Clinical guidelines for herpes labialis: recommendations and quality evaluation according to AGREE II.

Cold sores require Healthcare professionals to employ specific approaches for prevention and management, with the need for effective therapeutic guidelines and ongoing improvement in patient care. AIM: To evalúate the methodological quality of Clinical Guidelines (CG), clinical guides and manuals for care of the population affected by herpes labialis, to verify their compliance with evidence-based health standards. MATERIALS AND METHOD: A search was conducted for CG on labial herpes in the MedicalLiteratureAnalysis andRetrieval System Online (Medline) database, Google Scholar, Brazilian Virtual Health Library (BVS), and sites of institutions/professional categories, using the descriptors "herpes labialis" or "oral herpes". Document quality was assessed using the Appraisal of Guidelines for Research & Evaluation Instrument (AGREE II). The Kappa test was used to avoid randomness or poor agreement between results. RESULTS: Analysis of the 12 selected publications on the management of labial herpes revealed flaws in quality, as the publications did not follow a quality standard. The main quality flaws identified were in "rigor in development" and "applicability. ". CONCLUSIONS: Priorities need to be redefined in the development of CG for clinical practice related to fever blisters to reduce the variability of the quality standard, and generate reliable, applicable recommendations.

A Herpes labial requer dos profissionais abordagens específicas para prevenido e manejo, com a ne-cessidade de diretrizes terapéuticas eficazes e continuo aprimoramento do cuidado ao paciente. OBJETIVO: avaliar a qualidade metodológica de documentos que abordaram Diretrizes Clínicas (DC), guias clínicos e manuais para o cuidado da populando afetada pelo herpes labial, verificando sua conformidade com padroes de saúde baseados em evidencias. MATERIAIS E MÉTODO: As DC sobre herpes labial foram pesquisadas na base de dados Medical Literature Analysis and Retrieval System Online (Medline), Google Académico, Biblioteca Virtual em Saúde (BVS) e em sites de instituigoes/categorias profissionais, utilizando os descritores "herpes labial" ou "herpes oral". Utilizamos aferramenta The Appraisal of Guidelines for Research & Evaluation Instrument (AGREE II) para a avaliagdo da qualidade. O teste Kappa também foi utilizado para evitar aleatoriedade ou baixa concordáncia entre os resultados. RESULTADOS: Na análise das 12 publicagoes selecionadas sobre o manejo do herpes labial, foram identificadas falhas na qualidade dos documentos, que ndo seguiram um padrdo de qualidade. As principais falhas de qualidade identificadas foram em "rigor no desenvolvimento" e "aplicabilida-de". CONCLUSÃO: é necessário um reenfoque para definir prioridades no desenvolvimento de DC para a prática clínica do herpes labial, a fim de reduzir a variabilidade do padrdo de qualidade e gerar recomendagoes que possam ser confiáveis e aplicáveis.

Hemoperitoneum after a Bothrops snakebite: Case report.

Snakebites are frequent in tropical countries. Brazil has an average of 27,000 cases per year, with a fatality rate of 0.5%, and the Bothrops genus is the most common causative agent, accounting for about 70-90% of the accidents. This report describes a case of human envenomation by a juvenile Bothrops jararaca snake in São Paulo, Brazil, in a 71 years-old man, previously healthy. He presented a life-threatening envenomation, which developed to severe hypotension, acute kidney injury and extensive peritoneal hemorrhage. The hemoperitoneum was diagnosed due to persistent hypotension associated with anemia, pain and gastrointestinal complaints. Abdominal Computed Tomography scans showed a moderate to large amount of presumable hematic material inside the abdominal cavity, predominantly in the perihepatic and perisplenic spaces. The intra-abdominal hemorrhage was not surgically addressed, and the patient was discharged 5 days after hospitalization, with the progressive absorption of the hemoperitoneum. Systemic bleeding is one of the complications and main causes of death in Bothrops envenomations. Acute peritoneal hemorrhage is one of these serious complications that must be carefully addressed since its management must take into account the risk of bleeding caused by toxins that affect hemostasis. The case described highlights the importance of early diagnosis and adequate management of this potentially fatal complication in snakebites.

