Is it possible to get COVID infection 3 times? Case report

Rare cases of suspected COVID-19 reactivation have been reported. Reactivation is defined by two positive real-time RT-PCR results for the SARS-CoV-2 virus, with an interval equal to or greater than 90 days between two episodes of COVID-19. A nurse, started with COVID-19 symptoms in July 2020 and a RT-PCR SARS-CoV-2 confirmed the diagnosis. In November 2020, more than 4 months later, she developed a new episode of COVID-19 confirmed by a second RT-PCR SARS-CoV-2. The patient received a first dose of CoronaVac ­ (Sinovac/Butantan) in January 2021 and a second dose in February 2021, but 30 days after a third episode was confirmed. Contrary to what happens with many infectious diseases which generate antibodies and protect people from future episodes, this aspect is still not clear in relation to COVID-19. In addition to vaccination, the use of Personal Protective Equipment is essential for healthcare workers.

Prevalência de dor lombar e fatores de risco em trabalhadores de uma lavanderia hospitalar: um estudo transversal / Prevalence of low back pain and risk factors in hospital laundry workers: a cross-sectional study

Introdução: A dor lombar representa um problema de saúde pública na população em idade economicamente ativa em todo o mundo, incluindo trabalhadores de lavanderia hospitalar. Neste artigo é avaliada a prevalência de dor lombar em trabalhadores de lavanderia do Hospital de Clínicas de Porto Alegre e sua associação com dados sociodemográficos, clínicos, ocupacionais e prática de exercícios físicos. Métodos: Foi realizado um estudo transversal do qual participaram 99 funcionários da lavanderia do Hospital. Foi utilizado instrumento de pesquisa composto por um questionário com questões sociodemográficas, clínicas e ocupacionais dos trabalhadores. Os dados obtidos foram processados pelo Teste Qui-Quadrado de Pearson e pela regressão de Poisson com variâncias robustas. Resultados: A prevalência de dor lombar encontrada foi de 68,69% (IC 95% 59,4%;78,0%). Entre os participantes, 12,1% relataram afastamento do trabalho pela Previdência Social devido a dor lombar. Na análise multivariada, ser trabalhador do setor costura foi associado a maior risco de apresentar dor lombar, enquanto que ter duplo emprego e tempo de serviço na função não estiveram significativamente associados. Conclusões: A dor lombar foi uma queixa prevalente em trabalhadores da lavanderia hospitalar, especialmente no setor costura. Ter duplo emprego ou maior tempo de trabalho na função não se mostraram fatores associados à prevalência de dor lombar na população estudada. Sugere-se a adoção de estratégias de prevenção e controle da dor lombar e a realização de mais estudos no tema, a fim de aprofundar os fatores associados e estabelecer medidas preventivas eficazes. (AU)

Introduction: Low back pain represents a public health problem in the working-age population worldwide, including hospital laundry workers. This article evaluates the prevalence of low back pain in laundry workers at the Hospital de Clínicas de Porto Alegre and its association with sociodemographic, clinical, and occupational data and physical exercises. Methods: We conducted a cross-sectional study of 99 laundry workers at the Hospital. We applied a research instrument consisting of a questionnaire with sociodemographic, clinical, and occupational questions. We used Pearson's chi-square test and Poisson regression with robust variance for data analysis. Results: The prevalence of low back pain was 68.69% (95% confidence interval, 59.4%- 78.0%). Among the participants, 12.1% reported previous sick leave due to low back pain. In the multivariate analysis, being a sewing worker was associated with a higher risk of developing low back pain, whereas keeping two jobs and length of service were not significantly associated with low back pain. Conclusions: Low back pain was a prevalent complaint among hospital laundry workers, especially in the sewing sector. Keeping two jobs and longer length of service were not associated with low back pain prevalence in the study population. We suggest that strategies to prevent and control low back pain should be adopted and that further studies on the topic should be conducted to better understand the associated factors and to establish effective preventive measures. (AU)

Caracterização dos trabalhadores da enfermagem afastados por distúrbios osteomusculares em hospital universitário / Caracterización de trabajadores de enfermería en licencia por trastornos musculoesqueléticos en un hospital universitário / Characterization of nurse staffing who are away from work due musculoskeletal disorders in a university hospital

Objetivo: descrever características sociodemográficas e ocupacionais de trabalhadores da equipe de enfermagem afastados por distúrbios osteomusculares em hospital universitário e sua associação com o tempo de afastamento. Método: estudo quantitativo retrospectivo, transversal e analítico. Os dados foram coletados nos prontuários de trabalhadores afastados no período de 2012 a 2017, e analisados por meio da estatística descritiva e analítica. Resultados: de 2.761 afastamentos registrados, 449 se referiam a distúrbios osteomusculares (16,26%), o maior percentual por dorsalgia (41,5%) e 78 trabalhadores apresentaram diagnóstico psiquiátrico, principalmente depressão (43,4%). Identificou-se no grupo com maior tempo de afastamento (> de 15 dias) o predomínio da categoria de auxiliares e técnicos de enfermagem (p=0,006), trabalhadores com menor mediana de idade (p=0,021) e de maior escolaridade (p=0,035). Conclusão: o elevado número de afastamentos por distúrbios osteomusculares, por vezes associado a outras comorbidades, exige acompanhamento e medidas preventivas nos locais de trabalho.

Aim: to describe the sociodemographic and occupational characteristics of nurse staffing from an university hospital who are away from work due to musculoskeletal cumulative disorders and the association with absenteeism. Method: retrospective and cross-sectional study. Were analysed medical records from 2012 to 2017, and analyzed using descriptive and analytical statistics. Results: Out of 2,761 recorded absences from nurse staffing, 449 referred to musculoskeletal disorders (16.26%), the highest percentage due to back pain (41.5%) and 78 workers had psychiatric diagnosis, especially depression (43.4%). It was identified in the group with longer time of absence (> 15 days) the predominance of the category of nursing assistants and technicians (p = 0.006), with lower median age (p = 0.021) and higher education (p = 0.035). Conclusion: The elevated number of absence due to musculoskeletal disorders, sometimes associated with other comorbidities, requires follow-up and prevention in the workplace.

Objetivo: Describir las características sociodemográficas y ocupacionales de los trabajadores del personal de enfermería en licencia debido a trastornos musculoesqueléticos en un hospital universitario y su asociación con el tiempo de ausencia. Método: estudio retrospectivo, transversal y analítico. Se analizaron los registros médicos de los trabajadores con licencia de 2012 a 2017, utilizando estadísticas descriptivas y analíticas. Resultados: De 2,761 ausencias registradas, 449 fueron trastornos musculoesqueléticos (16.26%), debido a dolor de espalda (41.5%) y 78 trabajadores tuvieron diagnóstico psiquiátrico, especialmente depresión (43.4%). Se identificó en el grupo con mayor tiempo de ausencia (> 15 días) el predominio de la categoría de auxiliares y técnicos de enfermería (p = 0.006), trabajadores con menor edad media (p = 0.021) y educación superior (p = 0,035). Conclusión: El alto número de ausencia por enfermedad debido a trastornos musculoesqueléticos, a veces asociados con otras comorbilidades, requiere seguimiento y prevención en el entorno laboral.

Contribution of ultra-processed food to the daily food intake of hiv-positive and hiv-negative women during pregnancy / Contribuição dos alimentos ultraprocessados no consumo alimentar diário de mulheres soropositivas e soronegativas para o HIV durante a gestação

Abstract Objective To assess the daily dietary intake and energy contribution of ultraprocessed foods among women who are positive and negative for the human immunodeficiency virus (HIV) during pregnancy. Methods This case-control study included 77 HIV-positive and 79 HIV-negative puerperal women between 2015 and 2016. The socioeconomic and maternal demographic data were assessed, and a food frequency questionnaire (FFQ) adapted for pregnant women was applied. The Fisher exact test and the Mann-Whitney test were applied to detect differences between the groups. Linear regression was used to assess the associations between the intake of ultra-processed food and energy, macro- and micronutrients, with values of p < 0.05 considered significant. Results The HIV-positive group was older (p< 0.001) and had lower income (p= 0.016) and level of schooling (p< 0.001) than the HIV-negative group. Both groups presented similar average food intake: 4,082.99 Kcal/day and 4,369.24 Kcal/day for the HIV-positive and HIV-negative women respectively (p= 0.258).The HIV-positive group consumed less protein (p= 0.048), carbohydrates (p= 0.028) and calcium(p= 0.001), andmore total fats (p= 0.003). Ultra-processed foods accounted for 39.80% and 40.10% of the HIV-positive and HIV-negative groups' caloric intake respectively (p= 0.893). The intake of these foods was associated with a higher consumption of carbohydrates (p < 0.001), trans fat (p= 0.013) and sodium (p< 0.001), as well as lower protein (p < 0.001) and fiber intake (p= 0.022). Conclusion These findings demonstrate that the energy consumption and ultraprocessed food intake were similar in both groups, which reinforces the trend toward a high intake of ultra-processed food in the general population. The intake of ultraprocessed food was positively associated with the consumption of carbohydrates, trans fat and sodium, and negatively associated with the consumption of protein and fiber.

Resumo Objetivo Avaliar o consumo alimentar diário e a contribuição dos alimentos ultraprocessados na dieta de gestantes soropositivas e soronegativas para o vírus da imunodeficiência humana (HIV). Métodos Estudo de caso-controle com 77 puérperas soropositivas e 79 soronegativas entre 2015 e 2016. Analisaram-se dados socioeconômicos e demográficos maternos, e aplicou-se um questionário de frequência alimentar (QFA) adaptado para gestantes. Utilizou-se o teste exato de Fisher e o teste de Mann-Whitney para detectar diferenças entre os grupos. A regressão linear avaliou a associação entre o consumo de ultraprocessados e de energia, macro e micronutrientes. Valores de p < 0,05 foram considerados significativos. Resultados O grupo de puérperas soropositivas foi mais velho (p < 0,001), com menor renda familiar (p = 0,016) e escolaridade (p < 0,001) quando comparado com o grupo das soronegativas. Ambos os grupos apresentaram médias de consumo semelhantes, com 4.082,99 Kcal/dia entre as puérperas soropositivas e 4.369,24 kcal/dia entre as soronegativas (p = 0,258). Observou-se que as puérperas soropositivas consumiam menos proteínas (p = 0,048), carboidratos (p = 0,028) e cálcio (p = 0,001), e mais gorduras totais (p = 0,003). Os ultraprocessados corresponderam a 39,80% das calorias entre as soropositivas, e a 40,10% entre as soronegativas (p = 0,893). O consumo destes alimentos esteve associado a um maior consumo de carboidratos (p < 0,001), gordura trans (p = 0,013) e sódio (p < 0,001), e a um menor consumo de proteínas (p < 0,001) e fibras (p = 0,022). Conclusão Esses achados demonstram que o consumo de energia e de alimentos ultraprocessados foram semelhantes nos dois grupos, o que reforça a tendência ao consumo elevado de alimentos ultraprocessados na população geral. O consumo de alimentos ultraprocessados foi positivamente associado ao consumo de carboidratos, gorduras trans e sódio, e negativamente associado ao consumo de proteínas e fibras.

Efetividade de um programa de prevenção e capacitação para redução de acidentes ocupacionais por material biológico / Effectiveness of a prevention and training program to reduce work accidents involving exposure to biological materials

Introdução: Os acidentes de trabalho com material biológico (ATMB) vêm aumentando significativamente no decorrer dos anos e suas consequências de maior importância epidemiológica são as transmissões de patógenos como os vírus da imunodeficiência humana e das hepatites B e C. Objetivo: Avaliar a efetividade de um programa de prevenção e capacitação para redução de acidentes ocupacionais por material biológico em hospital-escola a partir da incidência dos ATMB durante os oito anos de implementação do programa. Métodos: O presente estudo foi realizado de forma descritiva, retrospectiva, por coleta no banco de dados do Serviço de Tecnologia em Recursos Humanos de um hospital-escola. A população do estudo foi composta por 1.445 funcionários do hospital-escola que sofreram acidente ocupacional de exposição com material biológico do tipo perfurante ou cortante. Resultados: De um total de 1.445 acidentes de trabalho com instrumentos perfurantes ou cortantes, 47,5% foram por descarte inadequado de materiais potencialmente contaminados. Foi observada uma taxa de queda anual de 0,21% nos acidentes percutâneos e de 0,36% nos acidentes percutâneos por descarte inadequado. Conclusão: Os achados deste estudo indicam que o programa desenvolvido e implementado resultou na diminuição significativa dos acidentes ocupacionais por material biológico do tipo perfurocortante.

Background: The frequency of work accidents involving exposure to biological materials (WAEMB) is significantly increasing. The most relevant epidemiological consequences of this type of accidents are due to the transmission of pathogens including the human immunodeficiency and hepatitis B and C viruses. Objective: To assess the effectiveness of a prevention and training program to reduce the incidence of WAEMB at a teaching hospital along 8 years of implementation. Methods: Retrospective descriptive study based on data obtained from the hospital Human Resource Technology Department. We analyzed records of 1,445 hospital employees who suffered sharps injuries. Results: About 50% of the incidents were caused by inadequate sharps disposal. The overall rate of sharps injuries decreased by 0.21%/year and that of accidents due to inadequate sharps disposal by 0.36%. Conclusion: The results of the present study indicate that the implemented program was associated with significant reduction of the incidence of WAEMB.

Effect of depressive symptoms and HIV exposure on the quality of life of HIV-seropositive and seronegative pregnant women

Introduction: Depression among human immunodeficiency virus (HIV)-seropositive individuals has been associated with reduced quality of life. The aim of the study was to evaluate the effect of depressive symptoms and HIV exposure on mean quality of life scores in HIV-seropositive and HIV-seronegative postpartum women. Methods: A cross-sectional study was conducted with two groups: 80 HIV-seropositive and 80 HIV-seronegative postpartum women. The Edinburgh Postnatal Depression Scale and the World Health Organization Quality of Life short-version scale were used to assess presence of depressive symptoms and quality of life scores. Two-way analysis of variance was used to compare the effects of depressive symptoms, HIV exposure and interaction between depressive symptoms and HIV exposure on mean quality of life scores, with p < 0.05 considered statistically significant. Results: Depressive symptoms were present in 35% (28) of HIV-seropositive and 17.5% (14) of HIV-seronegative participants (p = 0.02). The interaction between depressive symptoms and HIV exposure was not significant for any quality of life domain. The main effect of HIV exposure was also not significant. Depressive symptoms had a negative influence on quality of life scores in all domains (physical health, psychological health, social relationships and environment) (p < 0.001). Conclusions: The quality of life of pregnant women is negatively influenced by the presence of depressive symptoms. (AU)

Analysis of the presence of organic matter (ATP) in mobile devices of healthcare workers in hospitals

We report the result of an awareness campaign about the importance of hand hygiene after using different devices used in assistance to patients, such as tablets, notebooks, mobile phones, identification cards, watches, cameras, showing the level of contamination found after detection of adenosine triphosphate (ATP) via bioluminescence, which enables a quantitative assessment ready and easy to implement. ATP molecules found in all living cells react with the enzyme complex to generate light and represent the presence of organic matter in such objects(AU)

Factors that affect mother-to-child HIV transmission at a university hospital in southern Brazil

Introduction: The prevention strategies for MTCT of HIV proposed by the World Health Organization (WHO) and other agencies have significantly reduced the number of infected children, child morbidity and mortality associated with HIV, and have improved maternal health. However, the detection rate of pregnant women with HIV in Brazil significantly increased in the last decade10. Objective: To evaluate factors that may interfere in mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV). Methods: A historical cohort study with a sample of 299 HIV-infected mothers and their newborns who delivered at the Obstetric Center of the Hospital de Clínicas de Porto Alegre, southern Brazil, from January 2010 to December 2014. Results: Of the 299 newborns of HIV-infected mothers, 3.7% (n = 11) were infected. Of those, 90.9% (n = 10) were born by cesarean section; 90.9% (n = 10) had ≥ 37 weeks; 54.6% (n = 6) received zidovudine starting within the first 4 hours after birth; and 45.4% (n = 5) received zidovudine and nevirapine. Four women whose newborns were infected with HIV had syphilis during pregnancy (36.4%). Poor adherence to highly active antiretroviral therapy (HAART) (p < 0.003), viral load ≥ 1000 copies/mL or ignored in the third trimester (p < 0.000), and CD4 count < 500 cells/mm3 in the third trimester (p < 0.046) were significantly associated with an increased risk of MTCT. Conclusions: Lack of control of risk factors may contribute to unfavorable rates of MTCT of HIV (AU)

Needlestick accident resulting in occupational transmission of HCV: report of two cases

Occupational transmission of hepatitis C virus (HCV) through needlestick injury is a serious problem worldwide. Occupational transmission of HCV is estimated at an average rate between 0.5% and 0.75%. There are factors associated with increased risk of transmission, such as deep injuries, procedures involving hollow-bore needle placement in the source patient’s vein or artery, and high HCV RNA titer in the source patient. We describe two cases of HCV seroconversion in nursing assistants after different risk needlestick injuries...

A citologia na prevenção do câncer anal / The cytology in anal cancer prevention

O câncer anal não tem sido considerado problema de saúde pública. No entanto, sua incidência vem aumentando em pessoas que praticam sexo anal receptivo, promíscuos e portadores de doenças sexualmente transmissíveis, principalmente HPV (papilomavírus humanos) e HIV (vírus da imunodeficiência humana). Nos últimos anos, em vários países, a incidência do câncer anal aumentou 1,5 vezes entre os homens e triplicou nas mulheres. Embora a literatura não reforce o rastreamento de rotina das lesões intraepiteliais anais nas populações de risco, seu uso racional baseia-se no sucesso obtido com o rastreamento por meio da citologia cervical na redução da incidência do câncer cervical. Neste artigo revisamos os métodos diagnósticos disponíveis e as possibilidades de tratamentos das lesões precursoras anais a fim de prevenir a evolução para o câncer anal. Os aspectos biológicos das lesões precursoras anais são semelhantes aos das lesões cervicais. Dessa forma, como o ginecologista é o principal responsável pelo acompanhamento das mulheres, poderia

Anal cancer was not considered a neoplasm of public health concern until recently. Nevertheless, it may be object of attention in groups in which its incidence is increasing: people who have anoreceptive intercourse, promiscuous people and people who have sexual transmitted diseases (HPV and HIV infection). The incidence of anal cancer increased 1.5 fold among men and tripled among women in recent years. Although there is no strong literature evidence that document the value of screening for ASILs (anal squamous intraepithelial lesions) in the risk population, the rationale screening relies upon the success of cervical cytology screening in the reduction of cervical cancer incidence. It was reviewed the availability of screening modalities that effectively diagnosis the precursor lesion and the possibility of treatments that can prevent ASILs from progressing to anal cancer. The biologic consequences of anal dysplasia or ASIL are considered analogous of those of cervical dysplasia so the gynecologists may contribute to this diagnosis and to the prevention of anal cancer.

Tratamento atual dos miomas / Current treatment of leiomyomas

Leiomiomas são tumores benignos. Eles surgem no miométrio e contêm quantidade variável de tecido conjuntivo fibroso. Cerca de 75 por cento dos casos são assintomáticos, encontrados ocasionalmente durante exame abdominal, pélvico bimanual ou ultra-sonografia. Os sintomas são relacionados diretamente ao tamanho, ao número e à localização dos miomas. Nessa revisão, são apresentadas as abordagens terapêuticas atuais clínicas (anticoncepcionais orais, progestágenos e antiprogestágenos, análogos do hormônio liberador das gonadotrofinas (GnRH), e antiinflamatórios não esteróides) e cirúrgicas (histerectomia, miomectomia e embolização) para o tratamento de leiomiomas.

Leiomyomas are benign tumors. They appear in the myometrium and present a variable amount of fibrous conjunctive tissue. About 75 percent of the cases are not symptomatic and are usually found during abdominal, bimanual pelvic examination or during ultrasonography. The symptoms are directly related to the size, number and localization of the myomas. In the present review, the current clinical therapeutic procedures (oral anti-conceptive drugs, progestins and anti-progestins, analogues of the gonadothrophins releasing hormone (GnRH), and non-steroid anti-inflammatory drugs), and also the surgical procedures (hysterectomy, myomectomy, embolization) are presented for the treatment of leiomyomas.

Preservaçäo do complexo aréolo-mamilar em fístula mamária: nova técnica cirúrgica de abordagem / Anatomic preservation of nipple and areolar complex in mammary fistula: a new surgical approach

Os autores apresentam uma nova técnica cirúrgica para o tratamento da fístula mamária, visando à manutençäo estética e funcional do complexo aréolo-mamilar. O procedimento consiste na realizaçäo de 2 incisöes independentes ao nível da pele, uma periareolar e outra ao nível do mamilo, incluindo a regiäo fistulosa, sendo integradas sob a pele com a ressecçäo total do complexo ductal. Esta técnica cirúrgica visa oferecer à mulher melhor resultado estético, näo esquecendo de sugerir um tratamento definitivo à doença fistulosa crônica existente.