Percepção dos profissionais de enfermagem sobre manejo de reação infusional a antineoplásicos: estudo qualitativo / Perception of nursing professionals on the management of infusion reactions to antineoplastics: qualitative study

Identificar a percepção dos profissionais de enfermagem sobre o manejo de reação infusional imediata a antineoplásicos. Método: Trata-se de um estudo descritivo de caráter exploratório com abordagem qualitativa realizado em um hospital no Rio Grande do Sul. Resultados: Todos os participantes afirmaram saber identificar uma reação infusional. Após a identificação da reação, nota-se que a maioria obedeceu a uma ordem de condutas a serem realizadas. Quanto aos cuidados para prevenção das reações infusionais, a maioria dos participantes mencionou a administração de medicamentos pré-quimioterápicos, como antialérgicos e antieméticos. Conclusão: Os achados demonstram que a maioria dos profissionais sabe reconhecer e manejar, porém há a necessidade de treinamentos e padronização das ações.(AU)

To identify the perception of nursing professionals about the management of immediate infusion reactions to antineoplastic drugs. Method: This is a descriptive, exploratory study with a qualitative approach carried out in a hospital in Rio Grande do Sul. Results: All the participants said they knew how to identify an infusion reaction. After identifying the reaction, it was noted that the majority followed an order of conduct to be carried out. As for precautions to prevent infusion reactions, most of the participants mentioned the administration of pre-chemotherapy drugs, such as anti-allergic and anti-emetic drugs. Conclusion: The findings show that most professionals know how to recognize and manage them, but there is a need for training and standardization of actions.(AU)

Identificar la percepción de los profesionales de enfermería sobre el manejo de las reacciones infusionales inmediatas a medicamentos antineoplásicos. Método: Se trata de un estudio descriptivo, exploratorio, con abordaje cualitativo, realizado en un hospital de Rio Grande do Sul. Resultados: Todos los participantes afirmaron saber identificar una reacción a la infusión. Después de identificar la reacción, la mayoría siguió un orden de conducta. En cuanto a las precauciones para prevenir las reacciones a la infusión, la mayoría de los participantes mencionó la administración de fármacos prequimioterápicos, como antialérgicos y antieméticos. Conclusión: Los hallazgos muestran que la mayoría de los profesionales saben reconocerlas y manejarlas, pero es necesaria la formación y la estandarización de actuaciones.(AU)

Uma revisão integrativa a respeito de métodos contraceptivos / An integrative review on contraceptive methods / Una revisión integrativa de los métodos anticonceptivos

Os métodos contraceptivos desempenham um papel vital na saúde sexual e reprodutiva, oferecendo opções que permitem o planejamento familiar e a prevenção de gravidezes indesejadas. Este artigo busca descrever os benefícios e desvantagens dos principais anticoncepcionais presentes na atualidade por meio de uma revisão integrativa da literatura, que buscou identificar os achados científicos publicados nos últimos 10 anos (2013 a fevereiro de 2023). A seleção de artigos foi feita nas bases eletrônicas de dados da PubMed, BVS, SciELO e no Google Acadêmico. Para a realização da revisão integrativa foi estabelecida a pergunta norteadora, para possibilitar a busca na base dados: Quais os benefícios e as desvantagens dos anticoncepcionais adesivo combinado, anel vaginal, sistema intrauterino de liberação de Levonorgestrel (SIU-LNG), contracepção de emergência (pílula de emergência), implante hormonal e anticoncepcional oral (ACO). Um dos pontos mais notáveis nesta revisão foi a grande variedade de métodos contraceptivos e suas peculiaridades, que se adequam à necessidade da usuária, sendo, portanto, preciso uma análise cuidadosa do método a ser escolhido. Outro ponto de destaque, foi que apesar dos benefícios dos contraceptivos, também estão presentes os efeitos adversos e possíveis complicações, além das precauções em sua utilização.

Contraceptive methods play a vital role in sexual and reproductive health, offering options that allow for family planning and the prevention of unwanted pregnancies. This article seeks to describe the benefits and disadvantages of the main contraceptives currently available through an integrative literature review, which sought to identify scientific findings published in the last 10 years (2013 to February 2023). The selection of articles was made in the electronic databases of PubMed, VHL, SciELO and Google Scholar. To carry out the integrative review, the guiding question was established, to enable the search in the database: What are the benefits and disadvantages of contraceptives combined patch, vaginal ring, Levonorgestrel-releasing intrauterine system (LNG-IUS), emergency contraception (emergency pill), hormonal implant and oral contraceptive (OC). One of the most notable points in this review was the wide variety of contraceptive methods and their peculiarities, which adapt to the user's needs, therefore requiring a careful analysis of the method to be chosen. Another highlight was that despite the benefits of contraceptives, adverse effects and possible complications are also present, in addition to precautions in their use.

