A new and simple score to predict adequate and deep response to ursodeoxycholic acid in patients with primary biliary cholangitis: the ALP-A score.

BACKGROUND: Ursodeoxycholic acid (UDCA) is the standard treatment for primary biliary cholangitis (PBC), but a significant proportion of patients do not respond adequately, leading to increased risk of adverse outcomes. This study aims to develop a new and straightforward predictive score to identify PBC patients likely to achieve a complete response to UDCA. METHODS: A logistic regression analysis was conducted using a derivation cohort of PBC patients to identify pre-treatment variables associated with response to UDCA. This analysis led to the development of the ALP-A score, calculated as: Age at diagnosis divided by (alkaline phosphatase at diagnosis/upper limit of normal). ALP-A score accuracy was evaluated using the area under the ROC curve, validated with a large external cohort from Brazil. Additionally, the correlation between the ALP-A score and the previously validated UDCA response score (URS) was assessed. RESULTS: ALP-A score had good predictive power for adequate (AUC 0.794; 95% CI, 0.737-0.852) and deep (0.76; 95% CI, 0.69-0.83) UDCA response at 1 year of treatment. A cutoff score of 17 and 23 points was determined to be the optimal threshold for distinguishing adequate and deep responders, respectively, from non-responders. ALP-A score demonstrated a sensitivity of 73%, specificity of 71%, positive predictive value of 65%, negative predictive value of 78%, and overall accuracy of 72% for biochemical response. The URS displayed similar discriminative ability (AUC 0.798; 95% CI, 0.741-0.855). CONCLUSION: ALP-A score performs comparably to URS but offers the great advantage of simplicity for routine clinical use. It serves as a valuable tool to identify PBC patients less likely to respond to UDCA treatment, facilitating early consideration of alternative therapeutic approaches.

Risk factors for cancer in patients with primary biliary cholangitis and autoimmune hepatitis and primary biliary cholangitis overlap syndrome.

INTRODUCTION AND OBJECTIVES: Primary biliary cholangitis (PBC) and autoimmune hepatitis (AIH) and PBC overlap syndrome (AIH/PBC) have been associated with a higher risk of hepatocellular carcinoma (HCC) and extra-hepatic malignancy (EHM). This study aims to assess potential risk factors associated with cancer development in PBC and AIH/PBC. MATERIALS AND METHODS: The Brazilian Cholestasis Study Group database was reviewed to compare clinical and laboratory features of PBC patients with HCC and EHM with those without cancer. RESULTS: Among the 752 PBC patients enrolled, 64 of them with AIH/PBC, 87 cancers were identified in 72 patients, including 20 cases of HCC and 67 of EHM. Patients with HCC had a higher prevalence of cirrhosis (95% vs. 32.5% of those subjects without cancer, p≤0.001), smoking (55% vs. 12.3%, p≤0.001), CREST syndrome (30% vs 7.6%, p=0.003) and prior azathioprine (30% vs 8%, p= 0.005) and prednisone (35% vs 14%, p= 0.018) use, whereas patients with EHM had a higher prevalence of smoking (42.3% vs 12.4% of those subjects without cancer, p= <0.001), AMA positivity (96.6% vs 80.1%, p≤0.001), azathioprine therapy (21% vs 7.9%, p= 0.01) and concurrent other autoimmune diseases. In multivariate analysis, cirrhosis, obesity and prior azathioprine therapy were independent risk factors for HCC, while Sjogren syndrome and psoriasis were associated with EHM. Fibrates reduced EHM risk. CONCLUSIONS: The prevalence of EHM is higher when compared to HCC in PBC patients. Cirrhosis, obesity, prior azathioprine use, and concurrent autoimmune diseases were significantly associated with cancer in PBC.

Response to Ursodeoxycholic Acid May Be Assessed Earlier to Allow Second-Line Therapy in Patients with Unresponsive Primary Biliary Cholangitis.

BACKGROUND: Response to ursodeoxycholic acid (UDCA) in primary biliary cholangitis (PBC) has been traditionally assessed 1 to 2 years after treatment initiation. With the development of new drugs, some patients may benefit from an earlier introduction of second-line therapies. AIMS: This study aims to identify whether well-validated response criteria could correctly identify individuals likely to benefit from add-on second-line therapy at 6 months. METHODS: Analysis of a multicenter retrospective cohort which included only patients with clear-cut PBC. RESULTS: 206 patients with PBC (96.6% women; mean age 54 ± 12 years) were included. Kappa concordance was substantial for Toronto (0.67), Rotterdam (0.65), Paris 1 (0.63) and 2 (0.63) criteria at 6 and 12 months, whereas Barcelona (0.47) and POISE trial (0.59) criteria exhibited moderate agreement. Non-response rates to UDCA was not statistically different when assessed either at 6 or 12 months using Toronto, Rotterdam or Paris 2 criteria. Those differences were even smaller or absent in those subjects with advanced PBC. Mean baseline alkaline phosphatase was 2.73 ± 1.95 times the upper limit of normal (× ULN) among responders versus 5.05 ± 3.08 × ULN in non-responders (p < 0.001). CONCLUSIONS: After 6 months of treatment with UDCA, the absence of response by different criteria could properly identify patients who could benefit from early addition of second-line therapies, especially in patients with advanced disease or high baseline liver enzymes levels.

Problemas éticos vivenciados por enfermeiros gestores na pandemia da COVID-19 em um hospital universitário / Ethical problems experienced by nurse managers in the pandemic of COVID-19 in a university hospital

RESUMO Objetivo compreender os problemas éticos vivenciados por enfermeiros gestores no contexto da pandemia da COVID-19. Métodos estudo qualitativo, realizado com 19 enfermeiros gestores. Os critérios de inclusão foram enfermeiros que exerciam a função de gestão há, pelo menos, seis meses, e os de exclusão, os que ocupavam cargo assistencial. Coleta de dados realizada por meio de entrevistas individuais com roteiro semiestruturado e análise documental, e analisados por meio da Análise de Conteúdo. Resultados os problemas éticos estão relacionados a: duplicidade e falta de informação sobre as normas e rotinas; ausência de fluxo dos pacientes; mudanças de rotina sem comunicação com os enfermeiros coordenadores; absenteísmo e presenteísmo da equipe de enfermagem; recusa de remanejamento por parte dos técnicos; profissionais da enfermagem que optaram por atuar no setor da COVID-19 e ganhar adicional de insalubridade e os que não optaram devido ao medo da doença; e conflitos provenientes do paciente. Conclusão a análise revelou situações marcadas por problemas éticos que comprometem a dinâmica de trabalho e a qualidade do atendimento. Contribuições para a prática a compreensão dos problemas éticos contribui para a promoção de melhorias no planejamento, intervenção e preparo dos profissionais para lidar com questões conflitantes vivenciadas na gestão hospitalar.

