OS CONCEITOS DE MORTE E MORRER NA ENFERMAGEM E AS RELAÇÕES COM O ETHOS DO CUIDADO

 In this study, we analyze the influence of the concepts of death and dying of the nursing staff on the practice of care given in some areas of hospitalization. The data was produced by from a questionnaire containing open ended questions. The subjects of the investigation nurses, technicians and nurses’ auxiliaries who act in the sectors of the medical clinic, the center of intensive care and emergency in public hospitals in the city of Rio de Janeiro, Brazil. After the analysis of the data, two categories emerged: the INFLUENCE and CONFLICT of the concepts about death in the CHOICE and DYNAMICS of ethos of care and death: BEGINNING a new life and END of everything. The results point that the concepts of do not change among the nursing professionals who work in the units studied, and also it seems not to have influenced them when they chose their ethos of care giving. It draws attention that professionals in these units relate a conflict when thinking of death and facing it in their daily care.En este estudio analizamos la influencia de los conceptos de muerte y morir del equipo de Enfermería sobre las prácticas de cuidados en algunos espacios de internación hospitalaria. Los datos se produjeron a partir de la aplicación de un formulario conteniendo preguntas abiertas, siendo los sujetos de la investigación Enfermeros, Técnicos y Auxiliares de Enfermería que actúan en los sectores de Clínica Médica, Unidad de Terapia Intensiva y Emergencia de hospitales de la red pública localizados en el municipio de Rio de Janeiro. Después del análisis de los datos, emergieron dos categorías: la INFLUENCIA y el CONFLICTO de los conceptos acerca de la muerte en la ELECCIÓN y en la DINÁMICA de del ethos del cuidado, y Muerte: INICIO de una nueva vida y FIN de todo.  Los resultados apuntan que los conceptos de muerte no se alteran entre los profesionales de enfermería que actúan en esas unidades investigadas y también parece no haberles influenciado cuando eligieron sus ethos para cuidar. Llama la atención que los profesionales entrevistados relataron conflicto en el pensar la muerte y en encararla en su cotidianidad de cuidar.Neste estudo, analisamos a influência dos conceitos de morte e morrer da equipe de Enfermagem sobre as práticas de cuidar em alguns espaços de internação hospitalar. Os dados foram produzidos a partir da aplicação de um formulário contendo perguntas abertas, sendo os sujeitos da pesquisa, Enfermeiros, Técnicos e Auxiliares de Enfermagem que atuam nos setores de Clínica Médica, Unidade de Terapia Intensiva e Emergência de hospitais da rede pública localizados no município do Rio de Janeiro. Após a análise dos dados, emergiram duas categorias: A INFLUÊNCIA e o CONFLITO dos conceitos acerca da morte na ESCOLHA e na DINAMICA do ethos do cuidado; e Morte: INICIO de uma nova vida e FIM de tudo. Os resultados apontam que os conceitos de morte não se alteram entre os profissionais de enfermagem que atuam nessas unidades pesquisadas e também parece não ter os influenciado quando escolheram os seus ethos para cuidar. Chama atenção que os profissionais entrevistados relataram conflito no pensar a morte, e de encará-la em seu cotidiano de cuidar.

Human papillomavirus prevalence among women with cervical intraepithelial neoplasia III and invasive cervical cancer from Goiânia, Brazil

This study estimated the prevalence and distribution of human papillomavirus (HPV) types among women with cervical intraepithelial neoplasia (CIN) grade III and invasive cervical cancer from Goiás (Brazil Central Region). Seventy-four cases were analyzed and consisted of 18 CIN III, 48 squamous cell carcinomas, 4 adenocarcinomas, 1 adenosquamous carcinoma and 3 undifferentiated carcinomas. HPV-DNA sequences were examined in formalin-fixed and paraffin-embedded tissues using primers from L1 region GP5+/GP6+. Polymerase chain reaction products were typed with dot blot hybridization using probes for HPV 16, 18, 31, 33, 45, 54, 6/11, 42/43/44, 51/52, 56/58. The prevalence of HPV was estimated to be 76% (56/74). HPV 16 was the most frequently found type, followed by HPV 33, 18 and 31. The prevalence of untyped HPV was 6%; 79% percent of the squamous cell carcinoma cases and 61% percent of the CIN III were positive for HPV and the prevalence rate of HPV types was the same for the total number of cases. According to other studies, HPV type 16 is the most prevalent virus in all Brazilian regions, but there is variation regarding to other types. Type 18 is the second most prevalent HPV in North, Southeast and South Brazil regions and types 31 and 33 are the second most prevalent HPV in Northeast and Central Brazil, respectively

Risk Factors and Characterization of Plasmodium Vivax-Associated Admissions to Pediatric Intensive Care Units in the Brazilian Amazon

BACKGROUND: Plasmodium vivax is responsible for a significant proportion of malaria cases worldwide and is increasingly reported as a cause of severe disease. The objective of this study was to characterize severe vivax disease among children hospitalized in intensive care units (ICUs) in the Western Brazilian Amazon, and to identify risk factors associated with disease severity. METHODS AND FINDINGS: In this retrospective study, clinical records of 34 children, 0-14 years of age hospitalized in the 11 public pediatric and neonatal ICUs of the Manaus area, were reviewed. P. falciparum monoinfection or P. falciparum/P. vivax mixed infection was diagnosed by microscopy in 10 cases, while P. vivax monoinfection was confirmed in the remaining 24 cases. Two of the 24 patients with P. vivax monoinfection died. Respiratory distress, shock and severe anemia were the most frequent complications associated with P. vivax infection. Ninety-one children hospitalized with P. vivax monoinfections but not requiring ICU were consecutively recruited in a tertiary care hospital for infectious diseases to serve as a reference population (comparators). Male sex (p = 0.039), age less than five years (p = 0.028), parasitemia greater than 500/mm(3) (p = 0.018), and the presence of any acute (p = 0.023) or chronic (p = 0.017) co-morbidity were independently associated with ICU admission. At least one of the WHO severity criteria for malaria (formerly validated for P. falciparum) was present in 23/24 (95.8%) of the patients admitted to the ICU and in 17/91 (18.7%) of controls, making these criteria a good predictor of ICU admission (p = 0.001). The only investigated criterion not associated with ICU admission was hyperbilirubinemia (p = 0.513)]. CONCLUSIONS: Our study points to the importance of P. vivax-associated severe disease in children, causing 72.5% of the malaria admissions to pediatric ICUs. WHO severity criteria demonstrated good sensitivity in predicting severe P. vivax infection in this small case series

Understanding the clinical spectrum of complicated Plasmodium vivax malaria: a systematic review on the contributions of the Brazilian literature

The resurgence of the malaria eradication agenda and the increasing number of severe manifestation reports has contributed to a renewed interested in the Plasmodium vivax infection. It is the most geographically widespread parasite causing human malaria, with around 2.85 billion people living under risk of infection. The Brazilian Amazon region reports more than 50% of the malaria cases in Latin America and since 1990 there is a marked predominance of this species, responsible for 85% of cases in 2009. However, only a few complicated cases of P. vivax have been reported from this region. A systematic review of the Brazilian indexed and non-indexed literature on complicated cases of vivax malaria was performed including published articles, masters' dissertations, doctoral theses and national congresses' abstracts. The following information was retrieved: patient characteristics (demographic, presence of co-morbidities and, whenever possible, associated genetic disorders); description of each major clinical manifestation. As a result, 27 articles, 28 abstracts from scientific events' annals and 13 theses/dissertations were found, only after 1987. Most of the reported information was described in small case series and case reports of patients from all the Amazonian states, and also in travellers from Brazilian non-endemic areas. The more relevant clinical complications were anaemia, thrombocytopaenia, jaundice and acute respiratory distress syndrome, present in all age groups, in addition to other more rare clinical pictures. Complications in pregnant women were also reported. Acute and chronic co-morbidities were frequent, however death was occasional. Clinical atypical cases of malaria are more frequent than published in the indexed literature, probably due to a publication bias. In the Brazilian Amazon (considered to be a low to moderate intensity area of transmission), clinical data are in accordance with the recent findings of severity described in diverse P. vivax endemic areas (especially anaemia in Southeast Asia), however in this region both children and adults are affected. Finally, gaps of knowledge and areas for future research are opportunely pointed out