Aplicativos móveis sobre segurança do paciente idoso no ambiente cirúrgico: uma prospecção tecnológica / Mobile applications on the safety of elderly patients in the surgical environment: a technological prospecting

OBJETIVO: Descrever os aplicativos voltados para a segurança do paciente idoso cirúrgico nos períodos pré e pós-operatório. MÉTODO: Prospecção tecnológica com abordagem qualitativa realizada nas lojas virtuais Apple Store, Google Play e aplicativo web. Como estratégia de busca utilizou-se os termos: 'autocuidado idoso', 'pré-operatório', 'pós-operatório', 'segurança do paciente', 'segurança do paciente idoso'. RESULTADOS: Foram identificados 12 aplicativos na loja virtual Apple Store, 17 na Google Play e um web app, os quais estavam voltados a gamificação de profissionais da saúde e da população; aplicativos educacionais aos profissionais de saúde e usuários do sistema de saúde; aplicativos relacionados como ferramenta de trabalho para os profissionais de saúde; aplicativos como ferramenta de autocuidado para usuários do sistema de saúde; e, aplicativos voltados para pós-operatório de usuários do sistema de saúde. CONCLUSÃO: Não foram encontradas tecnologias voltadas para o autocuidado e segurança do paciente idoso nos períodos pré e pós-operatório

OBJECTIVE: To describe applications focused on the safety of elderly surgical patients in the pre- and postoperative periods. METHOD: Technology prospecting with a qualitative approach in the Apple Store, Google Play virtual stores, and web application. As a search strategy, the following terms were used: 'elderly self-care', 'preoperative', 'postoperative', 'patient safety', 'elderly patient safety'. RESULTS: 12 applications were identified in the Apple Store, 17 in Google Play, and a web app, which focused on the gamification of health and population professionals; educational applications to health professionals and health system users; related applications as a work tool for health professionals; applications as a self-care tool for health system users; and, post-operative applications for health system users. CONCLUSION: Technologies aimed at self-care and the safety of elderly patients were not found in the pre- and postoperative periods.

Effects of atelectatic areas on the surrounding lung tissue during mechanical ventilation in an experimental model of acute lung injury induced by lipopolysaccharide / Efeitos das áreas atelectásicas no tecido pulmonar circundante durante a ventilação mecânica em um modelo experimental de lesão pulmonar aguda induzida por lipopolissacarídeo

ABSTRACT Objective: To assess the effect of atelectasis during mechanical ventilation on the periatelectatic and normal lung regions in a model of atelectasis in rats with acute lung injury induced by lipopolysaccharide. Methods: Twenty-four rats were randomized into the following four groups, each with 6 animals: the Saline-Control Group, Lipopolysaccharide Control Group, Saline-Atelectasis Group, and Lipopolysaccharide Atelectasis Group. Acute lung injury was induced by intraperitoneal injection of lipopolysaccharide. After 24 hours, atelectasis was induced by bronchial blocking. The animals underwent mechanical ventilation for two hours with protective parameters, and respiratory mechanics were monitored during this period. Thereafter, histologic analyses of two regions of interest, periatelectatic areas and the normally-aerated lung contralateral to the atelectatic areas, were performed. Results: The lung injury score was significantly higher in the Lipopolysaccharide Control Group (0.41 ± 0.13) than in the Saline Control Group (0.15 ± 0.51), p < 0.05. Periatelectatic regions showed higher lung injury scores than normally-aerated regions in both the Saline-Atelectasis (0.44 ± 0.06 x 0.27 ± 0.74 p < 0.05) and Lipopolysaccharide Atelectasis (0.56 ± 0.09 x 0.35 ± 0.04 p < 0.05) Groups. The lung injury score in the periatelectatic regions was higher in the Lipopolysaccharide Atelectasis Group (0.56 ± 0.09) than in the periatelectatic region of the Saline-Atelectasis Group (0.44 ± 0.06), p < 0.05. Conclusion: Atelectasis may cause injury to the surrounding tissue after a period of mechanical ventilation with protective parameters. Its effect was more significant in previously injured lungs.

RESUMO Objetivo: Avaliar o efeito da atelectasia durante a ventilação mecânica nas regiões periatelectáticas e pulmonares normais em um modelo de atelectasia em ratos com lesão pulmonar aguda induzida por lipopolissacarídeo. Métodos: Foram distribuídos aleatoriamente 24 ratos em quatro grupos, cada um com 6 animais: Grupo Salina-Controle, Grupo Lipopolissacarídeo-Controle, Grupo Salina-Atelectasia e Grupo Lipopolissacarídeo-Atelectasia. A lesão pulmonar aguda foi induzida por injeção intraperitoneal de lipopolissacarídeo. Após 24 horas, a atelectasia foi induzida por bloqueio brônquico. Os animais foram submetidos à ventilação mecânica por 2 horas com parâmetros ventilatórios protetores, e a mecânica respiratória foi monitorada durante esse período. Em seguida, foram realizadas análises histológicas de duas regiões de interesse: as áreas periatelectásicas e o pulmão normalmente aerado contralateral às áreas atelectásicas. Resultados: O escore de lesão pulmonar foi significativamente maior no Grupo Controle-Lipopolissacarídeo (0,41 ± 0,13) do que no Grupo Controle-Solução Salina (0,15 ± 0,51), com p < 0,05. As regiões periatelectásicas apresentaram escores maiores de lesão pulmonar do que as regiões normalmente aeradas nos Grupos Atelectasia-Solução Salina (0,44 ± 0,06 versus 0,27 ± 0,74, p < 0,05) e Atelectasia-Lipopolissacarídeo (0,56 ± 0,09 versus 0,35 ± 0,04, p < 0,05). O escore de lesão pulmonar nas regiões periatelectásicas foi maior no Grupo Atelectasia-Lipopolissacarídeo (0,56 ± 0,09) do que na região periatelectásica do Grupo Atelectasia-Solução Salina (0,44 ± 0,06), p < 0,05. Conclusão: A atelectasia pode causar lesão no tecido circundante após um período de ventilação mecânica com parâmetros ventilatórios protetores. Seu efeito foi mais significativo em pulmões previamente lesionados.

The II Brazilian Guidelines for the pharmacological treatment of patients hospitalized with COVID-19 Joint Guidelines of the Associação Brasileira de Medicina de Emergência, Associação de Medicina Intensiva Brasileira, Associação Médica Brasileira, Sociedade Brasileira de Angiologia e Cirurgia Vascular, Sociedade Brasileira de Infectologia, Sociedade Brasileira de Pneumologia e Tisiologia and Sociedade Brasileira de Reumatologia / II Diretrizes Brasileiras para o tratamento farmacológico de pacientes hospitalizados com COVID-19 Diretriz conjunta da Associação Brasileira de Medicina de Emergência, Associação de Medicina Intensiva Brasileira, Associação Médica Brasileira, Sociedade Brasileira de Angiologia e Cirurgia Vascular, Sociedade Brasileira de Infectologia, Sociedade Brasileira de Pneumologia e Tisiologia e Sociedade Brasileira de Reumatologia

ABSTRACT Objective: To update the recommendations to support decisions regarding the pharmacological treatment of patients hospitalized with COVID-19 in Brazil. Methods: Experts, including representatives of the Ministry of Health and methodologists, created this guideline. The method used for the rapid development of guidelines was based on the adoption and/or adaptation of existing international guidelines (GRADE ADOLOPMENT) and supported by the e-COVID-19 RecMap platform. The quality of the evidence and the preparation of the recommendations followed the GRADE method. Results: Twenty-one recommendations were generated, including strong recommendations for the use of corticosteroids in patients using supplemental oxygen and conditional recommendations for the use of tocilizumab and baricitinib for patients on supplemental oxygen or on noninvasive ventilation and anticoagulants to prevent thromboembolism. Due to suspension of use authorization, it was not possible to make recommendations regarding the use of casirivimab + imdevimab. Strong recommendations against the use of azithromycin in patients without suspected bacterial infection, hydroxychloroquine, convalescent plasma, colchicine, and lopinavir + ritonavir and conditional recommendations against the use of ivermectin and remdesivir were made. Conclusion: New recommendations for the treatment of hospitalized patients with COVID-19 were generated, such as those for tocilizumab and baricitinib. Corticosteroids and prophylaxis for thromboembolism are still recommended, the latter with conditional recommendation. Several drugs were considered ineffective and should not be used to provide the best treatment according to the principles of evidence-based medicine and to promote resource economy.

RESUMO Objetivo: Atualizar as recomendações para embasar as decisões para o tratamento farmacológico de pacientes hospitalizados com COVID-19 no Brasil. Métodos: A elaboração desta diretriz foi feita por especialistas, incluindo representantes do Ministério da Saúde e metodologistas. O método utilizado para o desenvolvimento rápido de diretrizes baseou-se na adoção e/ou adaptação de diretrizes internacionais existentes (GRADE ADOLOPMENT) e contou com o apoio da plataforma e-COVID-19 RecMap. A qualidade das evidências e a elaboração das recomendações seguiram o método GRADE. Resultados: Chegaram-se a 21 recomendações, incluindo recomendações fortes quanto ao uso de corticosteroides em pacientes em uso de oxigênio suplementar e recomendações condicionais para o uso de tocilizumabe e baricitinibe, em pacientes com oxigênio suplementar ou ventilação não invasiva, e de anticoagulantes, para prevenção de tromboembolismo. Devido à suspensão da autorização de uso, não foi possível fazer recomendações para o tratamento com casirivimabe + imdevimabe. Foram feitas recomendações fortes contra o uso de azitromicina em pacientes sem suspeita de infecção bacteriana, hidroxicloroquina, plasma convalescente, colchicina e lopinavir + ritonavir, além de recomendações condicionais contra o uso de ivermectina e rendesivir. Conclusão: Foram criadas novas recomendações para o tratamento de pacientes hospitalizados com COVID-19, como as recomendações de tocilizumabe e baricitinibe. Ainda são recomendados corticosteroides e profilaxia contra tromboembolismo, esta em caráter condicional. Vários medicamentos foram considerados ineficazes e não devem ser usados, no intuito de proporcionar o melhor tratamento segundo os princípios da medicina baseada em evidências e promover a economia de recursos.

Incidental tomographic findings in patients with a Confirmed Diagnosis of COVID-19: An Observational Study / Achados Tomográficos Incidentais em Pacientes com Diagnóstico Confirmado de COVID-19: Estudo Observacional

Objective: Describe incidental tomographic in the sample, correlating them with risk factors for chest diseases and sociodemographic data. Methods: This is a retrospective and observational study covering 162 patients admitted to the COVID sector of the HU/UFJF, from April 1, 2020, to July 7, 2021, with a confirmed laboratory diagnosis of COVID-19. The variables were described in absolute and relative frequencies. The comparison of the correlation between the outcome variable (the tomographic findings) for independent samples was performed using Pearson's chi-square test (without correction) or Fisher's test when relevant. Results: Of the 162 patients, 15.4% had a solitary pulmonary nodule; 14.8% had multiple pulmonary nodules; 1.8%, lung mass; 3.1%, mediastinal mass, and 9.3% had mediastinal adenomegaly. Findings such as excavations, pleural effusion, emphysema, PTE, pneumothorax, chronic interstitial disease, cavitation, aneurysms, and significant atheromatosis, classified in this study in the "Other" category showed impressive results, with an overall prevalence of 81.5%. This study demonstrated that 34% of patients had two or more types of incidental CT findings and that 88.3% of patients had at least some type of incidental CT finding. Conclusion: The pandemic of SARS-CoV-2 infections has brought a series of challenges and lessons learned to healthcare teams around the world. The massive implementation of highly sensitive diagnostic methods, such as chest tomography, ends up bringing an additional challenge, which is to deal with incidental findings, making good clinical reasoning necessary to avoid unnecessary investigations and not leave without diagnosis and treatment of diseases in early and asymptomatic stages (AU)

Objetivo: Descrever os achados incidentais tomográficos na amostra, correlacionando-os com fatores de risco para doenças torácicas e dados sociodemográficos. Método: Trata-se de um estudo retrospectivo e observacional, abrangendo 162 pacientes admitidos no setor COVID do HU/UFJF, no período de 1º de abril de 2020 a 7 de julho de 2021, com diagnóstico laboratorial confirmado de COVID-19. As variáveis em frequências absolutas e relativas foram descritas. A comparação da correlação entre a variável desfecho (os achados tomográficos) para amostras independentes foi realizada por meio do teste qui-quadrado de Pearson (sem correção) ou Fisher quando pertinente. Resultado: Dos 162 pacientes, 15,4% apresentavam nódulo pulmonar solitário; 14,8%, nódulos pulmonares múltiplos; 1,8%, massa pulmonar; 3,1%, massa mediastinal e 9,3%, adenomegalia mediastinal. Achados como escavações, derrame pleural, enfisema, TEP, pneumotórax, intersticiopatia crônica, cavitação, aneurismas e ateromatose significativa, classificados, neste estudo, na categoria "Outros", apresentaram resultados impactantes, com uma prevalência global de 81,5%. Este estudo demonstrou que 34% dos pacientes apresentavam 2 ou mais tipos de achados tomográficos incidentais e que 88,3% dos pacientes apresentavam pelo menos algum tipo de achado tomográfico incidental. Conclusão: A pandemia de infecções pelo SARS-CoV-2 trouxe uma série de desafios e aprendizados para as equipes de saúde em todo o mundo. A realização maciça de métodos diagnósticos de elevada sensibilidade, como a tomográfica de tórax, acaba por trazer um desafio adicional, que é o de lidar com achados incidentais, fazendo-se necessário um bom raciocínio clínico para evitar investigações desnecessárias e não deixar sem diagnóstico e tratamento doenças em fases iniciais e assintomáticas

Grupo de Trabalho em Práticas Corporais e Atividades Físicas na APS da SBAFS: criação, atividades e perspectivas / Working Group on Body Practices and Physical Activities in PHC of BSPAH: creation, activities, and perspectives

A Sociedade Brasileira de Atividade Física e Saúde (SBAFS) exerce papel importante no desenvolvimento e na disseminação do conhecimento científico, além de promover a articulação entre pesquisadores, estudantes, gestores e profissionais dos serviços de saúde nos cenários nacional e internacional. Nos últimos anos, estimulou-se a elaboração e a manutenção de Grupos de Trabalhos (GT) em diferentes temáticas na área de atividade física e saúde. Em 2021, foi instituído o GT em Práticas Corporais e Atividades Físicas na Atenção Primária à Saúde (PCAF-APS), o qual busca desenvolver ações para fortalecer a área temática, por meio da realização de encontros e debates com profissionais, gestores e acadêmicos, além do desenvolvimento de pesquisas. Desse modo, o objetivo deste manuscrito é descrever as ações relacionadas à criação, trajetória e perspectivas do GT PCAF-APS

The Brazilian Society of Physical Activity and Health (BSPAH) is essential in developing and disseminat-ing scientific knowledge and promoting articulation between researchers, students, stakeholders, and health service professionals in national and international scenarios. Developing and maintaining Working Groups ( WG) on different physical activity and health topics has been encouraged in recent years. In 2021, the Body Practices and Physical Activities in Primary Health Care (BPPA-PHC) WG was established, which seeks to develop actions to strengthen the thematic area through meetings and debates with professionals, stakeholders, and academics, in addition to research development. Thus, the paper aims to describe the actions related to the creation, trajectory, and perspectives of the BPPA-PHC

Condições de trabalho, adoecimento e enfrentamento da enfermagem na pandemia de covid-19 em uma capital brasileira / Working conditions, illness and nursing coping in the covid-19 pandemic in a brazilian capital / Condiciones de trabajo, enfermedades y enfermería enfrentando la pandemia del covid-19 en una capital brasileña

Objetivo: Descrever as condições de trabalho, adoecimento e o enfrentamento da enfermagem na pandemia de COVID-19 em uma capital brasileira. Métodos: Trata-se de um estudo descritivo, transversal, com abordagem quantitativa. Os dados foram coletados entre agosto e setembro de 2021, de forma on-line. A análise foi realizada por meio do BioEstat 5.0, com técnicas de estatística descritiva e analítica a partir do teste Qui-quadrado de Pearson e do Exato de Fisher, sendo calculado o Odds Ratio nas variáveis em que houve associação significativa. Resultados: Dos 121 participantes do estudo, 106 eram do sexo feminino e mais de 50% possuíam dois vínculos de trabalho. 102 profissionais referiram receber baixos salários pela complexidade do trabalho desenvolvido e 46 apontaram condições precárias para o exercício profissional. Foi encontrada associação estatística na variável referente às orientações de como inspecionar as máscaras N95/PFF2 ou equivalente (p=0.017; OR=0.31; IC 95%=0.13-0.77) e na variável acerca dos profissionais que já apresentaram sintomas de COVID-19 e/ou tiveram diagnóstico confirmado (p=0.047; OR=0.43; IC 95%=0.20-0.93). Conclusão: O presente estudo aponta a necessidade de melhor organização e condições de trabalho nos serviços de saúde de forma que os profissionais de enfermagem possam prestar uma assistência de qualidade. (AU)

Objective: To describe the working conditions, illness and nursing coping in the COVID-19 pandemic in a Brazilian capital. Methods: This is a descriptive, cross-sectional study with a quantitative approach. Data were collected between August and September 2021, online. The analysis was performed using BioEstat 5.0, with descriptive and analytical statistical techniques from Pearson's chi-square test and Fisher's exact test, with the Odds Ratio being adequate for the variables in which there was a linked association. Results: Of the 121 study participants, 106 were female and more than 50% had two jobs. 102 professionals reported salaries earned due to the complexity of the work performed and 46 indicated precarious conditions for professional practice. A statistical association was found regarding the guidelines on how to inspect with masks N95 / PFF2 or equivalent (p = 0.017; OR = 0.31; 95% CI = 0.13-0.77) and the relative variable of professionals who are already associated students of COVID-19 and/or had a confirmed diagnosis (p = 0.047; OR = 0.43; 95% CI = 0.20-0.93). Conclusion: This study points to the need for better organization and working conditions in health services so that nursing professionals must provide quality care. (AU)

Objetivo: Describir las condiciones de trabajo, enfermedad y afrontamiento de enfermería en la pandemia de COVID-19 en una capital brasileña. Métodos: Se trata de un estudio descriptivo, transversal con enfoque cuantitativo. Los datos se recopilaron entre agosto y septiembre de 2021, en línea. El análisis se realizó mediante BioEstat 5.0, con técnicas estadísticas descriptivas y analíticas de la prueba chi-cuadrado de Pearson y la prueba exacta de Fisher, siendo la Odds Ratio adecuada para las variables en las que existía asociación ligada. Resultados: De los 121 participantes del estudio, 106 eran mujeres y más del 50% tenían dos trabajos. 102 profesionales reportaron sueldos percibidos por la complejidad del trabajo realizado y 46 señalaron condiciones precarias para el ejercicio profesional. Se encontró asociación estadística con respecto a las guías sobre cómo inspeccionar con mascarilla N95 / PFF2 o equivalente (p = 0.017; OR = 0.31; IC 95% = 0.13-0.77) y la variable relativa de profesionales que ya son estudiantes asociados de COVID- 19 y / o tenían un diagnóstico confirmado (p = 0,047; OR = 0,43; IC 95% = 0,20-0,93). Conclusión: Este estudio apunta a la necesidad de una mejor organización y condiciones de trabajo en los servicios de salud para que los profesionales de enfermería deban brindar una atención de calidad. (AU)

Effect of entomopathogenic fungi on the control of the coffee berry borer in the laboratory

Among the management and control tactics of the coffee berry borer Hypothenemus hampei (Ferrari), there is the use of entomopathogenic fungi. Due to the importance of prospecting isolates of entomopathogenic fungi for the control of the coffee berry borer, the objective of this study was to evaluate the efficiency of 26 isolates of entomopathogenic fungi in the control of this insect pest in the laboratory. The coffee berry borers were immersed in a solution adjusted to the concentration of 1 to 3 × 108 conidia/mL of each isolate and the control treatment (sterilized water). After seven days total mortality and confirmed mortality were evaluated. The isolates that caused the highest mortality and two commercial isolates were selected for evaluation of lethal concentration (LC50 and LC90) and lethal time (LT50 and LT90). Coffee berry borers were treated at different conidia concentrations for lethal concentration to assess total and confirmed mortality. For a lethal time, the coffee berry borers were treated at the concentration of 108 conidia/mL of the selected isolates, and, after two days and every 24 hours until the eighth day, the number of dead individuals was verified. Among the 26 isolates evaluated, 24 presented mortality higher than the control treatment, and three presented mortality higher than 85%. In the LC50 and LC90 assays, the IBCB 353 and IBCB 364 isolates were more lethal to H. hampei. In the LT50 and LT90 assays, the IBCB 66 and IBCB 353 isolates caused lethality in a shorter time.

