Os aspectos semiológicos do acidente vascular encefálico: uma abordagem neurológica

O Acidente Vascular Encefálico (AVC) é um evento neurológico súbito, com um foco de isquemia ou hemorragia. Ambos, qualificados pelo déficit neurológico focal abrupto. Ressaltando, que estes déficits podem ocorrer, sendo a ocorrência espontânea, perduração de 15 minutos, autoresolutiva é denominada como Ataque Isquêmico Transitório (AIT), no entanto, toda insuficiência neural que não melhorar pós esse período deve ser manejado como AVC. O artigo objetivou descrever os principais aspectos clínicos do AVC. O AVC é uma emergência para a saúde pública, em razão de ser um potencial em gerar morbimortalidades para os portadores e prejuízos para os sistemas de saúde. O AVC do tipo isquêmico representa a maioria das ocorrências, o quadro clínico do paciente é correspondente ao tecido neural afetado, inicialmente a tomografia computadorizada sem contraste é o primeiro exame, por ser crucial para descartar a etiologia hemorrágica, a condução terapêutica se baseia em medidas neuroprotetoras através da estabilização da glicemia, temperatura e sódio, adequar os níveis pressóricos, mediante o prazo estipulado impor terapia antitrombótica. A manifestação hemorrágica, pode ocorrer por torção de aneurisma sacular originando o sangramento subaracnóideo ou por hipertensão gerando o sangramento intraparenquimatoso. A partir da análise das informações coletadas, elucida-se que o diagnóstico precoce e o período transcorrido até o manejo terapêutico são cruciais para o desfecho clínico do portador, ou seja, é possível a normalização ou ocorrer sequelas neurais e óbito

A social and ecological assessment of tropical land uses at multiple scales: the Sustainable Amazon Network

Science has a critical role to play in guiding more sustainable development trajectories. Here, we present the Sustainable Amazon Network (Rede Amazonia Sustentavel, RAS): a multidisciplinary research initiative involving more than 30 partner organizations working to assess both social and ecological dimensions of land-use sustainability in eastern Brazilian Amazonia. The research approach adopted by RAS offers three advantages for addressing land-use sustainability problems: (i) the collection of synchronized and co-located ecological and socioeconomic data across broad gradients of past and present human use; (ii) a nested sampling design to aid comparison of ecological and socioeconomic conditions associated with different land uses across local, landscape and regional scales; and (iii) a strong engagement with a wide variety of actors and non-research institutions. Here, we elaborate on these key features, and identify the ways in which RAS can help in highlighting those problems in most urgent need of attention, and in guiding improvements in land-use sustainability in Amazonia and elsewhere in the tropics. We also discuss some of the practical lessons, limitations and realities faced during the development of the RAS initiative so far.Keywords: Social–ecological systems, Tropical forests, Land use, Interdisciplinary research, Sustainability, Trade-off

Coinfection with influenza A(H1N1)pdm09 and dengue virus in fatal cases

Abstract We report on four patients with fatal influenza A(H1N1)pdm09 and dengue virus coinfections. Clinical, necropsy and histopathologic findings presented in all cases were characteristic of influenza-dengue coinfections, and all were laboratory-confirmed for both infections. The possibility of influenza and dengue coinfection should be considered in locations where these two viruses’ epidemic periods coincide to avoid fatal outcomes. Dengue is a mosquito-borne viral infection caused by one of the four dengue viruses (DENV-1 to 4). Each of these viruses is capable of causing nonspecific febrile illnesses, classic dengue fever and dengue haemorrhagic fever (Gubler 1998). As a result, dengue is often difficult to diagnose clinically, especially because peak dengue season often coincides with that of other common febrile illnesses in tropical regions (Chacon et al. 2015). In April 2009, a new virus, influenza A/H1N1/pandemic (FluA/H1N1/09pdm), caused a severe outbreak in Mexico. The virus quickly spread throughout the world, and in June 2009, the World Health Organization declared a pandemic (WHO 2010). In Brazil, the first laboratory confirmed case of FluA/H1N1/09pdm was in July 2009 (Pires Neto et al. 2013). The state of Ceará, in Northeast Brazil, is a dengue endemic area. In this state, the virus influenza A(H1N1)pdm09 has circulated since 2009, and through the first half of 2012, 11 deaths caused by the virus were confirmed (Pires Neto et al. 2013). The influenza and dengue seasons in Ceará overlap, which led to diagnostic difficulties. We report four cases of laboratory-confirmed coinfection of deadly influenza A(H1N1)pdm09 with DENV, which occurred during the dengue and influenza season in 2012 and 2013 in Ceará

Evaluation of the World Health Organization 2009 classification of dengue severity in autopsied individuals, during the epidemics of 2011 and 2012 in Brazil

Abstract: INTRODUCTION: The dengue classification proposed by the World Health Organization (WHO) in 2009 is considered more sensitive than the classification proposed by the WHO in 1997. However, no study has assessed the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue. In the present study, we evaluated the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue in Northeast Brazil, where the disease is endemic. METHODS: This retrospective study included 121 autopsied individuals suspected of having dengue in Northeast Brazil during the epidemics of 2011 and 2012. All the autopsied individuals included in this study were confirmed to have dengue based on the findings of laboratory examinations. RESULTS: The median age of the autopsied individuals was 34 years (range, 1 month to 93 years), and 54.5% of the individuals were males. According to the WHO 1997 classification, 9.1% (11/121) of the cases were classified as dengue hemorrhagic fever (DHF) and 3.3% (4/121) as dengue shock syndrome. The remaining 87.6% (106/121) of the cases were classified as dengue with complications. According to the 2009 classification, 100% (121/121) of the cases were classified as severe dengue. The absence of plasma leakage (58.5%) and platelet counts <100,000/mm3 (47.2%) were the most frequent reasons for the inability to classify cases as DHF. CONCLUSIONS: The WHO 2009 classification is more sensitive than the WHO 1997 classification for identifying dengue deaths among autopsied individuals suspected of having dengue

