Análise do perfil dos pacientes atendidos em um ambulatório de fisioterapia pediátrica / Analysis of the profile of patients attended in a pediatric physiotherapy outpatient clinic.

Introdução: O crescimento e o desenvolvimento são eixos referenciais para todas as atividades de atenção à criança e ao adolescente. Patologias podem prejudicar o desenvolvimento motor, cognitivo, social e psicológico. A procura pelas clínicas escolas de fisioterapia vem aumentando, visto que facilitam as demandas da população e oferecem serviço de qualidade. Objetivos: Traçar o perfil dos pacientes pediátricos atendidos no decorrer do ano de 2020 a julho de 2021, na clínica escola de fisioterapia (UNIFESO), na cidade de Teresópolis. Métodos: Trata-se de uma análise descritiva, retrospectiva e quantitativa do perfil dos pacientes atendidos no ambulatório de fisioterapia, no setor de pediatria, no período de 2020 a julho de 2021, através das variáveis: faixa etária, gênero, endereço, bairro, diagnóstico clínico, tempo de tratamento e utilização de cadeiras de rodas. Resultados: A maior prevalência dos assistidos é residente do bairro Meudon-Teresópolis/RJ. A maioria das crianças foram do sexo feminino, tendo diagnóstico clínico de maior incidência o atraso neuropsicomotor. A fisioterapia motora teve dominância nos atendimentos. Conclusão: A partir da análise dos dados, serão adotadas medidas de estruturação da ficha de avaliação da pediatria, proporcionando um atendimento mais eficaz e baseado na literatura científica.

Changes in Coagulation Study and Risk of Developing Cholesteatoma: Is There a Link?

Background and Objectives@#The etiopathogenesis of acquired pediatric cholesteatoma has not yet been fully clarified. Recent studies and modern technologies have led researchers to look for explanations at a molecular level. This study aims to understand if the origins of cholesteatoma could be related to dysfunctions in coagulation factors, thereby emphasizing its role in angiogenesis. @*Subjects and Methods@#This was a retrospective case-control study carried out at a tertiary hospital center between January 2010 and December 2020. The study included 92 children. The variables of the summary coagulation study (partial thromboplastin time, prothrombin time, and international normalized ratio) were compared among children with and without development of chronic otitis media with cholesteatoma. @*Results@#The cases and controls were comparable in terms of age, type, and number of times that ventilation tubes were placed. Partial thromboplastin times tended to be higher in children who developed cholesteatoma, with a statistically significant difference between the two groups in terms of normal and abnormal partial thromboplastin times (p=0.029). @*Conclusions@#The results of this case control study indicate that slight extension of partial thromboplastin times in the coagulation study may not meet the criteria for diagnosis of certain hematological pathologies or clinical significance, but at a molecular level may already have implications for activation of angiogenesis and other growth factors involved in the onset, growth, and expansion of acquired pediatric cholesteatoma.

COVID-19 crítico e disfunção neurológica - uma análise comparativa direta entre o SARS-CoV-2 e outros agentes infecciosos / Critical COVID-19 and neurological dysfunction - a direct comparative analysis between SARS-CoV-2 and other infectious pathogens

RESUMO Objetivo: Avaliar se a infecção grave pelo SARS-CoV-2 está mais comumente associada a sinais de disfunção do trato corticoespinhal e outros sinais, sintomas e síndromes neurológicas, em comparação com outros agentes infecciosos. Métodos: Este foi um estudo de coorte prospectivo com inclusão consecutiva de doentes admitidos a unidades de cuidados intensivos devido a síndrome do desconforto respiratório agudo infeccioso primário, com necessidade de ventilação mecânica invasiva por > 48 horas. Os doentes incluídos foram atribuídos aleatoriamente a três investigadores para a avaliação clínica, a qual incluía a pesquisa de sinais de disfunção do trato corticoespinhal. Os dados clínicos, incluindo outras complicações neurológicas e possíveis preditores, foram obtidos independentemente a partir dos registros clínicos. Resultados: Foram incluídos consecutivamente 54 doentes com síndrome do desconforto respiratório agudo, 27 devido a SARS-CoV-2 e 27 devido a outros agentes infecciosos. Os grupos eram comparáveis na maioria das características. Os doentes com COVID-19 apresentavam risco significativamente superior de complicações neurológicas (RR = 1,98; IC95% 1,23 - 3,26). Os sinais de disfunção do trato corticoespinhal tendiam a ser mais prevalentes em doentes com COVID-19 (RR = 1,62; IC95% 0,72 - 3,44). Conclusão: Este estudo foi a primeira análise comparativa visando avaliar disfunção neurológica, entre doentes com infecção SARS-CoV-2 e outros agentes infecciosos, em um contexto de unidade de cuidados intensivos. Reportamos um risco significativamente superior de disfunção neurológica em doentes com COVID-19. Como tal, sugere-se o rastreio sistemático de complicações neurológicas em doentes com COVID-19 crítico.

