Pediatric Emergency Care for Children and Adolescents with Cancer: Causes of Consultation and Factors Associated with Hospitalization

Introduction: Pediatric emergency care is essential for adequate medical treatment of pediatric cancer-associated complications and for increasing the chances of cure. Objective: This study aimed to describe pediatric cancer-associated emergencies and outcomes, and to analyze the factors associated with hospitalization. Method: A retrospective observational cohort study was conducted including patients aged ≤19 years who attended the pediatric emergency of a general cancer hospital from April 17 to October 17, 2019. The variables analyzed were demographics, socioeconomic status, disease and treatment factors, reasons for seeking emergency care, and associated outcomes. Results: This study included 309 patients who required 994 emergency consultations, with a total of 766 reasons for seeking care. The median age was 4.86 years; 50.8% were female and 51.5% were white. The patients had solid tumors (49.8%), central nervous system tumors (27.5%), and hematological neoplasms (15.5%). Most of the patients were home discharged (72.2%) or to support houses (6.7%). Fever was the most frequent symptom (30.8%) and the most common reason for admission. 19.2% of the patients were admitted to the ward and 2.0% to the pediatric intensive care unit (2.0%). Only two of the 309 patients (0.6%) seeking care in the pediatric emergency died in the emergency room, and these patients were in end-of-life care. Conclusion: The availability of a pediatric emergency room with skilled professionals in supportive care of pediatric patients with cancer was essential for the management of disease and treatment-related complications

Assistência de enfermagem ao idoso com doença de Alzheimer: uma revisão integrativa

O objetivo deste estudo foi identificar o tipo de assistência de enfermagem prestada ao idoso com doença de Alzheimer. Quanto ao método, trata-se de uma revisão integrativa, com abordagem qualitativa, que buscou responder a seguinte questão de pesquisa: que tipo de assistência de enfermagem é prestada ao idoso com doença de Alzheimer? A busca foi realizada na Biblioteca Virtual em Saúde tendo como critérios de inclusão o período compreendido entre 2010 e 2019, artigos completos em português. Foram evidenciados 1.780 estudos, dos quais 40 atenderam aos critérios de inclusão. Foram elegíveis 05 artigos nas bases de dados LILACS e BDENF. Os resultados apontaram as seguintes categorias: a assistência de enfermagem prestada ao idoso com doença de Alzheimer, Fatores que interferem no cuidado ao  idoso com Alzheimer e Percepção da consulta de enfermagem por idosos e seus cuidadores. Concluiu-se que o enfermeiro tem um papel de grande importância na assistência ao idoso com doença de Alzheimer, pois através da realização de cuidados, exames, orientações e apoio familiar, sua atuação pode fazer a diferença na melhoria da qualidade de vida de todos os envolvidos

Avaliação de fatores imunológicos e Endocrino-metabólicos nos paciente diabéticos acometidos por Covid-19: uma revisão de literatura / Evaluation of immunological and Endocrine-metabolic factors in diabetic patients affected by Covid-19: a literature review

Introdução: Em dezembro de 2019 ocorreu o primeiro surto da Síndrome Respiratória Aguda Grave por Coronavírus em Wuhan na China. É fundamental compreender a razão de alguns indivíduos evoluírem para formas graves, quais os fatores de gravidade relacionados e os principais efeitos sistêmicos desencadeados pela infecção. Doenças como diabetes mellitus, hipertensão e obesidade grave são mais propensos a serem infectados e evoluem com mais complicações tendo maior risco de morte. Objetivos: identificar e relacionar os fatores imunológicos, endócrinos e metabólicos em pacientes portadores crônicos de Diabetes Mellitus tipo 2 ao pior prognostico em infectados pela COVID- 19. Métodos: Trata-se de uma revisão integrativa de literatura com análise qualitativa descritiva.  Foram incluídas publicações de dezembro de 2019 a maio de 2021 disponibilizados na íntegra, online e gratuitos. Dentre os artigos publicados com os descritores determinados foram encontrados 142 artigos, contudo foram utilizados 18 artigos para o embasamento teórico. Resultados: Nas pesquisas realizadas na China, a taxa de mortalidade em pacientes acometidos por COVID-19 de 7,3% em pacientes portadores de DM quando comparados a população em geral com a taxa de mortalidade de 2,3%. Em outro estudo foram analisados 48 pacientes diabéticos principalmente entre homens, com maior tempo de diagnóstico da doença crônica, maior idade, com sintomas de respiratórios, que foram tratados com glicocorticoides e ventilação mecânica estavam associados a maior gravidade. No Brasil, segundo o boletim epidemiológico do ministério da Saúde de 04 de janeiro de 2021 portaria n°44, foram registrados 49.149 óbitos em diabéticos acima de 60 anos e 12.363 óbitos com idade inferior a 60 anos, em um total de 188.584 mortos. Nesse contexto a diabetes mellitus é a segunda patologia com maior associação a óbitos por SRAG desencadeados pelo coronavírus. Conclusões: Nota-se a evidente influencia da diabetes mellitus como fator de mau prognostico para infecção da covid-19, sendo necessário acompanhamento clínico atento para possíveis complicações e desfechos desfavoráveis.  

ANÁLISE COMPARATIVA DO USO DE LISDEXANFETAMINA E DE METILFENIDATO NO TRATAMENTO DO TDAH

  Considering the increasing prevalence of Attention Deficit Hyperactivity Disorder (ADHD) and the need for effective and safe therapeutic interventions, this research aimed to conduct a comparative analysis between lisdexamfetamine and methylphenidate in the treatment of ADHD. To this end, a comprehensive qualitative literature review was conducted, using sources such as Scielo, Google Scholar, scientific journals, institutional repositories, and virtual libraries, without specific time period limitations. Thus, it was observed that both medications demonstrated efficacy in reducing ADHD symptoms. Lisdexamfetamine showed a more prolonged and consistent effect on dopaminergic neurotransmission and a potentially more favorable side effect profile, with fewer reports of severe adverse effects compared to methylphenidate. Methylphenidate, in turn, showed significant efficacy, especially in the short term. It is concluded that both lisdexamfetamine and methylphenidate are valid therapeutic options for the treatment of ADHD, with specific advantages in different clinical contexts. The choice between these medications should consider the individual characteristics of patients and the available evidence of efficacy and safety, contributing to the optimization of treatment and the improvement of the quality of life of patients with ADHD.Considerando a crescente prevalência do Transtorno de Déficit de Atenção e Hiperatividade (TDAH) e a necessidade de intervenções terapêuticas eficazes e seguras, esta pesquisa objetivou realizar uma análise comparativa entre lisdexanfetamina e metilfenidato no tratamento do TDAH. Para tanto, procedeu-se a uma revisão bibliográfica qualitativa abrangente, utilizando fontes como Scielo, Google Acadêmico, revistas científicas, repositórios institucionais e bibliotecas virtuais, sem limitação de período específico. Desse modo, observou-se que ambos os medicamentos demonstraram eficácia na redução dos sintomas do TDAH. A lisdexanfetamina apresentou um efeito mais prolongado e consistente na neurotransmissão dopaminérgica e um perfil de efeitos colaterais potencialmente mais favorável, com menos relatos de efeitos adversos graves em comparação ao metilfenidato. O metilfenidato, por sua vez, mostrou eficácia significativa, especialmente em curto prazo. Conclui-se que tanto a lisdexanfetamina quanto o metilfenidato são opções terapêuticas válidas para o tratamento do TDAH, com vantagens específicas em diferentes contextos clínicos. A escolha entre esses medicamentos deve considerar as características individuais dos pacientes e as evidências de eficácia e segurança disponíveis, contribuindo para a otimização do tratamento e a melhoria da qualidade de vida dos pacientes com TDAH

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Background A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials

Técnica de Incidentes Críticos: Aplicabilidade nas Pesquisas de Enfermagem Critical incident technique: applicability in nursing research

Objetivo: Descrever a técnica de incidentes críticos (TIC) e sua aplicabilidade nas pesquisas de enfermagem. Métodos: Trata-se de uma revisão integrativa sobre as produções encontradas através dos sites  PubMed, Biblioteca Digital Brasileira de Teses e Dissertações (BDTD), Coordenação de Aperfeiçoamento de Pessoal de Ensino Superior (CAPES) e Biblioteca Virtual de Saúde (BVS), incluindo neste as seguintes bases de dados: Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS), Medical Literature Analysis and Retrieval System Online (MedLine), Scintific Library Online (SciELO) e Bases de Dados em Enfermagem (BDENF). Resultados: Foram analisados e discutidos 19 trabalhos após o levantamento digital. Conclusão: A partir deste estudo conclui-se que a TIC ainda é pouco utilizada e difundida entre os pesquisadores. Esta revisão apresenta um panorama geral e permite o conhecimento da técnica, consolidando-a como uma metodologia inovadora, caracterizada em especial por sua plurivalência e facilidade de aplicação.

Factors associated with the functional capacity of older adults with leprosy

ABSTRACT Objective: to investigate the association between socio-demographic and clinical factors and the functional capacity of older adults with leprosy. Method: cross-sectional analytical study conducted in Fortaleza, Ceará, Brazil, with 77 older adult patients with leprosy in a referral service, through interview, medical records and application of the Katz Index and the Lawton and Brody Scale. Results: the mean age was 68.23 years, with prevalence of men, in stable union/married, with mean monthly family income of 2.04 minimum wages, positive bacillary index, clinical dimorphic form and grade zero disability. In the Lawton and Brody scale, independence (58.5%) was predominant and associated to the variables "living arrangement" and "educational attainment". Total independence (87.0%) was predominant in the Katz Index and statistically associated to the variable monthly family income. Conclusion: most of the participants were classified as independent in the instruments used. Furthermore, the instruments pointed to a greater number of associations with socio-demographic and clinical factors not related to leprosy

Ambulatory and hospitalized patients with suspected and confirmed mpox: an observational cohort study from BrazilResearch in context

Summary: Background: By October 30, 2022, 76,871 cases of mpox were reported worldwide, with 20,614 cases in Latin America. This study reports characteristics of a case series of suspected and confirmed mpox cases at a referral infectious diseases center in Rio de Janeiro, Brazil. Methods: This was a single-center, prospective, observational cohort study that enrolled all patients with suspected mpox between June 12 and August 19, 2022. Mpox was confirmed by a PCR test. We compared characteristics of confirmed and non-confirmed cases, and among confirmed cases according to HIV status using distribution tests. Kernel estimation was used for exploratory spatial analysis. Findings: Of 342 individuals with suspected mpox, 208 (60.8%) were confirmed cases. Compared to non-confirmed cases, confirmed cases were more frequent among individuals aged 30–39 years, cisgender men (96.2% vs. 66.4%; p < 0.0001), reporting recent sexual intercourse (95.0% vs. 69.4%; p < 0.0001) and using PrEP (31.6% vs. 10.1%; p < 0.0001). HIV (53.2% vs. 20.2%; p < 0.0001), HCV (9.8% vs. 1.1%; p = 0.0046), syphilis (21.2% vs. 16.3%; p = 0.43) and other STIs (33.0% vs. 21.6%; p = 0.042) were more frequent among confirmed mpox cases. Confirmed cases presented more genital (77.3% vs. 39.8%; p < 0.0001) and anal lesions (33.1% vs. 11.5%; p < 0.0001), proctitis (37.1% vs. 13.3%; p < 0.0001) and systemic signs and symptoms (83.2% vs. 64.5%; p = 0.0003) than non-confirmed cases. Compared to confirmed mpox HIV-negative, HIV-positive individuals were older, had more HCV coinfection (15.2% vs. 3.7%; p = 0.011), anal lesions (45.7% vs. 20.5%; p < 0.001) and clinical features of proctitis (45.2% vs. 29.3%; p = 0.058). Interpretation: Mpox transmission in Rio de Janeiro, Brazil, rapidly evolved into a local epidemic, with sexual contact playing a crucial role in its dynamics and high rates of coinfections with other STI. Preventive measures must address stigma and social vulnerabilities. Funding: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz)