Mudança de decúbito na UTI: uma análise sobre as repercussões hemodinâmicas

A study that aimed to analyze and compare hemodynamic parameters before and after changing position. This is an observational, analytical, cross-sectional study with a quantitative approach, carried out in an intensive care unit. After performing a sample calculation, 27 patients were included in the research who were under continuous hemodynamic monitoring of heart rate, respiratory rate, systolic, diastolic, and mean blood pressure, as well as peripheral oxygen saturation and axillary temperature. There were no statistically significant differences (p> 0.05) in hemodynamic parameters when comparing the pre- and post-change positions. It was concluded that the patients analyzed in the sample did not present hemodynamic repercussions after the change in decubitus, praising this as a safe technique from the hemodynamic point of view and beneficial for the treatment and prevention of health problems of critical patients.Estudo que teve como objetivo analisar e comparar os parâmetros hemodinâmicos antes e após a mudança de decúbito. Trata-se de um estudo observacional, analítico, de delineamento transversal, com abordagem quantitativa, realizado em uma unidade de terapia intensiva. Após realização de cálculo amostral foram inseridos na pesquisa 27 pacientes que estavam sob monitorização hemodinâmica contínua de frequência cardíaca, frequência respiratória, pressão arterial sistólica, diastólica e média, assim como saturação periférica de oxigênio e temperatura axilar. Não foram observadas diferenças estatisticamente significativas (p>0,05) nos parâmetros hemodinâmicos quando comparados os momentos pré e pós-mudança de decúbito. Concluiu-se que os pacientes analisados na amostra não apresentaram repercussões hemodinâmicas após a mudança de decúbito, enaltecendo esta como uma técnica segura do ponto de vista hemodinâmico e benéfica para o tratamento e a prevenção de agravamentos de saúde do paciente crítico

Anti-PGL1 salivary IgA/IgM, serum IgG/IgM, and nasal Mycobacterium leprae DNA in individuals with household contact with leprosy

Objectives: Leprosy household contacts represent a group at high risk of developing the disease. the aim of this study was to detect Mycobacterium leprae subclinical infection in this group through serological and molecular parameters.Methods: Serum anti-PGL1 IgG/IgM and salivary anti-PGL1 IgA/IgM was investigated using an ELISA, and nasal carriage of M. leprae DNA was detected by PCR, in leprosy household contacts of paucibacillary (PB) and multibacillary (MB) household leprosy patients (n = 135), their index cases (n = 30), and in persons living in a low endemic city (n = 17).Results: Salivary anti-PGL1 IgA and IgM and serum anti-PGL1 IgG showed good correlation comparing contacts and index cases (p 0.05). A high frequency of anti-PGL1 IgM positivity was found in IgG-negative samples (p < 0.0001). for IgG-positive samples, IgM antibodies were also positive in most of the samples. None of the 17 volunteers living in a low endemic city presented seropositivity for IgG; however, two of them showed positivity for anti-PGL1 IgM. M. leprae DNA was found in the nasal swabs of nine out of the 85 MB household leprosy contacts (10.6%) and in three out of the 50 PB household leprosy contacts (6.0%).Conclusion: We strongly suggest that serum IgG/IgM and salivary anti-PGL1 IgA/IgM measurements are used to follow leprosy household contacts. (C) 2013 International Society for Infectious Diseases. Published by Elsevier B.V. All rights reserved.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ Fed Ceara, Fac Pharm, Dept Clin Anal & Toxicol, BR-60430370 Fortaleza, Ceara, BrazilUniv Fed Ceara, Fac Pharm, Dept Pharm, BR-60430370 Fortaleza, Ceara, BrazilUniversidade Federal de São Paulo, Div Pediat Infect Dis, São Paulo, BrazilUniv Fed Ceara, Fac Med, Dept Pathol, BR-60430370 Fortaleza, Ceara, BrazilUniversidade Federal de São Paulo, Div Pediat Infect Dis, São Paulo, BrazilCNPq: 472.471/2007-4Web of Scienc

Influenza virus type/subtype and different infection profiles by age group during 2017/2018 season