Conhecimento sobre as verdadeiras e falsas contraindicações às imunizações em uma Unidade Básica de Saúde

Material desenvolvido por Renata Holanda dos Anjos Lima para Dissertação: Conhecimento sobre as verdadeiras e falsas contraindicações às imunizações em uma Unidade Básica de Saúde, apresentada ao Programa de Pós-Graduação - Mestrado Profissional em Enfermagem na Atenção Primária em Saúde no Sistema Único de Saúde da Escola de Enfermagem da Universidade de São Paulo.

Detection of Trypanosoma cruzi DTUs TcI and TcIV in two outbreaks of orally-transmitted Chagas disease in the Northern region of Brazil.

This study describes the laboratory investigation of two acute Chagas disease outbreaks that occurred in the riverside communities of Marimarituba and Cachoeira do Arua, in the Santarem municipality, Para State, located in the Northern region of Brazil, and occurred in March 2016 and August 2017, respectively. The generation of data regarding the diversity of Trypanosoma cruzi parasites circulating in the Amazon region is key for understanding the emergence and expansion of Chagas disease. This study aimed to identify T. cruzi Discrete Typing Units (DTUs) involved in two outbreaks of acute Chagas disease (ACD) directly from the patient's biological sample. Nested and multiplex PCR targeting the 24Sα (rRNA) and mini-exon genes, respectively, were used to identify T. cruzi DTU in blood samples from patients diagnosed with ACD. The samples with positive cPCR were submitted for analysis for T. cruzi DTUs, which included 13 samples from the patients with ACD by oral transmission and two samples collected from two newborns of two women with ACD, from Marimarituba and Cachoeira do Arua. The samples were classified as T. cruzi TcIV, from Marimarituba's outbreak, and T. cruzi TcI, from Cachoeira do Arua's outbreak. The molecular identification of T. cruzi may increase understanding of the role of this parasite in Chagas disease's emergence within the Amazon region, contributing to the improvement of the management of this important, but also neglected, disease.

Detection of Trypanosoma cruzi DTUs TcI and TcIV in two outbreaks of orally-transmitted Chagas disease in the Northern region of Brazil

ABSTRACT This study describes the laboratory investigation of two acute Chagas disease outbreaks that occurred in the riverside communities of Marimarituba and Cachoeira do Arua, in the Santarem municipality, Para State, located in the Northern region of Brazil, and occurred in March 2016 and August 2017, respectively. The generation of data regarding the diversity of Trypanosoma cruzi parasites circulating in the Amazon region is key for understanding the emergence and expansion of Chagas disease. This study aimed to identify T. cruzi Discrete Typing Units (DTUs) involved in two outbreaks of acute Chagas disease (ACD) directly from the patient's biological sample. Nested and multiplex PCR targeting the 24Sα (rRNA) and mini-exon genes, respectively, were used to identify T. cruzi DTU in blood samples from patients diagnosed with ACD. The samples with positive cPCR were submitted for analysis for T. cruzi DTUs, which included 13 samples from the patients with ACD by oral transmission and two samples collected from two newborns of two women with ACD, from Marimarituba and Cachoeira do Arua. The samples were classified as T. cruzi TcIV, from Marimarituba's outbreak, and T. cruzi TcI, from Cachoeira do Arua's outbreak. The molecular identification of T. cruzi may increase understanding of the role of this parasite in Chagas disease's emergence within the Amazon region, contributing to the improvement of the management of this important, but also neglected, disease.

Tuberculosis from the perspective of men and women.

OBJECTIVE: To analyze aspects related to the experience of tuberculosis from the perspective of men and women with tuberculosis. METHOD: Qualiquantitative cross-sectional study. Patients with tuberculosis in the city of Campina Grande-PB were interviewed through a semi-structured questionnaire between September/2017 and January/2018. Discourse Analysis and Chi-Square test were performed. RESULTS: Sixty-three subjects were interviewed, of which 34 (54.0%) were men. There was an association of the category gender with level of education (p = 0.004), work activity (p = 0.023), time spent on activities outside the home (p = 0.013), and time spent on activities at home (p = 0.001). The analysis of the statements specially revealed that men perceive their role as the family's main provider and the women with a social role of caregiver, often postponing the search for a health care due to fear of not being able to perform this role in the family and/or in society. CONCLUSION: The weakness caused by the disease and the long duration of treatment changed the interviewees' routine, causing suffering and frustration, with consequences in the performance of social roles within the family and in society, constituting a barrier to adherence to tuberculosis treatment.