ABSTRACT Objective to understand the ethical problems experienced by nurse managers in the context of the COVID-19 pandemic. Methods qualitative study, conducted with 19 nurse managers. The inclusion criteria were nurses who had held a management position for at least six months, and the exclusion criteria were those who held an assistance position. Data were collected through individual interviews with a semi-structured script and document analysis and analyzed using Content Analysis. Results the ethical problems were related to duplicity and lack of information about norms and routines; lack of patient flow; routine changes without communication with the nurse coordinators; absenteeism and presenteeism of the nursing team; refusal of reassignment by technicians; nursing professionals who chose to work in the COVID-19 sector and earn additional unhealthy salary and those who did not choose due to fear of disease; and conflicts arising from the patient. Conclusion the analysis revealed situations marked by ethical problems that compromise the dynamics of work and the quality of care. Contributions to practice understanding ethical problems contributes to the promotion of improvements in planning, intervention, and preparation of professionals to deal with conflicting issues experienced in hospital management.

Diagnosis, Prognosis and Treatment of Canine Cutaneous and Subcutaneous Mast Cell Tumors.

Mast cell tumors (MCTs) are hematopoietic neoplasms composed of mast cells. It is highly common in dogs and is extremely important in the veterinary oncology field. It represents the third most common tumor subtype, and is the most common malignant skin tumor in dogs, corresponding to 11% of skin cancer cases. The objective of this critical review was to present the report of the 2nd Consensus meeting on the Diagnosis, Prognosis, and Treatment of Canine Cutaneous and Subcutaneous Mast Cell Tumors, which was organized by the Brazilian Association of Veterinary Oncology (ABROVET) in August 2021. The most recent information on cutaneous and subcutaneous mast cell tumors in dogs is presented and discussed.

Clinical features and treatment outcomes of primary biliary cholangitis in a highly admixed population.

INTRODUCTION AND OBJECTIVES: Little is known about primary biliary cholangitis (PBC) in non-whites. The purpose of this study was to evaluate clinical features and outcomes of PBC in a highly admixed population. MATERIAL AND METHODS: The Brazilian Cholestasis Study Group multicentre database was reviewed to assess demographics, clinical features and treatment outcomes of Brazilian patients with PBC. RESULTS: 562 patients (95% females, mean age 51 ± 11 years) with PBC were included. Concurrent autoimmune diseases and overlap with autoimmune hepatitis (AIH) occurred, respectively, in 18.9% and 14%. After a mean follow-up was 6.2 ± 5.3 years, 32% had cirrhosis, 7% underwent liver transplantation and 3% died of liver-related causes. 96% were treated with ursodeoxycholic acid (UDCA) and 12% required add-on therapy with fibrates, either bezafibrate, fenofibrate or ciprofibrate. Response to UDCA and to UDCA/fibrates therapy varied from 39%-67% and 42-61%, respectively, according to different validated criteria. Advanced histological stages and non-adherence to treatment were associated with primary non-response to UDCA, while lower baseline alkaline phosphatase (ALP) and aspartate aminotransferase (AST) levels correlated with better responses to both UDCA and UDCA/fibrates. CONCLUSIONS: Clinical features of PBC in highly admixed Brazilians were similar to those reported in Caucasians and Asians, but with inferior rates of overlap syndrome with AIH. Response to UDCA was lower than expected and inversely associated with histological stage and baseline AST and ALP levels. Most of patients benefited from add-on fibrates, including ciprofibrate. A huge heterogeneity in response to UDCA therapy according to available international criteria was observed and reinforces the need of global standardization.

Anti-mitochondrial Antibody-Negative Primary Biliary Cholangitis Is Part of the Same Spectrum of Classical Primary Biliary Cholangitis.

BACKGROUND: Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease in which anti-mitochondrial antibodies (AMA) are the diagnostic hallmark. Whether AMA-negative PBC patients represent a different phenotype of disease is highly debated. AIMS: The purpose of our study was to compare AMA-positive and AMA-negative PBC patients in a large non-white admixed Brazilian cohort. METHODS: The Brazilian Cholestasis Study Group multicentre database was reviewed to assess demographics, clinical features and treatment outcomes of Brazilian PBC patients, stratifying data according to AMA status. RESULTS: A total of 464 subjects (95.4% females, mean age 56 ± 5 years) with PBC were included. Three hundred and eighty-four (83%) subjects were AMA-positive, whereas 80 (17%) had AMA-negative PBC. Subjects with AMA-negative PBC were significantly younger (52.2 ± 14 vs. 59.6 ± 11 years, p = 0.001) and had their first symptom at an earlier age (43.2 ± 13 vs. 49.5 ± 12 years, p = 0.005). Frequency of type 2 diabetes was significantly increased in subjects with AMA-negative PBC (22.5% vs. 12.2%, p = 0.03). Lower IgM (272.2 ± 183 vs. 383.2 ± 378 mg/dL, p = 0.01) and triglycerides (107.6 ± 59.8 vs.129.3 ± 75.7 mg/dL, p = 0.025) and higher bilirubin (3.8 ± 13.5 vs. 1.8 ± 3.4 mg/dL, p = 0.02) levels were also observed in this subgroup. Response to ursodeoxycholic acid varied from 40.5 to 63.3% in AMA-positive and 34 to 62.3% in AMA-negative individuals, according to different response criteria. Outcomes such as development of liver-related complications, death and requirement for liver transplantation were similar in both groups. CONCLUSIONS: AMA-negative PBC patients are similar to their AMA-positive counterparts with subtle differences observed in clinical and laboratory features.

Refractory feline sporotrichosis: a comparative analysis on the clinical, histopathological, and cytopathological aspects / Esporotricose felina refratária: uma análise comparativa sobre os aspectos clínico, histopatológico e citopatológico

Sporotrichosis is a chronic fungal infection caused by Sporothrix species. The occurrence of cases that are resistant to long-term treatment, especially in the nasal planum of cats, emphasizes the importance of studying its pathogenesis. The purpose of this study was to analyze and compare the inflammatory process of cutaneous lesions of feline refractory sporotrichosis to clinical aspects through cytopathological and histopathological examination. Moreover, the study included 13 cats with cutaneous lesions that had been resistant to itraconazole treatment for more than a year. Cutaneous lesions samples were collected for cytopathological, histopathological, and fungal culture analyses. Tissue fragments were processed and stained with hematoxylin-eosin (HE) and Grocott methenamine silver (GMS). Further, two clinical presentations had the highest occurrence: the localized cutaneous form in animals with good general condition and stable disease (n=9, 69.2%) and the disseminated cutaneous form in cats with poor general condition (n=4, 30.8%). In cats with refractory sporotrichosis, the nasal planum (84.6%) was the most common location of lesions. In the cytopathological study, cats with fewer than two lesions and in good general condition (n=9, 69.2%) showed absence or mild yeast intensity (up to 5 yeasts per field), lower intensity of macrophages and neutrophils, and higher intensity of epithelioid cells, lymphocytes, plasma cells, and eosinophils. On the other hand, (n=4, 30.8%) of the cats with disseminated sporotrichosis and a poor general condition had a marked intensity of yeasts, which were mostly phagocytosed by an increased number of macrophages and neutrophils. Of those animals with good general condition, the majority (n=6, 66.7%) had higher eosinophil intensity. In histopathology, malformed suppurative granuloma was the predominant type (n=9, 69.2%) in feline sporotrichosis lesions, followed by well-formed granulomas (n=4, 30.8%). Malformed granulomas showed mild to moderate fungal intensity (55.6%) in animals with good general condition and localized lesions while marked fungal intensity (44.4%) in cats with the disseminated form of the disease and poor general condition. Well-formed granulomas (n=4, 30.7%) had mild to moderate intensity of fungal load, and 75% of the animals with this type of granuloma had only one lesion and were in good general condition. Long-term itraconazole treatment in these cats with refractory sporotrichosis can keep the infection under control and localized lesions stable; however, fungus reactivation can occur, resulting in an exuberant and inefficient immune response.(AU)

A esporotricose é uma infecção fúngica crônica causada por espécies do gênero Sporothrix. A ocorrência de casos refratários ao tratamento de longo prazo, especialmente na região nasal de gatos, alerta para a importância do estudo de sua patogênese. Este estudo teve como objetivo analisar o processo inflamatório das lesões cutâneas de esporotricose felina refratária ao tratamento, por meio de exames citopatológico e histopalógico, e comparar com aspectos clínicos. Treze gatos com lesões cutâneas refratárias ao tratamento com Itraconazol por mais de um ano foram incluídos no estudo. Amostras de lesões cutâneas foram coletadas para análises citopatológicas, histopatológicas e cultura fúngica. Fragmentos de tecidos foram processados e corados pela hematoxilina-eosina (HE) e Prata Metenamina de Grocott (GMS). Duas apresentações clínicas tiveram maior ocorrência: a forma localizada cutânea em animais com bom estado geral e doença estável (n=9, 69,2%); e a forma disseminada cutânea em gatos com estado geral ruim (n=4, 30,8%). A região nasal (84,6%) foi a localização mais frequente das lesões nos gatos com esporotricose refratária ao tratamento. No estudo citopatológico, felinos com menos de duas lesões, e em bom estado geral, (n=9, 69,2%) revelaram ausência ou leve intensidade de leveduras (até 5 leveduras por campo), menor intensidade de macrófagos e neutrófilos, e maior intensidade de células epitelióides, linfócitos, plasmócitos e eosinófilos. Enquanto, (n=4, 30,8%) dos felinos que apresentavam a forma disseminada da esporotricose associada a um estado geral ruim, revelaram acentuada intensidade de leveduras em sua maioria fagocitadas por acentuado número de macrófagos e neutrófilos. Dos animais com bom estado geral, a maioria (n=6, 66,7%) apresentava maior intensidade de eosinófilos. Na histopatologia, o granuloma supurativo mal formado foi o tipo predominante (n=9, 69,2%) nas lesões de esporotricose felina, e (n=4, 30,8%) foram de granulomas bem formados. Granulomas mal formados apresentaram leve a moderada intensidade fúngica (55,6%) nos animais com bom estado geral e lesões localizadas, e acentuada intensidade fúngica (44,4%) nos gatos com a forma disseminada da doença e estado geral ruim. Granulomas bem formados (n=4, 30,7%) apresentaram leve a moderada intensidade de carga fúngica, sendo 75% dos animais com esse tipo de granuloma com apenas uma lesão e bom estadogeral. O tratamento de longo prazo com itraconazol, nesses gatos com esporotricose refratária, pode manter a infecção controlada e lesões localizadas estáveis de forma temporária, contudo a reativação do fungo pode ocorrer levando a uma resposta imunológica exuberante e ineficiente.(AU)

Refractory feline sporotrichosis: a comparative analysis on the clinical, histopathological, and cytopathological aspects / Esporotricose felina refratária: uma análise comparativa sobre os aspectos clínico, histopatológico e citopatológico

Sporotrichosis is a chronic fungal infection caused by Sporothrix species. The occurrence of cases that are resistant to long-term treatment, especially in the nasal planum of cats, emphasizes the importance of studying its pathogenesis. The purpose of this study was to analyze and compare the inflammatory process of cutaneous lesions of feline refractory sporotrichosis to clinical aspects through cytopathological and histopathological examination. Moreover, the study included 13 cats with cutaneous lesions that had been resistant to itraconazole treatment for more than a year. Cutaneous lesions samples were collected for cytopathological, histopathological, and fungal culture analyses. Tissue fragments were processed and stained with hematoxylin-eosin (HE) and Grocott methenamine silver (GMS). Further, two clinical presentations had the highest occurrence: the localized cutaneous form in animals with good general condition and stable disease (n=9, 69.2%) and the disseminated cutaneous form in cats with poor general condition (n=4, 30.8%). In cats with refractory sporotrichosis, the nasal planum (84.6%) was the most common location of lesions. In the cytopathological study, cats with fewer than two lesions and in good general condition (n=9, 69.2%) showed absence or mild yeast intensity (up to 5 yeasts per field), lower intensity of macrophages and neutrophils, and higher intensity of epithelioid cells, lymphocytes, plasma cells, and eosinophils. On the other hand, (n=4, 30.8%) of the cats with disseminated sporotrichosis and a poor general condition had a marked intensity of yeasts, which were mostly phagocytosed by an increased number of macrophages and neutrophils. Of those animals with good general condition, the majority (n=6, 66.7%) had higher eosinophil intensity. In histopathology, malformed suppurative granuloma was the predominant type (n=9, 69.2%) in feline sporotrichosis lesions, followed by well-formed granulomas (n=4, 30.8%). Malformed granulomas showed mild to moderate fungal intensity (55.6%) in animals with good general condition and localized lesions while marked fungal intensity (44.4%) in cats with the disseminated form of the disease and poor general condition. Well-formed granulomas (n=4, 30.7%) had mild to moderate intensity of fungal load, and 75% of the animals with this type of granuloma had only one lesion and were in good general condition. Long-term itraconazole treatment in these cats with refractory sporotrichosis can keep the infection under control and localized lesions stable; however, fungus reactivation can occur, resulting in an exuberant and inefficient immune response.

A esporotricose é uma infecção fúngica crônica causada por espécies do gênero Sporothrix. A ocorrência de casos refratários ao tratamento de longo prazo, especialmente na região nasal de gatos, alerta para a importância do estudo de sua patogênese. Este estudo teve como objetivo analisar o processo inflamatório das lesões cutâneas de esporotricose felina refratária ao tratamento, por meio de exames citopatológico e histopalógico, e comparar com aspectos clínicos. Treze gatos com lesões cutâneas refratárias ao tratamento com Itraconazol por mais de um ano foram incluídos no estudo. Amostras de lesões cutâneas foram coletadas para análises citopatológicas, histopatológicas e cultura fúngica. Fragmentos de tecidos foram processados e corados pela hematoxilina-eosina (HE) e Prata Metenamina de Grocott (GMS). Duas apresentações clínicas tiveram maior ocorrência: a forma localizada cutânea em animais com bom estado geral e doença estável (n=9, 69,2%); e a forma disseminada cutânea em gatos com estado geral ruim (n=4, 30,8%). A região nasal (84,6%) foi a localização mais frequente das lesões nos gatos com esporotricose refratária ao tratamento. No estudo citopatológico, felinos com menos de duas lesões, e em bom estado geral, (n=9, 69,2%) revelaram ausência ou leve intensidade de leveduras (até 5 leveduras por campo), menor intensidade de macrófagos e neutrófilos, e maior intensidade de células epitelióides, linfócitos, plasmócitos e eosinófilos. Enquanto, (n=4, 30,8%) dos felinos que apresentavam a forma disseminada da esporotricose associada a um estado geral ruim, revelaram acentuada intensidade de leveduras em sua maioria fagocitadas por acentuado número de macrófagos e neutrófilos. Dos animais com bom estado geral, a maioria (n=6, 66,7%) apresentava maior intensidade de eosinófilos. Na histopatologia, o granuloma supurativo mal formado foi o tipo predominante (n=9, 69,2%) nas lesões de esporotricose felina, e (n=4, 30,8%) foram de granulomas bem formados. Granulomas mal formados apresentaram leve a moderada intensidade fúngica (55,6%) nos animais com bom estado geral e lesões localizadas, e acentuada intensidade fúngica (44,4%) nos gatos com a forma disseminada da doença e estado geral ruim. Granulomas bem formados (n=4, 30,7%) apresentaram leve a moderada intensidade de carga fúngica, sendo 75% dos animais com esse tipo de granuloma com apenas uma lesão e bom estadogeral. O tratamento de longo prazo com itraconazol, nesses gatos com esporotricose refratária, pode manter a infecção controlada e lesões localizadas estáveis de forma temporária, contudo a reativação do fungo pode ocorrer levando a uma resposta imunológica exuberante e ineficiente.

Refractory feline sporotrichosis: a comparative analysis on the clinical, histopathological, and cytopathological aspects

ABSTRACT: Sporotrichosis is a chronic fungal infection caused by Sporothrix species. The occurrence of cases that are resistant to long-term treatment, especially in the nasal planum of cats, emphasizes the importance of studying its pathogenesis. The purpose of this study was to analyze and compare the inflammatory process of cutaneous lesions of feline refractory sporotrichosis to clinical aspects through cytopathological and histopathological examination. Moreover, the study included 13 cats with cutaneous lesions that had been resistant to itraconazole treatment for more than a year. Cutaneous lesions samples were collected for cytopathological, histopathological, and fungal culture analyses. Tissue fragments were processed and stained with hematoxylin-eosin (HE) and Grocott methenamine silver (GMS). Further, two clinical presentations had the highest occurrence: the localized cutaneous form in animals with good general condition and stable disease (n=9, 69.2%) and the disseminated cutaneous form in cats with poor general condition (n=4, 30.8%). In cats with refractory sporotrichosis, the nasal planum (84.6%) was the most common location of lesions. In the cytopathological study, cats with fewer than two lesions and in good general condition (n=9, 69.2%) showed absence or mild yeast intensity (up to 5 yeasts per field), lower intensity of macrophages and neutrophils, and higher intensity of epithelioid cells, lymphocytes, plasma cells, and eosinophils. On the other hand, (n=4, 30.8%) of the cats with disseminated sporotrichosis and a poor general condition had a marked intensity of yeasts, which were mostly phagocytosed by an increased number of macrophages and neutrophils. Of those animals with good general condition, the majority (n=6, 66.7%) had higher eosinophil intensity. In histopathology, malformed suppurative granuloma was the predominant type (n=9, 69.2%) in feline sporotrichosis lesions, followed by well-formed granulomas (n=4, 30.8%). Malformed granulomas showed mild to moderate fungal intensity (55.6%) in animals with good general condition and localized lesions while marked fungal intensity (44.4%) in cats with the disseminated form of the disease and poor general condition. Well-formed granulomas (n=4, 30.7%) had mild to moderate intensity of fungal load, and 75% of the animals with this type of granuloma had only one lesion and were in good general condition. Long-term itraconazole treatment in these cats with refractory sporotrichosis can keep the infection under control and localized lesions stable; however, fungus reactivation can occur, resulting in an exuberant and inefficient immune response.

RESUMO: A esporotricose é uma infecção fúngica crônica causada por espécies do gênero Sporothrix. A ocorrência de casos refratários ao tratamento de longo prazo, especialmente na região nasal de gatos, alerta para a importância do estudo de sua patogênese. Este estudo teve como objetivo analisar o processo inflamatório das lesões cutâneas de esporotricose felina refratária ao tratamento, por meio de exames citopatológico e histopalógico, e comparar com aspectos clínicos. Treze gatos com lesões cutâneas refratárias ao tratamento com Itraconazol por mais de um ano foram incluídos no estudo. Amostras de lesões cutâneas foram coletadas para análises citopatológicas, histopatológicas e cultura fúngica. Fragmentos de tecidos foram processados e corados pela hematoxilina-eosina (HE) e Prata Metenamina de Grocott (GMS). Duas apresentações clínicas tiveram maior ocorrência: a forma localizada cutânea em animais com bom estado geral e doença estável (n=9, 69,2%); e a forma disseminada cutânea em gatos com estado geral ruim (n=4, 30,8%). A região nasal (84,6%) foi a localização mais frequente das lesões nos gatos com esporotricose refratária ao tratamento. No estudo citopatológico, felinos com menos de duas lesões, e em bom estado geral, (n=9, 69,2%) revelaram ausência ou leve intensidade de leveduras (até 5 leveduras por campo), menor intensidade de macrófagos e neutrófilos, e maior intensidade de células epitelióides, linfócitos, plasmócitos e eosinófilos. Enquanto, (n=4, 30,8%) dos felinos que apresentavam a forma disseminada da esporotricose associada a um estado geral ruim, revelaram acentuada intensidade de leveduras em sua maioria fagocitadas por acentuado número de macrófagos e neutrófilos. Dos animais com bom estado geral, a maioria (n=6, 66,7%) apresentava maior intensidade de eosinófilos. Na histopatologia, o granuloma supurativo mal formado foi o tipo predominante (n=9, 69,2%) nas lesões de esporotricose felina, e (n=4, 30,8%) foram de granulomas bem formados. Granulomas mal formados apresentaram leve a moderada intensidade fúngica (55,6%) nos animais com bom estado geral e lesões localizadas, e acentuada intensidade fúngica (44,4%) nos gatos com a forma disseminada da doença e estado geral ruim. Granulomas bem formados (n=4, 30,7%) apresentaram leve a moderada intensidade de carga fúngica, sendo 75% dos animais com esse tipo de granuloma com apenas uma lesão e bom estadogeral. O tratamento de longo prazo com itraconazol, nesses gatos com esporotricose refratária, pode manter a infecção controlada e lesões localizadas estáveis de forma temporária, contudo a reativação do fungo pode ocorrer levando a uma resposta imunológica exuberante e ineficiente.

