Construction and validation of a logical model for specialized Rehabilitation Centers

OBJETIVO Construir e validar um modelo lógico para a atenção nos Centros Especializados em Reabilitação (CER) a partir da análise do processo de trabalho e de questões organizativas de centros do Rio Grande do Norte. MÉTODOS Estudo metodológico desenvolvido em três etapas: 1) estudo documental de legislações e portarias relacionadas ao serviço de saúde e à Rede de Cuidados à Pessoa com Deficiência (RCPD); 2) realização de grupos focais, com estudo censitário dos CER do Rio Grande do Norte, para compreender e avaliar o cotidiano do serviço; e 3) sistematização das informações coletadas e, por fim, proposição e validação do modelo lógico avaliativo. RESULTADOS O modelo englobou cinco categorias centrais do processo de trabalho e organizacional: “demandas”, “recursos” (insumos, financeiros e força de trabalho), “processos”, “produtos e resultados” e “missão, valores e fatores externos”. CONCLUSÃO O modelo lógico construído foi adequado para representação gráfica do processo de trabalho e questões organizativas dos CER. Evidenciou-se que o funcionamento dos serviços está alinhado com as normativas. Contudo, ainda há lacunas organizacionais que precisam ser abordadas a fim de melhorar a resolutividade do serviço e a articulação com outros pontos da rede.OBJECTIVE To build and validate a logical model for health care in Specialized Rehabilitation Centers (CER) by analyzing the work process and organizational issues of centers in Rio Grande do Norte. METHODS This is a methodological study developed in three stages: 1) documentary research of legislation and ordinances concerning the healthcare service and the Disability Care Network (RCPD); 2) focus groups with a Census study of the CER in Rio Grande do Norte to understand and assess the daily activities of the service; and 3) systematization of the information collected and, finally, proposition and validation of the evaluative logical model. RESULTS The model encompassed five central categories of the work and organizational process: “demands”, “resources” (inputs, financial and workforce), “processes”, “products and results” and “mission, values and external factors”. CONCLUSION The logical model built was suitable for graphical representation of the work process and organizational issues of the SRC. The study showed that the functioning of the services is in line with the regulations. However, there are still organizational gaps that need to be addressed to improve the resolution capacity of the service and the articulation with other points of the network

Identification and characterization of expressed retrotransposons in the genome of the Paracoccidioides species complex

Background: Species from the Paracoccidioides complex are thermally dimorphic fungi and the causative agents of paracoccidioidomycosis, a deep fungal infection that is the most prevalent systemic mycosis in Latin America and represents the most important cause of death in immunocompetent individuals with systemic mycosis in Brazil. We previously described the identification of eight new families of DNA transposons in Paracoccidioides genomes. in this work, we aimed to identify potentially active retrotransposons in Paracoccidioides genomes.Results: We identified five different retrotransposon families (four LTR-like and one LINE-like element) in the genomes of three Paracoccidioides isolates. Retrotransposons were present in all of the genomes analyzed. P. brasiliensis and P. lutzii species harbored the same retrotransposon lineages but differed in their copy numbers. in the Pb01, Pb03 and Pb18 genomes, the number of LTR retrotransposons was higher than the number of LINE-like elements, and the LINE-like element RtPc5 was transcribed in Paracoccidioides lutzii (Pb01) but could not be detected in P. brasiliensis (Pb03 and Pb18) by semi-quantitative RT-PCR.Conclusion: Five new potentially active retrotransposons have been identified in the genomic assemblies of the Paracoccidioides species complex using a combined computational and experimental approach. the distribution across the two known species, P. brasiliensis and P. lutzii, and phylogenetics analysis indicate that these elements could have been acquired before speciation occurred. the presence of active retrotransposons in the genome may have implications regarding the evolution and genetic diversification of the Paracoccidioides genus.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ Fed Minas Gerais, Inst Ciencias Biol, Dept Microbiol, BR-31270901 Belo Horizonte, MG, BrazilUniv Fed Minas Gerais, Inst Ciencias Biol, Programa Posgrad Bioinformat, BR-31270901 Belo Horizonte, MG, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Microbiol Imunol & Parasitol, BR-04023062 São Paulo, SP, BrazilUniv Brasilia, Inst Ciencias Biol, Lab Biol Mol, BR-70910900 Brasilia, DF, BrazilUniv Fed Goias, Inst Ciencias Biol, Lab Biol Mol, BR-74001970 Goiania, Go, BrazilFIOCRUZ Minas, Ctr Pesquisas Rene Rachou, Grp Informat Biossistemas, BR-30190002 Belo Horizonte, MG, BrazilUniv Fed Minas Gerais, Dept Biol Geral, BR-31270901 Belo Horizonte, MG, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Microbiol Imunol & Parasitol, BR-04023062 São Paulo, SP, BrazilFAPEMIG: APQ-01661-13CNPq: 301652/2012-0CNPq: 486618/2013-7Web of Scienc

Uso do sabonete líquido como estratégia de higiene no controle da COVID-19 no Município de Seropédica, Rio de Janeiro / Liquid soap used as a hygiene strategy in the control of COVID-19 in Seropédica, Rio de Janeiro

As adoções de medidas preventivas e de promoção à saúde são de vital importância ao cotidiano, em especial em cenários de pandemia. A relação com a evitabilidade de uma doença se torna fortalecida quando o contágio é impedido por meio de medidas que fazem parte das condutas no contexto diário. O ato de lavar as mãos é conhecido como associado à higiene e preventivo para infecções contagiosas. A pandemia de COVID-19 relacionada ao contágio viral inclui a higienização correta das mãos, a assepsia e a antissepsia e o uso de máscaras de proteção facial. Neste sentido, este trabalho propôs a manipulação de sabonete líquido em uma Instituição de Ensino Superior (IES) pública, como estratégia para atender à demanda interna institucional e parte do Sistema Único de Saúde (SUS) do município de Seropédica. Para tanto, o preparo aconteceu em laboratório didático do Curso de Farmácia, contando com duas docentes e um estudante bolsista. Os materiais foram fornecidos pela referida instituição, com projeto aprovado ao Programa de Enfrentamento à Pandemia. O primeiro lote de produção foi produzido com auxílio financeiro concedido pela Associação dos Docentes. Entre os meses de maio e agosto de 2020 foram preparados 150 litros de sabonete líquido, fracionados em frascos de 50 mL, 100 mL e 200 mL. A distribuição foi realizada aos estudantes alojados, aos trabalhadores da Divisão de Guarda/Segurança e da Divisão de Saúde. Ao público externo, a distribuição aconteceu em três Unidades Básicas de Saúde (UBS) vinculadas ao Programa Estratégia Saúde da Família (ESF), na Unidade de Pronto Atendimento (UPA) e na Unidade Pré-Hospitalar do município de Seropédica. A receptividade diante do ato de entregar foi notada, assim como a relação universidade-serviço-comunidade foi fortalecida com as relações voltadas ao reforço de medidas preventivas diante da pandemia associada à COVID-19

The MHC Gene Region of Murine Hosts Influences the Differential Tissue Tropism of Infecting Trypanosoma cruzi Strains

We have previously demonstrated that both parasite genetic variability and host genetic background were important in determining the differential tissue distribution of the Col1.7G2 and JG T. cruzi monoclonal strains after artificial infections in mice. We observed that the JG strain was most prevalent in hearts of mouse lineages with the MHC haplotype H-2d (BALB/c and DBA2), while Col1.7G2 was predominant in hearts from C57BL/6 mice, which have the H-2b haplotype. To assess whether the MHC gene region indeed influenced tissue tropism of T. cruzi, we used the same two parasite strains to infect C57BL/6 (H-2b) and C57BLKS/J (H-2d) mice; the latter strain results from the introgression of DBA2 MHC region into the C57BL/6 background. We also performed ex vivo infections of cardiac explants from four congenic mice lineages with the H-2b and H-2d haplotypes arranged in two different genetic backgrounds: C57BLKS/J (H-2d) versus C57BL/6 (H-2b) and BALB/c (H-2d) versus BALB/B10-H2b (H-2b). In agreement with our former observations, Col1.7G2 was predominant in hearts from C57BL/6 mice (H-2b), but we observed a clear predominance of the JG strain in hearts from C57BLKS/J animals (H-2d). In the ex vivo experiments Col1.7G2 also prevailed in explants from H-2b animals while no predominance of any of the strains was observed in H-2d mice explants, regardless of the genetic background. These observations clearly demonstrate that the MHC region influences the differential tissue distribution pattern of infecting T. cruzi strains, which by its turn may be in a human infection the determinant for the clinical forms of the Chagas disease

The role of Kisspeptin in bovine in vitro embryo production

The aim of this study was to investigate the effect of Kisspeptin (Kp) on the medium used in different stages of in vitro production of bovine embryo (IVEP), evaluating cleavage (CR) and blastocyst (BR) rates. The study was divided into three experiments that analyzed, respectively, the action of Kp on in vitro maturation (IVM), in vitro fertilization (IVF), and in vitro culture (IVC) of bovine embryos. In experiment 1, the oocytes were matured in IVM medium and distributed into the following treatments: maturation (IVM Control, n = 102), maturation with addition of 10-7 M Kp (Kp 10-7 IVM, n = 90), and hormone-free maturation luteinizing hormone (LH) and follicle-stimulating hormone (FSH) with the addition of 10-7M Kp (No hormones + Kp 10-7, n = 84), following maturation to normal stages of IVEP. In experiment 2, the oocytes were fertilized in IVF medium, in the following treatments: TALP-FERT without Kp (Control IVF, n = 103) and TALP-FERT with the addition of 10-7M Kp (Kp 10-7 IVF, n = 119), usually following the other steps. Finally, in the third experiment, the oocytes passed through all phases and were divided into IVC in two treatments: SOF medium without Kp (Control IVC, n = 109) and SOF medium with the addition of 10-7M Kp (Kp 10-7, N = 106). The data were analyzed by PROC GLIMMIX of the SAS program. In experiment 1, the means of CR and BR were similar (P > 0.05) between treatments (IVM Control76.47% and 37.25%, Kp 10-7 MIV80% and 33.33%, and No hormones + Kp 10-770.24% and 30.95%, respectively). In experiment 2, the means of CR were similar for the IVF Control and Kp 10-7 IVF groups (P > 0.05), 76.70% and 86.55% respectively. But, the mean of the BR of the group Kp 10-7 IVF was 38.66%, which was higher (P 0.05) were similar between the IVC Control and Kp 10-7 IVC groups (CR 83.50% and 78.30%, and BR 26.60% and 23.60%, respectively). Although at this concentration of 10-7M during IVC no change in embryo production is seen, Kp presents the same performance as both gonadotrophins in oocyte maturation and modulates the fertilization process, providing more blastocysts. With these findings, it can be seen that Kp presents a regulatory action on bovine reproduction, and can be an excellent tool to maximize IVEP indexes

AVALIAÇÃO DA COMUNICAÇÃO VERBAL EQUIPE-PACIENTE COMATOSO NO CENTRO DE TERAPIA INTENSIVA (CTI)

Introdução: O coma é um estado clínico de inconsciência no qual o paciente não está ciente de si mesmo ou do ambiente por períodos prolongados. Mesmo nesta condição é fundamental que a equipe comunique aos pacientes os procedimentos médicos a serem realizados. Objetivo: Verificar se os profissionais da área de saúde atuantes em um hospital universitário sul mineiro comunicavam verbalmente aos pacientes comatosos os procedimentos realizados. Material e Métodos: O estudo foi conduzido em um hospital universitário sul mineiro, fundamentado em uma análise da comunicação verbal durante assistência a pacientes comatosos por diversos profissionais da área de saúde, seguindo o protocolo de CARDIM et al. (2004). Resultados: Verificou-se que 20,4% dos procedimentos foram comunicados aos pacientes comatosos e 79,60% foram executados sem comunicação. Conclusão: A equipe médica e os demais profissionais não estão utilizando comunicação verbal para informar ou explicar os procedimentos a serem realizados no paciente em coma, tornando-se fundamental a humanização da assistência

Eculizumab for the treatment of atypical hemolytic uremic syndrome: case report and revision of the literature

SHU atypical (aHUS), that is, not associated with Escherichia coli Shiga toxinproducing, is seen in 5 to 10% of cases of Hemolytic Uremic Syndrome (HUS), and can occur at any age and may be sporadic or familial. The prognosis in these cases is reserved, with high mortality and morbidity in the acute phase of the disease, and about 50% of cases can develop chronic kidney disease. The increased knowledge of the pathogenesis of aHUS (overactivation of the alternative pathway of complement), was accompanied by the appearance of a drug, eculizumab, which acts as an inhibitor of membrane attack complex. Our goal is to report a case of infant with aHUS with excellent clinical and laboratory response with the use of eculizumab. 14 month old infant, previously healthy, male, presented anemia and thrombocytopenia at 12 months of age. He was treated with corticosteroids and forwarded to our service for high blood pressure. However, the scans showed nephrotic proteinuria with renal involvement and hypoalbuminemia with direct Coombs negative. He developed anemia, thrombocytopenia, worsening of renal function and hypertension. Renal biopsy showed thrombotic microangiopathy (TMA). On the non-hemolytic anemia, thrombocytopenia and acute renal failure with histological substrate MAT, was diagnosed of aHUS. The patient received eculizumab excellent clinical and laboratory response. This case shows the importance of early diagnosis and treatment of the aHUS. Eculizumab is effective and keeps long-term remission, avoiding invasive measures such as plasmapheresis, which resolves only part of the picture.Síndrome Hemolítico Urêmica atípica (SHUa), isto é, não associada à Escherichia coli, produtora de Shiga toxina, é vista em 5% a 10% dos casos de Síndrome Hemolítico Urêmica (SHU), podendo ocorrer em qualquer idade e ser esporádica ou familiar. O prognóstico nestes casos é reservado, com alta mortalidade e morbidade na fase aguda da doença, e cerca de 50% dos casos podem evoluir para doença renal crônica terminal. O aumento do conhecimento da patôgenese da SHUa (hiperativação da via alternativa do complemento) foi acompanhado pelo surgimento de uma droga, eculizumab, a qual age como inibidor da via final do complemento. Nosso objetivo é relatar um caso de lactente com SHUa que apresentou excelente resposta clínica e laboratorial com o uso de eculizumab. Lactente, 14 meses de idade, sexo masculino, previamente hígido, apresentou quadro de anemia e plaquetopenia aos 12 meses de idade. Foi tratado com corticoterapia e encaminhado ao nosso serviço por hipertensão arterial. Entretanto, os exames demonstraram acometimento renal com proteinúria nefrótica e hipoalbuminemia, com Coombs direto negativo. Evoluiu com anemia, plaquetopenia, piora de função renal e hipertensão. Realizada biópsia renal que mostrou microangiopatia trombótica (MAT). Diante do quadro de anemia não hemolítica, plaquetopenia e insuficiência renal aguda com substrato histológico de MAT, foi feito diagnóstico de SHUa. O paciente recebeu eculizumab, com excelente resposta clínico-laboratorial. Este caso denota a importância de diagnóstico e tratamento precoces nesta entidade grave que é a SHUa. Eculizumab é eficaz e mantém remissão a longo prazo, evitando medidas invasivas como a plasmaferese, a qual resolve apenas parcialmente o quadro.23724

Dynamics and determinants of SARS-CoV-2 RT-PCR testing on symptomatic individuals attending healthcare centers during 2020 in Bahia, Brazil

RT-PCR testing data provides opportunities to explore regional and individual determinants of test positivity and surveillance infrastructure. Using Generalized Additive Models, we explored 222,515 tests of a random sample of individuals with COVID-19 compatible symptoms in the Brazilian state of Bahia during 2020. We found that age and male gender were the most significant determinants of test positivity. There was evidence of an unequal impact among socio-demographic strata, with higher positivity among those living in areas with low education levels during the first epidemic wave, followed by those living in areas with higher education levels in the second wave. Our estimated probability of testing positive after symptom onset corroborates previous reports that the probability decreases with time, more than halving by about two weeks and converging to zero by three weeks. Test positivity rates generally followed state-level reported cases, and while a single laboratory performed ~90% of tests covering ~99% of the state's area, test turn-around time generally remained below four days. This testing effort is a testimony to the Bahian surveillance capacity during public health emergencies, as previously witnessed during the recent Zika and Yellow Fever outbreaks