Safety of direct oral provocation test to delabel reported mild beta-lactam allergy in infants.

BACKGROUND: Around 10% of people report a drug allergy and avoid some medications because of fear of allergic reactions. However, only after a proper diagnostic workup can some of these reactions be confirmed as allergic or nonallergic hypersensitivities. Beta-lactams (BLs) are the most common medication suspected of being involved in drug hypersensivity reactions (DHRs) in children. Recently, direct oral provocation tests (DPT) with BLs gained popularity within pediatric populations as a tool for delabeling children with suspected BL allergies. This study aimed to evaluate the safety of direct provocation tests in infants with mild cutaneous non-immediate reactions to BLs. METHODS: The authors retrospectively analyzed the data of 151 infants between 2015 and 2022, referred for evaluating a suspected allergy to BLs that occurred before age 24 months. RESULTS: The mean age of the children, including 55% male kids, at the suspected reaction was 15.9 months and the mean age at the time of the DPT was 39.6 months. In most cases, antibiotics were prescribed to treat common upper respiratory infections, such as acute otitis (54.3%) and acute tonsillitis (27.2%). Amoxicillin was considered the culprit drug in 62.9% of the cases, and the combination of amoxicillin-clavulanic acid in the case of 33.8% of children. The most frequent associated cutaneous clinical manifestations were maculopapular exanthema in 74.8% and delayed urticaria/angioedema in 25.2%. Of the 151 infants evaluated, parents of 149 infants agreed for a direct DPT, and only three had a positive test (2%). Symptoms resulting from the DPT were mild and easily treatable. CONCLUSIONS: A direct DPT without prior tests is a safe and effective procedure to delabel BL allergy, even in infants. The authors wish to emphasize the importance of properly validating BL allergy suspicions by promoting appropriate diagnostic procedures in infants as, in most cases, DHRs can be excluded and there is no need for further therapeutic restrictions.

Safety of direct oral provocation test to delabel reported mild beta-lactam allergy in infants

Background: Around 10% of people report a drug allergy and avoid some medications because of fear of allergic reactions. However, only after a proper diagnostic workup can some of these reactions be confirmed as allergic or nonallergic hypersensitivities. Beta-lactams (BLs) are the most common medication suspected of being involved in drug hypersensivity reactions (DHRs) in children. Recently, direct oral provocation tests (DPT) with BLs gained popularity within pediatric populations as a tool for delabeling children with suspected BL allergies. This study aimed to evaluate the safety of direct provocation tests in infants with mild cutaneous non-immediate reactions to BLs. Methods: The authors retrospectively analyzed the data of 151 infants between 2015 and 2022, referred for evaluating a suspected allergy to BLs that occurred before age 24 months. Results: The mean age of the children, including 55% male kids, at the suspected reaction was 15.9 months and the mean age at the time of the DPT was 39.6 months. In most cases, antibiotics were prescribed to treat common upper respiratory infections, such as acute otitis (54.3%) and acute tonsillitis (27.2%). Amoxicillin was considered the culprit drug in 62.9% of the cases, and the combination of amoxicillin–clavulanic acid in the case of 33.8% of children. The most frequent associated cutaneous clinical manifestations were maculopapular exanthema in 74.8% and delayed urticaria/angioedema in 25.2%. Of the 151 infants evaluated, parents of 149 infants agreed for a direct DPT, and only three had a positive test (2%). Symptoms resulting from the DPT were mild and easily treatable. Conclusions: A direct DPT without prior tests is a safe and effective procedure to delabel BL allergy, even in infants... (AU)

Vulnerability to Suicide Ideation: Comparative Study between Adolescents with and without Psychosocial Risk.

Adolescents are characterized as a risk group for suicide, being the fourth leading cause of death in young people. The main aim was to compare vulnerability to suicidal ideation in a sample of young people with and without psychosocial risk. The total sample consisted of 137 adolescents, aged between 10 and 19 years (M = 14.76; SD = 1.40), and it was composed of two groups-the psychosocial risk group (n = 60) and general population group (n = 77). In both groups, suicidal ideation correlated positively with negative events and negatively with self-esteem and social support satisfaction. When comparing the two groups, the psychosocial risk group presented significantly higher mean values of negative life events (mainly separations/losses and physical and sexual abuse) and significantly lower mean values of satisfaction with social support (particularly with family and social activities). It was also found that, in the psychosocial risk group, negative life events were the only significant predictors of suicidal ideation. This study allowed identifying the role of risk and protective factors in suicidal ideation, according to the psychosocial risk of adolescents. The practical implications of the findings on adolescents' mental health and the promotion of their well-being are discussed.

