O papel das estratégias multimodais na diminuição dos eventos adversos associados ao uso de opioide

Introdução: desde a década de 1960, os opioides têm sido utilizados como medicamentos de referência em induções anestésicas, uma vez que permitem uma inibição do sistema simpático sem colapso cardiovascular e liberação de histamina. Contudo, recentemente, diversos estudos têm mostrado as consequências do uso exacerbado de opioides e a necessidade de estratégias multimodais com baixas (ou nenhuma) quantidades de opioides estão sendo exploradas e instituídas para um melhor bem-estar do paciente cirúrgico. Objetivo: Compreender os efeitos dos opioides sobre o paciente cirúrgico e os eventos adversos associados. Material e método: Trata-se de uma revisão de literatura integrativa, com buscas nas bases de dados Pubmed, Lilacs, Bireme e Google Scholar. Foram utilizados quatro descritores: anestesia, opioid-free, técnicas analgésicas e multimodal treatment. Definiu-se como critério de inclusão a relevância temática, artigos com qualis Capes na plataforma sucupira superior a B2 e/ou fator de impacto superior a três e publicação a partir do ano de 2016. Resultados: Os opioides, além da depressão respiratória intraoperatória, são responsáveis, na sua maioria, por afecções pós-operatórias, como hiperalgesia, indução de tolerância, isquemia intestinal e especificamente em pacientes geriátricos, o delirium e a disfunção cognitiva no momento pós-cirúrgico. Devido a isso, estratégias multimodais têm sido adotadas e apontam melhoras para os pacientes, não só na diminuição dos efeitos inerentes ao opioide, como na redução de náuseas e vômitos, além da diminuição do tempo de recuperação pós-cirúrgica e sua menor associação menores índices de mortalidade, melhor desfecho cardiopulmonar, renal, intestinal e neurológico quando comparado a infusão de agente único, além de uma extubação mais rápida e menor permanência em Unidades de Tratamento Intensivo. Conclusão: O uso de estratégias multimodais com baixos níveis ou sem opioides se mostrou eficaz em relação aos efeitos pós-operatórios. Além disso, essas estratégias também apresentaram eficiência igual ou melhor do que o uso de anestesia de infusão única com menor período de recuperação, menos reações adversas e melhor prognóstico para o paciente

Perfil epidemiológico de pessoas vivendo com HIV atendidas em uma unidade dispensadora de medicamentos no Município de Juiz de Fora - MG / Epidemiological profile of people living with HIV attended at an unit medication dispenser in the City of Juiz de Fora - MG

Introdução: O perfil dos pacientes com o Vírus da Imunodeficiência Humana sofreu transformações nos últimos anos com propensão a interiorização, heterossexualização, feminização e pauperização. O Brasil distribui gratuitamente os medicamentos antirretrovirais garantindo o tratamento desses pacientes. Objetivo: analisar o perfil epidemiológico de indivíduos com Vírus da Imunodeficiência Humana, usuários da Unidade Dispensadora de Medicamentos do município de Juiz de Fora. Métodos: estudo observacional retrospectivo, descritivo e analítico. Amostra contendo 4.078 indivíduos, com dados coletados no Sistema de Controle Logístico de Medicamentos da Unidade Dispensadora de Medicamentos localizada no Serviço de Assistência Especializada de Juiz de Fora – MG, do ano de 2010 a 2019. Resultados: Dos 2.405 pacientes, 295 encontravam-se em abandono e 2.110 ativos no sistema. A menor incidência de pacientes ativos foi em 2010 e a maior em 2018. Quanto a evasão do tratamento, 2015 teve o maior número (54 casos), contraposto com 2010 que teve a menor taxa (13 casos). O sexo predominante na pesquisa foi o masculino (70,2%); a faixa etária prevalente foi de 20 a 40 anos (60,2%). Em relação ao perfil dos pacientes que abandonaram o programa de tratamento, o sexo masculino foi proeminente (59,7%), assim como a faixa etária de 20 a 40 anos (57,0%). Conclusão: Os achados ratificam o aumento da infecção pelo Vírus da Imunodeficiência Humana no Brasil, assim como o perfil do paciente que é do sexo masculino, adulto jovem e heterossexual. Destaca-se também que houve um aumento na população acima de 60 anos infectada com o vírus. 

Communication in breastfeeding support

Introdução: O aleitamento materno tem sido amplamente estudado por todas suas qualidades e benefícios, tanto para a saúde da criança como da mulher. Contudo, amamentar pode ser considerado um processo complexo. A mulher que amamenta deve sentir-se capaz de fazê-lo, sendo que o profissional de saúde compõe a rede de suporte social que a auxilia nesse processo. O aconselhamento em amamentação auxilia a fornecer o apoio necessário às mães, sendo a comunicação destacada como fundamental nesse processo. Objetivos: O objetivo do presente foi conhecer e analisar os aspectos inerentes à comunicação dos profissionais de enfermagem de um Banco de Leite Humano e Unidades de saúde com mulheres que buscam ajuda e apoio na amamentação. Percurso metodológico: Estudo com abordagem qualitativa, que utilizou como orientação metodológica o Estudo de Caso único integrativo para desenvolvimento desta investigação, sob a ótica do Referencial Teórico de Comunicação de Stefanelli e Carvalho (2012) e SILVA (2011) e orientação teórica das habilidades de Aconselhamento em Amamentação (ORGANIZAÇÃO MUNDIAL DE SAÚDE,1997). Para tanto, foi utilizada como estratégias de coleta de dados, a observação participante e gravação de áudio das interações entre os profissionais de enfermagem e as nutrizes nos atendimentos em amamentação. Os dados obtidos foram transcritos e analisados segundo a técnica de Análise Temática dedutiva. Resultados: Os dados foram descritos e analisado em torno de dois grandes temas que foram Comunicação não terapêutica (Subtemas: julgamento; comunicação unidirecional; indução de resposta; falsa tranquilização; ausência do senso de oportunidade e emissão de opinião) e Comunicação terapêutica (Subtemas; aceitação; interesse; frases descritivas; senso de oportunidade, perguntas abertas; estímulo de expressão de sentimentos; demonstração de empatia; oferecimento de sugestão; reconhecimento e elogio; ajuda prática e resumo interação e eliminação de barreiras). Considerações finais: Embora cada profissional tivesse apresentado mais ou menos atitudes, comportamentos e falas que pudessem favorecer uma relação de escuta às mães com vistas a ajudá-las nas suas necessidades durante as interações analisadas, ou seja, mais, ou menos habilidades para se manifestarem de forma a manter a relação terapêutica, mostra-se imperativo que a equipe conheça os elementos da comunicação para que assim, possa lapidar suas ações, no sentido de fazer com que a nutriz se valorize e seja capaz de ajudar a si própria, permitindo soluções e superação das suas dificuldades na vivência da amamentação.Introduction: Breastfeeding has been widely studied because of its qualities and benefits to the health of both mother and her baby, and it is considered a way to promote Public Health. However, it can be considered a complex process. The breastfeeding woman must feel capable of doing it, and a healthcare professional helps creating a social support network that will ease such process. Breastfeeding counseling must support the mothers, while this therapeutic communication is fundamental in counselling, and it could be a deciding factor for the decision to start and continue breastfeeding. Objectives: The aim of this study is to identify and analyse aspects that are inherent to the communication used by nurses in a Human Milk Bank, a Family Health Unit, a District Basic Health Unit and two Basic Health Units with women that were advised during breastfeeding. Methods: This is a qualitative approach study that used as methodologic orientation the only integrative Case Study to develop this investigation, under the optics of theoretical references from Stefanelli and Carvalho (2012), and Silva (2011) as well as the training course of Breastfeeding Counselling. (WORLD HEALTH ORGANIZATION, 1997). For such, data were collected by participating observation and audio recording of the service provided by nursing professionals to mothers that were counselled on breastfeeding at study locations. Data obtained was transcribed and analysed following the Deductive Thematic Analysis, by Braun and Clarke. Results and Discussion: Data was described and analysed around two major themes: Non Therapeutic Communication (subthemes: judgement, unidirectional communication, response induction, false tranquilization, absence of opportunity sense, giving opinions) and Therapeutic Communication (subthemes: acceptance, interest, descriptive phrases, open questions, feelings expression stimulation, empathy demonstration, giving suggestions, acknowledge and compliment, practical help and shortening interaction). Final considerations: Although each professional had more or less attitudes, behaviors and speech that could favor a listening relationship to the mothers in order to help them in their needs presented in the interactions analyzed, that is, more or less skills to manifest in order to maintain the therapeutic relationship, it is necessary that the professionals know the elements of communication so that they can polish their actions, in order to make the woman to value and be able to help herself, allowing solutions and overcoming her difficulties in the experience of breastfeeding

Interaction between saliva’s adenosine and tick parasitism: effects on feeding and reproduction

Abstract Background It has recently been demonstrated that saliva from Rhipicephalus sanguineus ticks contains adenosine (ADO) and prostaglandin E2 (PGE2), two non-protein molecules that have significant immunomodulatory properties. These molecules can inhibit cytokine production by dendritic cells (DCs), while also reducing the expression of CD40 in these cells. However, more studies are needed for a better understanding of their participation in the feeding of ticks in vivo. This work, therefore, evaluated the importance of ADO during tick infestations. Mice were infested with adult ticks (3 couples/mouse), and their skin was collected at the tick-infested site (3rd and 7th day), and mRNA for receptors of ADO was quantified by real-time PCR. Results Tick infestation increased by four and two times the expression of the A2b and A3v1 receptors on day 3, respectively, while expression of other ADO receptors was unaltered. In addition, we treated mice (n = 10/group) daily with 8-(p-Sulfophenyl)theophylline, 8-pSPT, 20 mg/kg, i.p.), a non-selective antagonist of ADO receptors, and evaluated the performance of ticks during infestations. Female ticks fed on 8-pSPT-treated mice presented a reduction in their engorgement, weight and hatching rates of egg masses, and survival times of larvae compared to the same parameters presented by ticks in the control group. To investigate if these 8-pSPT-treated mice presented altered immune responses, we performed three tick infestations and collected their lymph node cells to determine the percentages and activation state of DCs and cytokine production by lymphocytes by flow cytometry (Cytometric Bead Array technique, CBA). Our data showed that 8-pSPT-treated mice presented an increase in the percentage of DCs as well as of their stimulatory and co-stimulatory molecules (CD40, CD80 and MHCII). Regarding production of T cell cytokines, we observed a significant increase in the levels of IL-2 and a significant decrease in IL-10, IL-17, TNF-α and IFN-γ cytokines. Conclusions These results suggest that ADO produced by ticks helps them feed and reproduce and that this effect may be due to modulation of host DCs and T cells

Photovoice: method experiment research with adolescent mothers

Abstract Objective: To report on the development of the phases of the photovoice method in qualitative research with adolescent mothers who were experiencing or experienced breastfeeding and/or weaning. Method: Twelve individual interviews and one focus group were conducted. Results: The photovoice was developed in the phases: Identification of the political decision makers in the community with some community leadership profile; Recruitment of participants; Introduction of the methodology to the participants; Obtaining informed consent; Identification of the theme (s) for the photographs; Distribution of cameras and review of their handling; Provision of time for the registration of photographs; Meeting (s) for discussion on photographs and identification of community resources and issues; Shared planning of the dissemination formats of the images and stories produced. Final considerations and implications for the practice: Photovoice stands out as a way to approach health professionals with the life circumstances of adolescent mothers, in order to promote and support breastfeeding

Spatio-temporal six-year retrospective study on dermatophytosis in Rio de Janeiro, Southeast Brazil: A tropical tourist locality tale.

Trichophyton, Microsporum, Nannizzia and Epidermophyton genera cause dermatophytosis, the most common and highly contagious infectious skin disease. Rio de Janeiro is one of the most visited cities in the Southern Hemisphere, located in the most visited state of Brazil. This retrospective study investigated epidemiological and laboratorial aspects of dermatophytosis in Rio de Janeiro state, Brazil, by using spatiotemporal analysis. More than half of all individuals were infected by one or more dermatophytes. A variation between 18 and 106 years-old of the studied population was verified, and women more frequently affected. Patients were more frequently infected by Trichophyton spp., most of them T. rubrum, followed by T. mentagrophytes. M. canis and N. gypsea were more frequently isolated in the age group between 40 and 60 years old, while T. rubrum predominates among younger patients. All species presented homogeneous distribution while T. tonsurans appears to be restricted to the Rio de Janeiro capital and E. floccosum to the municipality of Macaé (190 Km apart from RJ). Rio de Janeiro state presented spatial clusters of dermatophytosis with high density in Guanabara Bay (E. floccosum, M. canis, N. gypsea, T. tonsurans) and Niterói (T. rubrum, T. mentagrophytes) but low density in Macaé (E. floccosum). Significant spatiotemporal clusters on dermatophytosis cases were detected in distinct municipalities (p-value ≤ 0.05). The Vulnerability Index (r = 0.293) and Demographic Density (r = 0.652) distributed according to neighborhoods in Niterói were direct related with dermatophytosis cases whereas Income (r = -0.306) was inversely correlated (p-value ≤ 0.05). The dermatophytosis spatiotemporal distinct distribution after two major international events in Rio de Janeiro, Brazil, highlight the pressing need for specific measures of its prevention and controlling. This is particularly relevant in touristic tropical localities which must consider both socio-economical and traveler's medicine variables

Spatio-temporal six-year retrospective study on dermatophytosis in Rio de Janeiro, Southeast Brazil: a tropical tourist locality tale

Institutional Qualification Program of the Fluminense Federal University (PQI/UFF – 2021 to SCPB) and Carlos Chagas Filho Research Foundation of the State of Rio de Janeiro (FAPERJ grant E-26/211.300/2022 to ARSB). This research was also partially financed by the Coordination for the Improvement of Higher Education Personnel (CAPES) –Finance Code 001 (MSc student supported: LMA; NFR). RLDM and ARSB are research fellows of Council for Scientific and Technological Development (grants PQ-CNPq 302722/2022-0 and PQ-CNPq 308986/2022-9, respectively).Fluminense Federal University. Department of Microbiology and Parasitology. Biomedical Institute. Center for Microorganisms Investigation. Niterói, RJ, Brazil.Fluminense Federal University. Department of Microbiology and Parasitology. Biomedical Institute. Center for Microorganisms Investigation. Laboratory of Biochemitry and Immunology of Mycoses. Niterói, RJ, Brazil.Fluminense Federal University. Department of Microbiology and Parasitology. Biomedical Institute. Center for Microorganisms Investigation. Niterói, RJ, Brazil.Fluminense Federal University. Department of Microbiology and Parasitology. Biomedical Institute. Center for Microorganisms Investigation. Niterói, RJ, Brazil.Diagnostic Medicine. Bittar Laboratory. Niterói, RJ, Brazil.Diagnostic Medicine. Bittar Laboratory. Niterói, RJ, Brazil.Santa Casa de Misericórdia do Rio de Janeiro. Gamboa Hospital. Rio de Janeiro, RJ, Brazil.Fluminense Federal University. Department of Microbiology and Parasitology. Biomedical Institute. Center for Microorganisms Investigation. Niterói, RJ, Brazil.Fluminense Federal University. Department of Microbiology and Parasitology. Biomedical Institute. Center for Microorganisms Investigation. Niterói, RJ, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Laboratório de Geoprocessamento. Ananindeua, PA, Brasil.Fluminense Federal University. Department of Microbiology and Parasitology. Biomedical Institute. Center for Microorganisms Investigation. Niterói, RJ, Brazil / Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro. Rede Micologia RJ. Rio de Janeiro, RJ, Brazil.Trichophyton, Microsporum, Nannizzia and Epidermophyton genera cause dermatophytosis, the most common and highly contagious infectious skin disease. Rio de Janeiro is one of the most visited cities in the Southern Hemisphere, located in the most visited state of Brazil. This retrospective study investigated epidemiological and laboratorial aspects of dermatophytosis in Rio de Janeiro state, Brazil, by using spatiotemporal analysis. More than half of all individuals were infected by one or more dermatophytes. A variation between 18 and 106 years-old of the studied population was verified, and women more frequently affected. Patients were more frequently infected by Trichophyton spp., most of them T. rubrum, followed by T. mentagrophytes. M. canis and N. gypsea were more frequently isolated in the age group between 40 and 60 years old, while T. rubrum predominates among younger patients. All species presented homogeneous distribution while T. tonsurans appears to be restricted to the Rio de Janeiro capital and E. floccosum to the municipality of Macaé (190 Km apart from RJ). Rio de Janeiro state presented spatial clusters of dermatophytosis with high density in Guanabara Bay (E. floccosum, M. canis, N. gypsea, T. tonsurans) and Niterói (T. rubrum, T. mentagrophytes) but low density in Macaé (E. floccosum). Significant spatiotemporal clusters on dermatophytosis cases were detected in distinct municipalities (p-value ≤ 0.05). The Vulnerability Index (r = 0.293) and Demographic Density (r = 0.652) distributed according to neighborhoods in Niterói were direct related with dermatophytosis cases whereas Income (r = -0.306) was inversely correlated (p-value ≤ 0.05). The dermatophytosis spatiotemporal distinct distribution after two major international events in Rio de Janeiro, Brazil, highlight the pressing need for specific measures of its prevention and controlling. This is particularly relevant in touristic tropical localities which must consider both socio-economical and traveler's medicine variables

Synthetic Derivatives against Wild-Type and Non-Wild-Type <i>Sporothrix brasiliensis</i>: In Vitro and In Silico Analyses

Recently, the well-known geographically wide distribution of sporotrichosis in Brazil, combined with the difficulties of effective domestic feline treatment, has emphasized the pressing need for new therapeutic alternatives. This work considers a range of synthetic derivatives as potential antifungals against Sporothrix brasiliensis isolated from cats from the hyperendemic Brazilian region. Six S. brasiliensis isolates from the sporotrichotic lesions of itraconazole responsive or non-responsive domestic cats were studied. The minimum inhibitory concentrations (MICs) of three novel hydrazone derivatives and eleven novel quinone derivatives were determined using the broth microdilution method (M38-A2). In silico tests were also used to predict the pharmacological profile and toxicity parameters of these synthetic derivatives. MICs and MFCs ranged from 1 to >128 µg/mL. The ADMET computational analysis failed to detect toxicity while a good pharmacological predictive profile, with parameters similar to itraconazole, was obtained. Three hydrazone derivatives were particularly promising candidates as antifungal agents against itraconazole-resistant S. brasiliensis from the Brazilian hyperendemic region. Since sporotrichosis is a neglected zoonosis currently spreading in Latin America, particularly in Brazil, the present data can contribute to its future control by alternative antifungal drug design against S. brasiliensis, the most virulent and prevalent species of the hyperendemic context