Use of elexacaftor+tezacaftor+ivacaftor in individuals with cystic fibrosis and at least one F508del allele: a systematic review and meta-analysis / Uso de elexacaftor + tezacaftor + ivacaftor em indivíduos com fibrose cística com pelo menos um alelo F508del: revisão sistemática e meta-análise

ABSTRACT Objective: To evaluate the effect of treatment with the combination of three cystic fibrosis transmembrane conductance regulator (CFTR) modulators-elexacaftor+tezacaftor+ivacaftor (ETI)-on important clinical endpoints in individuals with cystic fibrosis. Methods: This was a systematic review and meta-analysis of randomized clinical trials that compared the use of ETI in individuals with CF and at least one F508del allele with that of placebo or with an active comparator such as other combinations of CFTR modulators, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and the Patients of interest, Intervention to be studied, Comparison of interventions, and Outcome of interest (PICO) methodology. We searched the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from their inception to December 26th, 2022. The risk of bias was assessed using the Cochrane risk-of-bias tool, and the quality of evidence was based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: We retrieved 54 studies in the primary search. Of these, 6 met the inclusion criteria and were analyzed (1,127 patients; 577 and 550 in the intervention and control groups, respectively). The meta-analysis revealed that the use of ETI increased FEV1% [risk difference (RD), +10.47%; 95% CI, 6.88-14.06], reduced the number of acute pulmonary exacerbations (RD, −0.16; 95% CI, −0.28 to −0.04), and improved quality of life (RD, +14.93; 95% CI, 9.98-19.89) and BMI (RD, +1.07 kg/m2; 95% CI, 0.90-1.25). Adverse events did not differ between groups (RD, −0.03; 95% CI, −0.08 to 0.01), and none of the studies reported deaths. Conclusions: Our findings demonstrate that ETI treatment substantially improves clinically significant, patient-centered outcomes.

RESUMO Objetivo: Avaliar o efeito do tratamento com a combinação de três moduladores da proteína cystic fibrosis transmembrane conductance regulator (CFTR, reguladora de condutância transmembrana em fibrose cística) - elexacaftor + tezacaftor + ivacaftor (ETI) - sobre desfechos clínicos importantes em indivíduos com fibrose cística. Métodos: Revisão sistemática e meta-análise de ensaios clínicos randomizados que compararam o uso de ETI em indivíduos com fibrose cística com pelo menos um alelo F508del com o uso de placebo ou de um comparador ativo como outras combinações de moduladores da CFTR. O estudo foi realizado seguindo as recomendações Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) e a metodologia Patients of interest, Intervention to be studied, Comparison of interventions, and Outcome of interest (PICO). Foram realizadas buscas nos seguintes bancos de dados: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials e ClinicalTrials.gov, desde a sua criação até 26 de dezembro de 2022. O risco de viés foi avaliado por meio da ferramenta de risco de viés da Cochrane, e a qualidade das evidências foi determinada com base no sistema Grading of Recommendations Assessment, Development and Evaluation (GRADE). Resultados: Foram identificados 54 estudos na busca primária. Destes, 6 preencheram os critérios de inclusão e foram analisados (1.127 pacientes: 577 pacientes intervenção e 550 pacientes controle). A meta-análise revelou que o uso de ETI aumentou o VEF1 em porcentagem do previsto [diferença de risco (DR): +10,47%; IC95%: 6,88-14,06], reduziu o número de exacerbações pulmonares agudas (DR: −0,16; IC95%: −0,28 a −0,04) e melhorou a qualidade de vida (DR: +14,93; IC95%: 9,98-19,89) e o IMC (DR: +1,07 kg/m2; IC95%: 0,90-1,25). Os eventos adversos não diferiram entre os grupos (DR: −0,03; IC95%: −0,08 a 0,01), e nenhum dos estudos relatou óbitos. Conclusões: Nossos achados demonstram que o tratamento com ETI melhora substancialmente os desfechos clinicamente significativos centrados no paciente.

Emotional, hyperactivity and inattention problems in adolescents with immunocompromising chronic diseases during the COVID-19 pandemic

Abstract Objective: To assess factors associated with emotional changes and Hyperactivity/Inattention (HI) motivated by COVID-19 quarantine in adolescents with immunocompromising diseases. Methods: A cross-sectional study included 343 adolescents with immunocompromising diseases and 108 healthy adolescents. Online questionnaires were answered including socio-demographic data and self-rated healthcare routine during COVID-19 quarantine and validated surveys: Strengths and Difficulties Questionnaire (SDQ), Pittsburgh Sleep Quality Index (PSQI), Pediatric Quality of Life Inventory 4.0 (PedsQL4.0). Results: The frequencies of abnormal emotional SDQ scores from adolescents with chronic diseases were similar to those of healthy subjects (110/343 [32%] vs. 38/108 [35%], p = 0.548), as well as abnormal hyperactivity/inattention SDQ scores (79/343 [23%] vs. 29/108 [27%], p = 0.417). Logistic regression analysis of independent variables associated with abnormal emotional scores from adolescents with chronic diseases showed: female sex (Odds Ratio [OR = 3.76]; 95% Confidence Interval (95% CI) 2.00-7.05; p < 0.001), poor sleep quality (OR = 2.05; 95% CI 1.08-3.88; p = 0.028) and intrafamilial violence during pandemic (OR = 2.17; 95% CI 1.12-4.19; p = 0.021) as independently associated with abnormal emotional scores, whereas total PedsQL score was inversely associated with abnormal emotional scores (OR = 0.95; 95% CI 0.93-0.96; p < 0.0001). Logistic regression analysis associated with abnormal HI scores from patients evidenced that total PedsQL score (OR = 0.97; 95% CI 0.95-0.99; p = 0.010], changes in medical appointments during the pandemic (OR = 0.39; 95% CI 0.19-0.79; p = 0.021), and reliable COVID-19 information (OR = 0.35; 95% CI 0.16-0.77; p = 0.026) remained inversely associated with abnormal HI scores. Conclusion: The present study showed emotional and HI disturbances in adolescents with chronic immunosuppressive diseases during the COVID-19 pandemic. It reinforces the need to promptly implement a longitudinal program to protect the mental health of adolescents with and without chronic illnesses during future pandemics.

Prediction of intensive care admission and hospital mortality in COVID-19 patients using demographics and baseline laboratory data

Abstract Introduction: Optimized allocation of medical resources to patients with COVID-19 has been a critical concern since the onset of the pandemic. Methods: In this retrospective cohort study, the authors used data from a Brazilian tertiary university hospital to explore predictors of Intensive Care Unit (ICU) admission and hospital mortality in patients admitted for COVID-19. Our primary aim was to create and validate prediction scores for use in hospitals and emergency departments to aid clinical decisions and resource allocation. Results: The study cohort included 3,022 participants, of whom 2,485 were admitted to the ICU; 1968 survived, and 1054 died in the hospital. From the complete cohort, 1,496 patients were randomly assigned to the derivation sample and 1,526 to the validation sample. The final scores included age, comorbidities, and baseline laboratory data. The areas under the receiver operating characteristic curves were very similar for the derivation and validation samples. Scores for ICU admission had a 75% accuracy in the validation sample, whereas scores for death had a 77% accuracy in the validation sample. The authors found that including baseline flu-like symptoms in the scores added no significant benefit to their accuracy. Furthermore, our scores were more accurate than the previously published NEWS-2 and 4C Mortality Scores. Discussion and conclusions: The authors developed and validated prognostic scores that use readily available clinical and laboratory information to predict ICU admission and mortality in COVID-19. These scores can become valuable tools to support clinical decisions and improve the allocation of limited health resources.

Aging-related predictive factors for oxygenation improvement and mortality in COVID-19 and acute respiratory distress syndrome (ARDS) patients exposed to prone position: A multicenter cohort study

Abstract Background: Elderly patients are more susceptible to Coronavirus Disease-2019 (COVID-19) and are more likely to develop it in severe forms, (e.g., Acute Respiratory Distress Syndrome [ARDS]). Prone positioning is a treatment strategy for severe ARDS; however, its response in the elderly population remains poorly understood. The main objective was to evaluate the predictive response and mortality of elderly patients exposed to prone positioning due to ARDS-COVID-19. Methods: This retrospective multicenter cohort study involved 223 patients aged ≥ 65 years, who received prone position sessions for severe ARDS due to COVID-19, using invasive mechanical ventilation. The PaO2/FiO2 ratio was used to assess the oxygenation response. The 20-point improvement in PaO2/FiO2 after the first prone session was considered for good response. Data were collected from electronic medical records, including demographic data, laboratory/image exams, complications, comorbidities, SAPS III and SOFA scores, use of anticoagulants and vasopressors, ventilator settings, and respiratory system mechanics. Mortality was defined as deaths that occurred until hospital discharge. Results: Most patients were male, with arterial hypertension and diabetes mellitus as the most prevalent comorbidities. The non-responders group had higher SAPS III and SOFA scores, and a higher incidence of complications. There was no difference in mortality rate. A lower SAPS III score was a predictor of oxygenation response, and the male sex was a risk predictor of mortality. Conclusion: The present study suggests the oxygenation response to prone positioning in elderly patients with severe COVID-19-ARDS correlates with the SAPS III score. Furthermore, the male sex is a risk predictor of mortality.

