Carga de trabajo de los enfermeros en unidades de cuidados intensivos: relevancia del Nursing Activities Score

[Extrato] INTRODUCCIÓN: La investigación reciente en el dominio del comportamiento organizacional, principalmente por lo que se refiere a la gestión en enfermería, sobresale la necesidad de una previsión de la carga de trabajo de los enfermeros, pues se trata de un factor mayor de determinación de un equipo capaz que asegure una gestión conveniente de los cuidados y de los recursos accesibles. Se destaca así, en este contexto, el Nursing Activities Score – NAS (Miranda et al., 2003) como instrumento que permite evaluar la carga de trabajo de los enfermeros tomando como base el tiempo utilizado en las actividades de enfermería...info:eu-repo/semantics/publishedVersio

El paciente crítico transportado en helicóptero : historia del pasado reciente y panorama actual

Contexto: A Medicina de Emergência moderna tem as suas raízes na Primeira Guerra Mundial. Em Portugal o primeiro sistema de emergência médica data de 1965, tendo sido inaugurado o Serviço de Helicópteros de Emergência Médica pelo Instituto Nacional de Emergência Médica (INEM) em 1997. Objetivo: Dar a conhecer a história e o panorama atual no que se reporta ao transporte aéreo do doente crítico por helicópteros, através das duas principais entidades em Portugal, o INEM e a Força Aérea Portuguesa (FAP). Metodologia: Estudo de natureza histórica, de abordagem qualitativa, recorreu-se a análise documental através de fontes primárias fornecidas pelo Estado Maior da Força Aérea e pelo Instituto Nacional de Emergência Médica, bem como fontes secundárias. Resultados: Os resultados sugerem que a criação de um modelo de partilha de meios aéreos entre as diversas entidades resulta na eficácia e eficiência no que diz respeito ao transporte do doente crítico. Conclusão: Sugerem-se outros estudos que dêem a conhecer historicamente o papel desempenhado pelas equipas de médicos, enfermeiros, comandantes e pilotos em Portugal.Background: Emergency Medicine has its modern roots in the First World War. In Portugal, the first medical emergency system dates back to 1965. The Helicopter Emergency Medical Service of the National Institute of Medical Emergency (INEM) started operating in 1997. Objective: To inform about the history and current situation of the helicopter aeromedical transport of critically ill patients through the two major institutions in Portugal: the INEM and the Portuguese Air Force (FAP). Methodology: A qualitative historical study was conducted through documental analysis of the primary sources provided by the Portuguese Air Force and the National Institute of Medical Emergency, as well as the secondary sources. Results: The results suggest that the creation of a model for sharing air assets between various institutions leads to a more effective and efficient transport of critically ill patients. Conclusion: Further studies should be conducted to reveal the historical role played by the teams of physicians, nurses, commanders and pilots in Portugal.Marco contextual: La medicina de emergencia moderna tiene sus raíces en la Primera Guerra Mundial. En Portugal, el primer sistema de emergencia médica se remonta al año 1965, después de que el Instituto Nacional de Emergencia Médica (INEM) abriese el servicio de helicópteros de emergencia médica en 1997. Objetivo: Dar a conocer la historia y la situación actual en lo que respecta al transporte aéreo de pacientes en estado crítico en helicóptero, a través de las dos entidades principales en Portugal, el INEM y la Fuerza Aérea Portuguesa (FAP) . Metodología: Estudio de carácter histórico, de enfoque cualitativo, en el que se recurrió al análisis documental de fuentes primarias provistas por el Estado Mayor de la Fuerza Aérea y el Instituto Nacional de Emergencia Médica, así como de fuentes secundarias. Resultados: Los resultados sugieren que la creación de un modelo de intercambio de medios de transporte aéreo entre las diferentes entidades mejora la eficacia y eficiencia del transporte de pacientes críticos. Conclusión: Se sugieren otros estudios que den a conocer históricamente el papel desempeñado por los equipos de médicos, enfermeros, comandantes y pilotos en Portugal

Transcriptomic and chemogenomic analyses unveil the essential role of Com2-regulon in response and tolerance of Saccharomyces cerevisiae to stress induced by sulfur dioxide

During vinification Saccharomyces cerevisiae cells are frequently exposed to high concentrations of sulfur dioxide (SO2) that is used to avoid overgrowth of unwanted bacteria or fungi present in the must. Up to now the characterization of the molecular mechanisms by which S. cerevisiae responds and tolerates SO2 was focused on the role of the sulfite efflux pump Ssu1 and investigation on the involvement of other players has been scarce, especially at a genome-wide level. In this work, we uncovered the essential role of the poorly characterized transcription factor Com2 in tolerance and response of S. cerevisiae to stress induced by SO2 at the enologically relevant pH of 3.5. Transcriptomic analysis revealed that Com2 controls, directly or indirectly, the expression of more than 80% of the genes activated by SO2, a percentage much higher than the one that could be attributed to any other stress-responsive transcription factor. Large-scale phenotyping of the yeast haploid mutant collection led to the identification of 50 Com2-targets contributing to the protection against SO2 including all the genes that compose the sulfate reduction pathway (MET3, MET14, MET16, MET5, MET10) and the majority of the genes required for biosynthesis of lysine (LYS2, LYS21, LYS20, LYS14, LYS4, LYS5, LYS1 and LYS9) or arginine (ARG5,6, ARG4, ARG2, ARG3, ARG7, ARG8, ORT1 and CPA1). Other uncovered determinants of resistance to SO2 (not under the control of Com2) included genes required for function and assembly of the vacuolar proton pump and enzymes of the antioxidant defense, consistent with the observed cytosolic and mitochondrial accumulation of reactive oxygen species in SO2-stressed yeast cells.This work was funded by INNOVINE&WINE, Norte-01-0145-FEDER-000038, co-financed by the European Region-al Development Fund (ERDF) through Norte 2020 and by ERFD through POCI-COMPETE 2020. Support received by FCT-Portuguese Foundationfor Science and Technology(PTDC/EXPL/AGR-TEC/1823/2013 and PTDC/AGR-TEC/3315/2014) and by INTERACT project –“Integrated Research in Environment, Agro-Chain and Technology”, no. NORTE-01-0145-FEDER-000017, in its line of research enti-tled VitalityWine. Supportreceived by Biosystems and In-tegrative Sciences Institute (BioISI; FCT/UID/Multi/04046/2018) and iBB-Institute for Bioengi-neering and Biosciences (UID/BIO/04565/2019) by FCT and from Programa Operacional Regional de Lisboa 2020 (pro-ject no. 007317 and PTDC/AGR-TEC/3315/2014_LISBOA-01-0145-FEDER-016834) is also acknowledged.The authors thank Professor Isabel Sá-Correia for the help and guidance in conducting the chemogenomic analysi

Subtractive phage display selection from canine visceral leishmaniasis identifies novel epitopes that mimic leishmania infantum antigens with potential serodiagnosis applications

Visceral leishmaniasis (VL) is a zoonotic disease that is endemic to Brazil, where dogs are the main domestic parasite reservoirs, and the percentages of infected dogs living in regions where canine VL (CVL) is endemic have ranged from 10% to 62%. Despite technological advances, some problems have been reported with CVL serodiagnosis. The present study describes a sequential subtractive selection through phage display technology from polyclonal antibodies of negative and positive sera that resulted in the identification of potential bacteriophage-fused peptides that were highly sensitive and specific to antibodies of CVL. A negative selection was performed in which phage clones were adhered to purified IgGs from healthy and Trypanosoma cruzi-infected dogs to eliminate cross-reactive phages. The remaining supernatant nonadhered phages were submitted to positive selection against IgG from the blood serum of dogs that were infected with Leishmania infantum. Phage clones that adhered to purified IgGs from the CVL-infected serum samples were selected. Eighteen clones were identified and their reactivities tested by a phage enzyme-linked immunosorbent assay (phage-ELISA) against the serum samples from infected dogs (n 31) compared to those from vaccinated dogs (n 21), experimentally infected dogs with cross-reactive parasites (n 23), and healthy controls (n 17). Eight clones presented sensitivity, specificity, and positive and negative predictive values of 100%, and they showed no crossreactivity with T. cruzi- or Ehrlichia canis-infected dogs or with dogs vaccinated with two different commercial CVL vaccines in Brazil. Our study identified eight mimotopes of L. infantum antigens with 100% accuracy for CVL serodiagnosis. The use of these mimotopes by phage-ELISA proved to be an excellent assay that was reproducible, simple, fast, and inexpensive, and it can be applied in CVL-monitoring programsThis work was supported by grants from the Pró-Reitoria de Pesquisa of UFMG (supported 03/2013), the Instituto Nacional de Ciência e Tecnologia em Nano-Biofarmacêutica (INCT Nano-Biofar), Rede Nanobiotec/Brasil-UFU (CAPES), PRONEX-FAPEMIG (APQ-01019- 09), FAPEMIG (APQ-00496-11 and APQ-00819-12), and CNPq (APQ- 472090/2011-9 and APQ-482976/2012-8). E.A.F.C. and L.R.G. are recipients of grants from CNPq. M.A.C.-F. is the recipient of a grant from FAPEMIG/CAPE

Sensitive and specific serodiagnosis of Leishmania infantum infection in dogs by using peptides selected from hypothetical proteins identified by an immunoproteomic approach

In Brazil, the percentage of infected dogs living in areas where canine visceral leishmaniasis (CVL) is endemic ranges from 10 to 62%; however, the prevalence of infection in dogs is probably higher than figures reported from serological studies. In addition, problems with the occurrence of false-positive or false-negative results in the serodiagnosis of CVL have been reported. The present work analyzed the potential of synthetic peptides mapped from hypothetical proteins for improvement of the serodiagnosis of Leishmania infantum infection in dogs. From 26 identified leishmanial proteins, eight were selected, considering that no homologies between these proteins and others from trypanosomatide sequence databases were encountered. The sequences of these proteins were mapped to identify linear B-cell epitopes, and 17 peptides were synthesized and tested in enzyme-linked immunosorbent assays (ELISAs) for the serodiagnosis of L. infantum infection in dogs. Of these, three exhibited sensitivity and specificity values higher than 75% and 90%, respectively, to differentiate L. infantum-infected animals from Trypanosoma cruziinfected animals and healthy animals. Soluble Leishmania antigen (SLA) showed poor sensitivity (4%) and specificity (36%) to differentiate L. infantum-infected dogs from healthy and T. cruzi-infected dogs. Lastly, the three selected peptides were combined in different mixtures and higher sensitivity and specificity values were obtained, even when sera from T. cruzi-infected dogs were used. The study’s findings suggest that these three peptides can constitute a potential tool for more sensitive and specific serodiagnosis of L. infantum infection in dogsThis work was supported by grants from the Pró-Reitoria de Pesquisa from UFMG (Edital 07/2012), Instituto Nacional de Ciência e Tecnologia em Nano-biofarmacêutica (INCT-NANOBIOFAR, Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG) (CBB-APQ-02364-08, CBB-APQ-00356-10, CBB-APQ-00496-11, and CBB-APQ-00819-12), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) (APQ-472090/2011-9), and the Instituto Nacional de Ciência e Tecnologia em Vacinas (INCT-V). E.A.F.C. and A.P.F. are CNPq grant recipients. M.A.C.-F. is a FAPEMIG/CAPES grant recipient. This study was supported in Spain, in part, by grants from the Ministerio de Ciencia e Innovación (FIS/PI1100095)

WHIPPLE’s DISEASE: A CASE REPORT

Male, 46 years old, with arthralgia, abdominal pain, weight loss, diarrhea and inappetence. An upper digestive endoscopy was performed, which showed the duodenal bulb with diffuse whitish stippling. The anatomopathological examination of the duodenum showed positive periodic acid-Schiff, confirming the diagnosis of Whipple's disease. In view of the findings, treatment with sulfamethoxazole and trimethoprim was initiated, with significant improvement in symptoms. Whipple's disease is a rare pathology, as a consequence it presents a difficult diagnosis and the ideal treatment of the pathology is still not completely elucidated. Thus, clinical studies with greater scientific impact are needed to aid in the diagnosis and define the preferential approach to the condition.Masculino, 46 anos, com artralgia, dor abdominal, perda de peso, diarreia e inapetência. Realizada endoscopia digestiva alta que evidenciou bulbo duodenal apresentando pontilhado esbranquiçado difuso. Ao anatomopatológico de duodeno evidenciado periodic acid-Schiff positivos, firmando-se o diagnóstico de Doença de Whipple. Diante dos achados, iniciou-se o tratamento com sulfametoxazol+trimetropina, com melhora significativa dos sintomas. A Doença de Whipple é uma patologia rara, como consequência apresenta um difícil diagnóstico e o tratamento ideal da patologia ainda não é completamente elucidado. Assim, são necessários estudos clínicos com maior impacto científico para auxiliar no diagnóstico e definir a conduta preferencial diante do quadro.&nbsp

Validación del Nursing Activities Score en unidades de cuidados intensivos portuguesas

Objective: to describe the process of adaptation and validation of the Nursing Activities Score to the Portuguese context. Method: this was a pilot study of adaptation and validation of the Nursing Activities Score with a sample consisting of 67 patients hospitalized in the intensive care units of three Portuguese hospitals. The construct validity was assessed through factor analysis procedures and the internal consistency of the items was measured through the Cronbach’s alpha coeffi cient. Results: a mean workload value of 63.04% (SD = 14.25; Median = 61.30) was obtained. Psychometric data revealed a Cronbach’s alpha of 0.71 in the total scale, indicating an acceptable accuracy. Confi rmatory factor analysis suggested an appropriate adjustment between the model and the data (χ2 (199) = 214.5, p = 0.214; CFI = 0.95; RMSA = 0.035). Conclusion: in the present study, the Portuguese version of the Nursing Activities Score was found to be a valid instrument, enabling a safe assessment of the workload of nurses.Objetivo: descrever o processo de adaptação e validação do Nursing Activities Score para o contexto português. Método: trata-se de um estudo-piloto de adaptação e validação do Nursing Activities Score, com amostra de 67 doentes internados em unidades de cuidados intensivos de três hospitais portugueses. A validade de constructo avaliou-se mediante procedimentos de análise fatorial e a consistência interna dos itens através do coefi ciente Alpha de Cronbach. Resultados: obteve-se um valor médio da carga de trabalho de 63,04% (DP = 14,25; Mediana = 61,30). Os dados psicométricos revelaram um Alpha de Cronbach de 0,71, na escala total, indicando uma fi delidade aceitável. A análise fatorial confi rmatória sugeriu um ajustamento adequado entre o modelo e os dados (χ2(199) = 214,5, p = 0,214; CFI = 0,95; RMSA = 0,035). Conclusão: neste estudo, a versão portuguesa do Nursing Activities Score revelou-se um instrumento válido, permitindo avaliar a carga de trabalho dos enfermeiros com segurançaObjetivo: describir el proceso de adaptación y validación del Nursing Activities Score al contexto portugués. Método: estudio piloto de adaptación y validación del Nursing Activities Score, con muestra de 67 pacientes internados en unidades de cuidados intensivos de tres hospitales portugueses. La validez del constructo se evaluó mediante análisis factorial y por consistencia interna de los ítems evaluados a través del coefi ciente Alpha de Cronbach. Resultados: se obtuvo un valor medio de carga de trabajo de 63,04% (SD=14,25; Mediana=61,30). Los datos psicométricos expresaron un Alpha de Cronbach de 0,71 en la escala total, indicando fi delidad aceptable. El análisis factorial confi rmatorio sugirió un ajuste adecuado entre el modelo y os datos (χ2 (199)=214,5; p=0,214; CFI=0,95; RMSA=0,035). Conclusión: en este estudio, la versión portuguesa del Nursing Activities Score demostró ser un instrumento válido, permitiendo evaluar la carga de trabajo de los enfermeros con precisión

Caracterização clínica, patológica e molecular

Background: Some families fulfilling the Amsterdam Criteria (AC) differ from the Lynch syndrome (LS) in that colorectal cancers (CRC) do not present microsatellite instability (MSI) and DNA mismatch repair gene mutations are not found. These families have been designated as Familial Colorectal Cancer type X (XS) and their genetic basis remains unknown. Aims: In families fulfilling AC for LS: 1) To perform MSI testing in CRC and to correlate it with clinical and pathological characteristics and with the mutational analysis in the DNA mismatch repair genes; 2) In cases suggestive of XS, to study the suppressor pathway (SP) of carcinogenesis. Patients and methods: 45 patients with CRC, from 41 families fulfilling AC, were included. Clinical and pathological data were recorded. MSI testing was performed with the Bethesda marker panel and mutational analysis in MLH1, MSH2 and MSH6 genes was undertaken by DGGE, MLPA and direct sequencing. To study the SP, loss of heterozigoty was evaluated at the following loci: APC, p53, DCC and SMAD4 genes. Results: 33/41 (80%) and 8/41 (20%) families presented high-grade microsatellite instability (MSI-H) and microsatellite stable (MSS) CRC, respectively. In families suggestive of XS, a smaller number of CRC and less frequent spectrum associated tumors were detected. In comparison with MSI-H CRC, MSS CRC were preferentially located at the distal colon/rectum and less often presented mucous production or lymphocytic infiltrate. In 70% of families with MSI-H CRC, a pathogenic mutation in one of the DNA mismatch repair genes was identified, as opposed to none in the group with MSS CRC. The SP was followed in 2 cases and an alternative one in other two. The remaining 4 cases were noninformative; however, 5/8 (63%) presented allelic losses in the APC gene. Conclusions: 1) Families fulfilling AC and harbouring MSS CRC presented particular characteristics, which reinforce the existence of a new entity, different from LS; 2) The designation of Familial Colorectal Cancer type X seems appropriate to classify an entity whose CRC follow an unclear carcinogenesis pathway and that presents an unknown genetic basis; 3) The designation of LS should be restricted to families with an identified pathogenic DNA mismatch repair gene mutation.publishersversionpublishe