and food hygiene and safety, are key components of One Health needed to prevent the spread of antimicrobial-resistant microorganisms particularly in LMICs and reduce the AMR threat to global public health. The key Environmental Health practices in the prevention of AMR include: (1) adequate WASH through access and consumption of safe water; suitable containment, treatment and disposal of human excreta and other wastewater including from health facilities; good personal hygiene practices such as washing hands with soap at critical times to prevent the spread of resistant microorganisms, and contraction of illnesses which may require antimicrobial treatment; (2) proper disposal of solid waste, including the disposal of unused and expired antimicrobials to prevent their unnecessary exposure to microorganisms in the environment; and (3) ensuring proper food hygiene and safety practices, such as sale and consumption of animal products in which adequate antimicrobial withdrawal periods have been observed, and growing vegetables on unpolluted soil. Environmental Health is therefore crucial in the prevention of infectious diseases that would require antimicrobials, reducing the spread of resistant organisms, and exposure to antimicrobial residues in LMICs. Working with other professionals in One Health, Environmental Health Practitioners have a key role in reducing the spread of AMR including health education and promotion, surveillance, enforcement of legislation, and research.

Primeira Conferência Científica sobre COVID-19 em Moçambique com Uso Combinado de Plataformas de Informação e Comunicação / First Scientific Conference on COVID-19 in Mozambique with Combined Use of Information and Communication Platforms

O Instituto Nacional de Saúde (INS) organi zou, entre os dias 17 e 18 de Junho do presen te ano, a primeira Conferência Científica sobre a COVID-19 no país. O evento teve lugar nas instalações do INS, em Marracuene, tendo sido transmitida em directo por várias plataformas de comunicação e informação, uma vez que, pelo contexto da pandemia, não era possível realizar um evento presencial abrangente. Em cada um dos dias, houve uma sessão plenária seguida de painéis, com um orador e três comentadores. As sim, a conferência ligou entre si investigadores, académicos e público em geral através de várias plataformas de comunicação e informação (televi são, rádio, jornal e plataformas digitais: facebook, youtube e zoom) num evento que visava promo ver o debate científico sobre a COVID-19, e os desafios que ela coloca à sociedade moçambicana. Pretendia também analisar a resposta à pandemia em Moçambique e no mundo, nos planos eco nómico, social, cultural e, particularmente, no campo das ciências biomédicas. O modelo virtual desta conferência, permitiu a interacção com os participantes, tendo estes gozado da possibilidade de colocar questões aos membros do painel.

The National Institute of Health (INS) organized, between the 17th and 18th of June of this year, the first Scientific Conference on COVID-19 in the country. The event took place at the INS premises, in Marracuene, and was broadcast live by various communication and information platforms, since, due to the context of the pandemic, it was not possible to hold a comprehensive face-to-face event. On each day, there was a plenary session followed by panels, with one speaker and three commentators. Thus, the conference connected researchers, academics and the general public through various communication and information platforms (television, radio, newspaper and digital platforms: facebook, youtube and zoom) in an event that aimed to promote the scientific debate on COVID-19, and the challenges it poses to Mozambican society. It also intended to analyze the response to the pandemic in Mozambique and in the world, at the economic, social, cultural levels and, particularly, in the field of biomedical sciences. The virtual model of this conference allowed interaction with the participants, who enjoyed the possibility of asking questions to the panel members.

Gynecological surgery and Covid-19: what is the impact and how should I manage it? / Cirurgia ginecológica e Covid-19: qual impacto e como devo conduzir?

Abstract It is estimated that around 28 million surgeries will be postponed or canceled worldwide as a result of this pandemic, causing a delay in the diagnosis and treatment of more than 2 million cancer cases. In Brazil, both the National Health Agency (ANS) and National Health Surveillance Agency (ANVISA) advised the postponement of elective and non-essential surgeries, causing a considerable impact on the number of surgical procedures that decreased by 33.4% in this period. However, some women need treatment for various gynecological diseases that cannot be postponed. The purpose of this article is to present recommendations on surgical treatment during the COVID-19 pandemic.

Resumo Estima-se que cerca de 28 milhões de cirurgias sejam postergadas ou canceladas nomundo em decorrência desta pandemia, causando atraso no diagnóstico e tratamento de mais de 2 milhões de casos oncológicos. No Brasil, tanto a ANS (Agencia Nacional de Saúde) comoa ANVISA (Agencia Nacional de Vigilância Sanitária) orientaram o adiamento das cirurgias eletivas e não essenciais, tendo um impacto considerável no número de procedimentos cirúrgicos comdiminuição de 33,4% neste período no Brasil.No entanto, algumasmulheres necessitam de tratamento para várias doenças ginecológicas, algumas das quais não podem ser adiadas. O objetivo deste artigo é apresentar recomendações sobre o tratamento cirúrgico durante a pandemia de COVID-19.

Laparoscopic and robotic urology surgery during global pandemic COVID-19

ABSTRACT Known laparoscopic and robotic assisted approaches and techniques for the surgical management of urological malignant and benign diseases are commonly used around the World. During the global pandemic COVID-19, urology surgeons had to reorganize their daily surgical practice. A concern with the use of minimally invasive techniques arose due to a proposed risk of viral transmission of the coronavirus disease with the creation of pneumoperitoneum. Due to this, we reviewed the literature to evaluate the use of laparoscopy and robotics during the pandemic COVID-19. A literature review of viral transmission in surgery and of the available literature regarding the transmission of the COVID-19 virus was performed up to April 30, 2020. We additionally reviewed surgical society guidelines and recommendations regarding surgery during this pandemic. Few studies have been performed on viral transmission during surgery. No study has been made regarding this area during minimally invasive urology cases. To date there is no study that demonstrates or can suggest the ability for a virus to be transmitted during surgical treatment whether open, laparoscopic or robotic. There is no society consensus on restricting laparoscopic or robotic surgery. However, there is expert consensus on modification of standard practices to minimize any risk of transmission. During the pandemic COVID-19 we recommend the use of specific personal protective equipment for the surgeon, anesthesiologist and nursing staff in the operating room. Modifications of standard practices during minimally invasive surgery such as using lowest intra-abdominal pressures possible, controlled smoke evacuation systems, and minimizing energy device usage are recommended.

Universal masking during covid-19 pandemic - current evidence and controversies

ABSTRACT The emergence of coronavirus disease 19 pandemic and novel research on the high transmissibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has raised controversies over the use of face masks to prevent community transmission. Specific regulations need to be fulfilled to use a face mask as part of the personal protective equipment and high quality of evidence supporting its use to prevent respiratory viral infections, including SARS-CoV-2, is lacking. However, its widespread use is becoming a standard practice in some countries and discrepancies between health authorities on their policy have led to controversy. The aim of this review is to provide an outlook on recent research in this matter and areas of opportunity.

Childbirth, puerperium and abortion care protocol during the Covid-19 pandemic / Protocolo de cuidados no parto, no puerpério e no abortamento durante a pandemia de Covid-19

Abstract The new coronavirus (severe acute respiratory syndrome-related coronavirus 2, SARSCoV- 2) is a virus that causes a potentially serious respiratory disease that has spread in several countries, reaching humans in all age groups, including pregnant women. The purpose of this protocol is to provide technical and scientific support to Brazilian obstetricians regarding childbirth, postpartum and abortion care during the pandemic.

Resumo O novo coronavírus (severe acute respiratory syndrome-related coronavirus 2, SARS-CoV- 2) é umvírus que causa uma doença respiratória potencialmente grave que se espalhou por vários países, acometendo seres humanos de todas as faixas etárias, incluindo gestantes. O propósito deste protocolo é fornecer apoio técnico e científico aos obstetras brasileiros com relação aos cuidados no parto, pós-parto e aborto durante a pandemia.

Marco de referencia de la Red Integrada de Servicios de Salud a la respuesta de COVID-19 / Reference framework of the Integrated Health Services Network to the COVID-19 response

En el marco de la emergencia producida por el nuevo Coronavirus, COVID-19, surgido en la ciudad de Wuhan, provincia de Hubei en la República Popular de China en el mes de diciembre del 2019 y declaración oficial de Pandemia el 11 de marzo de 2020 por el Director General de la Organización Mundial de la Salud (OMS), la Directora de la Organización Panamericana de la Salud (OPS), Dra. Carissa Etienne ha solicitado elevar el nivel de preparación de los servicios de salud. Ante este nuevo escenario el Centro de Operaciones de Emergencias (COE), activado desde enero, ha pasado a una fase en la cual es prioritario orientar esfuerzos a que los servicios de salud de los países en la región de las Américas puedan estar preparados para la respuesta a una trasmisión comunitaria sostenida. En respuesta a estas orientaciones el departamento de sistemas y servicios de salud (HSS), ha definido como lineamiento general responder a la emergencia del COVID-19 a través de las redes de servicios de salud y el enfoque estratégico de Atención Primaria en Salud en los países.

Importancia del dentista y del equipo auxiliar de salud bucal en el proceso de diagnóstico de sífilis / Importance of the dentist and the auxiliary oral health team in the diagnosis of syphilis

ABSTRACT Introduction: Syphilis is classified as a sexually transmitted infectious-contagious disease with the causative agent Treponema pallidum (Tp). It presents distinct stages of evolution: The primary phase is characterized by the appearance of the hard chancre, the secondary phase by the spread of Tp through the bloodstream and systemic involvement, and the tertiary phase by organ infection and nervous system impairment. In congenital syphilis, the Tp is transmitted vertically from mother to child. Objective: Report a case in which the dental team participated in the diagnosis of syphilis. Case presentation: A male 26-year-old patient with leukoderma, HIV-positive and under regular antiretroviral treatment, with no other chronic systemic changes and no previous history of Tp infection, was referred for evaluation by the oral health team. The patient reported having had bisexual relations in recent months with a condom and orogenital contact without a condom. He had not noticed any type of "wound" on the body. Intraoral examination found multiple reddish macules scattered on the lingual dorsum, with a slight detachment and little pain. The quick test was a reagent for syphilis. The patient was referred for evaluation at the medical clinic. Treatment started by two applications of benzyl penicillin with a 7 days' separation between them. Complementary blood tests were also indicated, with special attention to VDRL, which eventually confirmed the Tp infection. Conclusions: Participation of the oral health team in the diagnosis of syphilis constitutes a complementary force for the improvement of health care processes(AU)

RESUMEN Introducción: La sífilis se clasifica como una enfermedad contagiosa infecciosa de transmisión sexual, con el agente causal Treponema pallidum (Tp). Presenta distintos estadios de evolución: la fase primaria caracterizada por la aparición del chancre duro; la fase secundaria, la diseminación de la Tp a través del torrente sanguíneo y la afectación sistémica; y la fase terciaria, en que hay infección de órganos y deterioro del sistema nervioso, además de sífilis congénita, forma esta en la que Tp es transmitida verticalmente por la mujer embarazada. Objetivo: Informar sobre un caso en el que la participación del equipo dental colaboró ​​en el proceso de diagnóstico de la sífilis. Presentación del caso: Paciente con 26 años de edad, leucodermia, VIH positivo y en tratamiento antirretroviral regular, sin otros cambios crónicos a nivel sistémico y sin antecedentes de infección por Tp. Se remitió para evaluación con el equipo de salud oral. Informó haber tenido relaciones bisexuales en los últimos meses con un condón y contacto orogenital sin condón. No notó ningún tipo de "herida" en el cuerpo. En el examen intrabucal, se encontraron múltiples máculas rojizas dispersas en el dorso lingual, con un ligero desprendimiento y con poco dolor. La prueba rápida fue un reactivo para sífilis. El paciente fue remitido para su evaluación a clínica médica. Comenzó el tratamiento con dos aplicaciones de penicilina bencilo, con un intervalo de 7 días y se solicitó análisis de sangre complementarios, con especial atención al VDRL, que posteriormente confirmó la infección por Tp. Conclusiones: La participación del equipo de salud bucal frente al diagnóstico de la sífilis, se constituye como una fuerza complementaria para la mejora de los procesos en salud(AU)