Contact dermatitis from black henna tattoo in child due to paraphenylenediamine.

Temporary henna tattoos have become increasingly popular, particularly among children and teenagers. The word "henna" is of Persian origin, and it is prepared from the plant Lawsonia inermis belonging to the family Lythraceae. Concerning allergic reactions, natural henna paste is rarely responsible for contact dermatitis, which is more frequent if paraphenylenediamine (PPD) is added to the paste. The authors present a case of female child with erythematous exanthems that appeared after the application of black henna tattoo. A diagnosis of contact dermatitis to black henna tattoo was hypothesised. Epicutaneous tests were performed at the Immunoalergology Department of the Coimbra University Hospital using standard European battery and natural henna paste. The tests revealed positive reaction to PPD.

The Volunteer Satisfaction Survey (VSS): Adaptation and Psychometric Properties among Portuguese Volunteers.

(1) Background: Volunteering satisfaction is one significant construct that nourishes the sustaining of volunteer work, and it is present in reference models such as the three-stage volunteer process model (VPM). The volunteer satisfaction survey (VSS), created by Vecina, Chacón and Sueiro, evaluates three different domains of volunteer satisfaction: specific motivations, organization management and volunteering tasks. The aim of this study was to adapt the instrument and explore the psychometric properties of the 17 items of the VSS in a sample of Portuguese volunteers. (2) Methods: The sample was composed of 335 Portuguese volunteers (aged between 14 and 81 years), mainly women (76.4%). Measures included volunteer satisfaction, work engagement and organizational commitment. (3) Results: The original three-factor model was tested with a confirmatory factor analysis (CFA) and the model fitted the data. Satisfactory levels of internal consistency, discriminant and convergent validity were found. (4) Conclusions: The VSS reveals good psychometric properties and can be considered a useful tool for professionals and future research for volunteers' satisfaction assessment.

Hypersensitivity Reactions to Vaccines: Current Evidence and Standards for SARS-CoV-2 Vaccines.

The first reports of hypersensitivity reactions following the rollout of COVID-19 vaccination programs have raised public concern. Given the recent availability and novel mechanisms of COVID-19 vaccines, there is limited data on possible hypersensitivity reactions. Although it seems rare, the incidence of anaphylaxis for approved COVID-19 vaccines has been suggested as being higher when compared to previous vaccines. Adequate risk assessment, recognition, classification, and management of hypersensitivity reactions is crucial to ensure safe immunization and avoid misinformation and vaccine hesitancy. In this review, we present an overview of the types of hypersensitivity reactions that can potentially occur due to vaccination and the possible allergenic components of COVID-19 vaccines, as well as a suggestion for causality and risk assessment for the BNT162b2, mRNA-1273 and AZD1222 vaccines.

Após o início dos programas de vacinação contra a COVID-19, os primeiros relatos de reações de hipersensibilidade suscitaram alguma preocupação. Dada a recente disponibilidade e os novos mecanismos das vacinas contra a COVID-19, existem poucos dados relativos a possíveis reações de hipersensibilidade. A incidência de anafilaxia às vacinas COVID-19 parece ser mais elevada comparativamente a vacinas anteriores, embora seja igualmente rara. Uma avaliação adequada dos riscos, reconhecimento, classificação e correta abordagem das reações de hipersensibilidade é crucial para garantir uma imunização segura e evitar desinformação e hesitação na vacinação. Nesta revisão, apresentamos uma visão geral das potenciais reações de hipersensibilidade que podem ocorrer após a vacinação com as vacinas BNT162b2, mRNA-1273 e AZD1222, os seus possíveis constituintes alergénicos, bem como uma sugestão de avaliação do risco em doentes alérgicos e causalidade.

Oligosecretory multiple myeloma: a devastating presentation of a difficult diagnosis.

A 57-year-old man with lumbar pain and fever was diagnosed with spondylodiscitis. Afterward, he acquired full paraplegia. Image studies showed a mass extending from D9 to the vertebral canal, plus numerous adjacent osteolytic lesions. Serum immunoelectrophoresis was normal, bone marrow had 0.5% of monoclonal plasmocytes, but D9's biopsy found a plasmacytoma. Despite bone marrow aspiration results, skeleton osteolytic lesions made multiple myeloma (MM) a more plausible diagnosis, later confirmed by the biopsy. The absence of classical MM findings, alongside a medullary compression syndrome, suggested an oligosecretory MM, which was proved by an altered FLC essay. This delayed diagnosis, with multiple diagnostic misguiding leads, also presents rare IgA and lambda chains production and normal levels of uninvolved immunoglobulins. Oligosecretory MM can lead to an inaccurate and delayed diagnosis, with devastating consequences to patient's morbidity and mortality. Therefore, FLC essay is essential in early assessment of potential MM patients.

Avaliação do impacto de um protocolo fisioterapêutico na diminuição do quadro álgico durante a primeira fase do trabalho de parto vaginal / Evaluation of the impact of a physiotherapeutic protocol on the reduction of pain during the first phase of vaginal labor

O objetivo deste estudo foi avaliar a eficiência de um protocolo fisioterapêutico, aplicado em gestantes atendidas na Santa Casa de Misericórdia de Sobral/CE voltado para a redução do quadro álgico na primeira fase do trabalho de parto e na humanização do parto vaginal. Participaram grávidas com idade gestacional entre 37-42 semanas de gestação com feto único, vivo em apresentação cefálica e que estivessem na primeira fase do trabalho de parto, atuando de forma ativa e com dilatação cervical mí­nima de 3 centí­metros e sem uso de medicação após entrada no hospital. As participantes do grupo controle (GC; N=25) receberam orientações sobre relaxamento, respiração, dor e parto vaginal como placebo. As parturientes do grupo de intervenção (GI; N = 25), além das orientações, realizaram exercí­cios de respiração, liberação miofascial, alongamento, exercí­cios cinético-funcionais e massagem. Observou-se que as intervenções realizadas no GI proporcionaram diminuição da dor relatada (p = 0,0001), tendência não observada no GC. Foi observado aumento da dilatação vaginal e saturação de O2 em ambos os grupos, entretanto a média foi maior entre as pacientes do GI (p = 0,0001). Infere-se que o protocolo utilizado diminui a dor da gestante na primeira etapa do parto genital, além de estar associado ao relaxamento das pacientes. (AU)

The objective of this study was to evaluate the physiotherapeutic practice on the impact of pain during the first phase of vaginal labor in pregnant women attended at Santa Casa de Misericórdia of Sobral/CE. Pregnant women of gestational age between 37-42 weeks with a single fetus, alive in cephalic presentation and in the first phase of labor, active and with cervical dilatation of at least 3 cm, without use of medication after hospital admission, participated in this study. Participants in the control group (CG; N = 25) received guidance on relaxation, breathing, pain and vaginal delivery as placebo. In the intervention group (GI; N = 25), the patients received physical therapy, breathing, myofascial release, stretching, kinetic-functional exercises and massage. We observed that the interventions performed in the GI provided a decrease in the pain reported by the patients (p = 0.0001), a tendency not observed in the CG. Increased vaginal dilation and O2 saturation were observed in both groups, however, the mean was higher among GI patients (p = 0.0001). It is inferred that the protocol used reduces the pain of the pregnant woman in the first stage of genital delivery, besides being associated with the relaxation of the patients. (AU)

Realização do auto-exame das mamas por profissionais de enfermagem / Realización del auto examen de los senos por profesionales de enfermería / Breast self-examination by nursing professionals

Os tumores da mama, na maioria, são detectados pela mulher, portanto o autoexame das mamas (AEM) ainda é uma estratégia eficaz. Objetivou-se analisar a realização do AEM por profissionais de enfermagem e fatores que dificultam a adesão dessa prática. Estudo descritivo, quantitativo, desenvolvido com 159 profissionais, sendo 40 enfermeiras, 48 auxiliares e 71 agentes de saúde, de 19 Unidades Básicas de Saúde de Fortaleza, Ceará. Os dados foram coletados com questionário autoaplicável e analisados com base na Teoria do Autocuidado. Das 159 profissionais, 86 (54 por cento) realizavam o AEM mensalmente. Das 73 que não realizavam, 60 (82 por cento) referiram como motivo o esquecimento, 38 (52 por cento) por não confiar na sua técnica/não sabiam a técnica correta, e 35 (48 por cento) por falta de atenção à saúde. Constatou-se que, apesar da maioria declarar fazer o AEM, as profissionais se sentiam inseguras e gostariam de aperfeiçoar esta prática.

Most breast tumors are detected by women, not health professionals, therefore breast self-examination (BSE) continues to be an efficacious strategy. The study objective was to analyze BSE performed by nursing professionals and factors that hinder their perseverance in this practice. This descriptive study was performed with 159 professionals: 40 nurses, 48 nurses aides, and 71 health agents from 19 Basic Health Units located in Fortaleza (Ceará, Brazil). Data collection was performed using a self-administered questionnaire, and the analysis was based on the Self Care Theory. Of the 159 professionals, 86 (54 percent) performed BSE on a monthly basis. Of the 73 professionals who did not perform BSE, 60 (82 percent) reported the reason for that was forgetting, 38 (52 percent) for not trusting the technique/did not know the correct technique, and 35 (48 percent) due to lack of health care. It was found that although most women reported performing BSE, the professionals felt insecure and would like to learn better about this technique.

Los tumores del seno, en la mayoría, son detectados por la mujer, por lo tanto el auto examen de los senos (AES) todavía es una estrategia eficaz. Se objetivó analizar la realización del AES por profesionales de enfermería y factores que dificultan la adhesión de esa práctica. Estudio descriptivo, cuantitativo, desarrollado con 159 profesionales, siendo 40 enfermeras, 48 auxiliares y 71 agentes de salud, de 19 Unidades Básicas de Salud de Fortaleza, Ceará. Los datos fueron recolectados con un cuestionario auto aplicable, y analizados con base en la Teoría del Auto Cuidado. De las 159 profesionales, 86 (54 por ciento) realizaban el AES mensualmente. De las 73 que no lo realizaban, 60 (82 por ciento) refirieron como motivo el olvido, 38 (52 por ciento) por no confiar en su técnica/no sabían la técnica correcta, y 35 (48 por ciento) por falta de atención a la salud. Se constató que, a pesar de que la mayoría declaró hacer el AES, las profesionales se sentían inseguras y les gustaría perfeccionar esta práctica.

Barreiras para a prática do autoexame das mamas entre acadêmicas da área de saúde - Fortaleza, Ceará / Barriers to breast self examination among students of health-related professions - Fortaleza, Ceará

Este trabalho teve o propósito de identificar barreiras para a prática do autoexame das mamas (AEM) entre acadêmicas de cursos da área da saúde em três universidades de Fortaleza,Ceará. Foi realizado estudo descritivo, transversal, durante o ano de 2005. Utilizou-se um questionário autoaplicável,contendo questões sociodemográficas e referentes ao cuidado dispensado às mamas, sendo os dados organizados no programa SPSS e os resultados discutidos à luz dos pressupostos da promoção da saúde. Entre as 741 acadêmicas que participaram deste estudo, 604 (81,5%) relataram que não examinavam as mamas mensalmente. As principais barreiras mencionadas foram: o esquecimento (67,8%), a falta de atenção à saúde (53,1%), o desconhecimento sobre a técnica correta (40,5%) e a ausência de confiança na técnica(30,1%). As acadêmicas referiram conhecer a importância da detecção precoce (78,3%), acreditar no autoexame das mamas (81,2%) e gostar de se tocar (78,8%), e manifestaram o desejo de aprender a técnica correta (92,4%). Constatou-se que a menarca precoce foi significativamente relacionada às barreiras medo de encontrar nódulo, medo da doença, vergonha e não gostar de se tocar. As duas primeiras barreiras também apresentaram associação significativa com o tipo de lazer (praia). Estes achados contribuem para a adoção de estratégias que ampliam a compreensão da futura profissional sobre a importância deste exame para o autoconhecimento do corpo e da saúde da mulher, sugerindo a inclusão desse conhecimento teórico-prático no ensino universitário.