DDI-INSA em colaboração com a Rede Portuguesa de Laboratórios para o Diagnóstico da GripeBackground: Influenza has a major impact in hospitalization during each influenza season. We analysed the influenza type/subtype distribution by age group and medical care wards (ambulatory, hospital, intensive care unit). Material and Methods: During 2017/2018 season, 14 hospitals from Portugal mainland and Atlantic Island (Azores and Madeira) reported to the National Influenza Centre 13747 cases of respiratory infection, all tested for influenza type and/or subtype. Epidemiological data: age, sample collection, hospital dwelling service and patient outcome were reported. Results: From the 13747 reported cases, 3717(27%) were influenza positive of which 2033 (55%) were influenza B, 722 (19%) A unsubtyped, 505 (14%) AH3, 442 (12%) AH1pdm09 and 15(0,1%) mixed infections. Influenza A was detected in 71% (204/208) of toddlers(<5 years) although in the remaining age groups influenza B was detected in more than 50% of the confirmed flu cases. Influenza B was the predominant virus in hospitalized and ICU influenza cases between 5-14 years (69% and 75%, respectively) and played a major role in elderly (65+ years) hospitalized and ICU cases(57% and 67%, respectively). AH1pdm09 virus was detected in 30% of the influenza confirmed ICU patients, 2.1 times more than in hospitalized cases in other wards and 3.3 times more than influenza AH1pdm09 cases in ambulatory care. Influenza mixed infection were detected sporadically,mainly in hospitalized and ICU patients. From 2080 known outcomes, 40(1.9%) patients deceased, influenza was confirmed in 11(28%) of these cases. Conclusions: Cocirculation of different influenza virus type/subtype may indicate different infection profiles by age groups and should guide influenza preventive/treatment measures.N/

The ITRAX core scanner, a useful tool to distinguish anthropic vs. climatic influences in lagoon of Aveiro (N Portugal)

The main goal of this work is to distinguish anthropic and climatic influences in sediments from the lagoon of Aveiro (Portugal). This study is based on a core (240-cm long) collected in Murtosa Channel. Optical and X-radiographic images and high-resolution elemental profiles were acquired with ITRAX micro-X-ray fluorescence (XRF) core scanner. Samples collected at each ≈3 cm along the core were analysed for grain size and total organic carbon. Furthermore, the fine fraction of selected layers was subjected to geochemical analysis by ICP-MS, after total acid digestion of the sediments, and mineralogical analysis, by XRD techniques. A radiocarbon age was determined by AMS, using molluscs shells collected at a depth of 90 cm. Sediments along the core are composed by fine and medium sand, with several mud layers. Sediments composing the first 100-cm may have been deposited after 1950, as it is indicated by the radiocarbon data, the increasing trend of Zn/Al, Pb/Al and Cu/Al and total concentrations of Zn, Pb, Cu, V, Cr, As and Ni in this interval that therefore might be linked with industrial activities of Chemical Complex of Estarreja. The progressive increase of Si/Al, Cl/Al, Rb/Al, K/Al and Br/Al and reduced Al concentrations, from the base to the top of this core, are interpreted as being related to higher marine influence and greater differences in tidal currents with longer exposition to air of the sediments with the consequent formation of brines favouring minerals precipitation in the area (e.g. anhydrite). These results seem to be a consequence of several works developed over time like: i) dredging to improve the navigation access to the harbour, located in the external sector of the lagoon; ii) the control of the course of some rivers influencing the supply of sediments. The tendency of sea level rise may have also emphasized the gradual increase of marine influence in this area. Fine-grained sections, related to an increase in Al, phyllosilicates, organic matter, pyrite and siderite contents would be attributed to phases of greater supply of fine-sediments during heavy rainfall events by the nearby Antuã river and other streams during negative phases of North Atlantic Oscillation. Higher deposition of organic matter enhanced diagenetic changes with pyrite and siderite formation. In the bottom of the core another record of pollution was unveiled to mining activities at the beginning of 20th century.FCT de Portugal - C/CTE/UI4035/2011CNPq - 401803/2010-

Influenza severe cases in hospitals, between 2014 and 2016 in Portugal

Rede Portuguesa de Laboratórios para o Diagnóstico da GripeBackground: Since 2009, the Portuguese Laboratory Network (PLNID) for Influenza Diagnosis has integrated 15 Laboratories in mainland and Atlantic Islands of Azores and Madeira. This PLNID added an important contribute to the National Influenza Surveillance Program regarding severe and hospitalized influenza cases. The present study aims to describe influenza viruses detected in influenza like illness (ILI) cases: outpatients (Outp), hospitalized (Hosp), and intensive care units (ICU), between 2014 and 2016. Methods: The PLNID performs influenza virus diagnosis by biomolecular methodologies. Weekly reports to the National Influenza Reference Laboratory ILI cases tested for influenza. Reports include data on detecting viruses, hospital assistance, antiviral therapeutics, and information on death outcome. Were reported during two winter seasons 8059 ILI cases,being 3560 cases in 2014/15 (1024 in Outp, 1750 Hosp, and 606 in ICU) and 4499 cases in 2015/2016 (1933 in Outp, 1826 Hosp, and 740 in ICU). Results: The higher percentage of influenza positive cases were detected in Outp in both seasons, 18% during 2014/15 and 20% in 2015/16. In 2014/15,influenza cases were more frequent in individuals older than 65 years old and these required more hospitalizations,even in ICU. In 2015/16,the influenza cases were mainly detected in individuals between 15-64 years old. A higher proportion of influenza positive cases with hospitalization in ICU were observed in adults between 45-64 years old.During the study period,the predominant circulating influenza viruses were different in the two seasons: influenza B and A(H3) co-circulated in 2014/15,and influenza A(H1)pdm09 was predominant during 2015/16. Even when influenza A is notthe dominant virus, A(H3) and A(H1)pdm09 subtypes correlate with higher detection rate in hospitalized cases (Hosp and UCI), with higher frequencies in adults older than 45. Influenza B,detected in higher proportion in outpatients, was frequently relatedwith influenza cases in younger age groups: 0-4 and 5-14 years old. Conclusions: This study highlights the correlation of theinfluenza virus type/subtype that circulates in each season with the possible need for hospitalization and intensive care in special groups of the population. Circulation of influenza A subtypes can cause more frequentdisease in individuals older than 45, with need of hospitalization including intensive care. On the other hand, influenza B is more frequently associated with less severe cases and with infection in children and younger adults. Influenza B circulation might predict lower number of hospitalizations.The identification of influenza type in circulation,byPLNID ineach season, could guide action planning measures in population health care.info:eu-repo/semantics/publishedVersio

Palivizumabe: a importância da imunização do prematuro contra o vírus sincicial respiratório - Revisão integrativa / Palivizumab: the importance of immunization of preterm infants against respiratory syncytial virus - Integrative reviewod

Introdução: O vírus sincicial respiratório (VSR) que acomete o trato respiratório inferior é responsável por doenças graves nos primeiros meses de vida, sendo uma causa importante de mortalidade nesta faixa etária. A prematuridade é fator de risco para hospitalização e agravamento de doenças pelo VSR. Objetivo: Analisar as produções científicas acerca do uso da imunoglobulina palivizumabe em recém-nascidos prematuros e sua importância. Método: Trata-se de uma revisão integrativa da literatura, onde foram coletadas informações das bases de dados Scielo (Scientific Electronic Library Online), MEDLINE (Medical Literature Analysis and Retrieval System Online) e Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde). Selecionados 11 artigos após adequação aos critérios de inclusão. Resultados: 27,3% dos artigos avaliados obtiveram em seus resultados a redução da taxa de hospitalização por VSR nas crianças que receberam a imunoprofilaxia, 36,6% consideram o custo benefício positivo, 18,2% consideraram que os critérios de elegibilidade são exíguos devido à quantidade de doenças que tornam bebês e crianças imunocomprometidas, especialmente as nascidas prematuras. Conclusão: A imunoprofilaxia é de extrema importância na sobrevida de prematuros acometidos pelo VSR. Os critérios de elegibilidade da imunoglobulina palivizumabe devem ser rediscutidos e reavaliados, a fim de ampliar seu acesso, objetivando queda de morbimortalidade por uma doença imunoprevenível.