Dengue 4 in Ceará, Brazil: characterisation of epidemiological and laboratorial aspects and causes of death during the first epidemic in the state

BACKGROUND The first dengue cases in Brazil with laboratory confirmation occurred in the northern region of the country, with the isolation of two serotypes, dengue virus 1 (DENV-1) and DENV-4. In Ceará, the introduction of DENV-4 was reported during a DENV-1 epidemic in 2011, with only two isolations. OBJECTIVES The aim of this study was to characterise the first DENV-4 epidemic in the state of Ceará, Brazil. METHODS The study population was composed of patients with suspected dengue that were reported to health care units from January to December 2012. The laboratory confirmation of infection was made by viral isolation, reverse transcription polymerase chain reaction (RT-PCR), AgNS1, immunohistochemistry and IgM enzyme-linked immunosorbent assay (ELISA). MAIN CONCLUSIONS In the study year, 72,211 suspected dengue cases were reported and 51,865 of these cases (71.8%) were confirmed to be positive. Co-circulation of three serotypes, DENV-1, DENV-3 and DENV-4, was detected with a predominance of DENV-4 (95.3%). Most cases were not severe, but there were 44 fatal outcomes. DENV-4 Genotype II was identified for the first time in Ceará

PERFIL DE SUSCEPTIBILIDADE A ANTIMICROBIANOS DE ISOLADOS DE STREPTOCOCCUS PNEUMONIAE RECUPERADOS EM AMOSTRAS POST-MORTEM, NO LACEN, CEARÁ

Introdução: A resistência microbiana frente aos antimicrobianos é uma das maiores ameaças à saúde pública mundial na atualidade. Associada a isso, agentes comumente isolados na comunidade como o Streptococcus pneumoniae surgem como um grande desafio para saúde pública, uma vez que podem causar doença pneumocócica invasiva, tendo importância epidemiológica mundial. Objetivo: Analisar o perfil de susceptibilidade aos antimicrobianos frente aos isolados de Streptococcus pneumoniae recuperados em culturas microbiológicas de amostras post-mortem, no Laboratório Central de Saúde Pública do Ceará (LACEN-CE). Metodologia: O estudo foi composto por 22 diferentes matrizes biológicas, obtidas por necropsia no Serviço de Verificação de Óbito, e enviadas ao LACEN Ceará para cultura microbiológica no período de janeiro de 2022 a maio de 2023. Após recuperação em cultura, foram submetidas à identificação por proteômica e testado susceptibilidade aos antimicrobianos utilizando a carta AST-ST03, no sistema VITEK-2 da Biomérieux e interpretados segundo Comitê Brasileiro de Testes de Sensibilidade aos Antimicrobianos (BrCAST), vigente. Foram testados os antimicrobianos Benzilpenicilina, Ceftriaxona e Sulfametoxazol-Trimetoprim. Resultados: Em relação à Benzilpenicilina 31,81% (n = 7) foram resistentes, 18,18% (n = 4) sensíveis aumentando a exposição e 50,01% (n = 11), sensíveis. Com relação à Ceftriaxona, 9,09% (n = 2) foram sensíveis aumentando a exposição, 4,54% (n = 1) resistente e n = 19, sensíveis. No Sulfametoxazol-Trimetoprim, 50% (n = 11) foram resistentes, 13,6% (n = 3) sensíveis aumentando a exposição e 36,36¨ (n = 8) sensíveis. Em relação à causa mortis 72,72% (n = 16) dos indivíduos foram a óbito por pneumonia lobar e insuficiência respiratória e 18,18% (n = 4) por meningite. Das matrizes biológicas recebidas, 59,09% (n = 13) eram fragmentos de pulmão, 18,18% (n = 4) sangue, 13,6% (n = 3) fragmentos de cérebro, 9,09% (n = 2) líquor, 4,54% (n = 1) líquido pleural. Conclusão: A resistência antimicrobiana à penicilina e a sulfametoxazol-trimetoprim, observada em um número considerável de isolados, demonstra disseminação de cepas resistentes, circulantes na comunidade, e que associada à virulência do pneumococo podem ter impactado na mortalidade da população estudada. Esses dados trazem à luz a importância de um diagnóstico e tratamento em tempo oportuno em se tratando de doença pneumocócica invasiva, de origem da comunidade

MeningoCast

Podcast sobre Meningite exercido pelos alunos do 2°ano de Enfermagem em conjunto com a Unidade Curricular de Patologia e com o projeto de extensão Clube do Saber.Podcast sobre Meningite, realizado pelos alunos do 2° ano de Enfermagem exercido na Unidade Curricular de Patologia coordenada pela Profa. Dra. Andréa Cristina de Moraes Malinverni e pelo Prof. Dr. Ricardo Artigiani Neto. Publicado no projeto de extensão Clube do Saber