This work aimed to identify barriers to breast self-examinationamong students from health-related professionsfrom three universities in Fortaleza, CE, Brazil. A descriptivecross-sectional study was undertaken in 2005.A self applicable questionnaire was used to investigatesociodemographic issues and breast care practices. TheSPSS was used for data analysis, and the results discussedaccording to health promotion assumptions. Among the741 students who participated in this study, 604 (81.5%)reported that they did not examine their breasts everymonth. The main obstacles mentioned were: forgetfulness(67.8%), lack of health concern (53.1%), lack of familiaritywith the right technique (40.5%), and lack of confidence inthe technique (30.1%). The students reported being familiarwith the importance of early detection (78.3%), believed inbreast self-examination (81.2%), liked to touch themselves(78,8%), and manifested the desire to learn the correct technique(92,4%). Early menarche was significantly relatedto the following barriers: fear to detect a nodule, fear ofthe illness, shame and discomfort with self-touching. Thefirst two barriers also showed significant association withthe type of recreation (beach). These findings point to theimportance of strategies to incresase the knowledge ofthese professionals to be about the importance of breastself-examination. Inclusion of the topic in the curriculashould be considered.

[Breast self-examination by nursing professionals]. / Realização do auto-exame das mamas por profissionais de enfermagem.

Most breast tumors are detected by women, not health professionals, therefore breast self-examination (BSE) continues to be an efficacious strategy. The study objective was to analyze BSE performed by nursing professionals and factors that hinder their perseverance in this practice. This descriptive study was performed with 159 professionals: 40 nurses, 48 nurses aides, and 71 health agents from 19 Basic Health Units located in Fortaleza (Ceará, Brazil). Data collection was performed using a self-administered questionnaire, and the analysis was based on the Self Care Theory. Of the 159 professionals, 86 (54%) performed BSE on a monthly basis. Of the 73 professionals who did not perform BSE, 60 (82%) reported the reason for that was forgetting, 38 (52%) for not trusting the technique/did not know the correct technique, and 35 (48%) due to lack of health care. It was found that although most women reported performing BSE, the professionals felt insecure and would like to learn better about this technique.

Temporal and spatial variations in tidepool fish assemblages of the northeast coast of Brazil / Variação espacial e temporal na fauna de peixes em poças de maré do nordeste do Brasil

Temporal and spatial variations and environmental factors influencing the structure of tidepool fish assemblages were quantitatively investigated at Iparana beach, northeast Brazilian coast. The majority of the tidepool fishes sampled were suprabenthic juvenile individuals of great mobility. We recorded during monthly diurnal underwater visual censuses a total of 4,750 fish from 26 species, represented mainly by partial residents from the families Scaridae, Haemulidae, Gerreidae and Pomacentridae. The number of species and individuals showed significant variability among tidepools as a response to variations in their volume and type of substrate cover. The greatest species abundance and richness associated with rocks covered with algae suggested that substrate complexity is one of the main factors defining the spatial structure of the tidepool ichthyofauna. Temporal variability in species abundance and richness was associated with changes in salinity levels due to seasonal rainfalls. A higher number of juvenile fishes from December to May in our samples corroborate the hypothesis that the tidepools act as nursery sites. Therefore, the species associations found in this study and their relation to seasonal and spatial discontinuities may be partly explained according to their habitat requirements and reproductive cycles.

Investigamos quantitativamente variações espaciais e temporais, assim como os fatores ambientais que podem influenciar a estrutura da fauna de peixes em poças de maré da praia de Iparana, nordeste do Brasil. A maioria dos peixes registrados eram indivíduos suprabênticos jovens de grande mobilidade. Registramos, através de censos visuais subaquáticos diurnos mensais, um total de 4.750 peixes pertencentes a 26 espécies, representados principalmente por residentes parciais das famílias Scaridae, Haemulidae, Gerreidae e Pomacentridae. Os números de espécies e indivíduos mostraram variação significativa entre as poças amostradas com relação ao seu volume e tipo de cobertura do substrato. As maiores abundância e riqueza de espécies foram associadas à presença de rochas cobertas com algas, sugerindo que a complexidade estrutural do substrato é um dos principais fatores que define a estrutura espacial da ictiofauna em poças de marés. A variabilidade temporal em abundância e riqueza de espécies foi associada com variações de salinidade devido à sazonalidade das chuvas. Um maior número de peixes jovens registrados entre dezembro e maio corrobora a hipótese de que as poças de maré funcionam como berçários. Portanto, as associações de espécies encontradas neste estudo, assim como suas relações de descontinuidades sazonais e espaciais podem ser explicadas parcialmente de acordo com as exigências de hábitat e ciclos reprodutivos.