ABSTRACT
Introducao: Todos os servicos de saude foram impactados durante a pandemia de COVID-19, os servicos de hemoterapia, que dependem de doadores voluntarios, sofreram com a necessidade de isolamento da populacao e pelo medo do contagio ao vir doar, tambem por doadores infectados e maior numero de transfusoes em pacientes com complicacoes da COVID-19. As outras patologias com necessidade de transfusao ainda existiam e os bancos de sangue tiveram que se reorganizar para buscar ativamente os doadores e atender as medidas necessarias para evitar o contagio, como nao causar aglomeracoes, distanciamento entre as cadeiras do doador e uso de mascara e alcool gel. Objetivos: Avaliar o perfil do doador de sangue do servico de hemoterapia do Hospital Marcio Cunha durante o periodo critico da pandemia de COVID-19. Materiais e Metodos: estudo descritivo, retrospectivo e quantitativo, realizado no servico de hemoterapia atraves de avaliacao do relatorio de producao Hemoterapica - Hemoprod, dos meses de maio 2020 a julho 2021, periodo com elevado numero de obitos por COVID-19 no Brasil. Resultados e Discussao: Nos meses de maio/20 a julho/21 foram entrevistados 12.154 candidatos, sendo 9.449 aptos para doacao de sangue total, media de 629 doadores/mes. A maior parte das doacoes foi espontanea (55,6%), seguida de reposicao e apenas uma doacao autologa no periodo. Em relacao ao tipo de doador;69,7% doaram pela primeira vez;29,5% de forma esporadica e apenas 0,7% de repeticao. A maioria dos doadores foi do genero masculino (58,2%) com idade acima de 29 anos (67,7%). A principal causa da inaptidao na triagem foi descrito como outras (20%), sendo mais comum o uso de medicamentos que impedem a doacao e procedimentos endoscopicos nos ultimos seis meses;3,65% apresentavam hematocrito abaixo do necessario;2,8% hipotensao e 1,04% comportamento de risco para doenca sexualmente transmissivel. No que se refere a triagem sorologica, 221 doadores apresentaram sorologia positiva (2,3%) sendo 47% anti-HBc total reagente, 45.8% sifilis;2,7% anti-HCV;1,8% HBsAg e HTLV e 0,9% HIV. Quanto ao perfil imunohematologico 41,8% foram do grupo O positivo e 28,7% A positivo, sendo os mais frequentes e 9,9% foram O negativo. No periodo foram produzidos 9.323 concentrados de hemacias e transfundidos 6.826 e produzidos 8.948 concentrados de plaquetas e transfundidos 3.983. Conclusao: Nao ha substituto para sangue humano, por isso os servicos de hemoterapia dependem dos doadores voluntarios para manter o estoque de hemocomponentes. No periodo da pandemia houve menor numero de doacoes e maior necessidade de transfusoes em decorrencias das complicacoes da COVID-19. O banco de sangue do Hospital Marcio Cunha atendeu as medidas sanitarias para evitar o contagio e utilizou de estrategias de captacao de doares para tentar diminuir o impacto para o setor assistencial, no periodo analisado o numero de doacoes foi suficiente para atender a demanda transfusional, fato tambem relacionado a reducao de cirurgias eletivas. Copyright © 2022
ABSTRACT
Vaccine immunization is considered a true milestone in public health by contributing to the reduction, protection and prevention of numerous communicable diseases and in the context of the COVID-19 pandemic it is no different. However, among the different expressions of the denialism of the coronavirus disease pandemic (COVID-19), are the fake news and information regarding the vaccine, making it difficult to adhere to immunization due to "fake news". Therefore, the present study aimed to present the educational actions that have popular health education as a reference, which were used in favor of adherence to vaccination in Brazil, and that are cited in the scientific literature. For this, a systematic review of scientific literature was carried out, using descriptors and search strategies: "Health Education AND COVID-19 Vaccines" and "Health Education AND Immunization", in the online databases Virtual Health Library (VHL) and Scientific Electronic Library Online (SciELO) - with the filters "Brazil", and publications from 2020, until December 2021, in the languages "Portuguese", "English" and "Spanish" and "article". The results point to different strategies of popular health education (HPS), such as: (i) conversation wheels in public health services;(ii) messages and electronic journals forwarded to SUS users by Primary Health Care;(iii) explanatory videos forwarded by public schools;and (iv) posters made available in public buildings in different municipalities. It is concluded that dialogical HPS contributes to the intellectual emancipation of citizens, making them able to decide about themselves, safely, when facing health situations.
ABSTRACT
The immune system is a complex architecture of a collective and coordinated network regulated by various pathways to thermodynamically maintain immune homeostasis. The gut microbiota plays a pivotal role that offers significant stimuli (i.e., gut-brain, gut-lung, and gut-liver axis) for both innate and adaptive immunity, mediating immune and metabolic homeostasis. An intricate correlation between changes in the gut microbiota (dysbiosis) and common diseases/disorders have been attributed to the invasion of pathogens, constant use of antibiotics, and hypercytokinemia—a hallmark of immune homeostasis imbalance. These factors contribute to the severity of inflammatory diseases such as cardiovascular diseases, neurological disorders, and of late the coronavirus disease, Covid-19. Probiotics (Lactobacillus spp. and Bifidobacterium spp.) have been considered as alternative and/or adjuvant therapeutic in restoring the balance of gut microbiota for maintaining immune homeostasis and integrity. The probiotics catalyze dietary fibers and proteins to generate short-chain fatty acids and tryptophan to promote antiinflammatory cytokines, reduce epithelium permeability, reinforcing immunity in the gut mucosa, and regulating the systemic immune response. Herein, we review our overarching understanding of current applications of probiotics in amelioration of gut microbiome, and the improvement of gut barrier function and maintaining immune homeostasis. We also highlight clinical trials on probiotics with reported results for the treatment of inflammatory diseases. Additionally, the looming global Covid-19 pandemic makes it prudent to highlight the role of probiotics in both the innate and adaptive human immune responses, especially amid the Covid-19 vaccination paradigm. © 2022 Elsevier Inc. All rights reserved.
ABSTRACT
RATIONALE: Competency in mechanical ventilation (MV) is essential for clinicians caring for critically ill patients and requires complex knowledge and skills to achieve optimal clinical outcomes. Most programs lack a structured MV curriculum and trainees report perception of insufficient training. Our objective was to create a MV curriculum for internal medicine residents. METHODS: We developed a MV curriculum in an academic hospital in Brazil, offered as an extensive eight-month course. Educational design followed principles to increase retention, interactivity and effectiveness of learning: self-directed learning modules, clinical scenarios, simulation, and continuous assessment with feedback. The course was structured in eight monthly synchronous online meetings that included the use of an online simulator (Xlung, Brazil). Participants completed a pre-course survey that included demographics, prior MV training, and confidence on MV skills, using Likert scales. We assessed baseline knowledge with an online multiple choice questionnaire (MCQ) with 24 questions, scored on a normalized scale of 0 to 10, that will be repeated at the end of the program. The project was submitted to the ethics committee and all residents in the first (PGY1) and second (PGY2) enrolled in the program were invited to participate and provide informed consent. We report baseline data on knowledge and confidence in MV for all participants. RESULTS: We included 137 internal medicine residents in April 2021, amidst the COVID-19 pandemic. Median age was 26 years-old (IQR 25-27), and 77 (56%) were males. The majority of participants reported critical care training during medical school, with 61% in the form of lectures and 78% in rotations, but only 43% reported having managed a mechanical ventilator during medical school. Sufficient training in MV prior to entering this study was reported by 17,6% of PGY1 and 51% of PGY2 . The majority of residents reported not being confident in setting MV parameters in obstructive lung disease and identifying patient-ventilator asynchrony (Figure 1). The median baseline MCQ score was 6,7 (IQR 5,8-7,5) for PGY1 and 7,1 (IQR 6,2-8,3) for PGY2. CONCLUSION: We developed an extensive eight month course encompassing MV competencies for internal medicine residents, combining self-directed learning modules with synchronous online meetings that include simulation. We found that prior to the course, most residents report not having received enough training in MV to perform their activities, do not feel confident in MV competencies, and have low to moderate performance on a knowledge test.