A atuação do enfermeiro no combate à sífilis na atenção primária à saúde: uma revisão de literatura

A sífilis é conhecida há séculos como uma infecção bacteriana sistêmica, crônica e exclusiva do ser humano. Causada pela bactéria Treponema pallidum, subespécie pallidum, tendo o contato sexual como principal modo de transmissão, a doença se manifesta nos estágios primário, secundário, latente e terciário. Logo, o objetivo geral deste presente artigo é buscar na literatura a assistência do enfermeiro na atenção primária mediante a sífilis adquirida. Para tanto, realizou-se como tipo de pesquisa uma revisão integrativa da literatura. As bases de dados utilizadas estão inseridas na Biblioteca Virtual de Saúde (BVS), dentre elas, a Scielo (Scientific Electronic Library Online) e Google Acadêmico Os resultados demonstram que o diagnóstico é feito mediante o teste treponêmico reagente, conduzindo o paciente e seu parceiro orientações sobre a importância do início do tratamento, a fim de quebrar a cadeia de contaminação, proporcionando a possibilidade de cura. Considera-se fundamental a assistência do enfermeiro com ações estratégicas na atenção primária diante ao diagnóstico positivo de sífilis, seguindo os protocolos do Ministério da Saúde

Perfil baropodométrico em crianças atendidas em uma clínica de fisioterapia / Baropodometric profile in children attended in a physiotherapy clinic

A baropodometria é um equipamento utilizado para avaliar pressões plantares, centro de gravidade e tipologia podal. Há escassez na literatura de artigos que falem sobre a utilização deste exame na avaliação da pisada de crianças. O objetivo deste estudo foi avaliar o perfil de pisada de crianças atendidas em uma clínica particular de Teresina – PI. Para isso foi realizado um estudo transversal com abordagem quali-quantitativa de caráter documental de exames baropodométricos cadastrados no banco de dados realizados no período de 2013 a 2018. Observou-se que não houve correlação entre as variáveis, altura, peso, IMC, idade e o pico de pressão plantar máximo. 94% dos exames avaliados apresentaram pé cavo. O estudo evidenciou que não houve uma correlação significativa do pico de pressão plantar com os dados antropométricos (idade, peso, altura, IMC), e maior incidência de pé cavo e centro de gravidade posteriorizado à direita.

Estudo Retrospectivo do perfil epidemiológico das lesões autoprovocadas no estado do Piauí entre 2018 a 2020 / Retrospective study of the epidemiological profile of self-harm in the state of Piauí between 2018 and 2020

Objetivou-se: conhecer o perfil epidemiológico das vítimas de lesão autoprovocada no estado do Piauí entre 2018 e 2020 e verificar se houve aumento ou diminuição dos casos notificados no período inicial da pandemia do COVID-19. Para tal, realizou-se um estudo descritivo, com coleta de dados retrospectiva, por meio do BO epidemiológico 001/2020, disponibilizado pela secretaria de saúde do estado do Piauí (SESAPI). Durante o período de 2018, 2019 e 2020, houve um montante de 3.757 registros de violência autoprovocada, no tracejo do perfil, houve destaque para o biotipo feminino, com idade variando de 15 a 29 anos, principalmente, a raça/cor mais afetada na pratica foi a cor parda, situação conjugal: solteiro, escolaridade: ensino fundamental incompleto, como principal meio usado: envenenamento/intoxicação e como local: residência. Apesar de os dados do ano de 2020 serem somente ate a metade do ano, verifica-se um aumento acentuado dos registros, principalmente se observados os mesmos períodos nos anos de 2018 e 2019. 

Carcinoma adenóide cístico do pulmão : Adenoid cystic carcinoma of the lung

Introdução: O carcinoma adenóide cístico primário de pulmão é uma neoplasia torácica de crescimento lento e com malignidade de baixo grau. Representa 0,04 a 0,2% de todos os tumores pulmonares, sendo considerada uma neoplasia rara. Apresentação do caso: Paciente, sexo masculino, 49 anos de idade, foi admitido no Hospital Santa Casa de Misericórdia de Goiania, apresentando tosse persistente, dispneia, hemoptise e cerca de 4 episódios previos de pneumonia; negou comorbidades, etilismo e tabagismo, uso de medicamentos e alergias conhecidas. Discussão: O adenocarcinoma pulmonar possui como subtipo o carcinoma adenóide cístico. Anteriormente conhecido como cilindroma. Têm baixo grau de malignidade principalmente pelo seu lento crescimento e curso clínico estendido. Conclusão: Por se tratar de uma baixa malignidade, a sobrevida a longo prazo é satisfatoriamente prevista

Cisto cavum interpositum: Cavum interpositum cyst

Introdução: O velum interpositum (VI) é uma membrana no subaracnóideo formado por uma invaginação da pia-máter preenchido por líquido cefalorraquidiano (LCR). Sua formação ocorre durante o período embrionário e regridem posteriormente. A persistência dessa estrutura primitiva pode acarretar em sua dilatação, sendo denominado cavum veli interpositum (CVI) e, se maior que 10 mm em medida transversal axial, cisto cavum veli interpositum. Sua prevalência é maior em recém nascidos e prematuros. Apresentação do caso: paciente do sexo masculino, recém-nascido de 10 dias, foi admitido no Hospital Materno Infantil (HMI), por quadro de vômitos intermitentes, associado a febre de 39.5ºC. A mãe relata prematuridade de 31 semanas, trabalho de parto prolongado, cesariana e apresentação pélvica. RN teve um episódio convulsivo minutos antes da chegada à unidade. Nega outras queixas. A ressonância magnética destaca-se como exame padrão ouro, seguido da tomografia computadorizada de crânio. Discussão: Os cistos de CVI não apontam fisiopatologia e quadro clínico bem definidos, mas os conhecimentos acerca de sua localização são importantes para correlacionar sinais e sintomas neurológicos que condizem com efeito de massa, sendo um diagnóstico diferencial de lesões císticas intracranianas da linha média. A terapêutica ainda é restrita, mas há muitos relatos de casos em que a técnica de fenestração endoscópica minimamente invasiva foi preconizada para o tratamento dos cistos de CVI. Conclusão: Quanto ao prognóstico, em âmbito radiológico, estudos demonstram redução do cisto e do efeito de massa em imagem de ressonância magnética pós-operatória. E, apesar da resposta clínica ser dependente se os sintomas são decorrentes direta ou indiretamente do cisto, também demonstraram melhora nessa esfera

Catálogo Taxonômico da Fauna do Brasil: setting the baseline knowledge on the animal diversity in Brazil

The limited temporal completeness and taxonomic accuracy of species lists, made available in a traditional manner in scientific publications, has always represented a problem. These lists are invariably limited to a few taxonomic groups and do not represent up-to-date knowledge of all species and classifications. In this context, the Brazilian megadiverse fauna is no exception, and the Catálogo Taxonômico da Fauna do Brasil (CTFB) (http://fauna.jbrj.gov.br/), made public in 2015, represents a database on biodiversity anchored on a list of valid and expertly recognized scientific names of animals in Brazil. The CTFB is updated in near real time by a team of more than 800 specialists. By January 1, 2024, the CTFB compiled 133,691 nominal species, with 125,138 that were considered valid. Most of the valid species were arthropods (82.3%, with more than 102,000 species) and chordates (7.69%, with over 11,000 species). These taxa were followed by a cluster composed of Mollusca (3,567 species), Platyhelminthes (2,292 species), Annelida (1,833 species), and Nematoda (1,447 species). All remaining groups had less than 1,000 species reported in Brazil, with Cnidaria (831 species), Porifera (628 species), Rotifera (606 species), and Bryozoa (520 species) representing those with more than 500 species. Analysis of the CTFB database can facilitate and direct efforts towards the discovery of new species in Brazil, but it is also fundamental in providing the best available list of valid nominal species to users, including those in science, health, conservation efforts, and any initiative involving animals. The importance of the CTFB is evidenced by the elevated number of citations in the scientific literature in diverse areas of biology, law, anthropology, education, forensic science, and veterinary science, among others

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

SARS-CoV-2 productively infects primary human immune system cells in vitro and in COVID-19 patients

Abstract: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with a hyperinflammatory state and lymphocytopenia, a hallmark that appears as both signature and prognosis of disease severity outcome. Although cytokine storm and a sustained inflammatory state are commonly associated with immune cell depletion, it is still unclear whether direct SARS-CoV-2 infection of immune cells could also play a role in this scenario by harboring viral replication. We found that monocytes, as well as both B and T lymphocytes, were susceptible to SARS-CoV-2 infection in vitro, accumulating double-stranded RNA consistent with viral RNA replication and ultimately leading to expressive T cell apoptosis. In addition, flow cytometry and immunofluorescence analysis revealed that SARS-CoV-2 was frequently detected in monocytes and B lymphocytes from coronavirus disease 2019 (COVID-19) patients. The rates of SARS-CoV-2-infected monocytes in peripheral blood mononuclear cells from COVID-19 patients increased over time from symptom onset, with SARS-CoV-2-positive monocytes, B cells, and CD4+ T lymphocytes also detected in postmortem lung tissue. These results indicated that SARS-CoV-2 infection of blood-circulating leukocytes in COVID-19 patients might have important implications for disease pathogenesis and progression, immune dysfunction, and virus spread within the host

ABC-SPH risk score for in-hospital mortality in COVID-19 patients : development, external validation and comparison with other available scores

The majority of available scores to assess mortality risk of coronavirus disease 2019 (COVID-19) patients in the emergency department have high risk of bias. Therefore, this cohort aimed to develop and validate a score at hospital admission for predicting in-hospital mortality in COVID-19 patients and to compare this score with other existing ones. Consecutive patients (≥ 18 years) with confirmed COVID-19 admitted to the participating hospitals were included. Logistic regression analysis was performed to develop a prediction model for in-hospital mortality, based on the 3978 patients admitted between March-July, 2020. The model was validated in the 1054 patients admitted during August-September, as well as in an external cohort of 474 Spanish patients. Median (25-75th percentile) age of the model-derivation cohort was 60 (48-72) years, and in-hospital mortality was 20.3%. The validation cohorts had similar age distribution and in-hospital mortality. Seven significant variables were included in the risk score: age, blood urea nitrogen, number of comorbidities, C-reactive protein, SpO/FiO ratio, platelet count, and heart rate. The model had high discriminatory value (AUROC 0.844, 95% CI 0.829-0.859), which was confirmed in the Brazilian (0.859 [95% CI 0.833-0.885]) and Spanish (0.894 [95% CI 0.870-0.919]) validation cohorts, and displayed better discrimination ability than other existing scores. It is implemented in a freely available online risk calculator (https://abc2sph.com/). An easy-to-use rapid scoring system based on characteristics of COVID-19 patients commonly available at hospital presentation was designed and validated for early stratification of in-hospital mortality risk of patients with COVID-19

ABC₂-SPH risk score for in-hospital mortality in COVID-19 patients

Objectives: The majority of available scores to assess mortality risk of coronavirus disease 2019 (COVID-19) patients in the emergency department have high risk of bias. Therefore, this cohort aimed to develop and validate a score at hospital admission for predicting in-hospital mortality in COVID-19 patients and to compare this score with other existing ones. Methods: Consecutive patients (≥ 18 years) with confirmed COVID-19 admitted to the participating hospitals were included. Logistic regression analysis was performed to develop a prediction model for in-hospital mortality, based on the 3978 patients admitted between March–July, 2020. The model was validated in the 1054 patients admitted during August–September, as well as in an external cohort of 474 Spanish patients. Results: Median (25–75th percentile) age of the model-derivation cohort was 60 (48–72) years, and in-hospital mortality was 20.3%. The validation cohorts had similar age distribution and in-hospital mortality. Seven significant variables were included in the risk score: age, blood urea nitrogen, number of comorbidities, C-reactive protein, SpO2/FiO2 ratio, platelet count, and heart rate. The model had high discriminatory value (AUROC 0.844, 95% CI 0.829–0.859), which was confirmed in the Brazilian (0.859 [95% CI 0.833–0.885]) and Spanish (0.894 [95% CI 0.870–0.919]) validation cohorts, and displayed better discrimination ability than other existing scores. It is implemented in a freely available online risk calculator (https://abc2sph.com/). Conclusions: An easy-to-use rapid scoring system based on characteristics of COVID-19 patients commonly available at hospital presentation was designed and validated for early stratification of in-hospital mortality risk of patients with COVID-19.</p