Effects Of Respiratory Physical Therapy In Patients With Lower Respiratory Tract Infection

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Are adventitious lung sounds responsive to one session of respiratory physiotherapy?

Physiotherapists often use adventitious lung sounds(ALS), i.e., wheeze(Wh) and crackle(Cr), to monitor respiratory techniques in acute obstructive(AO) and restrictive(AR) respiratory patients. ALS are responsive to bronchodilators however, evidence regarding its usefulness in respiratory physiotherapy(RP) is scarce. This study aimed to assess the responsiveness of ALS to one session of RP applied in acute obstructive and restrictive respiratory patients. RP included breathing retraining and airway clearance techniques. Sound recordings were acquired with a digital stethoscope pre/post intervention, following the CORSA short-term acquisition guidelines. Computerised analysis was used to characterise Wh(occupation rate and duration) and Cr parameters(number and two cycle duration-2CD) per breathing cycle(BC). Comparisons were explored with Paired-Samples t-Tests(PASW 18.0). Thirty outpatients(14 males, 55.2±17.8y), diagnosed with AO(exacerbation of COPD, acute bronquitis & asthma;n=18) and AR diseases(pneumonia; n=12) were recruited. A significant decrease for Wh occupation rate(t=4.19, p=0.03) and duration(t=2.35, p=0.04) per BC, in the trachea, was found for AR patients. In all chest locations, the number of Cr per BC, presented a significant increase(t=-2.71, p=0.01) for AO and decrease(t=2.05, p=0.05) for AR patients. No significant differences were found for the 2CD. Both Wh and Cr changed significantly in response to RP. Wh and Cr decrease in AR diseases may be indicative of more airways opened after treatment. Cr increase in AO diseases, suggest movement of secretions to more central airways, allowing more air to pass and leading airways to suddenly open. Further research is recommended.publishe

RIBS@UA: interface to collect and store respiratory data, a preliminary study

Objectives: The development of effective graphical user interfaces (GUIs) has been in an emergent demand in healthcare technologies, for assessing, managing and storing patients’ clinical data. Nevertheless, specifically for respiratory care there is a lack of tools to produce a multimedia database, where the main respiratory clinical data can be available in a single repository. Therefore, this study reports on the development of a usable application to collect, organise and store respiratory-related data in a single multimedia database. Methods: A GUI, named RIBS@UA, organised in a multilayer of windows was developed in MATLAB and evaluated. The evaluation consisted of usability inspection (by two respiratory health professionals and two system designers during the development of the prototype) and usability testing (by seven physiotherapists). Results: The users reported on the utility of the new application and its potential to be used in clinical/research settings. It was also stated that RIBS@UA facilitates diagnosis/assessment and contributes to the implementation of standardised interventions and treatment procedures. Nevertheless, some drawbacks were identified and suggestions were given to improve the content of specific features in the physiotherapy sessions window. Conclusions: RIBS@UA interface is an innovative application to collect, store and organise the main respiratory-related data, in a single multimedia database. Nevertheless, further improvements are still recommended before the final implementation of RIBS@UA

Doença Somática nas Pessoas com Doença Mental Grave

Since the beginning of the 20th century, several authors have found that people with severe mental illness (SMI) have higher rates of chronic medical illnesses and mortality in relation to the general population. With this work, we intended to perform a narrative review concerning the particularities of somatic disease and mortality in people with SMI, disparities in access to healthcare and interventions to be carried out in this population. The literature is consensual in the recognition that people with SMI have higher rates of chronic medical illnesses and premature mortality, which leads to an average life expectancy 10 to 30 years lower than the general population. Suicide does not explain these differences. People with SMI are especially affected by cardiovascular, metabolic and neoplastic diseases. Although these diseases are also highly prevalent in the general population, their impact is significantly greater in individuals with mental illness. If part of this discrepancy can be attributed to functional limitations directly caused by SMI, it is recognized that discrimination and stigma also play an important role in these inequalities. People with SMI have worse access to healthcare, leading to high rates of underdiagnosis and undertreatment. There are few studies in the literature aimed at interventions or programs that can decrease the inequality of health care in this population. The particularities of the expression of somatic disease in people with SMI lack adapted prevention strategies at the primary, secondary and tertiary levels that should be prioritized in clinical research and integrated into national health programs.Desde o início do século XX que vários autores foram constatando que as pessoas com doença mental grave (DMG) apresentam maiores taxas de doenças médicas crónicas e de mortalidade em relação à população geral. Com este trabalho, pretendeu‐se realizar uma revisão narrativa relativa às particularidades da doença somática e mortalidade nas pessoas com DMG, disparidades no acesso aos cuidados de saúde e intervenções a realizar nesta população. A literatura é consensual no reconhecimento de que pessoas com DMG têm maiores taxas de doenças médicascrónicas e uma mortalidade prematura, o que faz com que tenham uma esperança média de vida 10 a 30 anos inferior à população geral. O suicídio não explica estas diferenças. As pessoas com DMG são especialmente afetadas por doenças cardiovasculares, metabólicas e neoplásicas. Estas doenças, embora também muito comuns na população geral, têm um impacto significativamente maior em indivíduos com doença mental. Se parte desta discrepância pode ser atribuívela limitações funcionais diretamente causadas pela DMG, é reconhecido que a discriminação e o estigma tambémtêm um papel importante. Pessoas com DMG têm pior acesso aos cuidados de saúde, levando a taxas elevadas de subdiagnóstico e subtratamento.Na literatura são escassos os estudos dirigidos a intervenções ou programas que possam colmatar a desigualdadede cuidados de saúde nesta população. As particularidades da expressão de doença somática em pessoas com DMG carecem de estratégias adaptadas de prevenção de nível primário, secundário e terciário, que devem ser priorizadas na investigação clínica e integradas nos programas de saúde nacionais

