Catastrophic Kawasaki disease unresponsive to IVIG in a 3-month-old infant : a diagnostic and therapeutic challenge

The present report describes the severe evolution of Kawasaki disease in a three-month-old infant. The ailment was initially atypical in its presentation, with the patient exhibiting only persistent fever in association with a progressive lethargy and maculopapular rash on the face, trunk and limbs erroneously diagnosed as roseola infantum. On the 10th day of the condition, mainly due to the unexplained persistence of fever, the infant was admitted to a local hospital. The typical features of KD appeared only on the 14th day of illness with the relapse of the maculopapular rash in association with non-purulent conjunctivitis; dry, reddish and fissured lips; tongue with reddish and hypertrophic papillae; erythema and edema of the palms and soles. During the following days, the ailment rapidly evolved to a catastrophic clinical picture characterized by generalized vasculitis, splenic infarction, pulmonary thrombosis, giant right and left coronary aneurysms, dilatation of common and internal iliac arteries and progressive ischemia of the distal third of the feet resulting in necrotic lesions of both halluces. Appropriate therapy was initiated, but repeated administration of intravenous immunoglobulin G (IVIG) followed by three days of administration of methylprednisolone did not abate the intense inflammatory activity. The remission of inflammation and regression of vascular lesions were only achieved during the following five weeks after the introduction of methotrexate associated with etanercept. The report of this case aims to draw attention to severe forms of KD that exhibit an unfavorable evolution and can be extremely refractory to the conventional therapy

Gerenciamento de tempo: O que pensam os estudantes universitários

[Abstract] Time management practices allow users to meet their needs and pursue their goals within set deadlines. At university, time management is an important factor in promoting academic adaptation and good mental health. This article is based on a time management workshop for higher education students conducted over two years. A total of 17 students from public (n = 14) and private (n = 3) universities participated in the workshop, with a mean age of 28.4 years (SD = 15.3), of whom 14 were women. A Descending Hierarchical Classification (CHD) was employed using the software Iramuteq to analyze the participants’ conceptions about different time management strategies (both previously adopted and newly acquired), the difficulties involved in using them, and the lack of opportunities to implement them. The results revealed difficulties in relation to meeting deadlines for academic tasks, avoiding distractions, procrastination and maintaining study-life balance. The findings highlight the importance of providing students with spaces to accommodate their time management needs during their time at university.[Resumo] As práticas de gerenciamento do tempo permitem que os usuários satisfaçam as suas demandas e prossigam os seus objetivos dentro dos prazos estabelecidos. Na universidade, a gestão do tempo é um fator importante para promover a adaptação académica e a boa saúde mental. Este artigo baseia-se num seminário de gestão do tempo para estudantes do ensino superior realizado ao longo de dois anos. Participaram 17 estudantes de universidades públicas (n = 14) e privadas (n = 3), com uma média de idades de 28.4 anos (DP = 15.3), dos quais 14 eram mulheres. O estudo realizou uma Classificação Hierárquica Descendente (CHD), utilizando o software Iramuteq, das concepções dos participantes sobre as diferentes estratégias de gestão do tempo (existentes e recém-adquiridas), as dificuldades em utilizá-las e a falta de oportunidades para implementá-las. Os resultados revelaram dificuldades em relação ao cumprimento dos prazos das tarefas académicas, ao evitar distrações, àprocrastinação e como manter um equilíbrio entre o estudo e a vida pessoal. Os resultados evidenciam a importância de proporcionar aos estudantes espaços para acomodar as suas necessidades de gestão do tempo durante o seu tempo na universidade