Vulnerabilities of Arab refugees in primary health care: a scoping review.

OBJECTIVE: To map and analyze the vulnerabilities of Arab refugees in the context of primary health care. METHOD: Scoping review in which studies published in English, Spanish and Portuguese languages from 2011 onwards were reviewed. The following databases were surveyed: Cochrane, Scopus, Health System Evidence, MedLine-PubMed, CINAHL, Embase, Lilacs, Web of Science, SciELO, NYAM Grey Literature, BVS, Capes Thesis and Dissertation Database, Refworld and Journal of Refugee Studies. Data were analyzed in light of the concept of vulnerability. RESULTS: Of the 854 studies identified, 40 articles were held for analysis and extraction of vulnerability indicators in the individual, social and programmatic dimensions. Regarding the individual dimension, the main indicators identified were unemployment, unstable and overcrowded housing, lack of sanitation and access to water, mental disorders, communicable and chronic noncommunicable diseases, etc. In the programmatic dimension, were identified, mainly, health teams with work overload, lack of preparation to deal with cultural and linguistic barriers, and delays in providing care. In relation to the social dimension, lack of access to schools, to information about health programs in the host countries, and to rights, among others, were found. CONCLUSION: Vulnerabilities found highlight the disadvantage of refugees regarding health programs, services and system in host countries, in addition to highlighting the deep inequalities that affect this group. It is pointed out the need for programs and policies that promote actions, within the scope of primary health care, which recognize and respond to the health needs of refugees.

Fatores determinantes para a excelência no vôlei de praia: o caso de uma dupla de elite / Determining factors for excellence in beach volleyball: the case of an elite pai / Factores determinantes de laexcelenciaenel voleibol de playa: el caso de una pareja de élite

O objetivo deste estudo foi conhecer os fatores determinantes na aquisição, desenvolvimento e manutenção da excelência no Vôlei de Praia (VP) a partir da percepção de uma dupla de atletas de elite e seu técnico. Trata-se de um estudo de caso com abordagem qualitativa dos resultados que se utilizou da entrevista e análise documental para recolha dos dados. Sobre os fatores determinantes da excelência no VP destacaram-se nos fatores primários, o aspecto psicológico, verificado nos elementos disciplina, força de vontade, motivação e foco, seguido pelo tempo de parceria e da preparação física iniciada (prática deliberada). Enquanto nos fatores secundários, o apoio, técnico, infraestrutura, qualidade de material esportivo e financeiro. Conclui-se que a junção dos fatores primários e secundários descritos acima foi essencial para aquisição, desenvolvimento emanutenção da excelência no VP.

The objective of this study was to know the determining factors in the acquisition, development and maintenance of excellence in Beach Volleyball (VP) from the perception of a pair of elite athletes and theircoach. This is a case study with a qualitative approach to the results that used the interview and document analysis for data collection. Regarding the determining factors of excellence in the VP, the psychological aspect stood out in the primary factors,verified in the elements discipline, willpower, motivation and focus, followed by the partnership time and the physical preparation started (deliberate practice). While in secondary factors, support, technical, infrastructure, quality of sports and financial equipment. It is concluded that the combination of the primary and secondary factors described above was essential for the acquisition, development and maintenance of excellence in PV.

El propósito de este estudio fue conocer los factores determinantes en la adquisición, desarrollo y mantenimiento de la excelencia en el Voleibol de Playa (VP) a partir de la percepción de una pareja de deportistas de élite y su entrenador. Este es un estudio de caso con enfoque cualitativo de los resultados que utilizó la entrevista y el análisis de documentos para la recolección de datos. En cuanto a los determinantes de la excelencia en la PV, el aspecto psicológico se destacó en los factores primarios, verificado en los elementos disciplina, fuerza de voluntad, motivación y enfoque, seguido del tiempo de compañerismo y la preparación física iniciada (práctica deliberada). Mientras que en factores secundarios, soporte, técnico, infraestructura, calidad del equipamiento deportivo y financiero. Se concluye que la combinación de los factores primarios y secundarios descritos anteriormente fue fundamental para la adquisición, desarrollo y mantenimiento de la excelencia en el VP.

Vulnerabilities of Arab refugees in primary health care: a scoping review / Vulnerabilidades de refugiados árabes na atenção primária à saúde: uma revisão de escopo

ABSTRACT OBJECTIVE To map and analyze the vulnerabilities of Arab refugees in the context of primary health care. METHOD Scoping review in which studies published in English, Spanish and Portuguese languages from 2011 onwards were reviewed. The following databases were surveyed: Cochrane, Scopus, Health System Evidence, MedLine-PubMed, CINAHL, Embase, Lilacs, Web of Science, SciELO, NYAM Grey Literature, BVS, Capes Thesis and Dissertation Database, Refworld and Journal of Refugee Studies. Data were analyzed in light of the concept of vulnerability. RESULTS Of the 854 studies identified, 40 articles were held for analysis and extraction of vulnerability indicators in the individual, social and programmatic dimensions. Regarding the individual dimension, the main indicators identified were unemployment, unstable and overcrowded housing, lack of sanitation and access to water, mental disorders, communicable and chronic noncommunicable diseases, etc. In the programmatic dimension, were identified, mainly, health teams with work overload, lack of preparation to deal with cultural and linguistic barriers, and delays in providing care. In relation to the social dimension, lack of access to schools, to information about health programs in the host countries, and to rights, among others, were found. CONCLUSION Vulnerabilities found highlight the disadvantage of refugees regarding health programs, services and system in host countries, in addition to highlighting the deep inequalities that affect this group. It is pointed out the need for programs and policies that promote actions, within the scope of primary health care, which recognize and respond to the health needs of refugees.

RESUMO OBJETIVO Mapear e analisar as vulnerabilidades de refugiados árabes no contexto da atenção primária à saúde. MÉTODO Revisão de escopo em que foram analisados estudos publicados nos idiomas inglês, espanhol e português, a partir de 2011. As bases foram Cochrane, Scopus, Health System Evidence , MedLine-PubMed, CINAHL, Embase, Lilacs, Web of Science , SciELO, NYAM Grey Literature , BVS, Banco de teses e dissertações Capes, Refworld e Journal of Refugee Studies. A análise dos dados foi realizada à luz do conceito de vulnerabilidade. RESULTADOS Dos 854 estudos identificados, restaram 40 artigos para análise e extração dos indicadores de vulnerabilidade nas dimensões individual, social e programática. Em relação à dimensão individual, os principais indicadores identificados foram desemprego, moradias instáveis e superlotadas, falta de saneamento e de acesso à água, agravos mentais, doenças transmissíveis e crônicas não transmissíveis etc. Na dimensão programática foram identificadas, principalmente, equipes de saúde com sobrecarga de trabalho, falta de preparo para lidar com as barreiras culturais e linguísticas, demora para o atendimento. Em relação à dimensão social, constatou-se falta de acesso às escolas, à informação sobre os programas de saúde dos países de acolhida, aos direitos, entre outros. CONCLUSÃO As vulnerabilidades constatadas evidenciam desvantagem dos refugiados perante os programas, serviços e sistema de saúde nos países de acolhida, além de colocar em evidência as profundas desigualdades que incidem nesse grupo. Aponta-se a necessidade de programas e políticas que promovam ações, no âmbito da atenção primária à saúde, que reconheçam e respondam às necessidades de saúde de refugiados.