Los métodos anticonceptivos desempeñan un papel vital en la salud sexual y reproductiva, ofreciendo opciones que permiten la planificación familiar y la prevención de embarazos no deseados. Este artículo busca describir los beneficios y desventajas de los principales anticonceptivos actualmente disponibles a través de una revisión integrativa de la literatura, que buscó identificar hallazgos científicos publicados en los últimos 10 años (2013 a febrero de 2023). La selección de artículos se realizó en las bases de datos electrónicas PubMed, BVS, SciELO y Google Scholar. Para realizar la revisión integradora se estableció la pregunta orientadora, para posibilitar la búsqueda en la base de datos: Cuáles son los beneficios y desventajas de los anticonceptivos combinados parche, anillo vaginal, sistema intrauterino liberador de levonorgestrel (SIU-LNG), anticoncepción de emergencia (emergencia píldora), implante hormonal y anticonceptivo oral (AO). Uno de los puntos más destacables de esta revisión fue la gran variedade de métodos anticonceptivos y sus peculiaridades, que se adaptan a las necesidades del usuario, requiriendo por tanto un análisis cuidadoso del método a elegir. Otro destaque fue que a pesar de los beneficios de los anticonceptivos, también están presentes efectos adversos y posibles complicaciones, además de precauciones en su uso.

Eventos adversos pós-vacina contra o papilomavírus humano em adolescentes: revisão sistemática da literatura / Adverse events following human papillomavirus vaccine in adolescents: systematic review of the literature / Eventos adversos tras la vacuna contra el virus del papiloma humano en adolescentes: revisión sistemática de la literatura

Objetivo: O objetivo desse estudo foi investigar a ocorrência de Eventos Supostamente Atribuídos a Vacinação e/ou Imunização associados à vacina Papilomavírus Humano entre adolescentes de ambos os sexos. Métodos:Trata-se de uma revisão sistemática, realizada segundo os preceitos do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Resultados: Inicialmente, foram identificados 11.016 artigos e, após a remoção de duplicidades, restaram 6.824. Destes, 59 foram selecionados para leitura na íntegra. Ao final, nove estudos compuseram a amostra. Os resultados indicam que a maioria dos Eventos Supostamente Atribuídos a Vacinação e/ou Imunização foram leves e moderados, prevalecendo eventos no local da injeção, como a dor e edema. Os Eventos Supostamente Atribuídos a Vacinação e/ou Imunização sistêmicos mais frequentes foram a febre, cefaleia, fadiga e tontura. Conclusão: A vacina contra o Papilomavírus Humano para os adolescentes é segura, reforçando-se sua importância como estratégia para diminuir as taxas de incidência dos cânceres associados ao Papilomavírus Humano.

Objective: The objective of this study was to investigate the occurrence of Events Supposedly Attributable to Vaccination and/or Immunization associated with the Human Papillomavirus vaccine among adolescents of both sexes. Methods: This is a systematic review carried out according to the principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Initially, 11,016 articles were identified, of which 6,824 remained after removing duplicates, and 59 of these were selected for full reading. The sample comprised nine studies. The results indicate that most Events Supposedly Attributable to Vaccination and/or Immunization were mild and moderate, and events at the injection site, such as pain and edema, prevailed. The most common systemic Events Supposedly Attributable to Vaccination and/or Immunization were fever, headache, fatigue and dizziness. Conclusion: The Human Papillomavirus vaccine for adolescents is safe, reinforcing its importance as a strategy to reduce the incidence rates of Human Papillomavirus associated cancers

Objetivo: El objetivo de este estudio fue investigar la ocurrencia de Eventos Supuestamente Atribuibles a la Vacunación o Inmunización asociados a la Vacuna contra el Virus del Papiloma Humano entre adolescentes de ambos sexos. Métodos: Se trata de una revisión sistemática realizada según la declaración Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Resultados:Se identificaron 11.016 artículos y, tras eliminar duplicados, quedaron 6.824. De ellos, 59 fueron seleccionados para lectura completa. La muestra estuvo compuesta por nueve estudios. Los resultados indican que la mayoría de los Eventos Supuestamente Atribuibles a la Vacunación o Inmunización fueron leves y moderados, prevaleciendo los eventos en el lugar de la inyección, como dolor y edema. Los Eventos Supuestamente Atribuibles a la Vacunación o Inmunización sistémicos más comunes fueron fiebre, dolor de cabeza, fatiga y mareos. Conclusión: La vacuna contra el Virus del Papiloma Humano para adolescentes es segura, lo que refuerza su importancia como estrategia para reducir las tasas de incidencia de cánceres asociados al Virus del Papiloma Humano.

A novel agent for myeloma causing toxic keratopathy, belantamab mafodotin: a case report and literature review / Belantamabe-mafodotina, um novo agente para mieloma, causando ceratopatia tóxica: relato de caso e revisão da literatura

ABSTRACT A 60-year-old-male with refractory relapsed multiple myeloma presented with redness, pain, foreign body sensation, and blurred vision in both eyes that gradually increased after his third belantamab mafotodin infusion. Biomicroscopy revealed bilateral microcyst-like epithelial changes and epithelial crystal-like deposits, whereas in vivo confocal microscopy revealed intraepithelial and subepithelial hyperreflective deposits in corneal epithelium. Belantamab mafodotin therapy was discontinued for seven weeks due to corneal toxicity, which cleared progressively. We aim to demonstrate belantamab mafodotin-related corneal toxicity that may be detected using slit lamp and in vivo confocal biomicroscopy.

RESUMO Um homem de 60 anos, diagnosticado com mieloma múltiplo recidivante refratário, apresentou vermelhidão, dor, sensação de corpo estranho e visão turva em ambos os olhos, aumentando gradualmente após sua terceira infusão de belantamabe mafodotina. À biomicroscopia, foram observadas alterações epiteliais bilaterais semelhantes a microcistos e depósitos epiteliais semelhantes a cristais. A microscopia confocal in vivo revelou depósitos hiper-refletivos intraepiteliais e subepiteliais na córnea. Devido à toxicidade corneana, a terapia com belantamabe mafodotina foi interrompida por sete semanas e a toxicidade foi gradualmente resolvida. Nosso objetivo é demonstrar os achados à biomicroscopia confocal in vivo e à lâmpada de fenda da toxicidade corneana relacionada ao belantamabe mafodotina.

ERG and OCT abnormalities in retinoblastoma after melphalan intravitreous injection / Anormalidades do ERG e OCT em um caso de retinoblastoma após injeção intravítrea de melfalan

ABSTRACT The authors report full-field electroretinogram and optical coherence tomography findings of intravitreal melphalan retinal toxicity. An 18-month-old girl with unilateral group D retinoblastoma was evaluated with light-adapted 3 full-field electroretinogram protocol and optical coherence tomography (I-Stand optical coherence tomography, Optovue) after treatment with intravitreal melphalan for active vitreous seeds. After the third injection, the child developed retinal pigment epithelial changes near the injection site. The photopic response of the full-field electroretinogram standard flash cones showed a decrease in amplitude responses of waves a and b in the affected eye compared to the contralateral eye. Optical coherence tomography showed loss of photoreceptors and outer nuclear layers in the affected eye. Melphalan toxicity is dose-dependent, and despite its treatment benefits, it can affect vision. Our case shows an updated, in-depth retinal toxicity assessment of intravitreal melphalan in the human retina with optical coherence tomography and its correlation with electroretinogram changes.

RESUMO Os autores relatam os achados de eletrorretinograma de campo total e tomografia de coerência óptica (OCT) da toxicidade retiniana ao melfalan intravítreo. Menina de 18 meses com retinoblastoma foi avaliada com fases fotópicas do eletrorretinograma de campo total e tomografia de coerência óptica após o tratamento com melfalan intravítreo. Após a terceira injeção, a criança desenvolveu alterações do epitélio pigmentar da retina próximo ao local da injeção. A resposta fotópica do eletrorretinograma de campo total mostrou diminuição da amplitude das respostas das ondas a e b no olho afetado comparado com o olho sadio. A tomografia de coerência óptica mostrou alterações significativas nas camadas retinianas externas no olho comprometido. A toxicidade do melfalan é dose dependente e, apesar dos benefícios terapêuticos, podem causar alterações retinianas significativas. Este caso demonstra uma avaliação atual e aprofundada da toxicidade retiniana do melfalan intravítreo na retina humana através da tomografia de coerência óptica e sua correlação com as alterações no eletrorretinograma.

Effects of oral isotretinoin treatment for acne vulgaris patients on anger responses and the relationship with temperament

SUMMARY OBJECTIVE: Isotretinoin is the only medication against all the factors involved in acne vulgaris pathogenesis. The aim of our study was to verify whether patients with acne vulgaris receiving isotretinoin therapy exhibit elevated anger levels and to observe the correlation between age, temperament traits, and anger. METHODS: The study group comprised a sum of 100 cases, involving 50 individuals with acne vulgaris-required high-dose retinol therapy and 50 controls who did not start any medication. RESULTS: Our study showed that anger levels increased with drug use. A positive correlation between cyclothymic temperament, the anxiety-related behavior subdimension, and the introvert and passive-aggressive subdimension of interpersonal anger reactions has been recognized. In addition, a positive one was observed between hyperthymic temperament and the introvert subdimension, which is one of the anger-related thoughts and interpersonal anger reactions. CONCLUSION: This study elucidates anger dimensions such as anger-related thoughts, behaviors, and reactions in individuals who received retinol treatment for acne vulgaris. In addition to anger and its dimensions, temperament was also investigated. Although several studies have investigated the relationship between acne vulgaris and psychiatric symptoms, to the best of our knowledge, no research has been reported in the English-language literature regarding the relationship between anger dimensions and temperament after retinol treatment that might make our study an original and valuable contribution to the literature.

When the fever will not stop, stop the pills! A case report

ABSTRACT Neuroleptic malignant syndrome (NMS) is a neurologic emergency potentially fatal. This rare side effect is most commonly associated with first-generation antipsychotics and less frequently with atypical or second-generation antipsychotics. The diagnosis relies on both clinical and laboratory criteria, with other organic and psychiatric conditions being ruled out. CASE REPORT: A 39-year-old female patient, who is institutionalized and completely dependent, has a medical history of recurrent urinary infections and colonization by carbapenem-resistant Klebsiella pneumoniae. Her regular medication regimen included sertraline, valproic acid, quetiapine, risperidone, lorazepam, diazepam, haloperidol, baclofen, and fentanyl. The patient began experiencing dyspnea. Upon physical examination, she exhibited hypotension and a diminished vesicular murmur at the right base during pulmonary auscultation. Initially, after hospitalization, she developed high febrile peaks associated with hemodynamic instability, prompting the initiation of antibiotic treatment. Despite this, her fever persisted without an increase in blood inflammatory parameters, and she developed purulent sputum, necessitating antibiotherapy escalation. The seventh day of hospitalization showed no improvement in symptoms, suggesting NNMS as a differential diagnosis. All antipsychotic and sedative drugs, as well as antibiotherapy, were discontinued, after which the patient showed significant clinical improvement. CONCLUSION: Antipsychotic agents are commonly employed to manage behavioral changes linked to various disorders. However, their severe side effects necessitate a high degree of vigilance, the cessation of all medications, and the implementation of supportive care measures. A prompt and accurate diagnosis of NMS is crucial to alleviating the severe, prolonged morbidity and potential mortality associated with this syndrome.