Meningioma intracraniano em cão - tratamento com radioterapia / Intracranial meningioma in a dog - treatment with radiotherapy

Background: The most common primary brain neoplasm is meningioma. Dolichocephalic breeds are predisposed and there is no sexual predilection. Clinical signs depend on the location and size of the tumor and have a progressive course. Primary treatement includes surgery, radiotherapy or both. This study aimed to describe the treatment of a dog with suspected intracranial meningioma with definitive radiotherapy, which resulted in significant clinical improvement and prolonged survival. Case: A 9-year-old Shetland Shepherd bitch was diagnosed with a head tilt to the left side that progressed over a few weeks. She previously received corticosteroid therapy, which resulted a clinical improvement that worsened after treatment was discontinued. Computed tomography revealed an extra-axial brain mass in the caudal fossa, lateralized to the right, welldelimited, and measuring approximately 1.5 × 1.4 × 1.7 cm, suggestive of intracranial meningioma. The patient was treated with radiotherapy using Cobalt-60 equipment, with 18 daily fractions of 2.5 Gy at a total dose of 45 Gy using parallel and opposite technique fields. A new tomography performed 30 days after treatment showed a remission of 85% of the initial brain mass measuring approximately 0.9 × 1.0 × 0.5 cm, as well as complete resolution of the clinical signs initially presented. After 14 months, the patient presented with signs of lethargy and ataxia and was medicated with hydroxyurea at a dose of 50 mg/kg 3 times a week and corticosteroid therapy. However, the patient's neurological condition deteriorated, and she was subjected to reirradiation using the same protocol used previously, which resulted in clinical improvement and a 54% reduction in tumor volume on magnetic resonance. As a late side effect, only permanent alopecia in the irradiated region was observed. The patient died of disease 330 days after the second course of radiotherapy, with a total survival time of 1087 days. Discussion: Meningiomas are extra-axial neoplasms of the central nervous system that grow inside the dura mater. The literature shows that meningiomas are more common in dolichocephalic races with a mean age of 9 years, which supports our findings. Meningiomas most commonly affect the cortical thalamus and cerebellopontine region in dogs, which are normally associated with vestibular symptoms, as seen in this case. Diencephalic damage can result in vestibular signals since the thalamus functions as a relay station for vestibular afferent stimuli that are relayed to the cerebral cortex. In addition to the vestibular syndrome, common clinical signs associated with meningiomas in dogs include seizures, behavioral changes, and walking in circles, which are frequently misinterpreted due to tumor-induced side effects, such as cerebral edema, obstructive hydrocephalus, and cerebral hernia. Advanced imaging techniques should be used to diagnose intracranial neoplasms. In this case, computed tomography was critical for diagnosis and treatment planning. Meningioma treatment may comprise palliative measures, surgery, and radiotherapy. Radiotherapy as a single treatment can improve the quality of life with a decrease in clinical signs and a median survival time of approximately 250-536 days, as reported in the literature. Hydroxyurea can be a therapeutic option in inoperable cases and for patients with clinical limitations to undergo successive anesthesia during radiotherapy. Its most serious side effect is progressive myelosuppression. It can cause temporary partial tumor remission and improvement in clinical signs. As previously stated, radiotherapy can be an effective primary treatment option for treating intracranial meningiomas in dogs, with significant improvement in neurological clinical signs and mild side effects.

Estudo das prevalências de distúrbios metabólicos em pacientes obesos e em portadores de hepatite C / Study of prevalence of metabolic disorders in obese patients and in patients with hepatitis C

Introdução: a infecção crônica pelo vírus da hepatite C (HCV) e a obesidade podem induzir esteatose hepática e diabetes mellitus (DM). Objetivo: avaliar a prevalência de obesidade e de distúrbios metabólicos em pacientes com HCV; estudar a prevalência de HCV e os distúrbios metabólicos em pacientes obesos. Comparar o perfil glicêmico entre os grupos. Metodologia: estudo analítico, com pacientes acompanhados nos ambulatórios de Hepatite C e Obesidade. Variáveis analisadas: glicemia, hemoglobina glicada (A1C), esteatose hepática, HCV, estágio de fibrose hepática e dados sociodemográficos. Resultados: no ambulatório de obesidade 45 pacientes foram avaliados, dos quais 6,7% tinham hepatite C, 40% DM e 61-73% esteatose hepática. As médias das enzimas hepáticas (U/L) foram: AST 22,9; ALT 25,2; FAL 146,5 e GGT 63. Nos obesos com DM, 72,2% apresentavam A1C < 7%. A segunda amostra continha 159 portadores de HCV do ambulatório de hepatologia: 17,9% tinham obesidade, 18,9% DM e 27% esteatose hepática. As médias das enzimas hepáticas (U/L) consistiram em: AST 70,5; ALT 90,6; FAL 108,5 e GGT 131,7. Entre os diabéticos com HCV, 52% não apresentavam A1C < 7%. Conclusão: foi encontrada alta prevalência de hepatite C em pacientes com obesidade (6,7%) quando comparados com a população de Salvador (1,5-1,8%). Os distúrbios metabólicos foram mais frequentes entre obesos, porém os diabéticos com obesidade revelaram A1C menores do que os diabéticos com HCV, sugerindo, neste estudo, que pode existir interferência viral no controle glicídico. A esteatose hepática foi mais prevalente entre obesos.

Introduction: Hepatitis C virus infection (HCV) and Obesity can to induce hepatic steatosis and diabetes mellitus (DM). Objectives: to evaluate the prevalence of obesity and metabolic disorders in HCV viremic patients. To study the prevalence of hepatitis C and metabolic disorders in patients with obesity. To compare glycemic profile between the groups. Methods: analytical study, with patients followed up at hepatitis C and Obesity outpatient clinics patients. Variables studied: blood glucose, glycated hemoglobin (A1C), hepatic steatosis, HCV, hepatic fibrosis stage and sociodemographic data. Results: in Obesity clinic sample 45 patients were evaluated, 6,7% was hepatitis C, 40% DM and 61% -73% hepatic steatosis. Mean of liver enzymes levels (U/L) were: AST 22.9; ALT 25.2; FAL 146.5 and GGT 63. In obese with DM, 72.2% of them were able to maintain A1C < 7%. The second sample contained 159 HCV carriers at the hepatology clinic, 17,9% was Obesity, 18,9% DM and 27% hepatic steatosis. Averages of serum liver enzymes level (U/ L) were: AST 70.5; ALT 90.6; FAL 108.5 and GGT 131.7. Among diabetics with HCV, 52% are unable to maintain A1C < 7%. Conclusions: found high prevalence of hepatitis C in patients with obesity (6.7%) when compared to the population of Salvador (1.5%-1.8%). Metabolic disorders were more frequent in the obese group, but diabetics with obesity have lower A1C values than diabetics with HCV, suggesting, in this study, that there may be a viral interference with glycid control. Liver steatosis is more prevalent among obese people

Atuação do enfermeiro no contexto da acreditação hospitalar: uma revisão integrativa / Nurse's performance in the contexto of hospitalar accreditation: na integrative review

Resumo Objetivo: Compreender a atuação do enfermeiro no contexto da Acreditação Hospitalar. Método: Trata-se de uma revisão integrativa da literatura, realizada de janeiro a junho de 2019, nas bases Literatura Latino-Americana e do Caribe em Ciências da Saúde, Bases de Dados Específica da Enfermagem, Cumulative Index to Nursing and Allied Health Literature (CINAHL) e Medical Literature Analysis and Retrieval System Online. Foram selecionados artigos originais, nos idiomas português, inglês e espanhol, que apresentassem relatos ou experiências da atuação do enfermeiro em contextos de Acreditação Hospitalar da Organização Nacional de Acreditação. Os artigos foram analisados por meio da análise de conteúdo. Resultado: Como resultado encontraram-se 10 artigos que respondiam ao objetivo do estudo e emergiram três categorias temáticas referentes ao papel do enfermeiro: Assistencial, Administrativo e Educativo. Na assistência, o enfermeiro exerce atividades de avaliação de resultados e ações, emprego e elaboração de indicadores, aplicação de protocolos, controle de medicamentos, produtos e equipamentos, articulação entre a equipe multiprofissional e incorporação de medidas de segurança. No administrativo, realização de planejamento, estabelecimento de metas, participação em comissões, desenvolvimento de políticas de qualidade e reorganização do trabalho. Como educador, o enfermeiro desenvolve ações de fortalecimento da cultura de segurança e qualidade. Conclusão: Que o enfermeiro possuía competências e habilidades que auxiliavam no processo de Acreditação Hospitalar, importantes para o credenciamento da instituição Hospitalar

Abstract Objective: Understand the role of nurses in the context of Hospital Accreditation. Method: This was an integrative literature review, carried out between January and June 2019, on the basis of Latin American and Caribbean Literature in Health Sciences, Specific Nursing Databases, Cumulative Index to Nursing and Allied Health Literature and Medical Literature Analysis and Retrieval System Online. Original articles were selected, in Portuguese, English and Spanish, that presented reports or experiences of the nurse's performance in contexts of Hospital Accreditation of the National Accreditation Organization. The articles were analyzed through content analysis. Results: As a result, 10 articles were found that responded to the objective of the study and emerged three thematic categories referring to the role of the nurse: Assistance, Administrative and Educational. In care, nurses perform activities to evaluate results and actions, use and develop indicators, apply protocols, control medications, products and equipment, articulation between the multidisciplinary team and incorporation of safety measures. In the administrative area, carrying out planning, setting goals, participating in commissions, developing quality policies and reorganizing work. As an educator, the nurse develops actions to strengthen the culture of safety and quality. Conclusión: That was understood that the nurse had skills and abilities that assisted in the Hospital Accreditation process, which were important for the accreditation of the hospital institution.

Resumen Objetivo: Comprender el papel del enfermero en el contexto de la acreditación hospitalaria. Método: Se trata de una revisión integrativa de la literatura, realizada entre enero y junio de 2019, sobre la base de la literatura latinoamericana y caribeña en ciencias de la salud, bases de datos de enfermería específicas, índice acumulativo de literatura de enfermería y salud afín y sistema de análisis y recuperación de literatura médica en línea. Se seleccionaron artículos originales, en portugués, inglés y español, que presentaban informes o experiencias sobre el desempeño del enfermero en contextos de acreditación hospitalaria de la Organización Nacional de Acreditación. Los artículos fueron analizados mediante análisis de contenido. Resultados: Como resultado, se encontraron 10 artículos que respondieron al objetivo del estudio y emergieron tres categorías temáticas relacionadas con el rol del enfermero: Asistencial, Administrativo y Educativo. En el asistencial, el enfermero realiza actividades para evaluar resultados y acciones, usar y desarrollar indicadores, aplicar protocolos, controlar medicamentos, productos y equipos, articulación entre el equipo multidisciplinario e incorporación de medidas de seguridad. En el área administrativa, realiza la planificación, establece metas, participa en comisiones, desarrolla políticas de calidad y reorganiza el trabajo. Como educador, el enfermero desarrolla acciones para fortalecer la cultura de seguridad y calidad. Conclusión: El enfermero tenía habilidades y destrezas que ayudan en el proceso de acreditación del hospital, que son importantes para la acreditación de la institución hospitalaria.

Regimes de verdade na pandemia de Covid-19: discursos científicos e desinformativos em disputa no Youtube / Real regimes in the pandemic of Covid-19: scientific and misinformation in dispute on Youtube

Apesar dos esforços para combater a desinformação em meio a um cenário de infodemia, o YouTube tem sido um espaço proeminente para a circulação de boatos, fake news e desinformação relacionados a Covid-19. Este artigo tem como objetivo contribuir, a partir da observação de discursos circulantes na plataforma no Brasil ao longo de 2020, para a compreensão do processo de produção social de sentidos sobre a pandemia. Buscamos especificamente compreender as disputas pela produção de "verdades" entre narrativas imprecisas e contraditórias e discursos científicos. Adotamos procedimentos metodológicos mistos, combinando análise de redes sociais e análise de conteúdo, para identificar a teia de relações estabelecidas entre vídeos em circulação no YouTube a partir da combinação entre os termos "Sars-Cov 2", "coronavírus" ou "Covid-19" ao termo "verdade". Investigamos ainda de que forma a autoridade epistêmica é acionada em seis produções de maior destaque do universo coletado. Concluímos que as mediações algorítmicas da plataforma são relevantes para a popularização de discursos alternativos às instituições hegemônicas nas disputas discursivas sobre a pandemia. O levantamento também aponta para a relevância de signos e símbolos de autoridade epistêmica "tradicional", que por vezes parecem substituir a apresentação de evidências científicas produzidas acerca da doença no período analisado. (AU)

Despite efforts to combat disinformation in an infodemic scenario, YouTube has been a prominent space for the circulation of rumors, fake news and disinformation related to Covid-19. This article aims to contribute, from the observation of discourses circulating on the platform in Brazil throughout 2020, to the understanding of the process of social production of meanings about the pandemic. We specifically seek to understand the disputes over the production of "truths" between imprecise and contradictory narratives and scientific discourses. We adopted mixed methodological procedures, combining social network analysis and content analysis, to identify relations between videos circulating on YouTube from the combination of the terms "Sars-Cov 2", "coronavirus" or "Covid-19 and the term "truth". We also investigated how epistemic authority appears in the six most prominent productions in the collected data. We conclude that the platform's algorithmic mediations are relevant to the popularization of alternative discourses to hegemonic institutions in the discursive disputes about the pandemic. The survey also points to the relevance of signs and symbols of "traditional" epistemic authority, which sometimes seem to replace the presentation of scientific evidence produced about the disease in the analyzed period. (AU)

Esporotricose felina: um relato de caso de disseminação cutânea e sistêmica em gato negativo para FIV e FeLV / Feline sporotrichosis: a case report of cutaneous and systemic dissemination in cat negative for FIV and FeLV

A esporotricose é uma zoonose causada por fungos do gênero Sporothrix. Os gatos doentes têm importante potencial zoonótico e frequentemente revelam uma apresentação disseminada da doença. O objetivo deste relato de caso é descrever as características clínicas e anatomopatológicas de um caso de esporotricose felina refratária ao tratamento com apresentação clínica cutânea disseminada e sistêmica. Um felino macho de 3 anos de idade foi tratado para esporotricose com itraconazol e obteve resolução completa das lesões cutâneas. Porém, um ano após alta clínica, o animal apresentou aumento e ulceração da região nasal. Após cultura fúngica positiva para Sporothrix spp foi instituído tratamento com itraconazol 100mg associado ao iodeto de potássio 20mg por via oral diariamente e transcorrido 3 meses de tratamento, foi observada piora progressiva do sinais clínicos com disseminação de lesões para outras regiões do corpo. O animal foi submetido à eutanásia e encaminhado para necrópsia no Serviço de Anatomia Patológica da Faculdade de Veterinária da Universidade Federal Fluminense. Amostras da língua, pulmão, fígado, baço, rim, cérebro, linfonodo e pele foram coletadas para evidência de disseminação do agente fúngico e avaliação de alterações microscópicas. A coloração de metenamina de prata de Grocott foi utilizada para facilitar a visualização de leveduras sugestivas de Sporothrix spp nos cortes histológicos. Leveduras foram visualizadas em amostras de pele, língua, linfonodo, rim, fígado, baço e cérebro. No presente relato a disseminação do Sporothrixspp para diversos órgãos sinaliza a necessidade de uma minuciosa investigação dos casos graves de esporotricose felina para o tratamento adequado.

Sporotrichosis is a zoonosis caused by fungi of the genus Sporothrix. Sick cats have an significant zoonotic potential and often show a widespread presentation of the disease. The purpose of this case report is to describe the clinical and anatomopathological characteristics of a case of feline sporotrichosis refractory to treatment with disseminated and systemic cutaneous clinical presentation. A 3-year-old male feline was treated for sporotrichosis with itraconazole and achieved complete resolution of the skin lesions. However, one year after clinical discharge, the animal presented an increase and ulceration of the nasal region. After a positive fungal culture for Sporothrix spp, treatment with itraconazole 100mg associated with potassium iodide 20mg was instituted orally daily and after 3 months of treatment, a progressive worsening of the symptoms was observed with the spread of lesions to other regions of the body. The animal was euthanized and sent for necropsy at the Pathological Anatomy Service of the Veterinary Faculty of Universidade Federal Fluminense. Samples of the tongue, lung, liver, spleen, kidney, brain, lymph node, and skin were collected for evidence of spread of the fungal agent and evaluation of microscopic changes. Grocott silver methenamine staining was used to facilitate the visualization of yeasts suggestive of Sporothrix spp in histological sections. Yeasts were visualized in samples of skin, tongue, lymph node, kidney, liver, spleen, and brain. In the present report, the spread of Sporothrix spp to different organs signals the need for a thorough investigation of severe cases of feline sporotrichosis for the proper treatment.

Esporotricose felina: um relato de caso de disseminação cutânea e sistêmica em gato negativo para FIV e FeLV / Feline sporotrichosis: a case report of cutaneous and systemic dissemination in cat negative for FIV and FeLV

A esporotricose é uma zoonose causada por fungos do gênero Sporothrix. Os gatos doentes têm importante potencial zoonótico e frequentemente revelam uma apresentação disseminada da doença. O objetivo deste relato de caso é descrever as características clínicas e anatomopatológicas de um caso de esporotricose felina refratária ao tratamento com apresentação clínica cutânea disseminada e sistêmica. Um felino macho de 3 anos de idade foi tratado para esporotricose com itraconazol e obteve resolução completa das lesões cutâneas. Porém, um ano após alta clínica, o animal apresentou aumento e ulceração da região nasal. Após cultura fúngica positiva para Sporothrix spp foi instituído tratamento com itraconazol 100mg associado ao iodeto de potássio 20mg por via oral diariamente e transcorrido 3 meses de tratamento, foi observada piora progressiva do sinais clínicos com disseminação de lesões para outras regiões do corpo. O animal foi submetido à eutanásia e encaminhado para necrópsia no Serviço de Anatomia Patológica da Faculdade de Veterinária da Universidade Federal Fluminense. Amostras da língua, pulmão, fígado, baço, rim, cérebro, linfonodo e pele foram coletadas para evidência de disseminação do agente fúngico e avaliação de alterações microscópicas. A coloração de metenamina de prata de Grocott foi utilizada para facilitar a visualização de leveduras sugestivas de Sporothrix spp

Sporotrichosis is a zoonosis caused by fungi of the genus Sporothrix. Sick cats have an significant zoonotic potential and often show a widespread presentation of the disease. The purpose of this case report is to describe the clinical and anatomopathological characteristics of a case of feline sporotrichosis refractory to treatment with disseminated and systemic cutaneous clinical presentation. A 3-year-old male feline was treated for sporotrichosis with itraconazole and achieved complete resolution of the skin lesions. However, one year after clinical discharge, the animal presented an increase and ulceration of the nasal region. After a positive fungal culture for Sporothrix spp, treatment with itraconazole 100mg associated with potassium iodide 20mg was instituted orally daily and after 3 months of treatment, a progressive worsening of the symptoms was observed with the spread of lesions to other regions of the body. The animal was euthanized and sent for necropsy at the Pathological Anatomy Service of the Veterinary Faculty of Universidade Federal Fluminense. Samples of the tongue, lung, liver, spleen, kidney, brain, lymph node, and skin were collected for evidence of spread of the fungal agent and evaluation of microscopic changes. Grocott silver methenamine staining was used to facilitate the visualization of yeasts suggestive of Sporothrix spp in histological sections. Yeasts were visualized in samples of skin, tongue, lymph node, kidney, liver, spleen, and brain. In the present report, the spread of Sporothrix spp to different organs signals the need for a thorough investigation of severe cases of feline sporotrichosis for the proper treatment.

Conhecimento dos educadores dos centros municipais de educação infantil sobre primeiros socorros / Knowledge of the educators of the municipality centers child education on first aid / Conocimiento de los educadores de los centros municipales de educación infantil sobre primeros auxilios

Objetivo: Compreender o conhecimento dos professores dos Centros de Educação Infantil sobre Primeiros Socorros referentes a crianças de 3 a 5 anos. Métodos: Trata-se de uma pesquisa de caráter exploratório, com abordagem qualitativa, desenvolvida com 18 professores de nove Centros Municipal de Educação Infantil de Divinópolis, localizado no município de Divinópolis, Minas Gerais. Foram realizadas entrevistas individuais no período de julho a dezembro de 2018, por meio de roteiro semiestruturo, posteriormente os dados foram analisados mediante a Análise de Conteúdo. Resultados: Emergiram três categorias temáticas: O professor do CMEI e sua relação com primeiros socorros: conceitos e suas inseguranças; Primeiros socorros durante acidentes no CMEI: atitudes corretas e incorretas e Educação Infantil: tipos de acidentes e exposições a riscos. Conclusão: É necessário que os professores tenham capacitações periódicas sobre o assunto, assim como os locais de trabalho ofertem material e suporte para os primeiros socorros.(AU)

Objective: To understand the knowledge of teachers at the Early Childhood Education Centers on First Aid for children aged 3 to 5 years. Methods: This is an exploratory research, with a qualitative approach, developed with 18 teachers from nine Municipal Centers for Early Childhood Education in Divinópolis, located in the municipality of Divinópolis, Minas Gerais. Individual interviews were carried out from July to December 2018, using a semi-structured script, then the data were analyzed using Content Analysis. Results: Three thematic categories emerged: The CMEI teacher and his relationship with first aid: concepts and their insecurities; First aid during accidents at CMEI: correct and incorrect attitudes and Early Childhood Education: types of accidents and risk exposures. Conclusion: It is necessary that teachers have periodic training on the subject, as well as workplaces offer material and support for first aid.(AU)

Objetivo: Comprender el conocimiento de los maestros en los Centros de Educación Infantil sobre Primeros Auxilios para niños de 3 a 5 años. Métodos: Esta es una investigación exploratoria, con un enfoque cualitativo, desarrollada con 18 maestros de nueve Centros Municipales para la Educación de la Primera Infancia en Divinópolis, ubicada en el municipio de Divinópolis, Minas Gerais. Las entrevistas individuales se llevaron a cabo de julio a diciembre de 2018, utilizando un guión semiestructurado, luego los datos se analizaron mediante el Análisis de contenido. Resultados: surgieron tres categorías temáticas: el maestro CMEI y su relación con los primeros auxilios: conceptos y sus inseguridades; Primeros auxilios durante accidentes en CMEI: actitudes correctas e incorrectas y Educación de la primera infancia: tipos de accidentes y exposiciones al riesgo. Conclusión: es necesario que los maestros tengan capacitación periódica sobre el tema, así como que los lugares de trabajo ofrezcan material y apoyo para primeros auxilios.(AU)

Ações para reduzir o risco de infecções relacionados à assistência à saúde / Actions to reduce the risk of health care infections

Identificar as ações realizadas pela equipe de SCIH e Gestão da Qualidade para alcançar a meta redução do risco de infecções relacionadas à assistência à saúde. Pesquisa qualitativa, exploratória e descritiva, realizada em duas instituições hospitalares. Houve triangulação de dados com entrevistas, observação e análise documental. Para a análise dos dados utilizou-se a análise de conteúdo. As ações mais realizadas foram educação permanente, identificação e correções de problemas em procedimentos, busca ativa, vigilância e higienização das mãos. Foi possível identificar a ocorrência de eventos adversos. A comunicação e os problemas estruturais aparecem como dificultadores no alcance da meta. As ações identificadas foram práticas tradicionais e muitas vezes ineficientes. A prevenção e o controle de infecções ainda são desafios para as instituições de saúde. Há necessidade de adoção de estratégias inovadoras para alcançar a meta de redução do risco de infecção relacionada à assistência à saúde.

To identify the actions taken by the SCIH and Quality Management team to achieve the goal of reducing the risk of infections related to health care. Exploratory descriptive qualitative study, carried out in two hospitals. There was triangulation of data with interviews, observation and document analysis. For data analysis, content analysis was used. The most performed actions were permanent education, identification and correction of problems in procedures, active search, surveillance and hand hygiene. It was possible to identify the occurrence of adverse events. Communication and structural problems appear as difficulties in reaching the goal. The actions identified are traditional practices and are often inefficient. The prevention and control of infections are still challenges for health institutions. There is a need to adopt innovative strategies to achieve the goal of reducing the risk of infection related to healthcare.

Esporotricose felina: um relato de caso de disseminação cutânea e sistêmica em gato negativo para FIV e FeLV / Feline sporotrichosis: a case report of cutaneous and systemic dissemination in cat negative for FIV and FeLV

A esporotricose é uma zoonose causada por fungos do gênero Sporothrix. Os gatos doentes têm importante potencial zoonótico e frequentemente revelam uma apresentação disseminada da doença. O objetivo deste relato de caso é descrever as características clínicas e anatomopatológicas de um caso de esporotricose felina refratária ao tratamento com apresentação clínica cutânea disseminada e sistêmica. Um felino macho de 3 anos de idade foi tratado para esporotricose com itraconazol e obteve resolução completa das lesões cutâneas. Porém, um ano após alta clínica, o animal apresentou aumento e ulceração da região nasal. Após cultura fúngica positiva para Sporothrix spp foi instituído tratamento com itraconazol 100mg associado ao iodeto de potássio 20mg por via oral diariamente e transcorrido 3 meses de tratamento, foi observada piora progressiva do sinais clínicos com disseminação de lesões para outras regiões do corpo. O animal foi submetido à eutanásia e encaminhado para necrópsia no Serviço de Anatomia Patológica da Faculdade de Veterinária da Universidade Federal Fluminense. Amostras da língua, pulmão, fígado, baço, rim, cérebro, linfonodo e pele foram coletadas para evidência de disseminação do agente fúngico e avaliação de alterações microscópicas. A coloração de metenamina de prata de Grocott foi utilizada para facilitar a visualização de leveduras sugestivas de Sporothrix spp(AU)

Sporotrichosis is a zoonosis caused by fungi of the genus Sporothrix. Sick cats have an significant zoonotic potential and often show a widespread presentation of the disease. The purpose of this case report is to describe the clinical and anatomopathological characteristics of a case of feline sporotrichosis refractory to treatment with disseminated and systemic cutaneous clinical presentation. A 3-year-old male feline was treated for sporotrichosis with itraconazole and achieved complete resolution of the skin lesions. However, one year after clinical discharge, the animal presented an increase and ulceration of the nasal region. After a positive fungal culture for Sporothrix spp, treatment with itraconazole 100mg associated with potassium iodide 20mg was instituted orally daily and after 3 months of treatment, a progressive worsening of the symptoms was observed with the spread of lesions to other regions of the body. The animal was euthanized and sent for necropsy at the Pathological Anatomy Service of the Veterinary Faculty of Universidade Federal Fluminense. Samples of the tongue, lung, liver, spleen, kidney, brain, lymph node, and skin were collected for evidence of spread of the fungal agent and evaluation of microscopic changes. Grocott silver methenamine staining was used to facilitate the visualization of yeasts suggestive of Sporothrix spp in histological sections. Yeasts were visualized in samples of skin, tongue, lymph node, kidney, liver, spleen, and brain. In the present report, the spread of Sporothrix spp to different organs signals the need for a thorough investigation of severe cases of feline sporotrichosis for the proper treatment.(AU)