Tuberculosis from the perspective of men and women / Tuberculosis desde la perspectiva del hombre y de la mujer / A tuberculose na perspectiva do homem e da mulher

ABSTRACT Objective: To analyze aspects related to the experience of tuberculosis from the perspective of men and women with tuberculosis. Method: Qualiquantitative cross-sectional study. Patients with tuberculosis in the city of Campina Grande-PB were interviewed through a semi-structured questionnaire between September/2017 and January/2018. Discourse Analysis and Chi-Square test were performed. Results: Sixty-three subjects were interviewed, of which 34 (54.0%) were men. There was an association of the category gender with level of education (p = 0.004), work activity (p = 0.023), time spent on activities outside the home (p = 0.013), and time spent on activities at home (p = 0.001). The analysis of the statements specially revealed that men perceive their role as the family's main provider and the women with a social role of caregiver, often postponing the search for a health care due to fear of not being able to perform this role in the family and/or in society. Conclusion: The weakness caused by the disease and the long duration of treatment changed the interviewees' routine, causing suffering and frustration, with consequences in the performance of social roles within the family and in society, constituting a barrier to adherence to tuberculosis treatment.

RESUMEN Objectivo: Analizar aspectos relacionados con la experiencia de la tuberculosis desde la perspectiva de hombres y mujeres con tuberculosis. Método: Estudio transversal cualicuantitativo. Fueron entrevistados pacientes con tuberculosis del municipio de Campina Grande-PB, por medio de cuestionario semiestructurado, entre septiembre/2017 y enero/2018. Se realizaron Análisis del Discurso y Chi-Cuadrado. Resultados: Sesenta y três sujetos fueron entrevistados, de los cuales 34 (el 54,0%) eran del sexo masculino. Hubo asociación de la categoria género con escolaridad (p = 0,004), actividad laboral (p = 0,023), tiempo dedicado a actividades fuera del domicilio (p = 0.013) y tiempo dedicado a las actividades em el domicilio (p = 0,001). El análisis de las declaraciones reveló, principalmente, que el hombre percibe su rol como principal proveedor de la familia y, la mujer, em el rol social de cuidadora, postergando muchas veces la búsqueda de un servicio de salud por temor a no poder realizar ese rol en la familia y/o en la sociedad. Conclusión: La debilidad provocada por la enfermedad y la larga duración del tratamiento modificaron la rutina de los entrevistados, provocando sufrimiento y frustración, con consecuencias en el desempeño de los roles sociales en la familia y en la sociedad, constituyendo una barrera para la adherencia al tratamiento de la tuberculosis.

RESUMO Objetivo: Analisar aspectos relacionados à vivência da tuberculose na perspectiva de homens e mulheres portadores de tuberculose. Método: Estudo transversal qualiquantitativo. Entrevistou-se, por meio de questionário semiestruturado, pacientes com tuberculose no município de Campina Grande-PB, entre setembro/2017 e janeiro/2018. Realizou-se Análise de Discurso e teste Qui-Quadrado. Resultados: Entrevistaram-se 63 sujeitos, sendo 34 (54,0%) do sexo masculino. Evidenciou-se associação da categoria gênero com escolaridade (p = 0,004), atividade de trabalho (p = 0,023), tempo despendido em atividades fora do domicílio (p = 0,013) e tempo despendido em atividades no domicílio (p = 0,001). A análise dos depoimentos revelou, principalmente, que o homem percebe seu papel como provedor principal da família e, a mulher, no papel social de cuidadora, adiando muitas vezes a busca por um serviço de saúde com receio de não conseguir exercer esse papel na família e/ou na sociedade. Conclusão A debilidade causada pela doença e a longa duração do tratamento mudaram a rotina dos entrevistados, causando sofrimento e frustração, com decorrências no desempenho dos papéis sociais no interior da família e na sociedade, constituindo-se em barreira na adesão ao tratamento da tuberculose.

Suspected vertical transmission of Chagas disease caused by DTU TcIV in an infection probably transmitted orally, during anoutbreak in the Brazilian Amazon.

This study describes difficulties in the monitoring of a child born during an oral outbreak of Chagas disease, in which there are several indications that the transmission occurred through the congenital route: 1. the mother was in the third trimester of pregnancy when she was infected; 2. She presented high parasitemia at the time of delivery; 3. In both, the mother and her daughter, T. cruzi was classified as DTU TcIV. The parasites were not found in the blood at birth and the infection was detected only three months later in an asymptomatic infant. As the mother and her child live in a highly endemic area, vector transmission could not be excluded during this period.