Comparison of menstrual cycle irregularities among young women based on coronavirus disease 2019 infection status: a cross-sectional study

SUMMARY OBJECTIVE: The coronavirus disease 2019 pandemic that has emerged recently has significantly affected and continues to affect our lives. The Severe Acute Respiratory Syndrome Coronavirus 2 virus has significant effects on women's health due to gender-related physiological differences. The aim of this study was to compare the menstrual cycle status of young women according to their status of having had coronavirus disease 2019. METHODS: This descriptive cross-sectional study was conducted with 220 young women aged between 18 and 25 years who received at least one dose of coronavirus disease 2019 vaccine. The study data were collected as a survey on the online platform. RESULTS: The descriptive characteristics of young women who had had and had not had coronavirus disease 2019 were distributed homogeneously between the groups (p>0.05). Furthermore, there was no statistical difference in terms of menstrual cycle patterns (p>0.05). The mean scores from the Premenstrual Syndrome Scale and its subscales and the mean scores from the COVID Stress Scale and its subscales were similar in both groups, and no statistically significant difference was identified (p>0.05). CONCLUSION: Although menstrual cycle irregularities due to coronavirus disease 2019 have been reported, these effects are usually observed during the pandemic. A decrease in stress and anxiety with the end of the pandemic may explain the return of the menstrual cycle to normal.

Assessment of the prevalence of depression and the use of antidepressants in a study population

The World Health Organization (WHO) has reported that there is an increasing burden of depression and other mental health conditions globally. WHO global health estimate for depression reports a prevalence of 5.4% in Sub-Saharan Africa. Pharmacological therapy still remains the most popular treatment for diagnosed depression. The aim of this study was to determine the prevalence of clinically diagnosed depression and outcomes of antidepressants among final year undergraduate students in a Federal University. A descriptive cross- sectional study was carried out at University of Benin, Benin City. A validated questionnaire was distributed to the 319 final year clinical students of the College of Medicine, School of Dentistry and Faculty of Pharmacy. Data obtained were organized and analysed with Microsoft Excel and SPSS version 25. Descriptive statistics was done; frequencies and percentages were used to summarize variables of interest. Ethical considerations were observed. All the questionnaires used were valid for analysis. About 90.0% of the respondents were knowledgeable about depression. Symptoms of depression were reported in 20.0% of the respondents with 16.6% having moderate symptoms of depression and 3.4% having moderately severe symptoms of depression. The same 20.0% used antidepressants and 14.7% did not adhere to their regimen. Side effects were experienced by majority of respondents (16.3%) on antidepressants. There was a low prevalence of depression in the study population. Adherence to drug therapy was poor. Side effects to treatment were reported by majority of students receiving antidepressants. Majority of patients claim to be better now that they are using antidepressant treatment as the symptoms of the disease are resolving.

Um raro caso de vasculite leucocitoclástica induzida por oxacilina / A rare case of oxacillin-induced leukocytoclastic vasculitis

A vasculite leucocitoclástica é uma patologia cujos mecanismos estão associados ao processo de inflamação vascular. Estima-se que até 24% dos casos de vasculite estão relacionados ao uso de fármacos, sendo os antimicrobianos beta-lactâmicos um dos grupos farmacológicos comumente associados a este desfecho adverso. A oxacilina, uma penicilina semissintética, possui um anel beta-lactâmico que confere atividade biológica e está associada com maior frequência a relatos de vasculite leucocitoclástica. No entanto, casos semelhantes relacionados a esse antimicrobiano são raros, sendo identificados apenas três casos na literatura. Diante desse contexto, relatamos um quarto caso de vasculite leucocitoclástica em um homem de 56 anos, em tratamento com oxacilina, que desenvolveu a vasculite no 3º dia de uso do antimicrobiano. Além da suspensão da oxacilina, ele foi tratado com 125 mg/dia de metilprednisolona endovenosa por sete dias, seguido de 20 mg/dia de prednisona oral por quatro dias, resultan-do em remissão satisfatória das lesões cutâneas e ausência de novos desfechos adversos. Este caso corrobora a possível relação causal entre o uso de oxacilina e o desenvolvimento da vasculite leucocitoclástica, apesar de sua ocorrência ser rara. A resposta favorável às intervenções terapêuticas, incluindo a suspensão da oxacilina e o uso de corticosteroides, destaca a eficácia dessas abordagens no tratamento dessa complicação (AU).

Leukocytoclastic vasculitis is a pathology whose mechanisms are associated with the process of vascular inflammation. It is estimated that up to 24% of the cases of vasculitis are drug-related, with beta-lactam antimicrobials be-ing one of the pharmacological groups commonly associated with this adverse outcome. Oxacillin, a semisynthetic penicillin, has a beta-lactam ring that confers biological activity and is most frequently associated with reports of leukocytoclastic vasculitis. However, similar cases related to this antimicrobial are rare, with only three cases identified in the literature. Against this background, we report a fourth case of leukocytoclastic vasculitis in a 56-year-old man, on oxacillin treatment, who developed the vasculitis on the 3rd day of antimicrobial use. In addition to oxacillin suspension, he was treated with 125 mg/day of intravenous methylprednisolone for seven days, followed by 20 mg/day of oral prednisone for four days, resulting in satisfactory remission of the skin lesions and no new adverse outcomes. This case provides further evidence supporting the potential causal relationship between the use of oxacillin and the development of leukocytoclastic vasculitis, albeit a rare occurrence. The positive response to therapeutic interventions, such as oxacillin suspension and corticosteroid treatment, underscores the effectiveness of these approaches in addressing this complication (AU),

Managerial Decision-Making of Nurses in Hospitals: creation and validation of a simulation scenario / Tomada de Decisão Gerencial do Enfermeiro da Área Hospitalar: construção e validação de cenário de simulação / Toma de Decisiones Gerenciales del Enfermero en el Área Hospitalaria: construcción y validación de un escenario de simulación

Abstract Objective: to build and validate a clinical simulation scenario on hospital nurse managerial decision-making competence for undergraduate nursing students. Method: a descriptive and methodological study was carried out in a higher education institution, with the participation of 10 judges and five players. To do so, the conceptual simulation model proposed by Jeffries and standards of the International Nursing Association for Clinical Simulation and Learning were used to prepare the scenario and the checklist. Results: the scenario was called "Managerial decision-making of nurses in the face of adverse events in a hospital". The scenario script and checklist were built for validation. The checklist was face- and content-validated. Afterward, judges used the checklist to validate the scenario, which, in its final version, was composed of Prebriefing (seven items), Scenario in Action (18 items) and Debriefing (seven items). Conclusion: the scenario proved to be a teaching strategy that anticipates the reality of future nurses, bringing them the self-confidence to perform their activities and helping them to act critically and reflectively during decision-making processes.

Resumo Objetivo: construir e validar um cenário de simulação clínica sobre a competência tomada de decisão gerencial do enfermeiro hospitalar para estudantes de graduação em enfermagem. Método: estudo descritivo e metodológico realizado em uma instituição de ensino superior, com a participação de 10 juízes e cinco atores. Utilizou-se o modelo conceitual de simulação proposto por Jeffries e guias padronizadas da International Nursing Association for Clinical Simulation in Learning para a elaboração do cenário e do checklist. Resultados: o cenário ficou denominado como "Tomada de decisão gerencial do enfermeiro diante de eventos adversos no contexto hospitalar". Construiu-se o script do cenário e o checklist para a sua validação. Realizou-se validação de face e conteúdo do checklist. Posteriormente, juízes de posse do checklist, validaram o cenário que, em sua versão final, ficou composto por Prebriefing (sete itens), Cenário em Ação (18 itens) e Debriefing (sete itens). Conclusão: o cenário mostrou-se uma estratégia de ensino capaz de antecipar a realidade do futuro enfermeiro, trazendo autoconfiança na execução de suas atividades, contribuindo para agir de forma crítica e reflexiva durante o processo de tomada de decisão.

Resumen Objetivo: construir y validar un escenario de simulación clínica sobre la competencia en la toma de decisiones gerenciales del enfermero hospitalario para estudiantes del grado en enfermería. Método: estudio descriptivo y metodológico realizado en una institución de educación superior, con la participación de 10 jueces y cinco actores. Se utilizó el modelo conceptual de simulación propuesto por Jeffries y guías estandarizadas de la International Nursing Association for Clinical Simulation in Learning para la elaboración del escenario y del checklist. Resultados: el escenario se denominó "Toma de decisiones gerenciales del enfermero ante eventos adversos en el contexto hospitalario". Se construyó el script del escenario y el checklist para su validación. Se realizó la validez aparente y el contenido del checklist. Posteriormente, los jueces en posesión del checklist, validaron el escenario que, en su versión final, quedó compuesto por Prebriefing (siete ítems), Escenario en Acción (18 ítems) y Debriefing (siete ítems). Conclusión: el escenario demostró ser una estrategia de enseñanza capaz de anticipar la realidad del futuro enfermero, trayendo autoconfianza en la ejecución de sus actividades, contribuyendo para actuar de forma crítica y reflexiva durante el proceso de toma de decisiones.

Predicción de toxicidad de la quimioterapia y radioterapia en el paciente oncológico quirúrgico

Fundamento la toxicidad asociada a los tratamientos de quimioterapia y radioterapia eleva la morbilidad y la mortalidad en los pacientes oncológicos. Objetivo diseñar un modelo predictivo de toxicidad de la quimioterapia y la radioterapia en el paciente oncológico quirúrgico. Métodos estudio analítico, de casos y controles, en pacientes oncológicos quirúrgicos que cumplieron los criterios de inclusión para la predicción de toxicidad preoperatoria, en el periodo enero a diciembre de 2022, en el Hospital Provincial Docente Oncológico María Curie, de Camagüey. Mediante el paquete estadístico Statistical Package for the Social Sciences, se seleccionó una muestra aleatoria de 334 pacientes, 197 sin toxicidad (grupo control) y 137 con toxicidad (grupo de estudio). Se realizó estimación de predictores de toxicidad mediante regresión logística binaria. Se seleccionó el modelo de mejor ajuste. Resultados el modelo en el paso tres predice un porcentaje global de 83,5 % con respecto a los valores observados. La sensibilidad resultó ser de 81,8; y la especificidad, 84,8. El modelo presentó buen poder discriminativo. Las variables en la ecuación fueron: hipertensión arterial, fracción de eyección del ventrículo izquierdo y anemia. La comparación de la predicción con la realidad, mediante curva Receiver Operating Characteristic determinó un área bajo la curva de 0,901. Conclusión se obtuvo una función de regresión logística que permitió la estimación de la probabilidad de toxicidad en pacientes oncológicos quirúrgicos electivos, la cual proporcionó una herramienta para su predicción desde el preoperatorio.

Foundation the toxicity associated with chemotherapy and radiotherapy treatments increases morbidity and mortality in cancer patients. Objective to design a predictive model of chemotherapy and radiotherapy toxicity in surgical cancer patients. Methods analytical, case-control study, in surgical oncology patients who met the inclusion criteria for the prediction of preoperative toxicity, from January to December 2022, at the María Curie Provincial Teaching Oncology Hospital in Camagüey. Using the Statistical Package for the Social Sciences, a random sample of 334 patients was selected, 197 without toxicity (control group) and 137 with toxicity (study group). Toxicity predictors were estimated using binary logistic regression. The model with the best fit was selected. Results the model in step three predicts an overall percentage of 83.5% with respect to the observed values. The sensitivity turned out to be 81.8; and the specificity, 84.8. The model presented good discriminative power. The variables in the equation were: arterial hypertension, left ventricular ejection fraction, and anemia. The comparison of the prediction with reality, using the Receiver Operating Characteristic curve, determined an area under the curve of 0.901. Conclusion a logistic regression function was obtained that allowed the estimation of the toxicity probability elective surgical cancer patients, which provided a tool for its prediction from the preoperative period.

Manejo das irregularidades menstruais secundárias ao uso de contraceptivos ­ análise das recomendações atuais / Management of menstrual irregularities secondary to contraceptive use ­ analysis of current recommendations

As irregularidades menstruais representam uma série de desordens na quantida- de, duração, frequência ou regularidade do sangramento uterino. Entre suas cau- sas destaca-se o sangramento secundário ao uso de anticoncepcionais, uma razão frequente de descontinuidade dos contraceptivos, podendo aumentar as taxas de gestações não planejadas. Boa parte dos contraceptivos pode levar a mudanças no padrão de sangramento uterino, e a abordagem inicial do sangramentos irregula- res inclui a avaliação de outras possíveis causas, o reforço do uso correto da medi- cação, a tranquilização da paciente quanto à benignidade do quadro e à tendência a melhora com a continuidade do uso. Os anti-inflamatórios podem ser usados como estratégia inicial, e, não havendo resposta satisfatória, há alternativas espe- cíficas para cada método. Este trabalho visa identificar as recomendações atuais sobre o manejo do sangramento anormal decorrente de contraceptivos, por meio de revisão narrativa de estudos publicados sobre o tema nos últimos vinte anos.

Abnormal uterine bleeding represents a series of disorders in the amount, du- ration, frequency and or regularity of uterine bleeding. Among its causes, uterine bleeding secondary to the use of contraceptives stands out as a frequent reason for contraceptive discontinuity, which could lead to unplanned pregnancies. Most contraceptives can cause changes in the pattern of uterine bleeding, and the ini- tial approach of the abnormal bleeding includes assessing other possible cau- ses, reinforcing the correct use of medication, and reassuring the patient about the benignity of the condition and the tendency to improve with the continuity of the treatment. Anti-inflammatory drugs can be used as an initial strategy, and, if there is no satisfactory answer, there are specific alternatives for each contracep- tive method. This work aims to identify them current recommendations on the management of abnormal bleeding resulting from contraceptives use, through a narrative review of studies published on the subject in the last twenty years.

EGFR inhibitors: clinical aspects, risk factors and biomarkers for acneiform eruptions and other mucosal and cutaneous adverse effects

Abstract The frequency of the use of drugs that act on the epidermal growth factor receptor (EGFR) is increasing, with the consequent onset of cutaneous toxicity, specifically acneiform eruption. The authors extensively review the topic, focusing on describing how these drugs can affect the skin and its appendages, that is, the pathophysiology that encompasses the cutaneous toxicity related to the use of EGFR inhibitors. In addition, it was possible to list the risk factors that may be associated with adverse effects of these drugs. Based on this recent knowledge, the authors expect to aid in the management of patients who are more vulnerable to toxicity, reduce morbidities, and improve the quality of life of patients undergoing treatment with EGFR inhibitors. Other issues related to the toxicity of EGFR inhibitors, such as the clinical aspects of the acneiform eruption grades, and other different types of cutaneous and mucosal reactions, are also included in the article.

Evaluation of usage of immunity boosters among the citizens of Pune district during the COVID-19 pandemic

Introduction: Post the coronavirus disease (COVID-19 pandemic), there was a spike in demand for immunity boosters, leading to the irrational use of supplements. To assess the usage of immunity boosters among the citizens of Pune City and correlate the side effects associated with supplements. Material and Methods: A cross-sectional study was conducted from September 2020 to May 2021 in Pune. Data, such as demographic, supplement intake (allopathic, homeopathic, and ayurvedic/home remedies), duration, frequency of supplements, and side effects associated with supplements, were collected through a personal interview and e-form circulation. The correlation of the immunity boosters with the side effects was done using Karl Pearson’s Correlation test in SPSS software version 22.0. Results: Out of 1006, the ayurvedic supplements/home remedies were preferred by 906 (98%) allopathic supplements by 599 (65%) and homeopathic supplements by 256 (28%) participants. The commonly reported side effects were acidity (37%), headache (29.6%), nausea (9%), loss of appetite (8.8%), diarrhea (7%), stomach ache (6%), cough (5.6%), and constipation (4.1%). These side effects had a weak positive linear proportionality with ayurvedic supplements such as amla (r = 0.162), Giloy Vati (r = 0.139), turmeric (r = 0.108), and Kadha (r = 0.102); also, Eupatorium perfoliatum, Vitamin C, and Vitamin D showed a linear proportionality with loss of appetite (r = 0.15), headache (r = 0.12), and cough (r = 0.12), respectively. A higher incidence of side effects such as nausea (r = 0.267), diarrhea (r = 0.243), headache (r = 0.164), and acidity (r = 0.113) was observed when supplements were taken for 6 months. Conclusion: Most participants were on immunity boosters during the COVID-19 pandemic. The study concluded that using immunity boosters in excess or for more than 6 months causes side effects, the most recurrent ones being acidity, headache, nausea, and lack of appetite.

Safety and effectiveness of adding fentanyl or sufentanil to spinal anesthesia: systematic review and meta-analysis of randomized controlled trials

Abstract Introduction Spinal infusions of either fentanyl or sufentanil have been reported in international reports, articles, and scientific events worldwide. This study aimed to determine whether intrathecal fentanyl or sufentanil offers safety in mortality and perioperative adverse events. Methods MEDLINE (via PubMed), EMBASE, CENTRAL (Cochrane library databases), gray literature, hand-searching, and clinicaltrials.gov were systematically searched. Randomized controlled trials with no language, data, or status restrictions were included, comparing the effectiveness and safety of adding spinal lipophilic opioid to local anesthetics (LAs). Data were pooled using the random-effects models or fixed-effect models based on heterogeneity. Results The initial search retrieved 4469 records; 3241 records were eligible, and 3152 articles were excluded after reading titles and abstracts, with a high agreement rate (98.6%). After reading the full texts, 76 articles remained. Spinal fentanyl and sufentanil significantly reduced postoperative pain and opioid consumption, increased analgesia and pruritus. Fentanyl, but not sufentanil, significantly reduced both postoperative nausea and vomiting, and postoperative shivering; compared to LAs alone. The analyzed studies did not report any case of in-hospital mortality related to spinal lipophilic opioids. The rate of respiratory depression was 0.7% and 0.8% when spinal fentanyl or sufentanil was added and when it was not, respectively. Episodes of respiratory depression were rare, uneventful, occurred intraoperatively, and were easily manageable. Conclusion There is moderate to high quality certainty that there is evidence regarding the safety and effectiveness of adding lipophilic opioids to LAs in spinal anesthesia.

Study of side effect profile of bedaquiline containing regimen among patients with extensively drug-resistant tuberculosis at a nodal drug-resistant center

Background: Extensively drug-resistant tuberculosis (XDR TB) is a type of tuberculosis (TB) characterized by resistance to isoniazid and rifampicin, along with resistance to one of the fluoroquinolones and at least one of the second line injectable drugs. Bedaquiline is a diarylquinoline antimycobacterial agent approved for the treatment of adults with pulmonary multidrug-resistant TB (MDR-TB) and XDR-TB by the food and drug administration. Aim and Objective: The aim of this study was to study the side effect profile of bedaquiline containing regimen among XDR TB patients. Materials and Methods: This study was conducted at outpatient and wards of nodal drug-resistant TB Center, Department of Pulmonary Medicine, SVRRGGH, Tirupati, for a period of 1 year. Forty patients of more than 18 years age and diagnosed with XDR TB were included in the study. Bedaquiline was started and daily monitoring was done with ECG and all organ function tests were repeated every 15 days. Results: All 40 cases were retreatment cases; no new XDR TB case was reported in study period. Most common age group of presentation in our study was 46 to 55 years (32.5%). Gastrointestinal adverse drug reactions were found to be more common (37.5%), cardiovascular QTc changes were observed in 10% of patients, 5% of patients had neurological reactions (Headache), 2.5% of patients had peripheral neuropathy, and 2.5% of patients had arthralgia. Conclusions: Bedaquiline containing regimen is very effective for the treatment of XDR TB cases. The study shows that compliance with this regimen is very good. Bedaquiline has minimal adverse reactions and even these are easily manageable. Bedaquiline has good safety profile and patients have improved quality of life.

A review of COVID-19 vaccination and the reported cardiac manifestations

In Singapore, 9.03 million doses of the mRNA COVID-19 vaccines by Pfizer-BioNTech and Moderna have been administered, and 4.46 million people are fully vaccinated. An additional 87,000 people have been vaccinated with vaccines in World Health Organization's Emergency Use Listing. The aim of this review is to explore the reported cardiac adverse events associated with different types of COVID-19 vaccines. A total of 42 studies that reported cardiac side effects after COVID-19 vaccination were included in this study. Reported COVID-19 vaccine-associated cardiac adverse events were mainly myocarditis and pericarditis, most commonly seen in adolescent and young adult male individuals after mRNA vaccination. Reports of other events such as acute myocardial infarction, arrhythmia and stress cardiomyopathy were rare. Outcomes of post-vaccine myocarditis and pericarditis were good. Given the good vaccine efficacy and the high number of cases of infection, hospitalisation and death that could potentially be prevented, COVID-19 vaccine remains of overall benefit, based on the current available data.

Eventos adversos pós-vacinais em pacientes imunizados contra a COVID-19 em um município do sul de Santa Catarina no ano de 2021 / Post-vaccine adverse events in patients immunized against COVID-19 in a munici-pality in the south of Santa Catarina state in 2021

A disponibilização em massa de vacinas contra o vírus SARS-CoV-2 é resultado de esforços científicos mundiais. Entretanto, a insegurança e a hesitação popular per-meiam os movimentos antivacinais. Objetivo: Analisar o perfil dos Eventos Adver-sos Pós-Vacinais (EAPV) na cidade de Tubarão-SC no ano de 2021. Metodologia: Estudo epidemiológico transversal com dados de todas as fichas de notificação padrão de EAPV no município de Tubarão em 2021. As variáveis analisadas foram o perfil epidemiológico do paciente, imunobiológico administrado, o tipo de evento e a evolução do caso. Calculou-se a taxa de incidência (TI) para 10 mil doses apli-cadas. Resultados: A população em estudo foi de 274 pacientes, sendo 73% do sexo feminino, com média das idades de 39,8±14,5 anos. Foram aplicadas 197.001 doses no ano de 2021, o que resultou em uma TI geral de EAPV de 13,9. Houve 206 reações notificadas em pacientes imunizados com a AstraZeneca (TI=29,1), 43 com a Pfizer (TI=5,1), 18 com a Coronavac (TI=4,8) e sete com a Janssen (TI=13,8). Houve apenas sete casos classificados como graves (TI=0,3) e, destes, um paciente evoluiu com óbito, sem relação causal estabelecida. Conclusão: A incidência geral de eventos graves foi baixa, o que corrobora o perfil de segurança dos imunobiológicos disponíveis contra a COVID-19 (AU).

The mass availability of vaccines against the SARS-CoV-2 virus is the result of worldwide scientific efforts. However, insecurity and popular hesitation permeate the antivaccine movements. Objective: Analyze the profile of Post-Vaccine Adverse Events (PVAE) in the city of Tubarão, SC, Brazil, in 2021. Methodology: Cross-sectional epidemiological study with data from all standard PVAE notification forms in the city of Tubarão-SC in 2021. The variables analyzed were the epidemiological profile of the patient, the immunobiological administered, the type of event and the evolution of the cases. The incidence rate (IR) was calculated for 10,000 doses ap-plied. Results: The study population was 274 patients, 73% were female, with a mean age of 39.8±14.5 years. A total of 197,001 doses were applied in the year 2021, resulting in an overall IR of 13.9. There were 206 reactions reported in pa-tients immunized with AstraZeneca (IR=29.1), 43 with Pfizer (IR=5.1), 18 with Coro-navac (IR=4.8) and seven with Janssen (IR=13.8). There were only seven cases classified as severe (IR=0.3) and, of these, one patient died, with no causal rela-tionship established. Conclusion: The overall incidence of serious events was low, which corroborates the safety profile of available immunobiologicals against COVID-19

Trackers for Adverse Events in Child Mental Health: descriptive analysis using the global trigger tool

Abstract The goal of this study is to identify the global trigger tool trackers used to place the adverse drug events presented in children that use psychotropic drugs accompanied by Child-adolescent Psychosocial Care Centers. This is a descriptive study carried out with the secondary data of 112 child care records that began in January 2017 in two Child-adolescent Psychosocial Care Centers. A median of medicine per child was 1.71 and among the most used we were to risperidone 100%, followed by valproic acid and periciazine with 16% each. A total of 42 adverse drug events were found in 36 medical records, being agitation 29.7% and agressive 16.2%, being the most frequent, and in 45.2% of infants presenting only one event. 50 were trackers detected in 83.3%, two records that identified adverse drug events. In 38.8% were found only one tracker, the most found ones were: combination of psychotropic medicines 32%, abrupt reduction of medicine dose 22% and abrupt cessation of medicine 12%. Finally, the present study showed that the global trigger tool evidenced adverse drug events by means of the detection of trackers in children and that it had to offer interventions to improve the quality of psychiatric therapy within two community services.