Implementation of the nursing process in an intermediate care unit / Implementación del proceso de enfermería en una unidad de cuidados intermedios / Implantação do processo de enfermagem em unidade de cuidados intermediários

Objective: to describe the implementation of the Nursing Process in an intermediate care unit. Method: action research conducted in a public teaching hospital from December 2019 to March 2020 with four training on Nursing Process and Nursing Theories; presentation of nursing process instruments, implementation and follow-up. Changes suggested by the nurses occurred through participant observation and field diary in in loco visits. Results: difficulties in initial filling of instruments were reported, as well as practical inexperience and lack of time and work overload. The benefits mentioned were related to the clear and orderly formatting of the instruments; ease in the application of steps and safety in care practice. Final considerations: the implementation of the Nursing Process in the sector occurred after the identification of the previous knowledge of the nursing team, followed by the survey of the profile of patients, creation of instruments, execution of permanent education of professionals, application and monitoring in the use of the instruments.

Objetivo: describir la implementación del Proceso de Enfermería en una unidad de cuidados intermedios. Método: investigación-acción realizada en un hospital docente público de diciembre de 2019 a marzo de 2020 con cuatro capacitaciones sobre Procesos de Enfermería y Teorías de Enfermería; presentación de instrumentos del proceso de enfermería, implementación y seguimiento. Los cambios sugeridos por las enfermeras ocurrieron a través de la observación participante y el diario de campo en las visitas in loco. Resultados: se reportaron dificultades en el llenado inicial de los instrumentos; inexperiencia práctica; falta de tiempo y sobrecarga de trabajo. Los beneficios mencionados estaban relacionados con el formato claro y ordenado de los instrumentos; facilidad en la aplicación de pasos y seguridad en la práctica asistencial. Consideraciones finales: la implementación del Proceso de Enfermería en el sector ocurrió después de la identificación de los conocimientos previos del equipo de enfermería, seguido de la encuesta del perfil de los pacientes, creación de instrumentos, realización de educación permanente de los profesionales, aplicación y seguimiento en el uso de los instrumentos.

Objetivo: descrever a implantação do Processo de Enfermagem em uma unidade de cuidados intermediários. Método: pesquisa-ação realizada em hospital público de ensino de dezembro de 2019 a março de 2020 contando com quatro capacitações sobre Processo de Enfermagem e Teorias de Enfermagem; apresentação dos instrumentos do Processo de Enfermagem, implantação e acompanhamento. Alterações sugeridas pelos enfermeiros ocorreram mediante observação participante e diário de campo nas visitas in loco. Resultados: relatadas dificuldades no preenchimento inicial dos instrumentos; inexperiência prática; falta de tempo e sobrecarga de trabalho. Os benefícios mencionados foram relacionados à formatação clara e ordenada dos instrumentos; facilidade na aplicação das etapas e segurança na prática assistencial. Considerações finais: a implantação do Processo de Enfermagem no setor ocorreu após a identificação do conhecimento prévio da equipe de Enfermagem, seguida do levantamento do perfil de pacientes, criação dos instrumentos, realização de educação permanente dos profissionais, aplicação e acompanhamento no uso dos instrumentos.

Rare case of sarcomatoid squamous cell carcinoma arising in an ovarian mature teratoma / Caso raro de carcinoma espinocelular sarcomatoide que surge em um teratoma ovariano maduro

Abstract Although mature cystic teratoma (MCT) is benign, malignant transformation (MT) occurs in ~ 1% to 2% of all cases, and usually consists of squamous cell carcinoma (SCC), which accounts for ~ 80% of the cases. Spindle-cell (sarcomatoid) carcinoma (SCSC) is an uncommon type of SCC, comprising up to 3% of all cases. The lack of characteristic symptoms and specific imaging findings may lead to preoperative misdiagnosis. Moreover, the clinicopathologic characteristics, the treatment, the prognostic factors and the mechanism of MT have not yet been well understood due to the rarity of such tumors, especially in women of reproductive age. The authors present a case of a 34- year-old patient with 14 weeks of gestation who was diagnosed with an adnexal mass suggestive of ovarian teratoma. A laparoscopy salpingo-oophorectomy was performed after 6 months of delivery, and the histological exam revealed a sarcomatoid SCC in the MCT.

Resumo Embora o teratoma cístico maduro (MCT) seja benigno, a transformação maligna (MT) ocorre em cerca de 1% a 2% dos casos, e geralmente apresenta-se sob a forma de carcinoma espinocelular (CEC), responsável por cerca de 80% dos casos. O carcinoma (sarcomatoide) de células fusiformes (CSCF) é um tipo incomum de CEC, compreendendo até 3% de todos os casos. A falta de sintomas característicos e achados imagiológicos específicos pode levar a erros diagnósticos pré-operatórios. Além disso, as características clinico-patológicas, o tratamento, os fatores prognósticos e o mecanismo da MT ainda não são bem compreendidos devido à raridade de tais tumores, principalmente em mulheres em idade reprodutiva. Os autores apresentam um caso de uma paciente de 34 anos com 14 semanas de gestação que foi diagnosticada comumamassa anexial sugestiva de teratoma do ovário. A anexectomia laparoscópica foi realizada após 6 meses do parto, e o exame histológico revelou um CEC sarcomatoide tendo como origem um MCT.

HCMV UL97 phosphotransferase gene mutations may be associated with antiviral resistance in immunocompromised patients in Belém, PA, Northern Brazil

Abstract INTRODUCTION: Human cytomegalovirus is one of the causes of opportunist infections in immunocompromised patients, and is triggered by factors such as state of viral latency, weakened immune responses, and development of antiviral resistance to ganciclovir, the only drug offered by the public health system in Brazil to treat the infection. The goal of this study was to identify mutations that may be associated with antiviral resistance in immunocompromised patients. METHODS: Molecular analysis was performed in 82 blood samples and subjected to genomic DNA extraction by a silica-based method. Three sequences of the HCMV UL97 gene, which encodes a phosphotransferase protein required for activation of ganciclovir, were amplified by polymerase chain reaction. Pyrosequencing methods were applied to one external 2096-bp segment DNA and two internal sequences between nucleotides 1087 to 1828 to detect mutations in this gene. RESULTS: Approximately 10% of sequences contained mutations between nucleotides 377 and 594, in conserved regions of the UL97 gene, leading to amino acid changes. Eleven coding mutations were identified, including changes leading to amino acid substitutions, E596K and S604F, which were observed in 100% of samples and are described for the first time in Brazil. In addition, one mutation (A594V) that is associated with ganciclovir resistance was detected in a kidney transplant patient. CONCLUSIONS: Further studies to detect mutations associated with HCMV resistance to antiviral drugs are required to demonstrate the need to increase the variety and availability of drugs used to treat viral infections in the public health care system in Brazil.

Myocarditis associated with Plasmodium vivax malaria: a case report

Malaria remains a major public health problem in Brazil where Plasmodium vivax is the predominant species, responsible for 82% of registered cases in 2013. Though benign, P. vivax infection may sometimes evolve with complications and a fatal outcome. Here, we report a severe case of P. vivax malaria in a 35-year-old Brazilian man from a malaria endemic area, who presented with reversible myocarditis.

Guías Latinoamericanas de la RIICER para el diagnóstico de las rickettsiosis transmitidas por garrapatas / Latinamerican guidelines of RIICER for diagnosis of tick-borne rickettsioses

Tick-borne rickettsioses are worldwide infectious diseases that are considered emerging and re-emerging. Until recently the only tick-borne rickettsiosis present in Latin America was Rickettsia rickettsii infection, but to date, with the incorporation of new tools as PCR and sequencing and the quick cellular close tube cultures (Shell-vial), new species has been involved as human pathogens. In these guidelines, we offer an update of the microbiological assays for diagnosing rickettsioses. Besides we have included a section in which the most important hard ticks involved in human rickettsioses in Latinoamerica are detailed.

Las rickettsiosis transmitidas por garrapatas son afecciones de distribución mundial, que por diferentes motivos se pueden considerar emergentes y reemergentes. Hasta hace escasos años la única rickettsiosis transmitida por garrapatas en Latinoamérica era la infección por Rickettsia rickettsii, pero en la actualidad y fundamentalmente, gracias a la incorporación de nuevas herramientas para el diagnóstico microbiológico como la reacción en cadena de la polimerasa y secuenciación o el cultivo celular rápido en tubo cerrado, se han descrito e involucrado otras especies de Rickettsia en la producción de patología humana. En estas guías se detallan y describen las diferentes técnicas utilizadas para el diagnóstico microbiológico de las rickettsiosis. Además, se incluye una sección en la que se detallan las especies más importantes de garrapatas duras relacionadas con las rickettsiosis en Latinoamérica, con claves para su clasificación taxonómica.

Association between histological findings, aminotransferase levels and viral genotype in chronic hepatitis C infection

Introduction: The genomic heterogeneity of hepatitis C virus (HCV) influences liver disorders. This study aimed to determine the prevalence of HCV genotypes and to investigate the influence of these genotypes on disease progression. Methods: Blood samples and liver biopsies were collected from HCV-seropositive patients for serological analysis, biochemical marker measurements, HCV genotyping and histopathological evaluation. Results: Hepatitis C virus-ribonucleic acid (HCV-RNA) was detected in 107 patients (90.6% with genotype 1 and 9.4% with genotype 3). Patients infected with genotype 1 exhibited higher mean necroinflammatory activity and fibrosis. Conclusions: HCV genotype 1 was the most prevalent and was associated with greater liver dysfunction. .

Colonização por Pseudomonas aeruginosa em pacientes com fibrose cística na região amazônica: efeito na função respiratória / Colonization by Pseudomonas aeruginosa in patients with cystic fibrosis in Amazonregion: effect on respiratory function

Objetivo: descrever as características espirométricas e clínicas dos pacientes com fibrose císticacolonizados por Pseudomonas aeruginosa atendidos no Hospital Universitário João de BarrosBarreto (HUJBB), no estado do Pará, Brasil. Método: estudo retrospectivo nos prontuários de 44pacientes, período de 1997-2007, que atenderam aos critérios de inclusão, sendo 14 colonizadospor P. aeruginosa. Resultados: no grupo colonizado 10 eram do sexo feminino; a idade média dossintomas iniciais foi de 0.3±0.6 anos, com diferença significativa quando comparado com pacientesnão colonizados (p<0.05). A idade média ao diagnóstico foi de 13.1±10.8 nos colonizados, todosapresentando sintomas respiratórios persistentes ao diagnóstico. A média dos valores percentuaispreditos das espirometrias, referentes à avaliação inicial e final, do grupo colonizado foiVEF1(60.0± 25.0%) e (47,82±16.1%) e FEF25-75%(42.5± 22.9%) e (26,5±17.9%) e no grupo nãocolonizado foi VEF1(79.2± 21.0%) e (79,6±18.0%) e FEF25-75%(69.2± 26.7%) e (68,9±26.8%),respectivamente (p<0.005). A média do escore de Shwachman inicial nos colonizados foi de42.9±13.5 e nos não colonizados foi de 68.4±15.1(p<0.0001) e na avaliação final foi de 36.6±18.7 e73.6±12.3 (p<0.0001), respectivamente. Os fatores relacionados aos óbitos foram: colonização porP. aeruginosa, estado nutricional deficiente e VEF1 reduzido. Conclusões: o comprometimento dafunção pulmonar foi maior entre os pacientes com fibrose cística colonizados por P. aeruginosa,apresentando idade média mais elevada ao diagnóstico do que em outros estados brasileiros. Hánecessidade de ações para diagnóstico precoce no estado do Pará, propiciando abordagemterapêutica eficaz com aumento da sobrevida e qualidade de vida destes indivíduos.

Objective: to evaluate spirometric and clinic characteristics of patients who present cystic fibrosisand who are attended at João de Barros Barreto University Hospital (HUJBB), in the State of Pará,Brazil. Methods: a retrospective study was performed with 44 patient records that were attended atHUJBB during the 1997 to 2007; these patients fit into inclusion criteria, in which 14 presented P.aeruginosa bacteria colony. Results: within the group, who was colonized by P. aeruginosa, tenpatients were women and the median age for their initial symptoms was of 0.3 ± 0.6 year which wassignificantly different when compared with patients who didn?t present the bacteria colony (p?0.05). The median age for diagnosis was of 13.1 ± 10.8 in colonized patients and all of thempresented respiratory symptoms pertaining to the diagnosis. The median of the predicted percentagevalues of spirometries for initial and final evaluation of the colonized group was VEF1 (60.0 ±25.0%) and (47,82 ± 16.1%) and FEF 25-75% (42.5 ± 22.9%) and (26.5 ± 17.9%), and in the noncolonizedgroup, the median was VEF1 (79.2 ± 21.0%) and (79,6 ± 18.0%) and FEF 25-75% (69.2± 26.7%) and (68.9 ± 26.8%), respectively (p? 0.005). The median initial Shwachman score in thecolonized patients was 42.9 ± 13.5 and in the non-colonized patients it was 68.4 ± 15.1 (p? 0.0001),and at the final evaluation the median was 36.6 ± 18.7 and 73.6 ± 12.3 (p? 0.0001), respectively.Factors related to deaths found in the study were related to P. aeruginosa colonization, inadequatenutritional status and reduced VEF1. Conclusions: in the studied casuistry, a larger damage torespiratory function in P. aeruginosa colonized group and older median age for diagnosis werefound in the State of Pará when compared to other Brazilian States. There is the need for actiontowards precocious diagnosis in the State of Pará so that an efficient therapeutic approach is put intopractice guiding to survival increase and quality of life for these individuals.

Rickettsiosis en América Latina, el Caribe, España y Portugal / Rickettsioses in Latin America, Caribbean, Spain and Portugal

Data on genus and infectious by Rickettsia were retrospectively compiled from the critical review literature regarding all countries in Latin America, Caribbean islands, Portugal and Spain. We considered all Rickettsia records reported for human and/or animal hosts, and/or invertebrate hosts considered being the vector. In a few cases, when no direct detection of a given Rickettsia group or species was available for a given country, the serologic method was considered. A total of 13 Rickettsia species have been recorded in Latin America and the Caribbean. The species with the largest number of country confirmed records were Rickettsia felis (9 countries), R. prowazekii (7 countries), R. typhi (6 countries), R. rickettsii (6 countries), R. amblyommii (5 countries), and R. parkeri (4 countries). The rickettsial records for the Caribbean islands (West Indies) were grouped in only one geographical area. Both R. bellii, R. akari, and Candidatus ‘R. andeane’ have been recorded in only 2 countries each, whereas R. massiliae, R. rhipicephali, R.monteiroi, and R. africae have each been recorded in a single country (in this case, R. africae has been recorded in nine Caribbean Islands). For El Salvador, Honduras, and Nicaragua, no specific Rickettsia has been reported so far, but there have been serological evidence of human or/and animal infection. The following countries remain without any rickettsial records: Belize, Venezuela, Guyana, Surinam, and Paraguay. In addition, except for a few islands, many Caribbean islands remain without records. A total of 12 Rickettsia species have been reported in Spain and Portugal: R. conorii, R. helvetica, R. monacensis, R. felis, R. slovaca, R. raoultii, R. sibirica, R. aeschlimannii, R. rioja, R. massiliae, R. typhi, and R. prowazekii. Amongst these Rickettsia species reported in Spain and Portugal, only R. prowazekii, R. typhi, R. felis, and R. massiliae have also been reported in Latin America. This study summarizes the current...

