Cobertura vacinal da BCG, VIP e Tríplice Viral no Brasil, 2010 a 2020: um estudo epidemiológico / BCG, VIP, and Triple Viral vaccine coverage in Brazil, 2010 to 2020: an epidemiological study / Cobertura de vacunación de BCG, VIP y Triple Viral en Brasil, de 2010 a 2020: un estudio epidemiológico

O objetivo deste estudo foi descrever a cobertura vacinal da BCG, da VIP e da tríplice viral no Brasil, entre os anos de 2010 e 2020. Trata-se de um estudo epidemiológico, descritivo e retrospectivo, com utilização de dados epidemiológicos disponíveis publicamente no Departamento de Informática do Sistema Único de Saúde. Os dados coletados durante o período selecionado foram analisados descritivamente. No Brasil, entre 2010 e 2020, a cobertura vacinal apresentou sua maior taxa anual no ano de 2015 e sua menor taxa em 2016. No que se refere à cobertura vacinal por região do Brasil, a Centro-Oeste obteve a maior taxa geral nos anos estudados. Quanto aos imunobiológicos enfatizados no estudo, é possível observar que as regiões Centro-Oeste e Sul apresentam as maiores taxas. Os valores encontrados nesta pesquisa expressam que houve uma queda da cobertura vacinal a partir de 2016 em todo o território brasileiro, e a maior taxa entre os estados foi a da região Centro-Oeste. Entre os imunobiológicos mencionados nesta pesquisa, observou-se que apenas a BCG e a VIP alcançaram valores acima de 90% no período em estudo, contudo, ambas vem apresentando queda da cobertura nos últimos anos, principalmente no ano de 2020, demonstrando que o atual cenário brasileiro está fora do preconizado.

This study aimed to describe BCG, VIP, and MMR vaccination coverage in Brazil from 2010 to 2020. This epidemiological, descriptive, and retrospective study used epidemiological data publicly available in the Department of Informatics of the Unified Health System. Data collected for the selected period were descriptively analyzed. In Brazil, from 2010 to 2020, national vaccination coverage showed its highest annual rate in 2015 and the lowest rate in 2016. Regarding vaccination coverage by region of Brazil, the Midwest obtained the highest higher overall rate in the studied years. The immunobiologicals emphasized in studies showed that the Midwest and South have the highest rates. The values in this study express a drop in vaccination coverage from 2016 onward throughout the country, with the highest rate among states referring to the Midwest. Among the immunobiological products emphasized in this research, only BCG and VIP reached values above 90% in the studied period, but both have shown a drop in coverage in recent years, especially in the year 2020, evincing that the current Brazilian scenario remains outside recommendations.

El objetivo de este estudio fue describir la cobertura de vacunación de BCG, VIP y triple viral en Brasil, en el período de 2010 a 2020. Este es un estudio epidemiológico, descriptivo y retrospectivo, que utilizó datos epidemiológicos disponibles públicamente en el Departamento de Informática del Sistema Único de Salud. Se analizaron descriptivamente los datos recopilados durante el período seleccionado. En Brasil, entre 2010 y 2020, la cobertura de vacunación presentó la tasa anual más alta en 2015 y la más baja en 2016. En cuanto a la cobertura de vacunación por regiones de Brasil, la región Centro-Oeste obtuvo la tasa general más alta en los años de estudio. Respecto a los inmunobiológicos enfatizados en los estudios, se puede observar que las regiones Centro-Oeste y Sur presentan las tasas más altas. Los valores encontrados en esta investigación muestran un descenso en la cobertura de vacunación a partir de 2016 en todo el país, y la tasa más alta entre los estados se registró en la región Centro-Oeste. Entre los inmunobiológicos destacados en esta investigación, se observó que solo BCG y VIP alcanzaron valores superiores al 90% en el período de estudio, sin embargo, ambos han mostrado un descenso en la cobertura en los últimos años, especialmente el año 2020, lo que demuestra que el escenario brasileño actual está lejos de lo recomendado.

Idealização da maternidade e herança psíquica: reflexões no contemporáneo / Idealization of motherhood and psychic heritage: reflections in the contemporary / Idealización de la maternidad y herencia psíquica: reflexiones en lo contemporáneo

Considerando as transformações na maternidade ao longo da história e a atual crise identitária na relação da mulher com a maternidade, ou seja, o conflito entre os ideais de maternidade relacionados à figura da mulher/mãe e as demandas contemporâneas de realização individual no trabalho, realizou-se este estudo transversal, exploratório-descritivo de abordagem qualitativa, cujo objetivo consistia em descrever e analisar, a partir da psicanálise de casal e família, a experiência de mães que abandonaram da carreira profissional para a dedicação exclusiva à maternidade. Foram entrevistadas oito mulheres de classe média, entre 30 e 50 anos, que eram mães e abandonaram suas carreiras profissionais para se dedicarem à maternidade. As entrevistas que compuseram os resultados foram transcritas e as análises de conteúdo temática apontaram as múltiplas exigências, tanto sociais, quanto relacionadas à herança psíquica, que trazem implicações para a construção identitária dessas mulheres. Concluímos que um processo de elaboração dessa herança exige uma rede vincular de apoio e pressupõe a desidealização da maternidade, entendendo-a como plural, tanto no sentido de ser múltipla e diversa, quanto no sentido de ser uma construção vincular.

Noticing the history transformations in motherhood, and the current identity crisis in the woman's relationship between femininity and maternity, that is, the conflict between the ideas of motherhood related to the figure of the woman/mother and the contemporary demands of individual realization at work, this exploratory-descriptive, cross-sectional, study of a qualitative approach was carried out, whose objective was to describe and analyze, from the perspective of psychoanalysis of the linking configurations, the experience of mothers who abandoned the professional career for the exclusive dedication to motherhood. Eight middle-class women, aged between 30 and 50, who were mothers and abandoned their professional careers to dedicate themselves to motherhood-retirar, were interviewed. The interviews that composed the results were transcribed, and thematic content analyses pointed out the multiple demands, both social and related to psychic heritage, which have implications for the identity construction of these women. We conclude that an elaboration of this heritage requires a link network of support and presupposes the non-idealization of motherhood, understanding it as plural, both in the sense of being multiple and diverse, and in the sense of being a bonding construction.

Considerando los cambios en la maternidad a lo largo de la historia y la actual crisis de identidad en la relación de la mujer con la maternidad, es decir, el conflicto entre los ideales de maternidad relacionados con la figura de la mujer/madre y las demandas contemporáneas de realización individual en el trabajo, se realizó este estudio transversal, exploratorio-descriptivo de abordaje cualitativo, cuyo objetivo consistía en describir y analizar, a partir del psicoanálisis de las configuraciones vincular, la experiencia de madres que abandonaron de la carrera profesional para la dedicación exclusiva a la maternidad. Fueron entrevistadas ocho mujeres de clase media, entre 30 y 50 años. que eran madres y abandonaron sus carreras profesionales para dedicarse a la maternidad-retirar. Las entrevistas que compusieron los resultados fueron transcritas y los análisis de contenido temático señalaron las múltiples exigencias, tanto sociales, como relacionadas a la herencia psíquica, que traen implicaciones para la construcción identitaria de esas mujeres. Concluimos que un proceso de elaboración de esa herencia exige una red vincular de apoyo y presupone la desidealización de la maternidad, entendiéndola como plural, tanto en el sentido de ser múltiple y diversa, como en el sentido de ser una construcción vincular.

The Lockdown Impact on the Relations between Portuguese Parents and Their 1- to 3-Year-Old Children during the COVID-19 Pandemic.

Many countries have applied mandatory confinement measures in response to the COVID-19 pandemic, such as school and kindergarten closures, which confined families to their homes. The study concerns the impacts of the first COVID-19 lockdown on the relationships between Portuguese parents and their children, in a non-clinical population composed of fathers and mothers of children between the ages of 12 months and 3 years and 364 days. An online questionnaire (set by the research team) and the Parenting Daily Hassles Scale (PDHS) concerning the confinement period were applied between 17 June and 29 July 2020. To assess the impacts of the lockdown, outcomes regarding the impacts perceived by the parents, the potential regression in the development of children, and the willingness to promote changes in family routines in the future, were considered. Of the total sample (n = 1885), 95.4% of the parents (n = 1798) said that, after confinement, the relationship with their children had improved or remained similar to the pre-confinement period; 97.3% (n = 1835) noticed positive changes in the development of their children, and 63.7% (n = 1200) noted that the relationships with their children during the confinement period would lead to some changes in family routines in the future. Multivariate regression analyses showed that most of the sociodemographic variables chosen were not associated with the outcomes. However, significant levels of pressure over parenting and parental overload (reported by high scores in the PDHS intensity and frequency scales), challenging behaviors of the children, and the impacts they had on parental tasks had negative influences on the studied outcomes. On the contrary, the number of adults living with their children, the perceptions regarding the development of their children, and sharing new experiences with them were significant factors for positively-perceived impacts on the relationships between them or in the desire to bring about changes in family routines in the future. The impacts of the lockdown on the relationships between parents and children aged between 1 and 3 years old were more dependent on relational aspects and on the parents' sense of competence in exercising parental functions. We conclude that, despite the increased demands imposed by the lockdown, nearly all of the parents evaluated the quality of the relationship with their children as positive after this period.

Análise das boas práticas de atenção ao parto em maternidade pública de Roraima / Analysis of good practices for child care in Roraima public maternity

Objetivo: Analisar se boas práticas de atenção ao parto estão sendo executadas e quais necessitam ser aperfeiçoadas no Hospital Materno Infantil Nossa Senhora de Nazaré (HMINSN), em Boa Vista-RR. Métodos: Foram registrados os partos normais de setembro de 2019 a março de 2020, pela equipe administrativa do hospital, na base de dados do Apice On. Nove recomendações de boas práticas da Organização Mundial da Saúde (OMS) foram avaliadas e comparadas com outros serviços do País. Resultados: Observou-se que, em comparação com outros serviços do Brasil, entre as nove práticas analisadas, quatro apresentaram melhor resultado no HMINSN, com alta proporção de acompanhantes (90,1%), aplicação de ocitocina no terceiro período (98,7%), amamentação na primeira hora pós-parto (81,5%) e baixo número de episiotomia (8,8%). Além disso, atingiu metas do Apice On em quatro boas práticas, que são a presença de acompanhante (meta: acima de 90%), a aplicação de ocitocina no terceiro período (meta: acima de 90%), o clampeamento tardio do cordão umbilical (meta: acima de 90%) e a episiotomia (meta: abaixo de 10%). Conclusão: Este estudo identificou que é preciso melhorar as taxas de prescrição de dieta livre e o contato pele a pele na primeira hora pós-parto. De modo geral, o HMINSN tem apresentado bons indicadores em relação a outros serviços do País e vem buscando aprimorar a organização da equipe e do serviço para que todas as recomendações da OMS sejam efetivamente praticadas.(AU)

Objective: Analyze whether good practices for child care are being carried out and which need to be improved at the Hospital Materno Infantil Nossa Senhora de Nazaré (HMINSN), in Boa Vista-RR. Methods: Normal deliveries from September 2019 to March 2020 were recorded by the hospital's administrative staff in the Apice On database. Nine recommendations of World Health Organization (WHO) good practices were evaluated and compared with other services in the country. Results: It was observed, in comparison with other services in Brazil, among the nine practices analyzed, four of them had better results at HMINSN, with a high proportion of companions (90.1%), application of oxytocin in the third period (98.7 %), breastfeeding in the first hour postpartum (81.5%) and low number of episiotomy (8.8%). In addition, it reached Apice On targets in four good practices, which are the presence of a companion (target: above 90%), the application of oxytocin in the third period (target: above 90%), the late clamping of the umbilical cord (target: above 90%) and episiotomy (target: below 10%). Conclusion: This study identified that it is necessary to improve the prescription rates of free diet and skin-to-skin contact, in the first postpartum hour. In general, HMINSN has presented good indicators in relation to other services in the country and has been seeking to improve the organization of the team and the service, so that all WHO recommendations are effectively practiced.(AU)

Tailored Anterior Clinoidectomy: Beyond the Intradural and Extradural Concepts.

Anterior clinoidectomy (AC) is a key microsurgical step for the safe and successful management of parasellar pathologies that involve the anterior clinoid process (ACP) and the optic canal. Traditionally, extra and intradural ACs are performed separately according to the surgeon's experience or preference. The objective is to present and discuss the tailored AC concept through illustrative cases. We conducted a retrospective record review of three patients who underwent AC as a surgical step for the treatment of parasellar pathologies that involve the ACP and optic canal. A review of the relevant literature on AC was performed in the PubMed, LILACS, and SciELO databases. In all three cases, the pterional craniotomy was the preferred approach for AC. Case 1, a 47-year-old female patient with type III anterior clinoidal meningioma, underwent a tailored intradural technique (optic canal unroofing) with total tumor resection and complete visual recovery. Case 2, a 63-year-old female patient with a complex type II anterior clinoidal meningioma with extensive hyperostosis of the ACP, underwent a hybrid AC technique with complete removal of the tumor and visual improvement. Case 3, a 62-year-old female, underwent a tailored intradural AC for clipping an incidental carotid-ophthalmic aneurysm. Tailored AC aims to provide adequate exposure with less risk of neurovascular injury, allowing enough space to safely treat parasellar lesions. The type, size, and location of the lesion, as well as the surgeon's experience, should always be considered for surgical planning.

Distúrbio de movimento por conta de estado hiperosmolar não cetótico em idosa: relato de caso / Movement disorder caused by hyperosmolar hyperglycemic state in an older adult: a case report

O diabetes e suas complicações constituem as principais causas de mortalidade precoce na maioria dos países. O envelhecimento da população e a crescente prevalência da obesidade e do sedentarismo, além dos processos de urbanização, são considerados os principais fatores responsáveis pelo aumento da incidência e da prevalência do diabetes mellitus (DM) em todo o mundo. Este relato de caso objetiva descrever a presença de distúrbio do movimento em idoso por conta do estado hiperosmolar não cetótico. A combinação de hemicoreia-hemibalismo, hiperglicemia não cetótica e envolvimento dos gânglios da base em exames de imagem é considerada uma síndrome única. Os distúrbios do movimento em estado hiperosmolar não cetótico apresentam resposta terapêutica satisfatória com o uso de neurolépticos e controle glicêmico adequado. A escassez de trabalhos publicados proporciona subdiagnósticos clínico e laboratorial, interferindo no prognóstico e no acompanhamento dos pacientes.

Diabetes mellitus (DM) and its complications constitute the leading causes of early mortality in most countries. Population aging and the growing prevalence of obesity and sedentary lifestyles, in addition to spreading urbanization, are considered the main drivers of the increasing incidence and prevalence of DM worldwide. This case report describes the acute onset of movement disorder in an older woman secondary to hyperosmolar hyperglycemic state (HHS). The combination of hemichorea­hemiballismus, HHS, and evidence of basal ganglia involvement on neuroimaging is considered a unique syndrome. Movement disorders secondary to HHS respond satisfactorily to administration of neuroleptic agents and proper glycemic control. The lack of published studies on this pathologic entity may lead to clinical and laboratory underdiagnosis, with negative impacts on patient prognosis and follow-up.

Universal fluorescence module for intraoperative fluorescein angiography-a technical report.

BACKGROUND: Even in specialized centers, suboptimal aneurysm clipping can be as high as 12%. Intraoperative fluorescence angiography with indocyanine green and, more recently, fluorescein sodium have been shown to be a good method for intraoperative flow assessment. However, the cost with the apparatus it entails limits its widespread use. We have developed a low-cost universal fluorescence module (FM) designed to visualize fluorescein and perform intraoperative angiography. The purpose of this paper is to describe this device as well as to present our early experience with its use in the treatment of cerebral aneurysms. METHOD: A FM was designed and built using a cyan-blue narrow bandpass (460 to 490 nm) excitation filter and a yellow-orange longpass (blocking wavelengths under 520 nm) barrier filter mounted on a 3D-printed holding tray in a specific disposition to perfectly match the light source and the objective lens of the surgical microscope. It allowed switching from white light to fluorescence mode in a simple and sterile fashion. Its perfect attachment to the microscope was possible by reusing the lens fittings extracted from used original drape sets that would otherwise be discarded. Four patients underwent aneurysm clipping using the FM at two institutions from April to September 2018. RESULTS: A bright green fluorescence against a dark background was observed after intravenous bolus of fluorescein. Blood vessels became obviously distinct from non-contrast-filled structures such as clipped aneurysms and the brain. Vascular anatomy could be appreciated without any distortion, including perforating arteries. CONCLUSIONS: Intraoperative fluorescence angiography was successfully performed with the use of this universal FM after intravenous injection of fluorescein sodium. This simple and low-cost device may be useful in resource-limited centers, where other sorts of intraoperative angiography are not available.

Photobiomodulation therapy improves both inflammatory and fibrotic parameters in experimental model of lung fibrosis in mice.

Lung fibrosis (LF) is a chronic and progressive lung disease characterized by pulmonary parenchyma progressive lesion, inflammatory infiltration, and interstitial fibrosis. It is developed by excessive collagen deposition and other cellular matrix components, resulting in severe changes in the alveolar architecture. Considering the absence of effective treatment, the aim of this study was to investigate the effect of photobiomodulation therapy (PBMT) on the development of PF. For this purpose, we used C57BL6 mice subjected to induction of LF by bleomycin administration (1.5 U/kg) by orotracheal route and, after 14 days of the induction, mice were treated with PBMT applied to the thorax 1×/day for 8 days (wavelength 660 ± 20 nm, power 100 mW, radiant exposure 5 J/cm2, irradiance 33.3 mW/cm2, spot size 2.8cm2, total energy 15 J, time of irradiation: 150 s) and inflammatory and fibrotic parameters were evaluated with or without PBMT. Our results showed that PBMT significantly reduced the number of inflammatory cells in the alveolar space, collagen production, interstitial thickening, and static and dynamic pulmonary elastance. In addition, we observed reduced levels of IL-6 e CXCL1/KC released by pneumocytes in culture as well as reduced level of CXCL1/KC released by fibroblasts in culture. We can conclude that the PBMT improves both inflammatory and fibrotic parameters showing a promising therapy which is economical and has no side effects.

Surgical Treatment of a Case of Ledderhose's Disease: A Safe Plantar Approach to Subtotal Fasciectomy.

Plantar fibromatosis, Ledderhose's disease, or Morbus Ledderhose is an uncommon benign nodular hyperplasia of the plantar aponeurosis. The aim of this paper was to report the case of a 47-year-old male patient who had concomitant Dupuytren's disease and failed all conservative measures. He was treated surgically with prompt and complete relief of symptoms postoperatively, and he has had no recurrence at the 2-year follow-up. In this richly documented case, we discuss details of the surgical technique and anatomy, which was important for a successful outcome and preventing complications. The technique for subtotal fasciectomy is reviewed and the relevance of the adequate choice of skin incision to prevent painful scarring, skin necrosis, and difficulties with shoe wearing is highlighted.

Diagnóstico de câncer de mama na gestação: há dificuldades adicionais / Diagnosis of breast cancer in pregnancy: are there additional difficulties

O câncer de mama gestacional (CMG) é caracterizado como todo câncer de mama diagnosticado durante a gravidez ou até um ano após o parto. Na gravidez, as alterações fisiológicas da mama prejudicam a interpretação da mamografia nos casos em que é solicitada, já que não faz parte do rastreamento no pré-natal. Além disso, a pouca prática do autoexame das mamas dificulta o diagnóstico. Este trabalho foi desenvolvido por meio de uma revisão de literatura com uso de 18 artigos nacionais e 8 internacionais disponíveis em bancos de dados virtuais, tais como: Bibliomed, BVS, Scielo, Bireme, Lilacs, Guideline. Conforme a literatura, as variáveis acima citadas são limitadoras da detecção precoce do CMG. Destaca-se a importância de se mostrar que há associação de fatores que impedem a descoberta precoce da doença, tornando o estadiamento tardio e comprometendo a sobrevida das mulheres. Sendo o câncer de mama um problema de saúde pública, faz-se necessária uma abordagem especial da gestante para que haja a detecção dessa doença em seu início

The gestational breast cancer (CMG) is characterized as all breast cancer diagnosed during pregnancy or within one year after delivery. During pregnancy, physiological changes affect the interpretation of breast mammography where it is required, since it is not part of the prenatal screening. In addition the low frequency practice of self-examination of breast makes diagnosis difficult. This work was developed through a literature review by using 18 national articles and 8 international ones, all available in virtual databases such as Bibliomed, Scielo, Bireme, Lilacs, Guideline. Acording to literature, these variables are limiting the early detection of CMG. We emphasize the importance of showing that there is an association of factors that impede the early detection of disease, making the later stage, and compromising the survival of women. As breast cancer is a public health problem, a special approach to the pregnant woman is required so that there can be an early detection of the disease