Brazilian guidelines for the pharmacological treatment of the pulmonary symptoms of cystic fibrosis. Official document of the Sociedade Brasileira de Pneumologia e Tisiologia (SBPT, Brazilian Thoracic Association) / Diretrizes brasileiras para o tratamento farmacológico pulmonar na fibrose cística. Documento oficial da Sociedade Brasileira de Pneumologia e Tisiologia

ABSTRACT Cystic fibrosis (CF) is a genetic disease that results in dysfunction of the CF transmembrane conductance regulator (CFTR) protein, which is a chloride and bicarbonate channel expressed in the apical portion of epithelial cells of various organs. Dysfunction of that protein results in diverse clinical manifestations, primarily involving the respiratory and gastrointestinal systems, impairing quality of life and reducing life expectancy. Although CF is still an incurable pathology, the therapeutic and prognostic perspectives are now totally different and much more favorable. The purpose of these guidelines is to define evidence-based recommendations regarding the use of pharmacological agents in the treatment of the pulmonary symptoms of CF in Brazil. Questions in the Patients of interest, Intervention to be studied, Comparison of interventions, and Outcome of interest (PICO) format were employed to address aspects related to the use of modulators of this protein (ivacaftor, lumacaftor+ivacaftor, and tezacaftor+ivacaftor), use of dornase alfa, eradication therapy and chronic suppression of Pseudomonas aeruginosa, and eradication of methicillin-resistant Staphylococcus aureus and Burkholderia cepacia complex. To formulate the PICO questions, a group of Brazilian specialists was assembled and a systematic review was carried out on the themes, with meta-analysis when applicable. The results obtained were analyzed in terms of the strength of the evidence compiled, the recommendations being devised by employing the GRADE approach. We believe that these guidelines represent a major advance to be incorporated into the approach to patients with CF, mainly aiming to favor the management of the disease, and could become an auxiliary tool in the definition of public policies related to CF.

RESUMO A fibrose cística (FC) é uma doença genética que resulta em disfunção da proteína reguladora de condutância transmembrana da FC (CFTR), que é um canal de cloro e bicarbonato expresso na porção apical de células epiteliais de diversos órgãos. A disfunção dessa proteína resulta em manifestações clínicas diversas, envolvendo primariamente os sistemas respiratório e gastrointestinal com redução da qualidade e expectativa de vida. A FC ainda é uma patologia incurável, porém o horizonte terapêutico e prognóstico é hoje totalmente distinto e muito mais favorável. O objetivo destas diretrizes foi definir recomendações brasileiras baseadas em evidências em relação ao emprego de agentes farmacológicos no tratamento pulmonar da FC. As perguntas PICO (acrônimo baseado em perguntas referentes aos Pacientes de interesse, Intervenção a ser estudada, Comparação da intervenção e Outcome [desfecho] de interesse) abordaram aspectos relativos ao uso de moduladores de CFTR (ivacaftor, lumacaftor + ivacaftor e tezacaftor + ivacaftor), uso de dornase alfa, terapia de erradicação e supressão crônica de Pseudomonas aeruginosa, e erradicação de Staphylococcus aureus resistente a meticilina e do complexo Burkholderia cepacia. Para a formulação das perguntas, um grupo de especialistas brasileiros foi reunido e realizou-se uma revisão sistemática sobre os temas, com meta-análise quando aplicável. Os resultados encontrados foram analisados quanto à força das evidências compiladas, sendo concebidas recomendações seguindo a metodologia GRADE. Os autores acreditam que o presente documento represente um importante avanço a ser incorporado na abordagem de pacientes com FC, objetivando principalmente favorecer seu manejo, podendo se tornar uma ferramenta auxiliar na definição de políticas públicas relacionadas à FC.