Atividade antimicrobiana de espécies da flora africana

Atualmente tem-se verificado um aumento do número de plantas usadas a nível medicinal, especialmente para o tratamento de infeções, face ao aparecimento de resistências a fármacos antimicrobianos. Estas infeções têm um grande impacto em África, e, como tal, as plantas surgem como uma alternativa, uma vez que a maior parte da população já as utiliza para a manutenção do seu estado de saúde. Compilar os estudos que avaliem a atividade antimicrobiana de plantas existentes em África. Efetuou-se uma pesquisa nas bases de dados PubMed e Science Direct, usando as palavras chave “Plantas Africanas”, “Atividade Antimicrobiana”, “Microdiluição”, “African Plants”, “Antimicrobial Activity” e “Microdilution”, tendo sido incluídos artigos publicados entre 2010-2020, em língua inglesa ou portuguesa e que analisassem a atividade antimicrobiana em bactérias e fungos usando o método da microdiluição.info:eu-repo/semantics/publishedVersio

Polifarmacoterapia e interações medicamentosas:: perfil de prescrições pediátricas de um hospital de ensino

Acontecimentos adversos por medicamentos (AAM) constituem problema de saúde pública em todo o mundo, muitos são em decorrência de interações medicamentosas indesejáveis e de natureza prevenível. Estudo descritivo que objetivou caracterizar o perfil farmacoterápico e identificar interações medicamentosas (IMs). Analisaram-se 110 prescrições de pacientes na faixa etária de um a 12 anos de idade, em um hospital de ensino de Brasília, Distrito Federal, no período de outubro de 2005 a fevereiro de 2006. Constatou-se o registro de 292 medicamentos, predominantemente da classe do sistema nervoso (37,7%), preponderando prescrições com até cinco medicamentos (67,3%). Constatou-se a prescrição de medicamentos não aprovados e não autorizados para uso em pediatria. Foram identificadas seis IMs potenciais e grau de severidade moderada (66,7%). O horário de administração de medicamentos segue um padrão às 6, 12, 18 e 22 horas, desconsiderando-se possíveis IMs. Conhecer o perfil farmacoterápico envolvendo o paciente pediátrico é de extrema relevância para a prevenção de AAM evitáveis, como as IMs indesejáveis

Non-technical skills assessment scale in nursing: Construction, development and validation

© 2018 Revista Latino-Americana de Enfermagem. The introduction of non-technical skills during nursing education is crucial to prepare nurses for the clinical context and increase patient safety. We found no instrument developed for this purpose. Objectives: to construct, develop and validate a non-technical skills assessment scale in nursing. Method: methodological research. Based on the literature review and experience of researchers on non-technical skills in healthcare and the knowledge of the principles of crisis resource management, a list of 63 items with a five-point Likert scale was constructed. The scale was applied to 177 nursing undergraduate students. Descriptive statistics, correlations, internal consistency analysis and exploratory factor analysis were performed to evaluate the psychometric properties of the scale. Results: scale items presented similar values for mean and median. The maximum and the minimum values presented a good distribution amongst all response options. Most items presented a significant and positive relationship. Cronbach alpha presented a good value (0.94), and most correlations were significant and positive. Exploratory factor analysis using the Kaiser-Meyer-Olkin test showed a value of 0.849, and the Bartlett’s test showed adequate sphericity values (χ2=6483.998; p=0.000). One-factor model explained 26% of the total variance. Conclusion: non-technical skills training and its measurement could be included in undergraduate or postgraduate courses in healthcare professions, or even be used to ascertain needs and improvements in healthcare contexts

