Perfil social e clínico de crianças e adolescentes com diabetes mellitus tipo 1

Objective: to identify the social and clinical profile of children and adolescents with type 1 diabetes mellitus. Method: quantitative, cross-sectional and descriptive research, developed with 81 guardians of children and adolescents with type 1 diabetes mellitus between March and September/2021, in two reference centers in Paraiba. The descriptive analysis was performed using the Statistical Package for the Social Science software, version 18. Results: predominantly, the companions of the children and adolescents were the mothers themselves, 90.1%, and about 40% lived with family income lower than a minimum wage. Among the children and adolescents, 54% had high glycated hemoglobin values, even though they were undergoing treatment; 65.4% indicated ignorance of the correct form of insulin storage, and 77.6% had lipohypertrophy. Conclusion: socioeconomic vulnerability and ineffective clinical management of type 1 diabetes mellitus in children and adolescents were predominant.Objetivo: identificar el perfil social y clínico de niños y adolescentes con diabetes mellitus tipo 1. Método: investigación cuantitativa, transversal y descriptiva, realizada con 81 cuidadores de niños y adolescentes con diabetes mellitus tipo 1 entre marzo y septiembre/2021, en dos centros de referencia en Paraíba. El análisis descriptivo fue realizado mediante el software Statistical Package for Social Science, versión 18. Resultados: predominantemente, los acompañantes de los niños y adolescentes eran sus madres, el 90,1%, y cerca del 40% vivían con renta familiar inferior a un salario mínimo. Entre los niños y adolescentes, el 54% presentaba niveles elevados de hemoglobina glucosilada, a pesar de estar en tratamiento; El 65,4% indicó desconocer la forma correcta de almacenar la insulina y el 77,6% presentaba lipohipertrofia. Conclusión: predominó la vulnerabilidad socioeconómica y el manejo clínico ineficaz de la diabetes mellitus tipo 1 en niños y adolescentes.Objetivo: identificar o perfil social e clínico de crianças e adolescentes com diabetes mellitus tipo 1. Método: pesquisa quantitativa, transversal e descritiva, desenvolvida com 81 responsáveis de crianças e adolescentes com diabetes mellitus tipo 1 entre março e setembro/2021, em dois centros de referência da Paraíba.  A análise descritiva foi realizada com auxílio do software Statistical Package for the Social Science, versão 18. Resultados: predominantemente, os acompanhantes das crianças e adolescentes eram as próprias mães, 90,1%, e cerca de 40% viviam com renda familiar menor que um salário mínimo.  Entre as crianças e adolescentes, 54% apresentaram valores elevados de hemoglobina glicada, mesmo estando em tratamento; 65,4% indicaram desconhecimento na forma correta de armazenamento da insulina, e 77,6% possuía lipohipertrofia. Conclusão: foram preponderantes a vulnerabilidade socioeconômica e o manejo clínico ineficaz do diabetes mellitus tipo 1 em crianças e adolescentes

Antimicrobial consumption in pediatric intensive care units during the first year of COVID-19 pandemic / Consumo antimicrobiano em unidades de cuidados intensivos pediátricos durante o primeiro ano da pandemia de COVID-19

Introduction: The absence of standardized treatment for critical children admitted in pediatric intensive care units (PICUs) with COVID could lead to an increase in antimicrobial consumption, as indirect effect. Aim: To describe trends of antimicrobial consumption in two PICUs before and during the COVID pandemic year.Methods: We did a retrospective study in children admitted in two PICUs of Rio de Janeiro city, between March 2019 and March 2021. The first year represented the pre-pandemic period and the last one the pandemic period. Trends of antimicrobial consumption were measured by days of therapy (DOT/1000 patient-days) and analyzed by linear regression for antibiotics, antivirals and antifungals Results: Number of patients-days in the PICU 1 was 3495 in the pre-pandemic period and 3600 in the pandemic period. The overall DOT/1000 PD of antibiotics, antivirals and antifungal was 15,308.1, 942.8 and 1,691.1, respectively in the pre-pandemic period and 13,481.5, 1,335.4 and 1,243.7, respectively in pandemic period. It was verified trend of reduction of antibiotic and antifungals and increase in antivirals consumption. Number of patients-days in the PICU 2 was 5029 in the pre-pandemic period and 4557 in the pandemic period and the overall DOT/1000 PD of antibiotics, antivirals and antifungal was 16,668.5, 1,385 and 1,966.7, respectively in the pre-pandemic period and 10,896.5, 830.7 and 677.3 in pandemic period. It was verified trend of reduction of antibiotic, antivirals and antifungals consumption. Conclusion: Trends of antimicrobial consumption reduction were verified for antibiotics and antifungals in two PICUs and reduction for antiviral in one of them

HEPATOTOXICIDADE POR PARACETAMOL

Paracetamol has been marketed since the 1950s, being a drug widely accessible to the population because it does not need a medical prescription, is low cost and widely distributed, in addition to presenting medium analgesia, high antipyretic action and low antipyretic action. inflammatory effect compared to other drugs of the same class. Although it is considered safe in therapeutic doses, overdoses can cause severe liver damage. In this context, the present review aims to highlight the main factors that predispose paracetamol hepatotoxicity, as well as to show its mechanisms of hepatotoxicity. It is understood that paracetamol is one of the drugs most used indiscriminately by the world's population, resulting in high rates of self-medication. Thus, this drug, in high and repeated doses, plays a toxic role in the body, as can be seen through in vitro experiments, which attested to its potential for glutathione depletion, which disables the body from carrying out detoxification. Given this, as the liver is the main organ that metabolizes paracetamol, overdose of such a drug causes liver damage in three ways, such as overdose, CYP450 oxidation and hepatocyte depletion. However, it is observed that overdose is the most common toxicity factor due to recurrent poisoning, since it does not exclude a specific age group, affecting both children and the elderly.El paracetamol se comercializa desde la década de 1950, siendo un medicamento de amplio acceso a la población porque no necesita receta médica, es de bajo costo y tiene amplia distribución, además de presentar analgesia media, alta acción antipirética y baja acción antiinflamatoria en comparación con otros medicamentos de la misma clase. Aunque se considera seguro en dosis terapéuticas, las sobredosis pueden ocurrir con lesión hepática grave. En este contexto, la presente revisión tiene como objetivo destacar los principales factores que predisponen a la hepatotoxicidad por paracetamol, así como mostrar sus mecanismos de hepatotoxicidad. Se entiende que el paracetamol es uno de los medicamentos más utilizados indiscriminadamente por la población mundial con altas tasas de automedicación. Por lo tanto, este medicamento en dosis altas y repetidas juega un papel tóxico para el cuerpo, como se puede percibir a través de experimentos in vitro, que atestiguan su potencial para el agotamiento del glutatión que incapacitó al cuerpo para realizar la desintoxicación. Por lo tanto, como el hígado es el órgano principal que metaboliza el paracetamol, la sobredosis de dicho medicamento causa lesiones hepáticas de tres maneras, como sobredosis, oxidación de CYP450 y agotamiento de hepatocitos. Sin embargo, se observa que la sobredosis es el factor de toxicidad más común debido a la intoxicación recurrente, ya que no excluye un grupo de edad específico, afectando tanto a niños como a ancianos.O paracetamol é comercializado desde a década de 1950, sendo um medicamento de amplo acesso a população por não precisar de prescrição médica, ser de baixo custo e por ter ampla distribuição, além de apresentar de média analgesia, alta ação antipirética e baixa ação anti-inflamatória se comparados a outros medicamentos de mesma classe. Embora ele seja considerado seguro em doses terapêuticas, as superdoses podem cursar com lesão hepática grave. Nesse contexto, a presente revisão visa evidenciar os principais fatores que predispõem a hepatotoxicidade do paracetamol, bem como mostrar os seus mecanismos de hepatotoxicidade. Entende-se que o paracetamol é um dos medicamentos mais utilizados de maneira indiscriminada pela população mundial tendo como consequências elevados índices de automedicação. Dessa forma, esse fármaco em doses altas e repetidas exerce um papel tóxico ao organismo, como pode ser percebido por meio de experimentos in vitro, os quais atestaram o seu potencial de esgotamento de glutationa que incapacitam o organismo de realizar a desintoxicação. Diante disso, como o fígado é o principal órgão que metaboliza o paracetamol, a superdosagem de tal medicamento acarreta lesões hepáticas de três maneiras, tais como overdose, oxidação da CYP450 e depleção dos hepatócitos. Contudo, observa-se que a overdose é o fator de toxicidade mais comum devido ao envenenamento recorrente, uma vez que não exclui uma faixa etária específica, atingindo tanto crianças quanto idosos.O paracetamol é comercializado desde a década de 1950, sendo um medicamento de amplo acesso a população por não precisar de prescrição médica, ser de baixo custo e por ter ampla distribuição, além de apresentar de média analgesia, alta ação antipirética e baixa ação anti-inflamatória se comparados a outros medicamentos de mesma classe. Embora ele seja considerado seguro em doses terapêuticas, as superdoses podem cursar com lesão hepática grave. Nesse contexto, a presente revisão visa evidenciar os principais fatores que predispõem a hepatotoxicidade do paracetamol, bem como mostrar os seus mecanismos de hepatotoxicidade. Entende-se que o paracetamol é um dos medicamentos mais utilizados de maneira indiscriminada pela população mundial tendo como consequências elevados índices de automedicação. Dessa forma, esse fármaco em doses altas e repetidas exerce um papel tóxico ao organismo, como pode ser percebido por meio de experimentos in vitro, os quais atestaram o seu potencial de esgotamento de glutationa que incapacitam o organismo de realizar a desintoxicação. Diante disso, como o fígado é o principal órgão que metaboliza o paracetamol, a superdosagem de tal medicamento acarreta lesões hepáticas de três maneiras, tais como overdose, oxidação da CYP450 e depleção dos hepatócitos. Contudo, observa-se que a overdose é o fator de toxicidade mais comum devido ao envenenamento recorrente, uma vez que não exclui uma faixa etária específica, atingindo tanto crianças quanto idosos

Impacto da pandemia de COVID-19 nos procedimentos dermatológicos no Brasil

INTRODUCTION: Appointments in dermatology were hindered by the COVID-19 pandemic, resulting in delayed diagnoses and interrupted treatments. Patients at risk of skin cancer, for example, have been affected and metastasis risks increased. In this context, this study aimed to analyze the impact of the COVID-19 pandemic dermatological surgical procedures in Brazil. METHODS: The study is retroactive, descriptive, and revised. Data were extracted from DATASUS Health Information System (TABLET) records. “Small surgeries and open skin, subcutaneous tissue, and hospital mucosal surgeries of the SUS from January 2016 to December 2020 were analyzed, focusing on the variables Region and Character of Care. RESULTS: 554,591 small surgeries and skin, subcutaneous tissue, and mucosal surgeries were performed between 2016 and 2020 in Brazil. The Southeast had the highest regional records (47.15%; n=261,477). From 2016 to 2019, there was a 16.44% increase in the procedures performed, totaling 130,099 in 2019. However, in 2020 there was a decrease of 38.59% compared to 2019, with 79,887 procedures. Further, elective procedures were prevalent in all years, 402,344 (72.5%) in total. The numbers increased 25.2% from 2016 to 2019, but in 2020, compared to 2019, there was a 44.9% reduction. DISCUSSION: During the COVID-19 pandemic, the number of active healthcare professionals in clinics decreased due to workforce relocation and services' restructuring, infected in the reduction of consultations and procedures, resulting in the delay of the follow-up and resolution of dermatological diseases. CONCLUSION: It was found that dermatological procedures were deeply influenced by the COVID-19 pandemic, with a direct affection of dermatology services in Brazil.Introdução: Atendimentos dermatológicos foram prejudicados pela pandemia da COVID-19, com diagnósticos atrasados e tratamentos interrompidos. Pacientes com câncer de pele, por exemplo, foram especialmente afetados, já que a progressão de lesões e o risco de metástase aumentam. Nesse contexto, o objetivo do estudo foi analisar o impacto da pandemia da COVID-19 na realização de procedimentos cirúrgicos em dermatologia no Brasil. Metodologia: O estudo é retrospectivo, descritivo e quantitativo. Os dados foram obtidos a partir de registros do Sistema de Informações de Saúde (TABNET) do DATASUS. Foram analisadas “Pequenas cirurgias e cirurgias de pele, tecido subcutâneo e mucosa” entre os Procedimentos Hospitalares do SUS do período de janeiro de 2016 a dezembro de 2020, sendo consideradas as variáveis Região e Caráter de Atendimento. Resultados: Foram realizadas 554.591 pequenas cirurgias e cirurgias de pele, tecido subcutâneo e mucosa entre 2016 e 2020 no Brasil. O Sudeste apresentou o maior número de registros (47,15%; n=261.477). No período de 2016 a 2019 houve um aumento de 16,44% nos procedimentos realizados, totalizando 130.099 em 2019. Entretanto, no ano de 2020 houve queda de 38,59% em relação a 2019, com 79.887 procedimentos. Ademais, em todos os anos predominou o caráter eletivo, totalizando 402.344 (72,5%). O aumento foi de 25,2% no período de 2016 a 2019, mas em comparação a 2019, houve uma redução de 44,9% em 2020. Discussão: A pandemia da COVID-19 reduziu o número de profissionais especializados atuantes nos ambulatórios, com o remanejamento da mão de obra e reestruturação do serviço para o atendimento aos infectados pela COVID-19, refletindo na redução de consultas e procedimentos, resultando no atraso do acompanhamento e resolução de doenças dermatológicas. Conclusão: Conclui-se, portanto, que o a realização de procedimentos dermatológicos foi fortemente influenciada pela pandemia da COVID-19, com efeito direto no funcionamento de serviços da especialidade

Perspectivas Futuras em Terapias Imunomoduladoras para Psoríase uma análise abrangente

This scientific review provides a comprehensive and up-to-date analysis on Future Perspectives in Immunomodulatory Therapies for Psoriasis. Given the complexity and variability of this dermatological condition, it becomes crucial to thoroughly examine the available therapeutic approaches for a more effective understanding of this clinical challenge. Psoriasis, with its diverse clinical presentations, demands a holistic evaluation of available therapies, ranging from IL-23 inhibitors to lifestyle interventions, offering a complete overview of the current landscape. Not only does it highlight the diversity of available therapeutic approaches, but the review also emphasizes the crucial importance of personalization and early intervention. Recognizing the different manifestations of psoriasis and individual patient responses, the study underscores how therapeutic strategies tailored to the specific characteristics of each individual are essential to optimize outcomes. This personalization not only takes into account the uniqueness of each patient but also underscores the need for an integrative and multifaceted approach to psoriasis treatment. By exploring the latest findings and developments in this field, this study goes beyond consolidating existing information, aiming to foster a critical reflection on current therapeutic practices in psoriasis. In doing so, it provides valuable insights for healthcare professionals, researchers, and patients, fostering a deeper understanding of therapeutic strategies and contributing to the ongoing improvement of the quality of life for individuals with psoriasis.Esta revisão científica proporciona uma análise abrangente e atualizada sobre as Perspectivas Futuras em Terapias Imunomoduladoras para Psoríase. Diante da complexidade e variabilidade dessa condição dermatológica, torna-se crucial examinar detalhadamente as abordagens terapêuticas disponíveis para uma compreensão mais eficaz desse desafio clínico. A psoríase, com sua diversidade de apresentações clínicas, demanda uma avaliação holística das terapias disponíveis, desde os inibidores de IL-23 até intervenções no estilo de vida, oferecendo um panorama completo do cenário atual. Não apenas se destaca a diversidade de abordagens terapêuticas disponíveis, mas a revisão enfatiza a importância crucial da personalização e da intervenção precoce. Reconhecendo as diferentes manifestações da psoríase e as respostas individuais dos pacientes, o estudo ressalta como estratégias terapêuticas adaptadas às características específicas de cada indivíduo são essenciais para otimizar os resultados. Essa personalização não apenas leva em conta a singularidade de cada paciente, mas também sublinha a necessidade de uma abordagem integrativa e multifacetada para o tratamento da psoríase. Ao explorar as últimas descobertas e desenvolvimentos nessa área, este estudo vai além da consolidação de informações existentes, buscando promover uma reflexão crítica sobre as práticas terapêuticas atuais em psoríase. Ao fazê-lo, oferece insights valiosos para profissionais de saúde, pesquisadores e pacientes, fomentando uma compreensão mais profunda das estratégias terapêuticas e contribuindo para a contínua melhoria da qualidade de vida dos indivíduos com psoríase

Information and impacts generated on society by the novel coronavirus 2019-nCoV/SARS-CoV-2

SARS-CoV-2 has been affecting the lives of thousands of people around the world, leading to the death of more than 745,000 people. There is still no effective treatment for this disease it leads to chaos in the public health and economy of the affected countries. Thus, this study aimed to collect information regarding SARS-CoV-2, as well as the impacts generated in society by the novel coronavirus. Thus, a prospective study of a qualitative and cross-sectional nature was carried out, with the searches being carried out between the months of December 2019 to August 2020, this is the period that comprises studies of SARS-CoV-2. The BVS, PubMed and DOAJ databases had the largest number of published studies with 2,506, 1,616 and 914, respectively. The scientific findings show an increasing number of papers with information on symptoms, diagnosis, comorbidities and possible treatments. The impacts recorded in the literature include weakness in health systems, weakening of the world economy, psychological and physical problems in people. Thus, efforts by the whole society, together with public authorities, are needed to develop measures that can resolve social and economic issues while there is no effective treatment for SARS-CoV-2

Panoramic snapshot of serum soluble mediator interplay in pregnant women with convalescent COVID-19: an exploratory study

IntroductionSARS-CoV-2 infection during pregnancy can induce changes in the maternal immune response, with effects on pregnancy outcome and offspring. This is a cross-sectional observational study designed to characterize the immunological status of pregnant women with convalescent COVID-19 at distinct pregnancy trimesters. The study focused on providing a clear snapshot of the interplay among serum soluble mediators.MethodsA sample of 141 pregnant women from all prenatal periods (1st, 2nd and 3rd trimesters) comprised patients with convalescent SARS-CoV-2 infection at 3-20 weeks after symptoms onset (COVID, n=89) and a control group of pre-pandemic non-infected pregnant women (HC, n=52). Chemokine, pro-inflammatory/regulatory cytokine and growth factor levels were quantified by a high-throughput microbeads array.ResultsIn the HC group, most serum soluble mediators progressively decreased towards the 2nd and 3rd trimesters of pregnancy, while higher chemokine, cytokine and growth factor levels were observed in the COVID patient group. Serum soluble mediator signatures and heatmap analysis pointed out that the major increase observed in the COVID group related to pro-inflammatory cytokines (IL-6, TNF-α, IL-12, IFN-γ and IL-17). A larger set of biomarkers displayed an increased COVID/HC ratio towards the 2nd (3x increase) and the 3rd (3x to 15x increase) trimesters. Integrative network analysis demonstrated that HC pregnancy evolves with decreasing connectivity between pairs of serum soluble mediators towards the 3rd trimester. Although the COVID group exhibited a similar profile, the number of connections was remarkably lower throughout the pregnancy. Meanwhile, IL-1Ra, IL-10 and GM-CSF presented a preserved number of correlations (≥5 strong correlations in HC and COVID), IL-17, FGF-basic and VEGF lost connectivity throughout the pregnancy. IL-6 and CXCL8 were included in a set of acquired attributes, named COVID-selective (≥5 strong correlations in COVID and <5 in HC) observed at the 3rd pregnancy trimester.Discussion and conclusionFrom an overall perspective, a pronounced increase in serum levels of soluble mediators with decreased network interplay between them demonstrated an imbalanced immune response in convalescent COVID-19 infection during pregnancy that may contribute to the management of, or indeed recovery from, late complications in the post-symptomatic phase of the SARS-CoV-2 infection in pregnant women

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio