O Desabastecimento De Imunoglobulina Intravenosa E O Uso De Plasmaferese Em Primeira Linha Na Sindrome De Guillain - Barre Em Paciente Pediatrico: Relato De Caso E Revisao De Literatura

Objetivos: Relatar um caso de Guillain - Barre em paciente de 12 anos de idade que utilizou plasmaferese terapeutica como primeira linha, focando nos aspectos tecnicos do procedimento;Discutir as possiveis causas para o desabastecimento de imunoglobulina intravenosa (IGIV) atual. Metodologia: Coleta de dados clinicos no prontuario. Revisao de literatura, com enfase em plasmaferese na populacao pediatrica, suas indicacoes, paticularidades tecnicas e eventos adversos. Resultados: Paciente de 12 anos de idade, sexo feminino, 35 quilos, previamente higida, deu entrada no pronto - socorro com quadro de tetraparesia desproporcional - forca grau III em MMII e grau IV em MMSS - associada a mialgia difusa. Sem quadro infeccioso ou vacinacao recente antecedendo. Equipe da neurologia levantou hipotese de sindrome de Guillain- Barre e solicitou plasmaferese terapeutica, pois nao havia disponibilidade de IGIV. Foram realizadas 04 sessoes utilizando o sistema COM.TEC (Fresenius Kabi) com troca de uma volemia cada. O fluxo medio de extracao foi de 37,5ml/min (30-45ml/min). A taxa media de ACD infundido na paciente foi de 234ml e a proporcao ACD:sangue foi de 1:16. A duracao media foi de 73 minutos por procedimento. Em todas as sessoes foi utilizado reposicao profilatica com solucao de 10ml de gluconato de calcio 10%. A paciente apresentou tontura e parestesia perioral nas duas primeiras sessoes. Sem outros eventos adversos. Recebeu alta apos quarta sessao, ja sendo capaz de deambular sem auxilio. Discussao: A Sindrome de Guillain Barre corresponde a um grupo de polirradiculopatias autoimunes, inflamatorias e desmielinizantes. Os tratamentos de primeira linha constituem IGIV e plasmaferese. A IGIV costuma ser preferida principalmente em criancas por maior facilidade posologica e nao envolver uso de dispositivos invasivos. O desabastecimento de IGIV desde 2019 em diversos paises do mundo, inclusive no Brasil, tem dificultado o acesso a este tratamento. Entre as possiveis causas para este desabastecimento, podemos citar: aumento da demanda nao acompanhada por aumento na producao, impactos da pandemia de COVID- 19 sobre materia-prima (doadores de sangue) e logistica (transporte, etc), descontinuacao do produto por alguns laboratorios, entre outros. Segundo o ultimo guideline da Sociedade Americana de Aferese nao ha diferenca no desfecho entre IGIV e plasmaferese. Entre os principais eventos adversos da plasmaferese em pacientes pediatricos, destacam- se os relacionados ao acesso central (infeccoes, complicacoes mecanicas, entre outros), hipocalcemia, o volume extracorporeo utilizado no procedimento e riscos de intoxicacao por citrato. A paciente do caso apresentou apenas sintomas leves de hipocalcemia, que melhoraram apos reducao do fluxo de extracao. Conclusao: A plasmaferese terapeutica em pacientes pediatricos tem se mostrado eficaz, seja em primeira linha ou como tratamento complementar. Ajustes na taxa de extracao, reposicao profilatica de calcio e cuidados com o acesso central aumentam a seguranca do procedimento. Copyright © 2022

Distinct Antimicrobial Analysis to Evaluate Multi-Component Wound Dressing Performance

Wound infection hinders adequate healing, being particularly grievous and prevalent in burn wounds and chronic wounds. Wound infection extends inflammation, preventing epithelialization and angiogenesis. Therefore, infection prolongs healing time, steeply increases treatment costs and degrades patients wellbeing. One successful strategy to control wound infection is to apply an active wound dressing, able to eliminate or significantly reduce the microbial population present at the infection site. Silver nanoparticles (AgNPs) are a multipurpose antimicrobial agent with a wide scope of applications which include wound dressings. Nevertheless, several studies denote AgNPs dose-dependent cytotoxicity, and their capability to bypass the blood-brain barrier and induce a neurotoxic effect. Hence, we propose to adopt two different strategies to attempt the simultaneously immobilize and increase the load of AgNPs within the wound dressing fabric. Thus, the envisaged objective is to prevent potential systemic cytotoxicity/through immobilization and to improve its antimicrobial capability due to the higher concentration of AgNPs. Two different approaches were used: i. AgNPs were suspended in an alginate (ALG) solution, ii. AgNPs were embedded in Mordenite (MOR) zeolite, followed by the addition of an ALG solution. Both suspensions were incorporated into polyester fabric assisted by its surface activation by dielectric barrier discharge (DBD) plasma treatment. The bactericidal and virucidal effectiveness of each composite was tested against bacteria species known to induce nosocomial infections and a bacteriophage that is a potential surrogate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Two distinct antimicrobial analyses were used to provide insights on the antimicrobial effectiveness of the obtained composites and to indirectly assess the release of AgNPs.

Compartmental Epidemiological Models for Covid-19: Sources of Uncertainty, Goodness-of-Fit and Goodness-of-Projections

Compartmental Epidemiological Models have been widely used to describe the dynamics of infectious transmission diseases. These models describe the temporal progression of case counts related to an epidemic and evaluate hypotheses about the possible underlying mechanisms that explain patterns in the observed data, with distinct spatial and temporal scales. Furthermore, the models can vary in complexity, whether in terms of the number of parameters or the number of variables that characterize epidemiological states. Therefore, this approach is essential to select adequate models that characterize better transmission dynamics. This generates reliable estimates of the main parameters, which is a critical factor in minimizing uncertainty. This study aims to apply the main epidemiological compartmental models to the initial data of Covid-19 in the city of Parauapebas / PA - Brazil. A model selection criterion is proposed that, in addition to taking into account the quality of fit, mechanisms are added that capture information about past forecasts. Such a proposal contributes by providing subsidies for an adequate selection of the best model in order to enable more precise characterization of the transmission dynamics and with less loss of information.

Strateaies to keep kidney transplant alive amid the SARS-CoV-2 panaemic

OBJECTIVE: This study aims to describe the result of the strategies adopted to maintain the transplant program amid the COVID-19 pandemic. METHODS: Since March 2020, several measures have been adopted sequentially, including the compulsory use of personal protective equipment and the real-time polymerase chain reaction testing of collaborators, symptomatic patients, potential deceased donors, candidates for recipients, and in-hospital readmissions, regardless of symptoms. The living-donor transplantation was restricted to exceptional cases. RESULTS: Among 1013 health professionals, 201 cases of COVID-19 were confirmed between March and August 2020, with no severe cases reported. In this period, we observed a 19% institutional increase in the number of transplants from deceased donors compared with that observed in the same period in 2019. There was no donor-derived severe acute respiratory syndrome virus (SARS-CoV-2) infection. Four COVID-19-positive patients underwent transplantation;after 28 days, all were alive and with functioning allograft. Among the 11,875 already transplanted patients being followed up, there were 546 individuals with confirmed diagnosis, 372 who required hospitalization, and 167 on mechanical ventilation, resulting in a 27% mortality rate. CONCLUSIONS: These data confirm that the adoption of sequential and coordinated measures amid the pandemic was able to successfully maintain the transplant program and ensure the safety of health professionals and transplanted patients who were already in follow-up.

COVID-PA Bulletin: reports on artificial intelligence-based forecasting in coping with COVID-19 pandemic in the state of Pará, Brazil

OBJECTIVE: To report the university extension research result entitled 'The COVID-PA Bulletin', which presented forecasts on the behavior of the pandemic in the state of Pará, Brazil. METHODS: The artificial intelligence technique also known as 'artificial neural networks' was used to generate 13 bulletins with short-term forecasts based on historical data from the State Department of Public Health information system. RESULTS: After eight months of predictions, the technique generated reliable results, with an average accuracy of 97% (observed for147 days) for confirmed cases, 96% (observed for 161 days) for deaths and 86% (observed for 72 days) for Intensive Care Unit bed occupancy. CONCLUSION: These bulletins have become a useful decision-making tool for public managers, assisting in the reallocation of hospital resources and optimization of COVID-19 control strategies in various regions of the state of Pará. OBJETIVO: Relatar o produto de pesquisa e extensão universitária denominado Boletim COVID-PA, que apresentou projeções sobre o comportamento da pandemia no estado do Pará, Brasil. MÉTODOS: Utilizou-se da técnica de inteligência artificial conhecida como ‘redes neurais artificiais’, para geração de 13 boletins com projeções de curto prazo baseadas nos dados históricos do sistema da Secretaria de Estado de Saúde Pública. RESULTADOS: Após oito meses de projeções, a técnica gerou resultados confiáveis, com precisão média de 97% (147 dias observados) para casos confirmados, 96% (161 dias observados) para óbitos e 86% (72 dias observados) para ocupação de leitos de unidade de terapia intensiva. CONCLUSÃO: Esses boletins tornaram-se um instrumento útil para a tomada de decisão de gestores públicos, auxiliando na realocação de recursos hospitalares e otimização das estratégias de controle da COVID-19 nas diversas regiões do estado do Pará. OBJETIVO: Reporte el resultado de la investigación y extensión universitaria denominada ‘Boletim COVID-PA’ que presentó proyecciones sobre el comportamiento de la pandemia en el estado de Pará, con un enfoque práctico y computacionalmente eficiente. MÉTODOS: Fue utilizada una técnica de inteligencia artificial denominadas Redes Neurales para generar trece boletines con proyecciones basado en datos históricos del sistema de la Secretaría de Salud Pública. RESULTADOS: Después de ocho meses de previsiones, la técnica genero resultados confiables con una precisión promedio de 97% (147 días observados) para casos confirmados, 96% (161 días observados) para los fallecimientos y 86% (72 días observados) para la ocupación de camas en las unidades de cuidados intensivos. CONCLUSIÓN: Estos boletines se convirtieron en una herramienta para la toma de decisiones, auxiliando en la redistribución de recursos en los hospitales en el estado de Pará.