A gestão do tempo na rotina universitária: resultados de uma intervenção

Those who make use of time management skills find them to be a useful tool for the purpose of overcoming procrastination tendencies and fostering better task management. These two matters — procrastination and task management — are two issues of considerable relevance in the lives of many university students. Poor time management skills can result in an unbalanced relationship with one’s academic responsibilities, resulting in an increase in stress levels. Uneven distribution of tasks throughout the week, procrastination, task overload and the absence of strategies for eliminating distractions are some of the possible means through which a student can undermine their own well-being as it relates to academic life. These bad practices may be remedied by adopting time management strategies. With the purpose of fostering such strategies, two online workshops were developed. A total of 17 students participated in the intervention, of whom, 12 showed improvements in their time management skills, with two displaying particularly remarkable positive changes. From these results, it was concluded that these interventions can be of great value, and that, despite the interventions being brief, it is possible to obtain results that lead to the improvement of participants’ time management skills.Las habilidades de gestión del tiempo proporcionan una buena herramienta en la superación de la dilación y en la gestión de tareas. Estos, a su vez, son dos problemas que están presentes en la vida de muchos estudiantes de educación superior. La mala gestión del tiempo puede resultar en una relación desequilibrada con las responsabilidades académicas, lo que puede conducir a un aumento del estrés. La falta de planificación de las actividades, la toma de un número de tareas excesivo para sí y la ausencia de estrategias para la eliminación de distracciones pueden minar el bienestar en la vida académica. Estas prácticas pueden remediarse adoptando estrategias de gestión del tiempo. Con el fin de divulgar y fomentar tales estrategias, se elaboraron talleres online. Participaron en los talleres un total de 17 estudiantes, de los cuales 12 presentaron mejoras en su relación con la gestión del tiempo, dos de estos presentaron cambios positivos particularmente notables. Se concluye a partir de estos resultados que tales intervenciones pueden ser de gran valor y que incluso con intervenciones breves es posible obtener resultados que confirmen la mejora en las habilidades de gestión del tiempo de los participantes.As habilidades de gestão do tempo fornecem àquele que se utiliza delas uma boa ferramenta na superação da procrastinação e na gestão de tarefas. Estes, por sua vez, são dois problemas que estão presentes na vida de muitos estudantes do Ensino Superior. Má gestão do tempo pode resultar em uma relação desequilibrada com as responsabilidades acadêmicas, o que pode levar a um aumento do estresse. A falta de planejamento das atividades, a tomada de um número de tarefas excessivo para si e a ausência de estratégias para eliminação de distratores podem minar o bem-estar na vida acadêmica. Tais práticas podem ser remediadas pela adoção de estratégias de gestão do tempo. Com o fim de divulgar e fomentar tais estratégias, foram elaboradas oficinas em formato online. Participaram das oficinas um total de 17 estudantes, dos quais, 12 apresentaram melhoras na sua relação com a gestão do tempo e, destes, dois apresentaram mudanças positivas particularmente notáveis. Conclui-se a partir destes resultados que tais intervenções podem ser de grande valia, e que mesmo com intervenções breves é possível obter resultados que confirmem a melhora nas habilidades de gestão do tempo dos participantes

Breastfeeding in premature babies: speech-language and audiology performance based on education for health promotion concepts

This paper reports an experience of a speech-language and audiology (SLP) team based on health promotion and education to contribute for the maintainance of exclusive breastfeeding in premature newborns in a high-risk maternity. In the process, a multiprofessional group and individual strategies were combined, producing dialogic settings along with puerperals and their families. Exclusive breastfeeding increased comparing with the last three years before these approach and greater participation of the team and relatives involved in these activities since the pregnant admission until discharge. The analisys of the strategies used allowed the team to identify the most effective actions to improve longer lasting exclusive breastfeeding and those that ought to be reformulated. From a theoretical and methodological point of view, this experience also allowed to observe the limits and possibilities of the actions that are related to closer areas of scientific knowledge and the effective promotion of exclusive breastfeeding in transdisciplinary activities. Considering health promotion and education as a discipline, it means that the efforts are highly directed to act on the people knowledge and self-care, mainly to contribute to the development of critical judgment and ability to decide what would be better and possible in health care and in managing of their own lives.O artigo relata experiência de atuação fonoaudiológica baseada nos pressupostos da educação em saúde direcionada à promoção do aleitamento exclusivo em prematuros internados em uma maternidade de referência em alto risco. No trabalho desenvolvido, estratégias multiprofissionais realizadas com grupos e de forma individualizada foram combinadas, criando espaços dialógicos com as puérperas e seus familiares e a prevalência de aleitamento materno exclusivo aumentou nos últimos três anos na enfermaria. Houve grande participação dos envolvidos nas atividades propostas, desde a admissão da puérpera na enfermaria ao processo da alta hospitalar. A estratégia adotada permitiu detectar as intervenções mais efetivas e as que deverão ser reformuladas com toda equipe. Do ponto de vista teórico e metodológico, a experiência também permitiu observar os limites e potencialidades de ações que aproximam a área do saber científico e a promoção do aleitamento materno efetiva em atividades transdisciplinares. Considerar a educação em saúde como disciplina de ação significa dizer que o trabalho é dirigido para atuar sobre o conhecimento das pessoas, para que elas desenvolvam juízo crítico e capacidade de intervenção sobre suas próprias vidas e sobre o ambiente com o qual interagem e, assim, criarem condições para se apropriarem de sua própria existência.Universidade Estadual de Ciências da Saúde do Estado de Alagoas Maternidade Escola Santa Mônica Serviço de FonoaudiologiaUniversidade Federal do Rio Grande do SulUniversidade Federal de São Paulo (UNIFESP)Universidade Estadual de Ciências da Saúde do Estado de AlagoasUNIFESPSciEL

Outpatient pharmaceutical office: access to medicines in public health

We evaluated the implementation of the outpatient pharmaceutical office in a teaching hospital regarding the access to medicines available in the Unified Health System - SUS. This is a descriptive-analytical study, based on secondary data analysis of 735 appointments performed by the pharmacist from 2015 to 2017. Of the drugs prescribed to patients attended at the outpatient pharmacist office, 86.39% were listed in the National List of Essential Medicines - RENAME, of which 95.43% belonged to the Specialized Component of Pharmaceutical Assistance. Evaluating the patient’s diagnosis against the inclusion criteria of the Clinical Protocols and Therapeutic Guidelines (PCDT), that the most frequent pharmaceutical interventions were: adequacy of the medication request documents (56.4%) and examination requests for pharmacotherapeutic follow up (28.5%). When the prescribed drugs were not included in RENAME/PCDT, the intervention was accepted in 90.3% of the proposals for exchange with available drug in SUS. Still, it was possible to refer the patient to primary care for renewal of continuity of treatment in 95.1% of cases. In conclusion, the role of the clinical pharmacist contributes to the resolution of untreated health problems by promoting access to medicines within the scope of SUS and their rational use in accordance with the PCDT

Rheological Analysis of Asphalt Binders Modified with Hydrated Lime and Titanium Dioxide Nanoparticles

The significant increase in traffic on paved roads has accelerated the deterioration of asphalt coatings. Because of this, the use of additives to modify the properties of the asphalt binder has been studied in order to improve the performance in relation to, mainly, permanent deformations and fatigue life. This work evaluates the changes in the rheological properties of CAP 50/70 modified with fractionated particles of hydrated lime and titanium dioxide nanoparticles, obtained from the use of a ball mill. For this purpose, the CAP 50/70 was modified with the addition of fractionated lime particles in the contents of 3%, 5% and 7% by weight of the pure binder and with 3% of ground nano TiO2 (180 nm). The modified samples showed less loss of mass in the short term aging, proving to be an antioxidant alternative. In addition, it was found that the modified binders provided an increase in G* (stiffness parameter) and, consequently, in the maximum Performance Grade (PG) temperature, allowing the use of the studied binders at higher temperatures. The binder modified with a content of 5% hydrated lime presented better results in the tests of permanent deformation (MSCR and LAS). The decrease in TiO2 granulometry increased the integrity of the binder and made it more sensitive to deformations under temperature variations, however, milled titanium dioxide showed a positive result in increasing the resistance of the asphalt binder to fatigue when compared to the binder with nano TiO2 220 nm. Finally, it was possible to establish that the addition of fractionated particles of hydrated lime to CAP 50/70 is a viable and effective technique that meets the requirements of DNIT for use in paving and that the incorporation of ground nano TiO2 (180 nm) attributed to the asphalt binder 50/70 higher working temperature in the field

A gestão do tempo na rotina universitária: resultados de uma intervenção

As habilidades de gestão do tempo fornecem àquele que se utiliza delas uma boa ferramenta na superação da procrastinação e na gestão de tarefas. Estes, por sua vez, são dois problemas que estão presentes na vida de muitos estudantes do Ensino Superior. Má gestão do tempo pode resultar em uma relação desequilibrada com as responsabilidades acadêmicas, o que pode levar a um aumento do estresse. A falta de planejamento das atividades, a tomada de um número de tarefas excessivo para si e a ausência de estratégias para eliminação de distratores podem minar o bem-estar na vida acadêmica. Tais práticas podem ser remediadas pela adoção de estratégias de gestão do tempo. Com o fim de divulgar e fomentar tais estratégias, foram elaboradas oficinas em formato online. Participaram das oficinas um total de 17 estudantes, dos quais, 12 apresentaram melhoras na sua relação com a gestão do tempo e, destes, dois apresentaram mudanças positivas particularmente notáveis. Conclui-se a partir destes resultados que tais intervenções podem ser de grande valia, e que mesmo com intervenções breves é possível obter resultados que confirmem a melhora nas habilidades de gestão do tempo dos participantes

Investigation of vaccinia virus in bovines and buffaloes from the Marajó region, Brazil: standardization of a diagnostic test

The genus Orthopoxvirus (OPXV), belongs to the family Poxviridae and has 12 species, including Vaccinia virus (VACV) and Smallpox virus (VARV). Clinically, lesions in cattle are mostly seen on the teats and udders of lactating cows, which appear as bloody sores. The course of infection to complete healing takes two to four weeks. In humans, infections are currently occupational zoonoses. Little is still known about the ecoepidemiology of these viral agents, requiring further studies to seek alternatives for infection prevention and control. We sought to evaluate the epidemiology of VACV in asymptomatic buffaloes and cattle from farms on Marajó region, Brazil. Serum samples of 247 animals were tested collected in 2009. Viral DNA was extracted using commercial kits and detection was performed by the Polymerase Chain Reaction (PCR), targeting the growth factor gene of Vaccinia (VGF), followed by Nested PCR. Samples were undetectable to VACV by the methods used in the animals studied, requiring continuous epidemiological surveillance in the region, especially considering previous reports of outbreaks involving poxviruses in the country

Endobronchial myxoma: Case report

INTRODUCTION: Pulmonary myxoma is an extremely rare benign neoplasm. It is mostly parenchymal but may occasionally occur within the tracheobronchial tree. There are very few reports of endobronchial myxoma. CASE REPORT: We describe a case of endobronchial myxoma in a 40-year-old female patient with a history of asthma and repeated right-sided pneumonia. Thoracic computed tomography (CT) showed medium lobe atelectasis. Fiber optic bronchoscopy revealed a polypoid, well-circumscribed tumor, causing total obstruction of the medium lobe bronchus. Biopsy of the mass was non-diagnostic. Further study included a positron emission tomography (PET) which demonstrated low metabolic activity of the tumor and no evidence of neoplasia in other location. The patient was submitted to a medium lobectomy and microscopic examination of the tumor revealed myxoid stroma with lobulated pattern, elongated and stellate cells, compatible with myxoma. CONCLUSION: Pulmonary myxoma is extraordinary rare and endobronchial location is very few reported in medical literature