Gestão hospitalar: gerenciando processos de trabalho em saúde / Hospital management: managing health work processes

A função de gestor hospitalar é invariavelmente complexa, independentemente da região, de fato que, ainda em certos aspectos, os serviços de saúde são mais desafiadores em alguns países, devido à regulação de leitos, financiamento e tecnologias à disposição. Acrescenta-se à extensa relação de demandas gerenciais, a exigência por conhecimentos específicos na gestão dos recursos humanos e físicos. A influência do modelo fragmentado de organização do trabalho, em que cada profissional realiza parcelas do trabalho sem uma integração com as demais áreas envolvidas, tem sido apontada como uma das razões que dificultam a realização de um trabalho em saúde mais integrador e de melhor qualidade, tanto na perspectiva daqueles que o realizam como para aqueles que dele usufruem. A partir do momento em que profissionais de saúde, que trabalham diretamente com o paciente, ocupam coordenações, na medida em que ascendem na organização, passam a desempenhar mais tarefas administrativas. Como exemplo, é possível perceber que uma enfermeira ou médico que coordenam uma unidade de internamento, realizam mais funções administrativas e quase nenhuma técnica, usando seus conhecimentos técnicos para atuar na chefia. Esses profissionais, ao ocupar determinados cargos, nem sempre entendem das atividades administrativas. Com isso, o hospital perde um bom técnico e pode não ganhar um bom chefe. Este trabalho tem uma descrição reflexiva acerca do processo de gestão hospitalar.(AU)

The role of hospital manager is invariably complex, regardless of the region. In some countries, health services are even more challenging due to the regulation of beds, financing, and technologies available. In addition to the extensive list of managerial demands, there is also the requirement for specific knowledge in the management of human and physical resources. The influence of the fragmented model of work organization, where each professional performs portions of the work without integration with the other involved areas, has been pointed out as one of the reasons hindering the accomplishment of a more integrating and better-quality health work, both from the perspective of those who perform it and of those who use it. From the moment health professionals, who work directly with the patient, occupy managerial positions, as they ascend in the organization, they inevitably start to have more administrative tasks. As an example, it is possible to notice that a nurse or doctor who coordinates an inpatient unit performs more administrative functions and almost no technical ones. They use their technical expertise to act in managerial positions. These professionals, when occupying certain positions, are not always fully trained to understand administrative activities. Thus, the hospital ends up losing a good technician worker and may not always get a good manager in return. This work presents a reflexive description on the hospital management process.(AU)

Correction: Anemia in tuberculosis cases: A biomarker of severity?

[This corrects the article DOI: 10.1371/journal.pone.0245458.].

Anemia in tuberculosis cases: A biomarker of severity?

INTRODUCTION: Anemia is a common condition at tuberculosis diagnosis, and there is evidence that its prevalence is higher in patients with tuberculosis than in those infected with Mycobacterium tuberculosis and healthy controls. Information about anemia during tuberculosis diagnosis is still scarce in the Brazilian population. The aim of this study was to describe the prevalence of anemia in patients with tuberculosis cared for at a referral center and its association with clinical forms of tuberculosis and other characteristics of these patients. MATERIALS AND METHODS: This was a retrospective cross-sectional study of tuberculosis patients diagnosed from January 2015 to December 2018 at the Clinical Research Laboratory on Mycobacteria (LAPCLIN-TB) of Evandro Chagas National Institute of Infectious Diseases (INI)/Oswaldo Cruz Foundation (Fiocruz). A database of an ongoing cohort study underway at this service since 2000 provided the baseline information on tuberculosis cases extracted from a visit template. Exploratory and logistic regression analyses were performed to verify associations between anemia and demographic characteristics, socioeconomic status, clinical conditions, and laboratory results. RESULTS: Of the 328 cases reviewed, 70 were excluded, with258 retained. The prevalence of anemia was 61.2% (27.5% mild, 27.5% moderate and 6.2% severe). Among patients with anemia, 60.8% had normochromic normocytic anemia, and 27.8% showed hypochromic microcytic anemia. In logistic regression analysis, anemia was associated with a history of weight loss >10%, hospitalizations, coinfection with HIV, increased platelet count and microcytosis. Anemia was more frequent in the most severe clinical forms, such as meningeal and disseminated tuberculosis. CONCLUSIONS: Anemia was highly prevalent in tuberculosis patients at diagnosis, predominantly as normochromic normocytic anemia and in mild and moderate forms. It was associated with baseline characteristics and conditions indicative of severe disease, suggesting that anemia could be a biomarker of tuberculosis severity.

Multifocal Choroiditis Secondary to Acute Zika Virus Infection.

PURPOSE: To describe a case of Acute Zika infection with ocular involvementMethods: Review of clinical recordsResults: Patient presented with sudden blurred vision in both eyes during an acute episode of zika virus infection. Ophthalmological examination revealed clinical picture of multifocal choroiditis in both eyes. Lesions improved and visual acuities returned to normal level without any treatment.Conclusion: Ocular changes in acute Zika virus infection is a rare condition. Patiens may present spontaneous recovery.

Ageing with Chagas disease: an overview of an urban Brazilian cohort in Rio de Janeiro.

BACKGROUND: Chagas disease control programmes have decreased the prevalence of Chagas disease in Latin America. Together with migration to urban areas and increase in life expectancy, a new scenario for Chagas disease has emerged in Brazil with most patients currently elderly individuals living in urban areas. However, acute Chagas disease cases still occur due to vector transmission by sylvatic vectors and oral transmission by contaminated food. Therefore, we characterized the clinical and epidemiological profile of the patients followed at Evandro Chagas National Institute of Infectious Diseases in Rio de Janeiro, Brazil. We aimed to identify the clinical forms, associated co-morbidities, and geographical areas where younger patients originate from. This will aid in the identification of potential challenges to be currently faced. RESULTS: This is a cross-sectional study. Adult patients with chronic Chagas disease were recruited between March 2013 and April 2016. Clinical and epidemiological data were obtained from electronic medical records and interviews. The clinical form of the Chagas disease presented by the patients was determined following the Brazilian Consensus on Chagas disease. Six hundred and nineteen patients (mean age 60 ± 12 years; 56.9% women) were included in this study. Patients' clinical forms were classified as follows: indeterminate 29.1%; cardiac 55.4%; digestive 5.5%; and mixed 10.0%. Patients aged over 65 years comprised 38% of the population. Hypertension was present in 347 (56%) patients, dyslipidemia in 261 patients (42%) and diabetes mellitus in 185 patients (30%). There were no differences regarding gender, race, comorbidities frequency or place of origin across Chagas disease clinical forms. Most of the elderly population originated from Bahia, Minas Gerais and Pernambuco states, while most of the younger patients were born in Ceará, Paraíba and Rio de Janeiro states. CONCLUSIONS: We described a great proportion of elderly patients in the composition of an urban Brazilian Chagas disease patient cohort with a high prevalence of comorbidities. We also identified a change in the pattern of the place of origin among younger patients.

Prevalência de aloimunização eritrocitária em pacientes portadores de anemia falciforme / Prevalence of red blood cell alloimmunization in patients with sickle cell anemia

Embora as transfusões de concentrado de hemácias sejam importantes para o tratamento de pacientes com anemia falciforme, elas acarretam riscos imunológicos tais como a aloimunização a antígenos eritrocitários. Aproximadamente 50% dos pacientes de anemia falciforme recebem transfusões no decorrer da vida, e entre 5% a 10% destes pacientes são submetidos a um programa de transfusão crônica. A aloimunização eritrocitária é uma complicação séria da transfusão, mas relativamente comum. Esta condição pode inclusive levar a reações transfusionais hemolíticas tardias e contribuir para aumentar as comorbidades da doença. Importantes medidas para prevenção destas complicações nestes pacientes são o uso de hemácias previamente fenotipadas, além da fenotipagem do próprio receptor de concentrado de hemácias, determinando seu correto perfil fenotípico e possibilitando a escolha de concentrado de hemácias com antígenos correspondentes ao do paciente a ser transfundido. Extensa genotipagem eritrocitária profilática para selecionar doadores para pacientes que receberão repetidas transfusões durante um longo período é uma aplicação atraente de tipagem de sangue baseados em DNA. Isto é, particularmente relevante para pacientes com doença falciforme onde a taxa de aloimunização é elevada.

Although packed red blood cells transfusions are important for treating patients with sickle cell anemia, this intervention may lead to immunological disturbs, such as alloimmunization by erythrocyte antigens. Approximately 50% of patients with sickle cell anemia receive blood transfusions during their life span, and about 5 to 10% of them require a chronic transfusion scheme. The red blood cell alloimmunization is a serious but common transfusion reaction. This condition could lead to delayed hemolytic transfusion reactions, contributing to increase comorbidities of the disease. Important measures to prevent these complications in patients are the use of previously phenotyped red blood cells, in addition to the phenotyping of red blood cells from the acceptor patient, determining the correct phenotypic profile and enabling the choice of red blood cells with corresponding antigens to the patient to be transfused. Extensive prophylactic red blood cell genotyping to select donors for patients receiving repeated transfusions over a long period of time is a compelling application of DNA-based blood typing. This is particularly relevant for patients with sickle cell disease where the rate of alloimmunization is high.

Imunohematologia veterinária: antígenos eritrocitários caninos / Veterinary immunohematology: canine erythrocyte antigen / Inmunohematología veterinaria: antígenos eritrocitarios caninos

A imunohematologia veterinária vem ganhando interesse nos últimos anos devido a maior acessibilidade a tecnologias de detecção de antígenos e anticorpos, interesse dos donos e médicos veterinários em buscar uma melhor qualidade de vida para os animais e as necessidades de transfusões com o menor índice possível de reações indesejadas. Os cães possuem antígenos presentes na membrana de suas células vermelhas, podendo causar reações durante e após transfusões. Diferentemente de humanos e felinos, cães não possuem anticorpos naturais para os principais antígenos, a priori podendo ser transfundidos com qualquer tipo sanguíneo sem consequências posteriores, porém, se submetidos a uma segunda transfusão, sendo essa de um tipo sanguíneo incompatível e previamente sensibilizados, as chances de ocorrer reações transfusionais graves aumentam drasticamente, ocasionando danos ao animal, podendo levá-lo à morte. Por conta desses riscos se faz necessário uma maior atenção aos tipos sanguíneos desses animais onde 8 sistemas são reconhecidos internacionalmente classificados como sistema DEA, sendo eles DEA 1 e seus subtipos (DEA 1.1; DEA1.2; DEA 1.3); DEA 3; DEA 4; DEA 5; DEA 6; DEA 7 e DEA 8, e recentemente um novo sistema denominado Dal. Não há disponível ainda soros para os sistemas DEA 6 e DEA 8, tornando a pesquisa sobre esses antígenos dificultosa.(AU)

Veterinary immunohematology is gaining interest in recent years due to greater accessibility to antigen and antibody detection technologies, the interests of pet owners and veterinarians in seeking a better quality of life for animals, and requirement of transfusions with the lowest possible rate of collateral reactions. Dogs have antigens present in the membrane of their red blood cells that can cause reactions during and after transfusions. Unlike humans and cats, dogs do not have natural antibodies to the key antigens, and a priori they can be transfused with any type of blood without any further consequences. However, if they are ever subjected to a second transfusion, if using incompatible blood types and being previously sensitized, the likelihood of having serious transfusion reactions drastically increase, causing damage to the animal, which may even lead it to death. Due to those risks, greater attention is required to the blood type of those animals, which present 8 systems, internationally recognized and classified as the DEA system, namely DEA 1 and its subtypes (DEA 1.1; DEA 1.2; DEA 1.3); DEA 3; DEA 4; DEA 5; DEA 6; DEA 7 and DEA 8, and recently a new system referred to as Dal. No serum is yet available for DEA 6 and DEA 8 systems, hindering the research on those antigens.(AU)

La inmunohematología veterinaria ha ganado atención en los últimos años debido mayor accesibilidad a tecnologías de detección de antígenos y anticuerpos, interés de dueños y médicos veterinarios en buscar mejor calidad de vida para los animales y las necesidades de transfusiones con menor índice posible de reacciones indeseadas. Los perros poseen antígenos presentes en la membrana de sus células rojas, pudiendo causar reacciones durante y después de transfusiones. Diferentemente de humanos y felinos, perros no tienen anticuerpos naturales para los principales antígenos, a priori, pudiendo ser transfundidos con cualquier tipo de sangre sin consecuencias posteriores, todavía, si sometidos a una segunda transfusión, siendo esa de un tipo sanguíneo incompatible y previamente sensibilizados, la posibilidad de ocurrir reacciones transfusional grave aumenta drásticamente, ocasionando daños al animal, pudiendo llevarlo a la muerte. Por esos riesgos se hace necesario más atención a los tipos sanguíneos de esos animales, donde 8 sistemas son reconocidos internacionalmente y clasificados como sistema DEA, siendo ellos DEA 1 y sus subtipos (DEA 1.1; DEA 1.2; DEA 1.3); DEA 3; DEA 4; DEA 5; DEA 6; DEA 7 y DEA 8, y recién un nuevo sistema denominado Dal. No hay aún disponible sueros para los sistemas DEA 6 y DEA 8, haciendo dificultosa la investigación sobre esos antígenos.(AU)

Validation of western blot for Histoplasma capsulatum antibody detection assay.