High prevalence of Cryptococcal antigenemia using a finger-prick lateral flow assay in individuals with advanced HIV disease in Santarém Municipality, Brazilian Amazon Basin.

There is scarce information about HIV-related cryptococcosis in the Brazilian Amazon basin where laboratory infrastructure is limited. The serum cryptococcal antigen (CrAg) lateral flow assay (LFA) has simplified diagnosis of cryptococcosis and is recommended for screening in advanced HIV disease. We evaluated the prevalence of cryptococcal antigenemia using finger-prick CrAg LFA in the Brazilian Amazon basin. We enrolled a prospective cohort of outpatients and hospitalized individuals with advanced HIV disease at two centers in Santarém Municipality, Northern Brazil. All individuals were > 18 years old with advanced HIV disease, regardless of antiretroviral therapy (ART) status and with no prior or current history of confirmed cryptococcal meningitis. We tested CrAg LFA on finger-prick whole blood using an exact volume transfer pipette. From August 2018 to October 2019, 104 individuals were enrolled (outpatients 62 [60%] and hospitalized 42 [40%]). Median age was 38 years (interquartile range [IQR] 30-46), and 84 (81%) were male. Sixty-five (63%) individuals were ART-naïve. Prevalence of finger-prick CrAg LFA-positive was 10.6%; 95% CI, 5.4 to 18.1%. Prevalence of finger-prick CrAg LFA-positive among individuals without neurological symptoms was 6.0%; 95% CI, 1.7-14.6%. The number needed to test to detect one CrAg-positive individual was 9.4 persons (95% CI, 5.5-18.5). Prevalence of cryptococcal antigenemia using finger-prick whole blood CrAg LFA was high. Point-of-care approach was important for the diagnosis and screening of cryptococcosis in resource-limited settings. Screening and preemptive therapy strategy should be urgently implemented in individuals with advanced HIV disease in the Brazilian Amazon basin.

This prospective cohort study was carried-out in the Brazilian Amazon basin. We used a cryptococcal rapid test in patients with AIDS. We included 104 participants, and 11 (10.6%) of them had positive results showing a high prevalence of cryptococcal antigenemia.

Unusual case of lagochilascariasis with breast involvement: the first case report in pregnancy.

Lagochilascariasis is a neglected neotropical helminthiasis, responsible for human infections through the ingestion of raw or undercooked meat from wild animals infected by larvae encysted in their tissues. It is characterized by a chronic evolution with periods of remission and recurrences, affecting mainly the head and neck regions. It can progress to death by invasion of the central nervous system. It is caused by the Lagochilascaris minor nematode, first described in 1909 and mainly found in the Brazilian Amazon ecosystem, notably in Para State. In May 2010, a 15-year-old female, born in the city of Aveiro, Para State, was hospitalized in the city of Santarem, Para State, presenting with cervical and spinal abscesses and osteolytic lesions at T3-T5 level. During hospitalization, white larvae identified as L. minor were observed in a cervical subcutaneous fistula. After the surgical drainage of abscesses, albendazole 400 mg/day was started, with improvement of symptoms. The patient abandoned the follow-up and in January 2016, during the 20th week of pregnancy, she was readmitted to the Santarem Municipal Hospital with new cervical abscesses in the infra-mammary region, with numerous larvae exiting by subcutaneous left breast fistulas. The antiparasitic treatment was restarted due to possible reactivation of the infection in the spine and dissemination to the central nervous system. Ten weeks after hospital discharge, the patient had resolution of the fistulas and decreased abscesses, without gestational complications. This is the first case report of lagochilascariasis during pregnancy, as well as of involvement of mammary glands.

Guia de cuidados iniciais às vítimas de picada de escorpião na Flona de Tapajós

Parte da dissertação: Silva, Erli Marta Reis da. Acidente escorpiônico no Município de Santarém PA: características epidemiológicas e trajeto percorrido pelos pacientes até o serviço de saúde [dissertação]. São Paulo: Universidade de São Paulo, Escola de Enfermagem; 2018 [citado 2020-10-23]. doi:10.11606/D.7.2018.tde-05112018-133538.