ABSTRACT Objective: To evaluate whether critical SARS-CoV-2 infection is more frequently associated with signs of corticospinal tract dysfunction and other neurological signs, symptoms, and syndromes, than other infectious pathogens. Methods: This was a prospective cohort study with consecutive inclusion of patients admitted to intensive care units due to primary infectious acute respiratory distress syndrome requiring invasive mechanical ventilation > 48 hours. Eligible patients were randomly assigned to three investigators for clinical evaluation, which encompassed the examination of signs of corticospinal tract dysfunction. Clinical data, including other neurological complications and possible predictors, were independently obtained from clinical records. Results: We consecutively included 54 patients with acute respiratory distress syndrome, 27 due to SARS-CoV-2 and 27 due to other infectious pathogens. The groups were comparable in most characteristics. COVID-19 patients presented a significantly higher risk of neurological complications (RR = 1.98; 95%CI 1.23 - 3.26). Signs of corticospinal tract dysfunction tended to be more prevalent in COVID-19 patients (RR = 1.62; 95%CI 0.72 - 3.44). Conclusion: Our study is the first comparative analysis between SARS-CoV-2 and other infectious pathogens, in an intensive care unit setting, assessing neurological dysfunction. We report a significantly higher risk of neurological dysfunction among COVID-19 patients. As such, we suggest systematic screening for neurological complications in severe COVID-19 patients.

Infecções graves por SARS-CoV-2 com uso de tocilizumabe / Severe infections by SARS-CoV-2 with the use of tocilizumab

O SARS-CoV-2 é causador da doença infecciosa COVID-19. A infecção estimula o sistema imunológico a produzir citocinas próinflamatórias. A principal citocina envolvida é a IL-6, e está ligada à gravidade da doença. Devido à associação dos altos níveis de IL-6 com a mortalidade na COVID-19, investiga-se sobre o uso de tocilizumabe (TCZ), um anticorpo monoclonal humanizado antirreceptor de IL-6 humana. O objetivo desta revisão sistemática é avaliar a eficácia do uso do TCZ em pacientes com COVID-19 grave. As buscas foram feitas através das bases de dados Science Direct e PubMed em setembro de 2021. Foram incluídos os ensaios clínicos randomizados com pacientes em um único estágio de COVID-19, casos graves e sem restrição de idade, os quais receberam o TCZ como medicação de intervenção combinado a tratamentos protocolados por cada hospital e associado a corticosteroides. A análise desses estudos demonstrou resultados significantes sobre o uso de TCZ em casos severos de COVID-19. O uso de TCZ associado a glicocorticoides levou a uma redução no índice de mortalidade e de submissão a ventilações mecânicas e a uma melhora expressiva em relação à escala "WHO-endorsed 7-point ordinal scale". Entretanto, não houve melhora relevante quanto ao uso do TCZ de maneira isolada.

SARS-CoV-2 causes the COVID-19 infectious disease that affects the respiratory tract. From the beginning of the infection, the immune system starts to produce pro-inflammatory cytokines and chemokines. The main cytokine involved is IL-6 and is linked to the severity and prognosis of the disease, as it provokes a storm of cytokines and severe inflammatory responses. Due to the association of high levels of IL-6 with severity and mortality in COVID-19, the use of Tocilizumab (TCZ), a humanized anti-human IL-6 receptor monoclonal antibody, which binds to IL receptors, is being investigated. -6 and blocks intracellular signaling reducing cytokine storm and hyperinflammatory state. The aim of this review is to assess the effectiveness of using TCZ in the treatment of patients with severe COVID-19. Searches were performed using the Science Direct and PubMed databases in May 2021. Randomized clinical trials with patients in a single stage of COVID­19, severe cases and without age restriction, who received TCZ as medication for treatment, were included. Intervention was combined with treatments protocoled by each hospital and associated with corticosteroids. The analysis of these studies showed significant results regarding the use of TCZ in severe cases of COVID-19. The use of TCZ associated with glucocorticoids led to a reduction in the rate of mortality and compliance with mechanical ventilation and a significant improvement in relation to the "WHO-endorsed 7-point ordinal scale". However, there was no evidence of relevant improvement when using TCZ alone.

Nodular fasciitis on the zygomatic region: immunohistochemical analysis and literature review / Fascitis nodular en la región cigomática: análisis inmunohistoquímico y revisión de la literatura

Background: Nodular Fasciitis (NF) is characterized as a benign, fast-growing lesion with proliferation of fibroblasts and myofibroblasts. The use of immunohistochemistry is important for the diagnostic definition and if its findings are not clear, the differential diagnosis will be challenging, even more when the clinical findings do not correspond with the histopathological characteristics. Objective:Here, we reported a case of dermal Nodular Fasciitis affecting zygomatic region of a 64 years old male who complained of swelling in the right side of the face for 3 months, which appeared after an ox-horn trauma. Literature review: We reviewed the literature for all Nodular Fasciitis cases in the zygomatic region. Furthermore, we discussed the relationship of trauma as an etiological factor, main differential diagnoses and immunohistochemical markers for Nodular Fasciitis. Case report: Incisional biopsy was done which revealed benign neoplasm of mesenchymal origin characterized by the fusocellular proliferation. Immunohistochemistry revealed positivity for VIM and SMA, being negative for S-100, CKs, CD34, and p53. The Ki-67 index was low. Due to the clinical, histopathological and immunohistochemical findings, the diagnosis of dermal NF was established. Conclusion: This case consists of Nodular Fasciitis, which must be microscopically differentiated from dermatofibroma, solitary fibrous tumor, low-grade myofibroblastic sarcoma and atypical fibroxanthoma. Immunohistochemistry should always be performed to elucidate the nature of tumor cells and thus contribute to the correct diagnosis and treatment. Nodular Fasciitis appears to be uncommon in the zygomatic region.

Introdução: A Fasciíte Nodular (FN) é caracterizada como uma lesão benigna, de crescimento rápido, com proliferação de fibroblastos e miofibroblastos. O uso da imunoistoquímica é importante para a definição diagnóstica e se seus achados não forem claros, odiagnóstico diferencial será desafiador, ainda mais quando os achados clínicos não corresponderem às características histopatológicas. Objetivo: Relatar um caso de Fasciíte Nodular dérmica acometendo a região zigomática de um homem de 64 anos que se queixava de inchaço no lado direito da face há 3 meses, que surgiu após trauma ocasionado por chifre de boi. Revisão da literatura: A literatura foi revisada para todos os casos de Fasciíte Nodular na região zigomática. Além disso, discutiu-se a relação do trauma como fator etiológico, principais diagnósticos diferenciais e marcadores imunoistoquímicos para Fasciíte Nodular. Relato de caso: Foi realizada biópsia incisional que revelou neoplasia benigna de origem mesenquimal caracterizada pela proliferação fusocelular. A imunoistoquímica revelou positividade para VIM e AML, sendo negativa para S-100, CKs, CD34 e p53. O índice Ki-67 foi baixo. Devido aos achados clínicos, histopatológicos e imunoistoquímicos, foi estabelecido o diagnóstico de Fasciíte Nodular dérmica. Conclusão:Este caso consiste em Fasciíte Nodular, que deve ser diferenciada microscopicamente de dermatofibroma, tumor fibroso solitário, sarcoma miofibroblástico de baixo grau e fibroxantoma atípico. A imunoistoquímica deve sempre ser realizada para elucidar a natureza das células tumorais e assim contribuir para o correto diagnóstico e tratamento. A Fasciíte Nodular parece ser incomum na região zigomática

Cuidado pré-operatório para pacientes em estágio terminal de doença na perspectiva dos enfermeiros / Preoperative care for patients in terminal stage of disease from the perspective of nurses

RESUMO Objetivo compreender os significados atribuídos pelos enfermeiros à assistência pré-operatória prestada a pacientes em estágio terminal de doenças. Métodos pesquisa qualitativa que utilizou como referencial metodológico a Teoria Fundamentada nos Dados e foi realizada nas enfermarias cirúrgicas de um hospital universitário. Resultados participaram da pesquisa onze enfermeiros. Elaborou-se uma teoria para o fenômeno central: Os enfermeiros cuidando de pacientes em estágio terminal de doença no período pré-operatório no contexto de uma enfermaria cirúrgica. Conclusão os enfermeiros atribuem significados a este cuidado que tem particularidades próprias, que requer preparo do profissional e que demanda, ainda, mais de uma comunicação efetiva dentro da equipe multidisciplinar e na relação com paciente e família. Contribuições para a prática: a teoria apresentada permite a reflexão do profissional sobre sua práxis, a compreensão das condições intervenientes para os dilemas éticos e conflitos envolvidos e consequências, além de estratégias para melhorar a assistência neste cenário.

ABSTRACT Objective to understand the meanings attributed by nurses to preoperative care provided to terminal disease patients. Methods qualitative research that used the Grounded Theory as methodological reference and was conducted in the surgical wards of a university hospital. Results eleven nurses participated in the research. A theory was elaborated for the central phenomenon: Nurses caring for terminal disease patients in the preoperative period in the context of a surgical ward. Conclusion nurses attribute meanings to this care that has its own particularities, that requires professional preparation and that demands, even more, an effective communication within the multidisciplinary team and in the relationship with the patient and family. Contributions to practice: the theory presented allows professionals to reflect on their praxis, understand the intervening conditions for ethical dilemmas and conflicts involved and consequences, as well as strategies to improve care in this scenario.

Effect of using forced and free oviposition methods to obtain eggs and larvae of Mansonia (Diptera: Culicidae) females from Rondonia, Brazil (western Amazon)

ABSTRACT Species of the genus Mansonia Blanchard are disease pathogen vectors in some regions of the world and can cause considerable inconvenience due to their bites when present in high numbers. However, little is known regarding their biology in Brazil. The objective of this work was to investigate some reproductive parameters of Mansonia from the western Brazilian Amazon. Females were captured in the field using human landing catches in rural areas of Porto Velho, Rondonia, Brazil. The mosquitoes were identified and separated into two groups for oviposition: forced, i.e., with wing removal, and free oviposition, without wing removal. Daily observations of oviposition and female survival were conducted until oviposition. The eggs and subsequent larvae were counted for fecundity and fertility evaluation, respectively. The species collected in this study were Mansonia amazonensis (Theobald), Mansonia humeralis Dyar & Knab and Mansonia titillans (Walker). The oviposition percentage for Ma. amazonensis was much lower than for Ma. humeralis and Ma. titillans. Forced oviposition resulted in a higher number of ovipositing females only for Ma. humeralis. Fecundity and fertility were not affected by the oviposition method. Egg and larval numbers were generally lower for Ma. amazonensis compared with the other species. Forced oviposition may be a tool to increase the number of ovipositing females depending on the Mansonia species studied in order to establish colonies in the laboratory.

Oral Blue Nevus: Two case reports and literature review / Nevus azul oral: Dois relatos de caso e revisão de literatura

Case Description We report two cases of oral Blue Nevus. The first case is a 32 years old female patient with a brown-blue lesion on hard palate, with no clinical symptoms that has always been present but that recently had been growing. The second case is a 36 years old male patient with a brown macule on hard palate. Clinical Findings On case report 1, oral examinations revealed an irregular brown-blue macule, measuring 13 x 6 mm on hard palate. On case report 2, oral examination showed an oval brownish macule also located on hard palate. Treatment and Outcome: Excisional biopsy was performed in both cases and histopathology analyses revealed diagnosis of Blue Nevus. ClinicalRelevance: Diagnosis of pigmented lesions of the oral cavity can be challenging once there are avariety of causes such as racial pigmentation, systemic diseases, use of medication, metal tattooing, melanocytic nevus, melanoacanthoma, and melanoma. The correct diagnosis of this type of lesion is important to help professionals offer the best care for the patients and highlighting clinic criteria to differentiate malignant pigmented lesions is fundamental.

Relato de Caso: Relatamos doiscasos de Blue Nevus oral. O primeiro caso é de uma paciente de 32 anos, do sexo feminino, com lesão marrom-azulada em palato duro, sem sintomas clínicos que sempre estiveram presentes, mas que vinham crescendo recentemente. O segundo caso é de um pacientedo sexo masculino, 36 anos, com mácula marrom no palato duro.Achados clínicos: No relato de caso 1, os exames orais revelaram uma mácula marrom-azulada irregular, medindo 13 x 6 mm no palato duro. No caso clínico 2, o exame bucal mostrou uma mácula oval acastanhada também localizada no palato duro.Tratamento e Resultado: A biópsia excisional foi realizada em ambos os casos e a análise histopatológica revelou o diagnóstico de Nevo Azul.Relevância clínica: O diagnóstico de lesões pigmentadas da cavidade oral pode ser desafiador, uma vez que há uma variedade de causas, como pigmentação racial, doenças sistêmicas, uso de medicamentos, tatuagem em metal, nevo melanocítico, melanoacantoma e melanoma. O correto diagnóstico desse tipo de lesão é importante para auxiliar o profissional a oferecer o melhor atendimento aos pacientes e destacar critérios clínicos para diferenciar lesões malignas pigmentadas é fundamental.

Influence of dental treatment on quality of life and self-esteem of hemodialysis-therapy patients

Background: Patients undergoing dialysis treatment have a worse quality of life and have higher rates of malnutrition, inflammation and hospitalization than the general population. Objective: This study aimed to evaluate the influence of dental treatment on the quality of life and self-esteem of hemodialysis-therapy patients. Materials and Methods: An interventional study was developed with 27 patients undergoing hemodialysis in Diamantina, Brazil. Initially, patients received a clinical evaluation of a dentist and responded to questionnaires to estimate the quality of life (Medical Outcomes Study 36-Item Short Form Health Questionnaire (SF-36) and Oral Health Impact Profile (OHIP) version 14) and self-esteem (Scale Self-Esteem of Rosenberg). After 45 days, the questionnaires were reapplied, and the patients received dental treatment to adapt the oral environment. After the treatment, 45 days were awaited to reapply the questionnaires. Descriptive analyzes were performed, Wilcoxon and Friedman tests were done. The level of significance was set at 5% (p <0.05). Results: Twenty-seven low-income and educated individuals participated in the study, most of whom were men. Hypertension and diabetes were not widely reported systemic diseases. There was statistical significance in SF-36 and OHIP-14 dimensions and improvement of self-esteem. Conclusion: Dental treatment interfered positively with the quality of life and self-esteem of patients undergoing hemodialysis.

Parasitic lesions in fish in the Federal District, Brazil

Brazil has a vast territory and favorable climatic conditions that allow the cultivation of freshwater fish. The intensification of the productive system can cause an imbalance in the aquatic environment as a result of poor water quality, nutritional deficiencies and infectious or parasitic diseases. The laboratory diagnosis and the determination of the prevalence of the main lesions, which occur in a certain region, help to guide towards the etiological diagnosis. This study aimed to describe the main parasitic lesions in fish in the routine at the Veterinary Pathology Laboratory of the Universidade de Brasília (UnB). All records of fish with parasitic lesions were recovered. Those cases in which there was an intralesional parasite and which presented lesions compatible with the parasite were included. The screening of ectoparasites was done by scraping the superficial mucus from the gills and skin. Organ sections were routinely processed for histopathologyand stained with hematoxylin-eosin (HE). In some records, parasitological identification was carried. The information was divided into the species of the affected fish, epidemiology of the outbreak (water quality, temperature, type of breeding), lesion distribution, etiology and macroscopic and microscopic changes. The resulting data was organized in absolute frequency and percentage. In this study, 22 cases were counted, between individual deaths and outbreaks, totaling 83 necropsied teleost fish. Inflammatory changes of parasitic origin were seen in 13/22 (59%) of the cases had lesions of parasitic origin. Skin lesions and gills were the most relevant. Macroscopically, red areas or spots of hyperemia or hemorrhage on the body surface were the most prevalent findings. Under microscopy, proliferative gill inflammation was the most relevant diagnosis. Pscinoodinium pilullare (Dinoflagellida), Ichthyophthirius multifiliis (Ciliophora), and monogenetic worms (Monogenea) were the main parasites found. Trichodina sp. (Ciliophora), Ichtyobodo sp. (Kinetoplastida), Amoebas, and Chilodonella sp. (Ciliophora), were seen in fewer numbers. An unusual case suggestive of parasitism by Eustrongylides sp. (Nematoda), in a pirá-brasília (Simpsonichthys boitonei), specimen has been recorded. The diagnoses were based on epidemiology, anatomopathological and parasitological findings. The most frequent and significantly lethal lesion in the study was proliferative and / or hyperplastic branchitis. Proliferative branchitis with lamellar epithelial hyperplasia (LEH) is a response to some type of chemical or mechanical injury to the gill epithelium in order to protect the capillaries from further damage or microbial penetration. However, it also increases the diffusion distance between capillaries and the environment and, therefore, hinders breathing, excretory and osmoregulatory functions. Protozoan infections and monogenetic worms in general generated LEH and skin lesions of mechanical origin. Secondary bacterial infection, were observed in this parasitosis determining the cause of death of the fish. Its pathogenicity comes from the lesions caused by the colonization and histophagy of the epithelial surfaces, mainly gills and skin, causing epithelial proliferation, lamellar cell fusion, epithelial cell degeneration and necrosis forming several ulcers in the epithelium after the release of mature trophies. The pathogenesis of parasitism by Eustrongylides spp. is considerable when there is a large quantity of these larvae that can cause intestinal obstruction, rupture and compression of viscera, of greater importance in small fish. The main parasites of necropsied fish were protozoa and monogenetic worms, which mainly cause branquitis and dermatitis in varying grades.(AU)

Emotional labor of nurses in the front line against the COVID-19 pandemic / Trabajo emocional de enfermeros de primera línea frente a la pandemia de COVID-19 / Trabalho emocional de enfermeiros da linha de frente do combate à pandemia de COVID-19

ABSTRACT Objective: To analyze nurses' experiences in the front line of the fight against the COVID-19 pandemic regarding the performance of emotional labor (EL), aiming at its characterization and identification of support strategies and development opportunities of nurses and practices. Methods: Qualitative, descriptive, and exploratory study, with content analysis of eleven written narratives and reports from a focus group composed of nurses with experience in caring for patients with COVID-19 from different Hospital Centers in Lisbon, Portugal. Results: Five themes were extracted: 1) Challenges experienced by nurses in the frontline; 2) Emotions experienced by nurses in service care; 3) Emotional responses of nurses and patients: impact on care; 4) EL of nurses in the patient care process; 5) Opportunities for development in the face of the emotional challenge required of nurses in combating COVID-19. Final considerations: The nurses demonstrated the ability to transform this profoundly emotional experience positively.

RESUMEN Objetivo: Analizar las experiencias de enfermeros de primera línea frente a la pandemia de COVID-19 cuanto al desempeño del trabajo emocional (TE) visando su caracterización e identificación de estrategias de suporte y oportunidades de desarrollo de enfermeros y de prácticas. Métodos: Estudio cualitativo, descriptivo y exploratorio, con análisis de contenido de 11 narrativas escritas y relatos de un grupo focal compuesto por enfermeros con experiencia de cuidados a pacientes con COVID-19, de diferentes Centros Hospitalarios de Lisboa, Portugal. Resultados: Extrajeron cinco temas: 1) Desafíos vividos por enfermeros en primera línea; 2) Emociones experienciadas por enfermeros en la prestación de cuidados; 3) Respuestas emocionales de enfermeros y pacientes: impacto en los cuidados; 4) TE de enfermeros en el proceso de cuidados al paciente; 5) Oportunidades de desarrollo delante desafío emocional exigido de los enfermeros frente a la COVID-19. Consideraciones finales Los enfermeros demostraron capacidad de transformar positivamente esta experiencia profundamente emocional.

RESUMO Objetivo: Analisar as experiências de enfermeiros da linha de frente do combate à pandemia de COVID-19 quanto ao desempenho do trabalho emocional (TE) visando à sua caracterização e identificação de estratégias de suporte e oportunidades de desenvolvimento dos enfermeiros e das práticas. Métodos: Estudo qualitativo, descritivo e exploratório, com análise de conteúdo de 11 narrativas escritas e relatos de um grupo focal composto por enfermeiros com experiência de cuidados a pacientes com COVID 19, de diferentes Centros Hospitalares de Lisboa, Portugal. Resultados: Extraíram-se cinco temas: 1) Desafios vividos pelos enfermeiros na linha de frente; 2) Emoções experienciadas por enfermeiros na prestação de cuidados; 3) Respostas emocionais de enfermeiros e pacientes: impacto nos cuidados; 4) Trabalho Emocional de enfermeiros no processo de cuidados ao paciente; 5) Oportunidades de desenvolvimento face ao desafio emocional exigido dos enfermeiros no combate à COVID-19. Considerações finais: Os enfermeiros demonstraram capacidade de transformar positivamente esta experiência profundamente emocional.

Revisitando o Higienismo: a Revolta da Vacina e o discurso sanitarista / Revisiting Hygienism: the Vaccine Uprising and the sanitary discourse

A Revolta da Vacina: mentes insanas em corpos rebeldes de Nicolau Sevcenko é uma nova edição de 2018 da Editora UNESP. A obra é um clássico da historiografia brasileira e se propõe a analisar a primeira revolta urbana do período republicano. Muito além da questão sanitária o movimento se propunha a rebelar-se contra uma série de iniciativas políticas, sociais, econômicas e de higiene impostas entre 1904 e 1905 na cidade do Rio de Janeiro, epicentro de uma nova percepção de como deveria ser a vida em sociedade.

Informações e registros em saúde: reflexões teóricas e aplicações ao Sistema Único de Saúde / Health information and records: theoretical reflections and applications to the Unified Health System

Informações e Registros em Saúde e seus Usos no SUS é a primeira edição (2020) de uma obra publicada pela Editora Fiocruz e faz parte da Coleção Fazer Saúde. O livro tem o potencial de tornarse referência quanto aos registros e sistemas de informação em saúde pela qualidade e clareza do texto. Ademais, propõe-se a estimular uma reflexão sobre os conceitos e aplicações de informações e registros em saúde, e especialmente, no SUS.

Prevalence of virological and serological markers of SARS-CoV-2 infection in the population of Ribeirão Preto, Southeast Brazil: an epidemiological survey

Abstract INTRODUCTION: This epidemiological household survey aimed to estimate the prevalence of the current and past SARS-CoV-2 infections in Ribeirão Preto, a municipality of southeast Brazil. METHODS: The survey was conducted in two phases using a clustered sampling scheme. The first phase spanned May 1-3 and involved 709 participants. The second phase spanned June 11-14, 2020, and involved 646 participants. RESULTS: During the first phase, RT-PCR performed on nasopharyngeal swabs was positive at 0.14%. The serological tests were positive in 1.27% of the patients during the first phase and 2.79% during the second phase. People living in households with more than five members had a prevalence of 10.83% (95%CI: 1.58-74.27) higher than those living alone or with someone other. Considering the proportion of the positive serological test results with sex and age adjustments, approximately 2.37% (95%CI: 1.32-3.42) of the population had been cumulatively infected by mid-June 2020, which is equivalent to 16,670 people (95%CI: 9,267-24,074). Considering that 68 deaths from the disease in the residents of the city had been confirmed as at the date of the second phase of the survey, the infection fatality rate was estimated to be 0.41% (95%CI: 0.28-0.73). Our results suggest that approximately 88% of the cases of SARS-CoV-2 infection at the time of the survey were not reported to the local epidemiological surveillance service. CONCLUSIONS: The findings of this study provide in-depth knowledge of the COVID-19 pandemic in Brazil and are helpful for the preventive and decision-making policies of public managers.

Larvicidal activity of Maytenus guianensis (Celastraceae) against Aedes aegypti (Diptera: Culicidae)

Abstract INTRODUCTION: Bioprospection of plant products is used to discover new insecticides. METHODS: The larvicidal activity of ethanolic extract and triterpene (tingenone B) from the bark of Maytenus guianensis and their effect on pupation and emergence were evaluated against Aedes aegypti. RESULTS: Crude extract LC50 was 11.3 ppm and caused ejection of the larvae intestine; tingenone B LC50 was 14.8 ppm. Pupation was reduced by 20% and 10%, respectively; however, the emergence was not affected. CONCLUSIONS: The crude bark extract exhibited a higher larvicidal effect against the vector.

Ethnodirigid study of Medicinal plants used by the population assisted by the Programa de Saúde da Família (Family Health Program) in Marechal Deodoro - AL, Brazil / Estudo etnodirigido de Plantas medicinais utilizadas pela população atendida no Programa de Saúde da Família, Marechal Deodoro, AL, Brasil

Abstract This study aimed to assess diagnosis of Unique Health System (SUS) users profile with regard to herbal medicine. This is a cross-sectional study with observational data collection conducted in the city of Marechal Deodoro, through a semi-structured questionnaire with questions related to socioeconomic data, use, and knowledge of medicinal plants and herbal medicines and satisfaction with the use of medicinal herbs (MH) and interactions of phytotherapeutic drugs (PD). Among the topics, 86.89% of users used herbal medicines often, especially lemon balm (Melissa officinalis L.). It was also observed that the plants are generally used as a sedative (21.74%) and as tea (87.84%). 82.32% of respondents claim to have acquired the knowledge of herbal medicine through a family member and 85.36% make use of medicinal plants without having received any information on the use of MH and PD. 61% of the plants described that coincided with the form of use and therapeutic properties found in the literature. With regard to satisfaction by treatment with MH and PD, it was found that 56.67% are satisfied. Therefore, it is necessary to pay attention to this aspect of usage, in order to avoid possible drug interactions or adverse reactions resulting from the incorrect use.

Resumo Este trabalho teve como objetivo conhecer perfil diagnóstico de usuários do SUS com relação à fitoterapia. Trata-se de um estudo observacional transversal, com coleta de dados realizada no Município de Marechal Deodoro, por meio de um questionário semi-estruturado com perguntas relativas a dados socioeconômicos, utilização e conhecimentos sobre plantas medicinais e fitoterápicos e satisfação com o uso de plantas medicinais (PM) e medicamentos fitoterápicos (MF). Entre os usuários abordados, 87,08% utilizam plantas medicinais frequentemente, principalmente a erva cidreira (Melissa officinalis L.). Também foi observado que as plantas são geralmente usadas como calmante (16,05%) e na forma de chá (68,35%). 82,51% dos entrevistados afirmam ter adquirido o conhecimento sobre fitoterapia através de algum familiar e 85,56% fazem uso das PM e MF sem ter recebido algum tipo de informativo sobre o seu uso. 61% das plantas descritas pelos usuários teve seu uso e terapêutica coincidente com o citado em literatura específica. Com relação a satisfação através do tratamento com PM e MF observou-se que 56,80% estão satisfeitos. O uso de plantas medicinais por parte dos usuários é bastante frequente, principalmente pelo conhecimento acumulado ao longo de gerações. Portanto, se faz necessária maior atenção a esse aspecto de utilização, visando evitar possíveis reações adversas advindas do uso incorreto.

Are SARS-CoV-2 reinfection and Covid-19 recurrence possible? a case report from Brazil

Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19.

Elaboração de um protocolo hospitalar para cuidados de enfermagem aos pacientes com estomas intestinais / Elaboration of a hospital protocol for nursing care to patients with intestinal stomata

Objetivo: Descrever o processo de elaboração de um protocolo hospitalar para cuidados de enfermagem aos pacientes com estomas intestinais. Metodologia: Pesquisa metodológica, realizada em 2018, em quatro etapas: revisão de literatura e elaboração da primeira versão do instrumento, revisão por especialistas estomaterapeutas, teste-piloto com os enfermeiros das unidades de internação e unidade de terapia intensiva, e avaliação dos enfermeiros e redação final. A pesquisa cumpriu as exigências para trabalhos com seres humanos (Parecer CEP nº 3.007.868). Resultados: O protocolo elaborado contém itens sobre dados de identificação do paciente e estoma, mais quinze itens descritivos do exame físico e quatro Diagnósticos de Enfermagem. Enfermeiros (n=04; 25,0%) sugeriram que, associado ao uso do protocolo, estivesse o uso de régua para medição do estoma. Conclusão: O protocolo elaborado mostrou-se adequado e útil para a assistência de enfermagem ao paciente internado estomizado na avaliação dos estomaterapeutas e enfermeiros assistenciais.

Objective: To describe the process of elaborating a hospital protocol for nursing care for patients with intestinal stomata. Method: this methodological research, carried out in 2018, in four stages: literature review and preparation of the first version of the instrument, review by stomatherapist specialists, pilot test of clinical application by the nurses of the units, evaluation of nurses and final writing. The research met the requirements for working with human beings (Parecer CEP nº 3.007.868). Results: The elaborated protocol contains items on patient and stoma identification data, plus fifteen descriptive items of the physical examination and four Nursing Diagnoses. Nurses (n=04; 25.0%) suggested that the use of a ruler to measure the stoma was associated with the use of the protocol. Conclusion: The elaborated protocol proved to be adequate and useful for nursing care to hospitalized patients, in the evaluation of stomatherapist and care nurses.

Fatores associados a lesões de pele decorrentes do período intraoperatório / Factors associated with skin lesions resulting during the intraoperative period / Factores asociados a lesiones de piel resultantes del período intraoperatorio

Objetivo: Avaliar a ocorrência de lesões de pele no período intraoperatório decorrentes de procedimentos cirúrgicos realizados em um hospital universitário de grande porte. Método: Estudo transversal, descritivo, com abordagem quantitativa, realizado em um hospital universitário do Recife, Pernambuco, Brasil. A amostra foi constituída de 154 pacientes submetidos a cirurgias eletivas entre os meses de janeiro e abril de 2018, avaliados nos períodos pré e pós-operatório, por meio da aplicação da Escala de Avaliação de Risco para o Desenvolvimento de Lesões Decorrentes do Posicionamento Cirúrgico (ELPO), no intraoperatório. A coleta de dados ocorreu na visita pré-operatória e no primeiro dia de pós-operatório. Resultados: Dos 154 pacientes avaliados, sete apresentaram 11 lesões de pele, como lesões por pressão estágio I, estágio II e abrasão, predominantemente no glúteo e no tórax. As variáveis tempo do procedimento cirúrgico, tipo de anestesia e comorbidades foram os principais fatores de associados à ocorrência das lesões. Conclusão: Entre os pacientes que apresentaram lesões de pele devido ao posicionamento cirúrgico, a maioria foi classificada pela ELPO como alto risco, o que leva a crer que se trata de uma escala adequada para avaliação de risco de lesões de pele em pacientes cirúrgicos

Objective: To evaluate the occurrence of skin lesions in the intraoperative period due to surgical procedures performed at a large university hospital. Method: A cross-sectional, descriptive study with a quantitative approach, performed at a university hospital in Recife, Pernambuco, Brazil. The sample consisted of 154 patients undergoing elective surgeries between January and April 2018. They were evaluated in the pre and postoperative periods, through the application of the Risk Assessment Scale for the Development of Injuries due to Surgical Positioning (ELPO), during the intraoperative period. Data were collected at the preoperative visit and on the first postoperative day. Results: Of the 154 patients evaluated, seven presented 11 skin lesions, such as stage I, stage II and abrasion lesions, predominantly in the gluteus and thorax. The variables length of the surgical procedure, type of anesthesia and comorbidities were the main factors associated with the occurrence of lesions. Conclusion: Among patients who presented skin lesions due to surgical positioning, most were classified by the ELPO as high risk, which suggests that this is a suitable scale for assessing the risk of skin lesions in surgical patients.

Objetivo: Evaluar la ocurrencia de lesiones de piel en el período intraoperatorio resultantes de procedimientos quirúrgicos realizados en un hospital universitario de gran porte. Método: Estudio transversal, descriptivo, con abordaje cuantitativo, realizado en un hospital universitario de Recife, Pernambuco, Brasil. La muestra fue constituida de 154 pacientes sometidos a cirugías electivas entre los meses de enero y abril de 2018, valuados en los períodos pre y postoperatorio, por medio de la aplicación de la Escala de Evaluación de Riesgo para el Desarrollo de Lesiones Debidas al Posicionamiento Quirúrgico (ELPO), en el intraoperatorio. La recolección de datos ocurrió en la visita preoperatoria y en el primer día de postoperatorio. Resultados: De los 154 pacientes evaluados, siete presentaron 11 lesiones de piel, como lesiones por presión estadio I, II y abrasión, predominantemente en el glúteo y en el tórax. Las variables tiempo del procedimiento quirúrgico, tipo de anestesia y comorbilidades fueron los principales factores de asociados a la ocurrencia de las lesiones. Conclusión: Entre los pacientes que representaron lesiones de piel debido al posicionamiento quirúrgico, la mayoría fue clasificada por ELPO como alto riesgo, lo que lleva a creer que se trata de una escala adecuada para la evaluación del riesgo de lesiones de piel en pacientes quirúrgicos

Consumo de forragem por ovinos ingerindo grama missioneira gigante com ou sem acesso a amendoim forrageiro / Herbage intake by lambs grazing missioneira gigante grass with or without access to peanut pastures

A grama missioneira gigante (Axonopus catharinensis Valls) é uma espécie forrageira que merece ser melhor investigada tanto pura como recebendo a inclusão de leguminosas. Objetivou-se avaliar o consumo de MS por ovinos pastejando grama missioneira gigante com ou sem acesso a pastos de amendoim forrageiro (Arachis pintoi cv. Amarillo). Para isso, foi conduzido um experimento prévio com cordeiros alojados em gaiolas metabólicas, gerando-se uma equação para a estimativa do consumo tomando como base a excreção fecal de proteína bruta (PBf), que apresentou R2= 0,91. Em um segundo experimento, foi avaliado o consumo de forragem por ovinos em pastos de grama missioneira gigante com duas alturas de entrada (25 ou 35cm), com ou sem acesso a áreas de amendoim forrageiro por duas horas diárias. A altura de entrada na grama missioneira gigante não alterou o consumo total de MS, mas o acesso aos piquetes da leguminosa aumentou o consumo em aproximadamente 20%. Em conclusão, a grama missioneira gigante pode ser manejada com alturas de entrada entre 25 e 35cm, enquanto o acesso a áreas de amendoim forrageiro por duas horas diárias aumenta o consumo de MO por cordeiros pastejando a missioneira.(AU)

The missioneira gigante grass (Axonopus catharinensis Valls) is a grass that deserves to be better investigated both pure and receiving the inclusion of legumes. The objective of this work was to evaluate the herbage intake by sheep grazing missioneira gigante grass with or without access to peanut grass (Arachis pintoi cv. Amarillo). A previous experiment was conducted using lambs housed in metabolic cages, generating an equation for estimation of herbage intake as a function of faecal crude protein excretion (CPf). The equation presented a value of R 2 = 0.91. In the grazing experiment, the herbage intake was evaluated using missioneira gigante pastures with two pre-grazing sward heights (25 or 35cm), with or without access to peanut areas during two hours per day. The pre-grazing sward height of missioneira gigante did not change the total OM herbage intake, but the access to peanut pastures increased the herbage intake by approximately 20%. In conclusion, missioneira gigante grass has shown flexibility to be used with pre-grazing sward heights between 25 and 35cm, while the access to forage peanut pastures during two hours daily increases herbage OM intake by lambs grazing grass.(AU)