BACKGROUND: Histoplasmosis is worldwide systemic mycoses caused by the dimorphic fungus Histoplasma capsulatum. The isolation and identification of H. capsulatum in culture is the reference test for histoplasmosis diagnosis confirmation. However, in the absence of it, serology has been used as a presumptive diagnosis through antibody and antigen detection. The purpose of the present study was to validate an immunoassay method (western blot) for antibodies detection in the diagnosis of histoplasmosis. METHODS: To validate the western blot (WB) a study was conducted using 118 serum samples from patients with histoplasmosis and 118 serum controls collected from January 2000 to December 2013 in residents of the Rio de Janeiro State, Brazil. Diagnostic validation parameters were calculated based on the categorization of results obtained in a 2 × 2 table and subjected to statistical analysis. In addition, the viability of deglycosylated histoplasmin antigen (ptHMIN) onto nitrocellulose membranes previously sensitized was evaluated during the same period. RESULTS: The WB test showed sensitivity of 94.9 %, specificity of 94.1 %, positive predictive value of 94.1 %, negative predictive value of 94.9 %, accuracy of 94.5 %, and almost perfect precision. Besides, the strips have proved to be viable for using at least 5 years after ptHMIN antigen sensitization. CONCLUSION: Western blot test using ptHMIN provides sensitive, specific, and faster results. Therefore, could be considered a useful tool in the diagnosis of histoplasmosis being used by public health system, even in situations where laboratory facilities are relatively limited.

Análise epidemiológica e laboratorial de indivíduos coinfectados pelo vírus linfotrópicos para células T humanas do tipo 1 (HTLV-1) e vírus da hepatite C (HCV) / Epidemiological and laboratory analysis of patients coinfected with human T-cell lymphotropic virus type 1 (HTLV-1) and hepatitis C virus (HCV)

A infecção pelo vírus linfotrópico para células T humanas tipo 1 (HTLV-1) pode levar a alterações funcionais da resposta imune do hospedeiro. O HTLV-1 está associado ao desenvolvimento de duas doenças principais: leucemia de células T do adulto e paraparesia espástica tropical/mielopatia associada ao HTLV-1. A infecção pelo vírus da hepatite C (HCV) pode levar ao desenvolvimento de hepatite crônica, cirrose hepática e carcinoma hepatocelular. [...] Devido ao papel da resposta imune celular no desenvolvimento e progressão de doenças associadas ao HCV, espera-se que a interação entre o HTLV-1 e HCV possa modificar o curso natural dessas infecções. Com o objetivo de avaliar aspectos epidemiológicos e laboratoriais foi realizado um estudo transversal envolvendo uma serie de casos. Foram incluídos no estudo 50 pacientes coinfectados com HTLV-1/HCV, 46 portadores de infecção pelo HCV e 50 pacientes HTLV-1 monoinfectados selecionados randomicamente. Pacientes portadores de infecção pelo vírus da hepatite B e/ou vírus da imunodeficiência adquirida foram excluídos do estudo. A análise estatística das variáveis avaliadas foi realizada utilizando métodos descritivos, paramétricos ou não-paramétricos. Não houve diferença significativa em relação às características sócio-demográficas entre os grupos. O relato de uso de álcool foi mais frequente no grupo HCV (p< 0,001). O passado de transfusão de sangue foi considerado como provável via de infecção em 80,6 por cento dos casos do grupo HCV e 39 por cento dos pacientes HTLV-1/HCV coinfectados. Em 26,8 por cento dos coinfectados a provável via de infecção foi a utilização de drogas injetáveis. Por outro lado, a transmissão sexual (55,6 por cento) predominou no grupo HTLV-1 (p<0,001)...

Human T-cell lymphotropic virus type 1 (HTLV-1) infection may lead to functional alterations of host immune response. HTLV-1 is associated with the development of two major diseases: adult T-cell leukemia/lymphoma and tropical spastic paraparesis/HTLV-1-associated myelopathy. [...] Due to the role of cellular immunity in the development and progression of HCV-associated diseases, one could expect that the interaction between HTLV-1 and HCV might modify thenatural course of these infections. with the aim to evaluate the epidemiological and laboratory aspects of these infections, a cross-sectional study with a series of cases was conducted. The study included 50 HTLV-1/HCV coinfected patients, 46 HCV and 50 HTLV-1 infected patients randomly selected. Patients with hepatitis B virus and/or human immunodeficiency virus infection were excluded. Statistical analysis was performed using descriptive, parametric or nonparametricmethods. The socio-demographic characteristics were similar among the three groups of patients. Alcohol drinking was more frequent in HCV group (p <0.001). Past history of blood transfusion was considered as probable route of infection in 80.6 percent of HCV group cases and in 39 percent of HTLV-1/HCV coinfected patients. In 26.8 percent of coinfected patients the probable infection route was history of drug addiction...