Flora arbustivo-arbórea do Parque Estadual do Jaraguá, São Paulo - SP / Floristic composition of tree and shrub species of the Jaraguá State Park, São Paulo - SP, Brazil

O objetivo deste trabalho foi caracterizar a flora arbustivo-arbórea do Parque Estadual do Jaraguá (PEJ), a fim de contribuir para o conhecimento de sua diversidade. Foram feitas coletas mensais de material reprodutivo dos indivíduos arbustivos e arbóreos ao longo de três trilhas, durante um período de 12 meses. O levantamento resultou em uma lista florística contendo 262 espécies nativas, de 153 gêneros e 55 famílias. As famílias mais representativas foram Fabaceae, com 30 espécies, Myrtaceae (26), Asteraceae (24), Melastomataceae (20), Lauraceae (16) e Rubiaceae (15). Assim como relatado para outros remanescentes da região metropolitana de São Paulo e entorno, a vegetação do PEJ está situada em uma zona de transição, onde predomina a floresta ombrófila densa, com a presença de algumas espécies de floresta estacional semidecidual. Destaca-se ainda a existência de uma outra fitofisionomia em uma região de afloramentos de rocha e solo raso, onde ocorrem espécies de cerrado, e que merece estudos específicos. Nessa área, a vegetação é predominantemente herbácea, com árvores e arbustos esparsos, em geral de pequeno porte e com tronco suberoso. Especificamente nessa formação, foram registradas 55 espécies pertencentes a 41 gêneros e 18 famílias, das quais 22 não ocorreram nos outros locais amostrados. A família com maior riqueza foi Asteraceae (15 espécies), seguida por Myrtaceae (7), Fabaceae (5) e Melastomataceae (4). Em todo o levantamento, foram contabilizadas 20 espécies exóticas. Apesar de grande parte da vegetação do Parque ser secundária e estar exposta a fortes pressões antrópicas, foram encontradas 14 espécies presentes em alguma das categorias existentes nas listas oficiais de espécies ameaçadas, reforçando a importância do PEJ para a conservação da biodiversidade.

The objective of this study was to characterize the floristic composition of trees and shrubs of the Jaraguá State Park (PEJ), contributing to the knowledge of its biodiversity. Reproductive botanic material was collected along three trails during a 12-month period. The field survey resulted in a flora of 262 native species, 153 genera and 55 families. Fabaceae was the richest family (30 species), followed by Myrtaceae (26), Asteraceae (24), Melastomataceae (20), Lauraceae (16) and Rubiaceae (15). As mentioned for other forest remnants in São Paulo metropolitan region and surroundings, the PEJ vegetation is in a transition zone, where the main formation is the ombrophilous dense forest, but where species of seasonal semi-deciduous forest also occur. Besides that, there is a completely different phytophysiognomy occurring in a region with rocky outcrops and low depth soils, in which cerrado species were found, and that deserves more specific studies. In this site, the vegetation of grasses is the most abundant, and there are also shrubs and trees sparsely distributed, many of them with low height and suberous trunk. Most specifically in this area there were 55 species of 41 genera and 18 families, from which 22 did not occur in the other sites visited. Asteraceae was the family with the higher number of species (15), followed by Myrtaceae (7), Fabaceae (5) and Melastomataceae (4). Twenty exotic species were found along the trails. Despite the fact that PEJ has a big area of secondary vegetation and that it is exposed to strong anthropogenic pressures, there were 14 species belonging to some threat category defined at the official red lists, reinforcing the importance of the Park for biodiversity conservation.

Riquetsioses no Brasil e Portugal: ocorrência, distribuição e diagnóstico / Rickettsial diseases in Brazil and Portugal: occurrence, distribution and diagnosis

O presente artigo é uma atualização sobre a ocorrência e diagnóstico das riquetsioses existentes no Brasil e Portugal, com o objetivo de incentivar e incrementar a vigilância epidemiológica dessas doenças nos dois países. Realizou-se levantamento bibliográfico e foram apresentados dados não publicados de laboratórios e serviços de epidemiologia. Os resultados descreveram a ocorrência das riquetsioses no Brasil e Portugal, inclusive aquelas recém-descritas, advindas de riquétsias de potencial patogênico ainda incerto. Os métodos diagnósticos atualmente empregados foram discutidos. Como em outros países, as riquetsioses parecem assumir crescente importância em saúde pública. Relegadas a um plano secundário por muitas décadas, o interesse por essas infecções tem aumentado nos dois países, mas ainda carece de investigação para esclarecer seu real significado em saúde pública.