Testamento vital sob a ótica de enfermeiros que assistem pacientes em situação de terminalidade

Objetivos: conhecer a representação do Testamento Vital para os enfermeiros que atuam na assistência à pacientes em situação de terminalidade. Métodos: estudo de abordagem qualitativa, realizado em hospital público universitário de alta complexidade localizado na cidade de São Paulo, São Paulo, Brasil, com 15 enfermeiros que atuam na assistência à pacientes terminais, por meio de entrevista norteada pela questão “Fale a respeito do Testamento Vital”. A análise dos dados foi desenvolvida pelo Discurso do Sujeito Coletivo. Resultados: identificou-se três categorias que compõem o Discurso do Sujeito Coletivo dos enfermeiros em relação ao testamento vital: “o enfermeiro frente às diretivas antecipadas de vontade”; “o enfermeiro frente à família do paciente em terminalidade” e “o enfermeiro frente ao médico do paciente em terminalidade”. Conclusão: o testamento vital representa, na perspectiva dos enfermeiros, a autonomia e o direito do paciente pelas decisões nas situações de terminalidade que devem ser compartilhadas com seus familiares e profissionais de saúde

Endocarditis due to Coxiella burnetii (Q fever): a rare or underdiagnosed disease? Case report

A febre Q é uma zoonose de distribuição mundial causada por Coxiella burnetii, sendo raros os registros da doença no Brasil. Estudos soroepidemiológicos mostraram uma freqüência relativamente elevada de anticorpos contra Coxiella burnetii em populações com exposição ocupacional. Em humanos, pode se manifestar clinicamente como doença aguda ou crônica, sendo que a endocardite é a forma crônica mais freqüente da febre Q e de maior morbi-mortalidade. Relatamos um caso grave de endocardite por Coxiella burnetii adquirida no Brasil com desfecho fatal, apesar de antibioticoterapia adequada e tratamento cirúrgico valvar.Q fever is a zoonosis of worldwide distribution that is caused by Coxiella burnetii. However, reports of this disease in Brazil are rare. Seroepidemiological studies have shown relatively high frequencies of antibodies against Coxiella burnetii in populations with occupational exposure. In humans, it can be manifested clinically as acute or chronic disease. Endocarditis is the most frequent chronic form of Q fever and the form with the greatest morbidity and mortality. We report a severe case of endocarditis due to Coxiella burnetii acquired in Brazil that had a fatal outcome, despite specific antibiotic therapy and valve surgery treatment

Potencial de isolados fúngicos para a redução do parasitismo de Meloidogyne incognita em tomateiro / Potential of fungal isolates to reduce Meloidogyne incognita parasitism in tomato

A substituição de nematicidas químicos por produtos ecologicamente sustentáveis é uma importante ferramenta no gerenciamento microbiológico do solo e no manejo de fitonematoides. O objetivo do presente trabalho foi avaliar o potencial de isolados fúngicos na redução do parasitismo de Meloidogyne incognita em plantas de tomateiro. O experimento foi conduzido no Centro de Tecnologias Estratégicas do Nordeste. Em ambiente protegido foram testados três isolados fúngicos e dois produtos comerciais. Ao 15º dia do início da germinação, procedeu-se com a inoculação dos substratos com os controles (isolados fúngicos do gênero Trichoderma e Gongronella ou produto comercial) e após cinco dias da inoculação dos substratos, procedeu-se a inoculação de 1.100 ovos de M. incognita por planta, exceto a testemunha geral. Aos 45 dias após a inoculação, foram avaliadas a biomassa fresca da parte aérea e raiz, número de galhas no sistema radicular (NGSR), número de ovos (NO), fator de reprodução (FR) e pigmentos fotossintetizantes. Para os teores de todos os pigmentos avaliados, o produto 1 e o isolado CTFN-18 apresentaram médias inferiores às obtidas pela testemunha. Apesar de alguns tratamentos terem influência negativa no teor de pigmentos, não foram observadas alterações na biomassa fresca da parte aérea e raiz. Para o NGSR apenas o produto 1 diferiu dos demais tratamentos, apresentando média superior. Tanto para o NO quanto para o FR, o isolado CTFN-18 não diferiu significativamente do produto 2 que apresentou as menores médias, o que aponta o grande potencial do isolado CTFN-18 para o controle biológico de M. incognita

Validated medication deprescribing instruments for patients with palliative care needs a systematic review

Objectives: Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. Methods: A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by 2 independent researchers. Experimental and observational studies were eligible for inclusion. Results: Out of the 5791 studies retrieved, after excluding duplicates (n = 1050), conducting title/abstract screening (n = 4741), and full reading (n = 41), only 1 study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to 2 groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. Conclusions: Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only 1 of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs) and decrease the monthly costs of pharmacotherapy. Nevertheless, the impact on patient safety and humanistic outcomes remain unclear

P2X7 receptor contributes to long-term neuroinflammation and cognitive impairment in sepsis-surviving mice

Introduction: sepsis is defined as a multifactorial debilitating condition with high risks of death. The intense inflammatory response causes deleterious effects on the brain, a condition called sepsis-associated encephalopathy. Neuroinflammation or pathogen recognition are able to stress cells, resulting in ATP (Adenosine Triphosphate) release and P2X7 receptor activation, which is abundantly expressed in the brain. The P2X7 receptor contributes to chronic neurodegenerative and neuroinflammatory diseases; however, its function in long-term neurological impairment caused by sepsis remains unclear. Therefore, we sought to evaluate the effects of P2X7 receptor activation in neuroinflammatory and behavioral changes in sepsis-surviving mice. Methods: sepsis was induced in wild-type (WT), P2X7−/− , and BBG (Brilliant Blue G)-treated mice by cecal ligation and perforation (CLP). On the thirteenth day after the surgery, the cognitive function of mice was assessed using the novel recognition object and Water T-maze tests. Acetylcholinesterase (AChE) activity, microglial and astrocytic activation markers, and cytokine production were also evaluated. Results: Initially, we observed that both WT and P2X7−/− sepsis-surviving mice showed memory impairment 13 days after surgery, once they did not differentiate between novel and familiar objects. Both groups of animals presented increased AChE activity in the hippocampus and cerebral cortex. However, the absence of P2X7 prevented partly this increase in the cerebral cortex. Likewise, P2X7 absence decreased ionized calcium-binding protein 1 (Iba−1 ) and glial fibrillary acidic protein (GFAP) upregulation in the cerebral cortex of sepsis-surviving animals. There was an increase in GFAP protein levels in the cerebral cortex but not in the hippocampus of both WT and P2X7−/− sepsis-surviving animals. Pharmacological inhibition or genetic deletion of P2X7 receptor attenuated the production of Interleukin-1β (IL-1β), Tumor necrosis factor-α (TNF-α), and Interleukin-10 (IL-10). Conclusion: the modulation of the P2X7 receptor in sepsis-surviving animals may reduce neuroinflammation and prevent cognitive impairment due to sepsisassociated encephalopathy, being considered an important therapeutic target

Importation and early local transmission of COVID-19 in Brazil, 2020

We conducted the genome sequencing and analysis of the first confirmed COVID-19 infections in Brazil. Rapid sequencing coupled with phylogenetic analyses in the context of travel history corroborate multiple independent importations from Italy and local spread during the initial stage of COVID-19 transmission in Brazil

ANÁLISE DE INDICADORES DE SAÚDE NO BRASIL

  The analysis of health indicators plays a fundamental role in evaluating and monitoring a country's health system. In Brazil, this practice is essential for understanding the population's health situation and guiding effective public policies. In this study, we performed an integrative literature review to examine the approach, objectives and results of the analysis of health indicators in the Brazilian context. The objective of this study is to analyze the approach, objectives and main results of the analysis of health indicators in Brazil, through an integrative literature review. We conducted an integrative literature review, conducting searches in electronic databases such as PubMed, Scopus and the Virtual Health Library (VHL), using the following descriptors in Portuguese: health indicators, health analysis, Brazil. Studies published between 2010 and 2022 that addressed the analysis of health indicators in the Brazilian context were included. Studies that were not related to the topic, repeated studies and works in a foreign language were excluded. The analysis of health indicators in Brazil is an essential practice for evaluating and directing effective health policies. Through this integrative review, we observed that this approach is widely used to monitor specific diseases, assess the quality of health services and identify regional inequalities. The results of this analysis contribute to informed decision-making and the continuous improvement of the Brazilian healthcare system. However, it is important to emphasize the need to constantly update the indicators and the methodology used, in order to guarantee the accuracy and relevance of the analyses.A análise de indicadores de saúde desempenha um papel fundamental na avaliação e no monitoramento do sistema de saúde de um país. No Brasil, essa prática é essencial para compreender a situação da saúde da população e orientar políticas públicas eficazes. Neste estudo, realizamos uma revisão integrativa da literatura para examinar a abordagem, os objetivos e os resultados da análise de indicadores de saúde no contexto brasileiro. O objetivo deste estudo é analisar a abordagem, os objetivos e os principais resultados da análise de indicadores de saúde no Brasil, por meio de uma revisão integrativa da literatura. Realizamos uma revisão integrativa da literatura, conduzindo buscas em bases de dados eletrônicas, como PubMed, Scopus e Biblioteca Virtual em Saúde (BVS), utilizando os seguintes descritores em português: indicadores de saúde, análise de saúde, Brasil. Foram incluídos estudos publicados no período de 2010 a 2022 que abordassem a análise de indicadores de saúde no contexto brasileiro. Foram excluídos estudos que não estivessem relacionados ao tema, estudos repetidos e trabalhos em língua estrangeira. A análise de indicadores de saúde no Brasil é uma prática essencial para avaliar e direcionar políticas de saúde eficazes. Através desta revisão integrativa, observamos que essa abordagem é amplamente utilizada para monitorar doenças específicas, avaliar a qualidade dos serviços de saúde e identificar desigualdades regionais. Os resultados dessa análise contribuem para a tomada de decisões informadas e o aprimoramento contínuo do sistema de saúde brasileiro. No entanto, é importante ressaltar a necessidade de atualização constante dos indicadores e da metodologia utilizada, a fim de garantir a precisão e a relevância das análises

The germline mutational landscape of BRCA1 and BRCA2 in Brazil

The detection of germline mutations in BRCA1 and BRCA2 is essential to the formulation of clinical management strategies, and in Brazil, there is limited access to these services, mainly due to the costs/availability of genetic testing. Aiming at the identification of recurrent mutations that could be included in a low-cost mutation panel, used as a first screening approach, we compiled the testing reports of 649 probands with pathogenic/likely pathogenic variants referred to 28 public and private health care centers distributed across 11 Brazilian States. Overall, 126 and 103 distinct mutations were identified in BRCA1 and BRCA2, respectively. Twenty-six novel variants were reported from both genes, and BRCA2 showed higher mutational heterogeneity. Some recurrent mutations were reported exclusively in certain geographic regions, suggesting a founder effect. Our findings confirm that there is significant molecular heterogeneity in these genes among Brazilian carriers, while also suggesting that this heterogeneity precludes the use of screening protocols that include recurrent mutation testing only. This is the first study to show that profiles of recurrent mutations may be unique to different Brazilian regions. These data should be explored in larger regional cohorts to determine if screening with a panel of recurrent mutations would be effective.This work was supported in part by grants from Barretos Cancer Hospital (FINEP - CT-INFRA, 02/2010), Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP, 2013/24633-2 and 2103/23277-8), Fundação de Apoio à Pesquisa do Rio Grande do Norte (FAPERN), Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (FAPERGS), Ministério da Saúde, the Breast Cancer Research Foundation (Avon grant #02-2013-044) and National Institute of Health/National Cancer Institute (grant #RC4 CA153828-01) for the Clinical Cancer Genomics Community Research Network. Support in part was provided by grants from Fundo de Incentivo a Pesquisa e Eventos (FIPE) from Hospital de Clínicas de Porto Alegre, by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES, BioComputacional 3381/2013, Rede de Pesquisa em Genômica Populacional Humana), Secretaria da Saúde do Estado da Bahia (SESAB), Laboratório de Imunologia e Biologia Molecular (UFBA), INCT pra Controle do Câncer and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). RMR and PAP are recipients of CNPq Productivity Grants, and Bárbara Alemar received a grant from the same agencyinfo:eu-repo/semantics/publishedVersio