SARS-CoV-2 introductions and early dynamics of the epidemic in Portugal

Genomic surveillance of SARS-CoV-2 in Portugal was rapidly implemented by the National Institute of Health in the early stages of the COVID-19 epidemic, in collaboration with more than 50 laboratories distributed nationwide. Methods By applying recent phylodynamic models that allow integration of individual-based travel history, we reconstructed and characterized the spatio-temporal dynamics of SARSCoV-2 introductions and early dissemination in Portugal. Results We detected at least 277 independent SARS-CoV-2 introductions, mostly from European countries (namely the United Kingdom, Spain, France, Italy, and Switzerland), which were consistent with the countries with the highest connectivity with Portugal. Although most introductions were estimated to have occurred during early March 2020, it is likely that SARS-CoV-2 was silently circulating in Portugal throughout February, before the first cases were confirmed. Conclusions Here we conclude that the earlier implementation of measures could have minimized the number of introductions and subsequent virus expansion in Portugal. This study lays the foundation for genomic epidemiology of SARS-CoV-2 in Portugal, and highlights the need for systematic and geographically-representative genomic surveillance.We gratefully acknowledge to Sara Hill and Nuno Faria (University of Oxford) and Joshua Quick and Nick Loman (University of Birmingham) for kindly providing us with the initial sets of Artic Network primers for NGS; Rafael Mamede (MRamirez team, IMM, Lisbon) for developing and sharing a bioinformatics script for sequence curation (https://github.com/rfm-targa/BioinfUtils); Philippe Lemey (KU Leuven) for providing guidance on the implementation of the phylodynamic models; Joshua L. Cherry (National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health) for providing guidance with the subsampling strategies; and all authors, originating and submitting laboratories who have contributed genome data on GISAID (https://www.gisaid.org/) on which part of this research is based. The opinions expressed in this article are those of the authors and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government. This study is co-funded by Fundação para a Ciência e Tecnologia and Agência de Investigação Clínica e Inovação Biomédica (234_596874175) on behalf of the Research 4 COVID-19 call. Some infrastructural resources used in this study come from the GenomePT project (POCI-01-0145-FEDER-022184), supported by COMPETE 2020 - Operational Programme for Competitiveness and Internationalisation (POCI), Lisboa Portugal Regional Operational Programme (Lisboa2020), Algarve Portugal Regional Operational Programme (CRESC Algarve2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF), and by Fundação para a Ciência e a Tecnologia (FCT).info:eu-repo/semantics/publishedVersio

O perfil semiológico do paciente portador de hemorragia digestiva alta

OBJETIVO: O seguinte estudo objetivou descrever a semiologia do paciente portador de hemorragia digestiva alta, considerando como determinante na avaliação de potencias focos hemorrágicos. METODOLOGIA: Foram realizadas buscas nas plataformas do SciELO, LILACS, PubMed, Scopus e Google Scholar,utilizando os descritores gastrointestinal bleeding, peptic ulcerous disease e varicose hemorrhage, sendo identificados 35 estudos, dos quais foram incluídos 13 artigos completos. Desses estudos, 5 avaliaram as principais etiologias, 2 o surgimento de novos testes diagnósticos, 2 analisaram os aspectos epidemiológicos e 1 a sintomatologia apresentada pelo acometimento da hemorragia digestiva alta. Observou-se inicialmente a abundâncias de informações conceituais sobre o sangramento, como um transtorno clínico comum, acompanhada de inúmeras manifestações, considerando que o foco hemorrágico pode ocorrer em qualquer porção do trato gastrointestinal. Neste estudo, todas as publicações eleitas apresentaram o quadro semiológico composto por algia abdominal, indícios de choque hipovolêmico e taquicardia, alguns exibiram quedas abruptas da pressão arterial, odinofagia, êmese, náuseas e estado ictérico. Os pacientes implicados, cronicamente, já manifestaram ocorrências prévias, devido ao caráter recidivante torna-se essencial investigar a existência de varizes, fístula aorto-entérica, angiodisplasia e doença ulcerosa. CONCLUSÃO: Elucida-se que a hemorragia digestiva alta representa a principal causa de sangramento do trato gastrointestinal, majoritamente manifesta-se como hematêmese ou melena e cursam com o quadro sintomatológico que auxilia na avaliação da gravidade deste e o embasamento de potenciais focos de sangramento e que contribuam para disseminação de informações e intervenções futuras