COVID-19 in Piauí: initial scenario and perspectives for coping

N/

Pressão positiva na ventilação mecânica invasiva e implicações renais em pacientes críticos

Objetivo: Verificar se há influência da ventilação mecânica com pressão positiva, ao final da expiração, na função renal de pacientes internados em unidade de terapia intensiva. Método: Estudo prospectivo e quantitativo realizado, em unidade de terapia intensiva, especializada em trauma ortopédico e medular. A amostra foi não probabilística, composta por 31 pacientes em ventilação mecânica invasiva que desenvolveram lesão renal aguda na internação. Os pacientes foram alocados em grupos, conforme valor da pressão positiva, ao final da expiração, e os dados coletados por questionário estruturado. Para a análise das variáveis, realizaram-se testes não paramétricos. Resultados com p ≤ 0,05 foram considerados significativos. Resultados: A idade média foi 46,94±24,2 anos com predominância do sexo masculino (61,3%). A disfunção renal (70,97%), no estágio 1(risco) (35,5%), predominou. Pacientes com maior pressão positiva, ao final da expiração, evoluíram com disfunção renal (p=0,04). Além disso, para aqueles com pressão positiva, ao final da expiração≥ 10cmH2O, a idade (p=0,05) e a disfunção renal (p=0,04) mostraram-se associados significativamente. Conclusão: Pacientes críticos em ventilação mecânica invasiva com pressão positiva, ao final da expiração mais elevada, mostraram reunir maior predisposição para a lesão renal aguda

Atendimento humanizado à vítima de queimadura

A queimadura interrompe a continuidade da pele, corrompe a primeira barreira do corpo contra agentes infecciosos, ainda promove modificações na homeostase hidroeletrolítica, controle da temperatura interna, flexibilidade e lubrificação da superfície corporal, que são funções da pele. Neste cenário de sofrimento físico e psíquico, é necessário que os profissionais de saúde saibam preparar o paciente para o que ele poderá ver, quando for ser realizado algum cuidado ou procedimento. Objetivo: compreender com base em evidências científicas acerca do atendimento humanizado à vítima de queimadura. Metodologia: Revisão Integrativa da Literatura com coleta de dados em fontes disponíveis online, a busca foi realizada entre maio e junho de 2021. Resultados e discussão: Foram incluídos 13 artigos na revisão que discutem sobre o atendimento à vítima de queimadura tiveram, destacando principalmente as características das queimaduras e atribuições do enfermeiro nos cuidados às vítimas e a importância da enfermagem no atendimento. Conclusão: O atendimento à vítima de queimadura compreende ações sistematizadas, desde o Pré-atendimento hospitalar a interrupção do processo lesivo, portanto, é uma área que requer autonomia e aprofundamento científico dos profissionais

Protocol Proposal For The Care Of The Person With Venous Ulcer

Objective: To propose a care protocol for the care of the person with a venous ulcer in highly complex services. Methods and results: This is a methodological study, in three stages: literature review, validation of content and validation in the clinical context. The literature review was carried out from June to August/2011, being the basis for the construction of the Protocol for Venous Ulcers. The content validation included 53 judges (44 nurses, 8 physicians and 1 physiotherapist) selected through the Lattes platform to evaluate the items of the protocol. Validation in the clinical context occurred at the University Hospital Onofre Lopes, in Natal/RN with four judges (nurses), who worked in pairs, evaluating 32 patients with venous ulcers. The protocol was validated with 15 categories: sociodemographic data; anamnesis; examinations; ulcer characteristics; care with the lesion and perilesional area; medicines used to treat the lesion; evaluation and treatment of pain; surgical treatment of chronic venous disease; recurrence prevention (clinical and educational strategies); reference; counter-reference; and quality of life. Conclusion: The validated protocol regarding content and clinical context was applicable. Its implementation is a viable measure that assists in the reorientation of the team in high complexity services, aiming at wound healing and restoration of the patient´s integral health. Keywords: Varicose ulcer; Tertiary Health Care; Protocols; Validation studies

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Development and validation of predictive workable weight equations for Brazilian older adult residents in long-term care institutions.

BackgroundWeight measurement is important in the nutritional anthropometric monitoring of older adults. When this measurement is not possible, estimates may be used.AimDeveloping and validating weight predictive equations for older adult residents in long-term care institutions in Brazil.Subjects and methodsThe sample comprised 393 older adult residents in long-term care institutions. Data were collected in two stages, with 315 older adults in the first and 78 in the second. We have measured the arm, calf, and waist circumferences, as well as the triceps and subscapular skinfold and knee height. Multiple linear regression was used to develop the equations, which were evaluated through the coefficient of determination, standard error of estimation, Akaike information criterion, intraclass correlation coefficient (ICC), and Bland-Altmann plot.ResultsFive models with different anthropometric measurements were developed, (1) arm circumference as a discriminant variable (ICC: 0.842); (2) best statistical fit for men and women (ICC: 0.874) and its stratification by sex (3) (ICC: 0.876); (4) easy-to-perform measurement for men and women (ICC: 0.842) and its stratification by sex (5) (ICC: 0.828).ConclusionFive models for estimating the weight of older adult residents in long-term care institutions were developed and validated. The choice to use the models should be based on the physical capacity of the older adults to be evaluated

Genomic epidemiology reveals how restriction measures shaped the SARS-CoV-2 epidemic in Brazil

Abstract Brazil has experienced some of the highest numbers of COVID-19 infections and deaths globally and made Latin America a pandemic epicenter from May 2021. Although SARS-CoV-2 established sustained transmission in Brazil early in the pandemic, important gaps remain in our understanding of local virus transmission dynamics. Here, we describe the genomic epidemiology of SARS-CoV-2 using near-full genomes sampled from 27 Brazilian states and an adjacent country - Paraguay. We show that the early stage of the pandemic in Brazil was characterised by the co-circulation of multiple viral lineages, linked to multiple importations predominantly from Europe, and subsequently characterized by large local transmission clusters. As the epidemic progressed, the absence of effective restriction measures led to the local emergence and international spread of Variants of Concern (VOC) and under monitoring (VUM), including the Gamma (P.1) and Zeta (P.2) variants. In addition, we provide a preliminary genomic overview of the epidemic in Paraguay, showing evidence of importation from Brazil. These data reinforce the need for the implementation of widespread genomic surveillance in South America as a toolkit for pandemic monitoring and providing a means to follow the real-time spread of emerging SARS-CoV-2 variants with possible implications for public health and immunization strategies