MOLECULAR CHARACTERIZATION OF INFLUENZA B VIRUS OUTBREAK ON A CRUISE SHIP IN BRAZIL 2012

In February 2012, an outbreak of respiratory illness occurred on the cruise ship MSC Armonia in Brazil. A 31-year-old female crew member was hospitalized with respiratory failure and subsequently died. To study the etiology of the respiratory illness, tissue taken at necropsy from the deceased woman and respiratory specimens from thirteen passengers and crew members with respiratory symptoms were analyzed. Influenza real-time RT-PCR assays were performed, and the full-length hemagglutinin (HA) gene of influenza-positive samples was sequenced. Influenza B virus was detected in samples from seven of the individuals, suggesting that it was the cause of this respiratory illness outbreak. The sequence analysis of the HA gene indicated that the virus was closely related to the B/Brisbane/60/2008-like virus, Victoria lineage, a virus contained in the 2011-12 influenza vaccine for the Southern Hemisphere. Since the recommended composition of the influenza vaccine for use during the 2013 season changed, an intensive surveillance of viruses circulating worldwide is crucial. Molecular analysis is an important tool to characterize the pathogen responsible for an outbreak such as this. In addition, laboratory disease surveillance contributes to the control measures for vaccine-preventable influenza.Em fevereiro de 2012, durante a temporada de verão no Brasil, um surto de doença respiratória ocorreu no navio de cruzeiro MSC Armonia. Mulher de 31 anos, membro da tripulação, foi internada com insuficiência respiratória e morreu. Com o objetivo de estudar a etiologia da doença foram investigadas necrópsia de tecido do caso fatal e secreções respiratórias de 13 passageiros e membros da tripulação com sintomas respiratórios. O teste de influenza por RT-PCR em tempo real foi realizado e o gene completo da hemaglutinina (HA) das amostras positivas foi sequenciado. O vírus influenza B foi detectado em sete indivíduos, sugerindo-o como a causa do surto de doença respiratória a bordo do navio. A análise da sequência do gene da HA indicou que os vírus estão fortemente relacionados com o vírus B/Brisbane/60/2008, linhagem Victoria, componente da vacina de influenza para 2011-2012 no hemisfério sul. Uma vez que a composição da vacina foi alterada para uso na temporada de 2012-2013, é essencial a vigilância ativa dos vírus circulantes em todo o mundo. A análise molecular é uma ferramenta importante para caracterização do patógeno responsável pelo surto. Além disso, a vigilância de doenças baseada em dados laboratoriais contribui para as medidas de controle da influenza, uma doença imunoprevinível

Mathematical modelling using predictive biomarkers for the outcome of canine Leishmaniasis upon chemotherapy

Prediction parameters of possible outcomes of canine leishmaniasis (CanL) therapy might help with therapeutic decisions and animal health care. Here, we aimed to develop a diagnostic method with predictive value by analyzing two groups of dogs with CanL, those that exhibited a decrease in parasite load upon antiparasitic treatment (group: responders) and those that maintained high parasite load despite the treatment (group: non-responders). The parameters analyzed were parasitic load determined by q-PCR, hemogram, serum biochemistry and immune system-related gene expression signature. A mathematical model was applied to the analysis of these parameters to predict how efficient their response to therapy would be. Responder dogs restored hematological and biochemical parameters to the reference values and exhibited a Th1 cell activation profile with a linear tendency to reach mild clinical alteration stages. Differently, non-responders developed a mixed Th1/Th2 response and exhibited markers of liver and kidney injury. Erythrocyte counts and serum phosphorus were identified as predictive markers of therapeutic response at an early period of assessment of CanL. The results presented in this study are highly encouraging and may represent a new paradigm for future assistance to clinicians to interfere precociously in the therapeutic approach, with a more precise definition in the patient’s prognosis.This work was funded by the Brazilian agencies Bahia Research Foundation—FAPESB (Grant nº PRONEM 498/2011-PNE 0002/2011 to S.M.B-M), National Council for Scientific and Technological Development —CNPq (PQ scholarship nº 307813/2018-5 to SMBM, and nº 303621/2015-0 to HG) and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior —CAPES (PDSE scholarship nº 88881.189587/2018-01 to R.S.G; Finance Code 001 and PV scholarship nº 23066.033859/2018-73 to R.S.). This work was supported by grants from CESPU (TramTap-CESPU-2016, Chronic-TramTap_CESPU_2017 and TraTapMDMA-CESPU-2018), from the Northern Portugal Regional Operational Programme (NORTE 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER) (NORTE-01-0145-FEDER-000013), funded by FEDER funds through COMPETE2020—Programa Operacional Competitividade e Internacionalização (POCI) and the Fundação para a Ciência e Tecnologia (FCT) (contract IF/00021/2014 to R.S.), Infect-Era (project INLEISH to R.S.) and Proyecto SNIP N◦ 292900 “Creación del Servicio de Laboratorio de Enfermedades Infecciosas y Parasitarias de Animales Domésticos de la Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas.Instituto de Investigación en Ganadería y Biotecnología-IGBI. Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas