Revisão integrativa: avaliação da necessidade de algaliação/manutenção do cateter vesical na pessoa em situação crítica

Introduction: Infections associated with Health Care is a common and transversal problem for Health Care Units, which urinary tract infections (UTI) are the most frequent, with a big consequence for the patient and his / her family, as well as for the institutions, due to the direct and indirect costs that they entail. It is estimated that approximately 40% of infections associated with health care refer to UTIs, and that about 80% of these infections refer to urinary catheter use in person in critical situation. Thus, the use of bladder catheter is the major risk factor for the development of UTIs, so it should be used only in cases that really require this procedure. The patient's frequency and duration of use of a bladder catheter determine the greater or lesser risk of developing a UTI. In this way, it is verified by the professionals the need for a safe practice of care based on scientific evidence. Aim: Identify the effects of implementation of a protocol for the daily evaluation of the need to have a bladder catheter and maintenance it in the person in critical situation, according to the criteria defined by Direção Geral de Saúde, contributing to the reduction of the number of bladder catheterization. Materials and Methods: Integrative Literature Review with advanced research at EBSCOhost, being included complete articles, published in English, Portuguese and Spanish, with available references, full text, and publication dates between 2013 to 2017, excluding articles from the pediatrics area, duplicate articles and outside the objective of the study, having selected 8 articles. Results: According to the results obtained, it was verified that all authors defend that a daily evaluation of the need for bladder catheterization/permanence of the bladder catheter in the person in critical situation through the application of a defined protocol is very important to decrease the number of bladder catheterization insertions and days of permanence of the bladder catheter. Conclusion: Scientific evidence on the daily evaluation of the need for bladder catheterization and maintenance of the bladder catheter in person in critical situation was identified, through the implementation of a defined protocol, contributing to a decrease of catheter-associated UTI.  Introdução: A Infeção Associada aos Cuidados de Saúde (IACS) constitui uma problemática comum e transversal às Unidades Prestadoras de Cuidados de Saúde, em que as infeções do trato urinário (ITU) são as mais frequentes, com maior consequência para o doente e sua família, bem como para as instituições, devido aos custos diretos e indiretos que acarretam.  Estima-se que aproximadamente 40% das IACS se referem às ITU, e que cerca de 80% destas infeções estão associadas ao uso de cateter urinário, na pessoa em situação crítica. Desta forma, a algaliação constitui o maior fator de risco para o desenvolvimento de uma ITU, pelo que a sua utilização deve ser ponderada apenas para os casos que realmente necessitem deste procedimento. A frequência e o tempo de algaliação do doente são determinantes para o maior ou menor risco de desenvolvimento de uma ITU.  Verifica-se, portanto, por parte dos profissionais a necessidade de uma prática de cuidados segura baseada na evidência científica. Objetivo: Identificar os efeitos da implementação de um protocolo de avaliação diária da necessidade de algaliação e manutenção de cateter vesical na pessoa em situação crítica, de acordo com os critérios definidos pela Direção Geral de Saúde, contribuindo para a redução do número de algaliações (evitáveis). Materiais e Métodos: Revisão Integrativa da Literatura, com pesquisa avançada na EBSCOhost, tendo como critérios de inclusão artigos disponíveis com texto integral, publicados em inglês, português e espanhol, e datas de publicação entre o período de 2013 a 2017, excluindo os artigos da área de pediatria, artigos duplicados e fora do âmbito do objetivo do estudo, tendo sido selecionados 8 artigos. Resultados: De acordo com os resultados obtidos, constatou-se que, de facto, todos os autores defendem que uma avaliação diária da necessidade de algaliação/permanência do cateter vesical na pessoa em situação crítica através da aplicação de um protocolo definido é de extrema importância no que se refere à diminuição do número de algaliações e dias de permanência do cateter vesical. Conclusão: Desta forma, identificou-se a existência de evidência científica na avaliação diária da necessidade de algaliação e manutenção do cateter vesical na pessoa em situação crítica, através da implementação de um protocolo previamente definido, contribuindo para uma diminuição da taxa de ITU

Vivências da família do doente crítico: um estudo qualitativo

Introduction: The family is an extension of the patient, it is a target of care by the Nursing team, so it is necessary the development of interventions by the professionals in this context. Aim: Identify the main feelings of the Family of the Critically ill in hospitalization. Materials and Methods: This qualitative study was developed in a Unit of Intermediate Care Polyvalent, using a convenience sample of four participants, who were the target of a structured interview. Results: It has been found that the main feelings of the Family of the Critically ill in hospitalization are anxiety, stress, sadness, need for support and closeness of the patient, uncertainty about the change caused in family life and fear. However, although they are experiencing all these feelings, it is verified that the family considered everything related with the patient more important than in relation to itself, where there is evidence of sadness, anxiety and revolt with the situation. Conclusion:  Thus, this shows a low or absent awareness of the family to the fact that they are also a target for health professionals.Introdução: A família constitui uma extensão do próprio doente, revelando-se como um alvo de prestação de cuidados por parte da equipa de Enfermagem, pelo que é necessário o desenvolvimento de intervenções por parte dos profissionais neste contexto.  Objetivo: identificar os principais sentimentos da Família do Doente Crítico em contexto de internamento. Materiais e Métodos: Este estudo, do tipo qualitativo, foi desenvolvido numa Unidade Polivalente de Cuidados Intermédios, com recurso a uma amostra de conveniência de 4 participantes, os quais foram alvo de uma entrevista estruturada. Resultados: Verificou-se que os principais sentimentos da Família do Doente Crítico em contexto de internamento são ansiedade, stress, tristeza, necessidade de suporte e de proximidade do doente, incerteza quanto à mudança causada na vida familiar e medo. No entanto, apesar de se encontrarem a vivenciar todos estes sentimentos, verifica-se que a família atribui maior importância a tudo o que está relacionado com o seu familiar, do que em relação a si própria, onde são patentes vivências de tristeza, ansiedade e revolta com a situação. Conclusão: Ressalva, assim, uma baixa ou mesmo ausente consciencialização de que também constituem um alvo na prestação de cuidados por parte dos profissionais de saúde

Clinical performance of an infliximab rapid quantification assay

Background: Therapeutic drug monitoring (TDM)-based algorithms can be used to guide infliximab (IFX) adjustments in inflammatory bowel disease (IBD) patients. This study aimed to explore a rapid IFX-quantification test from a clinical perspective. Methods: This manuscript describes a prospective cohort study involving 110 ulcerative colitis (UC) patients on the maintenance phase of IFX. IFX trough levels were quantified using a rapid quantification assay and a commonly-used reference kit. Results: Irrespective of the assay used to measure IFX, its through levels were statistically different between patients with and without endoscopic remission (Mayo endoscopic score = 0), as well as between patients stratified by their faecal calprotectin (FC) levels. Despite the fact that the two methods correlated well with each other [Spearman's rank correlation coefficient = 0.843, p < 0.001; intraclass correlation coefficients = 0.857, 95% confidence interval (CI): 0.791-0.903], there was a discernible systematic variation; values obtained with the reference kit were on average 2.62 units higher than those obtained with the rapid assay. Notwithstanding, 3 mu g/ml was shown to be an acceptable cut-off to assess endoscopic status and inflammatory burden levels using both assays. The percentage of patients that had a positive outcome when the IFX concentration measured by the rapid assay ranked above 3 mu g/ml was 88% both for a Mayo endoscopic score <= 1 and for an FC concentration <250 mu g/g. Conclusions: Based on this study, we concluded that using the rapid IFX assessment system with a 3 mu g/ml threshold is a reliable alternative to the time-consuming enzyme-linked immunosorbent assays in patients on the maintenance phase of IFX.Portuguese IBD Group (GEDII, Grupo de Estudo da Doenca Inflamatoria Intestinal)info:eu-repo/semantics/publishedVersio

Detection of anti-infliximab antibodies is impacted by antibody titer, infliximab level and IgG4 antibodies: a systematic comparison of three different assays

Background: There is scant information on the accuracy of different assays used to measure anti-infliximab antibodies (ADAs), especially in the presence of detectable infliximab (IFX). We thus aimed to evaluate and compare three different assays for the detection of IFX and ADAs and to clarify the impact of the presence of circulating IFX on the accuracy of the ADA assays.Methods: Blood samples from 79 ulcerative colitis (UC) patients treated with infliximab were assessed for IFX levels and ADAs using three different assays: an in-house assay and two commercial kits, Immundiagnostik and Theradiag. Sera samples with ADAs and undetectable levels of IFX were spiked with exogenous IFX and analyzed for ADAs.Results: The three assays showed 81-96% agreement for the measured IFX level. However, the in-house assay and Immundiagnostik assays detected ADAs in 34 out of 79 samples, whereas Theradiag only detected ADAs in 24 samples. Samples negative for ADAs with Theradiag, but ADA-positive in both the in-house and Immundiagnostik assays, were positive for IFX or IgG4 ADAs. In spiking experiments, a low concentration of exogenous IFX (5 mu g/ml) hampered ADA detection with Theradiag in sera samples with ADA levels of between 3 and 10 mu g/ml. In the Immundiagnostik assay detection interference was only observed at concentrations of exogenous IFX higher than 30 mu g/ml. However, in samples with high levels of ADAs (> 25 mu g/ml) interference was only observed at IFX concentrations higher than 100 mu g/ml in all three assays. Binary (IFX/ADA) stratification of the results showed that IFX+/ADA and IFX-/ADAs + were less influenced by the assay results than the double-positive (IFX+/ADAs+) and double-negative (IFX-/ADAs-) combination.Conclusions: All three methodologies are equally suitable for measuring IFX levels. However, erroneous therapeutic decisions may occur when patients show double-negative (IFX-/ADAs) or double-positive (IFX+/ADAs+) status, since agreement between assays is significantly lower in these circumstances

Accuracy of faecal calprotectin and neutrophil Gelatinase B-associated Lipocalin in evaluating subclinical inflammation in UlceRaTIVE colitis-the ACERTIVE study

Background and Aims: Mucosal healing and histological remission are different targets for patients with ulcerative colitis, but both rely on an invasive endoscopic procedure. This study aimed to assess faecal calprotectin and neutrophil gelatinase B-associated lipocalin as biomarkers for disease activity in asymptomatic ulcerative colitis patients. Methods: This was a multicentric cross-sectional study including 371 patients, who were classified according to their endoscopic and histological scores. These results were evaluated alongside the faecal levels of both biomarkers. Results: Macroscopic lesions [i.e. endoscopic Mayo score >= 1] were present in 28% of the patients, and 9% had active disease according to fht Ulcerative Colitis Endoscopic Index of Severity. Moreover, 21% presented with histological inflammation according to the Geboes index, whereas 15% and 5% presented with focal and diffuse basal plasmacytosis, respectively. The faecal levels of calprotectin and neutrophil gelatinase B-associated lipocalin were statistically higher for patients with endoscopic lesions and histological activity. A receiver operating characteristic-based analysis revealed that both biomarkers were able to indicate mucosal healing and histological remission with an acceptable probability, and cut-off levels of 150-250 mu g/g for faecal calprotectin and 12 mu g/g for neutrophil gelatinase B-associated lipocalin were proposed. Conclusions: Faecal calprotectin and neutrophil gelatinase B-associated lipocalin levels are a valuable addition for assessment of disease activity in asymptomatic ulcerative colitis patients. Biological levels of the analysed biomarkers below the proposed thresholds can rule out the presence of macroscopic and microscopic lesions with a probability of 75-93%. However, caution should be applied whenever interpreting positive results, as these biomarkers present consistently low positive predictive values.Portuguese IBD Group [GEDII - Grupo de Estudo da Doenca Inflamatcria Intestinal]info:eu-repo/semantics/publishedVersio

Viral genetic clustering and transmission dynamics of the 2022 mpox outbreak in Portugal

Pathogen genome sequencing during epidemics enhances our ability to identify and understand suspected clusters and investigate their relationships. Here, we combine genomic and epidemiological data of the 2022 mpox outbreak to better understand early viral spread, diversification and transmission dynamics. By sequencing 52% of the confirmed cases in Portugal, we identified the mpox virus sublineages with the highest impact on case numbers and fitted them into a global context, finding evidence that several international sublineages probably emerged or spread early in Portugal. We estimated a 62% infection reporting rate and that 1.3% of the population of men who have sex with men in Portugal were infected. We infer the critical role played by sexual networks and superspreader gatherings, such as sauna attendance, in the dissemination of mpox virus. Overall, our findings highlight genomic epidemiology as a tool for the real-time monitoring and control of mpox epidemics, and can guide future vaccine policy in a highly susceptible population.info:eu-repo/semantics/publishedVersio

SARS-CoV-2 introductions and early dynamics of the epidemic in Portugal

Genomic surveillance of SARS-CoV-2 in Portugal was rapidly implemented by the National Institute of Health in the early stages of the COVID-19 epidemic, in collaboration with more than 50 laboratories distributed nationwide. Methods By applying recent phylodynamic models that allow integration of individual-based travel history, we reconstructed and characterized the spatio-temporal dynamics of SARSCoV-2 introductions and early dissemination in Portugal. Results We detected at least 277 independent SARS-CoV-2 introductions, mostly from European countries (namely the United Kingdom, Spain, France, Italy, and Switzerland), which were consistent with the countries with the highest connectivity with Portugal. Although most introductions were estimated to have occurred during early March 2020, it is likely that SARS-CoV-2 was silently circulating in Portugal throughout February, before the first cases were confirmed. Conclusions Here we conclude that the earlier implementation of measures could have minimized the number of introductions and subsequent virus expansion in Portugal. This study lays the foundation for genomic epidemiology of SARS-CoV-2 in Portugal, and highlights the need for systematic and geographically-representative genomic surveillance.We gratefully acknowledge to Sara Hill and Nuno Faria (University of Oxford) and Joshua Quick and Nick Loman (University of Birmingham) for kindly providing us with the initial sets of Artic Network primers for NGS; Rafael Mamede (MRamirez team, IMM, Lisbon) for developing and sharing a bioinformatics script for sequence curation (https://github.com/rfm-targa/BioinfUtils); Philippe Lemey (KU Leuven) for providing guidance on the implementation of the phylodynamic models; Joshua L. Cherry (National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health) for providing guidance with the subsampling strategies; and all authors, originating and submitting laboratories who have contributed genome data on GISAID (https://www.gisaid.org/) on which part of this research is based. The opinions expressed in this article are those of the authors and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government. This study is co-funded by Fundação para a Ciência e Tecnologia and Agência de Investigação Clínica e Inovação Biomédica (234_596874175) on behalf of the Research 4 COVID-19 call. Some infrastructural resources used in this study come from the GenomePT project (POCI-01-0145-FEDER-022184), supported by COMPETE 2020 - Operational Programme for Competitiveness and Internationalisation (POCI), Lisboa Portugal Regional Operational Programme (Lisboa2020), Algarve Portugal Regional Operational Programme (CRESC Algarve2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF), and by Fundação para a Ciência e a Tecnologia (FCT).info:eu-repo/semantics/publishedVersio