ALTERAÇÕES NO DESENVOLVIMENTO NEUROPSICOMOTOR EM CRIANÇAS COM MICROCEFALIA ACOMETIDAS PELA ZIKA VÍRUS: UMA REVISÃO DA LITERATURA

Crianças com microcefalia possivelmente irão ter um desenvolvimento anormal do seu cérebro, e essas anormalidades podem variar de atrasos leves ou graves no desenvolvimento neuropsicomotor. O estudo objetivou realizar uma revisão integrativa sobre as alterações do desenvolvimento neuropsicomotor de crianças com microcefalia acometidas pelo Zika vírus. A coleta de dados realizada nas bases de dados eletrônicos: Scientific Electronic Library Online (SciELO),  National Library of Medicine (PubMED) e o Google Acadêmico. Para o levantamento dos estudos foram utilizados os descritores: “Microcefalia”, “alterações”, “zika vírus” e “criança”, cadastrados nos Descritores em Ciência da Saúde (DeCS). Para a seleção da amostra foi estabelecido critérios de artigos originais encontrados entre os anos de 2010 a 2020 publicados em periódicos nacionais e internacionais, disponibilizados na íntegra em língua portuguesa e inglesa. A busca resultou em 16 artigos e após a utilização dos critérios de inclusão e exclusão, 9 artigos foram utilizados no estudo e agrupados em tabelas. Pôde-se observar que crianças com microcefalia acometidas pelo Zika vírus apresentam um neurotropismo no desenvolvimento cerebral, resultando em alterações no desenvolvimento psicomotor, com desempenho extremamente baixo na linguagem e domínios cognitivos. Manifestando inadequação do sistema sensório-motor oral, evidenciada pela imaturidade dos sistemas que pode trazer prejuízos como a transição da consistência alimentar, prejudicando as funções de sucção, deglutição e respiração inadequada para a idade

Práticas de cuidados multiprofissionais em pacientes dialíticos no ambiente intra-hospitalar / Multiprofessional care practices in dialytic patients in the intrahospital environment

O paciente portador de disfunção renal está presente nas diversas realidades intra hospitalares e demanda cuidados específicos principalmente relacionados ao tratamento dialítico. Objetivo: realizar uma revisão sobre a Lesão Renal Aguda (LRA) e a hemodiálise como terapia de escolha, elencando os cuidados em pacientes hemodialíticos no ambiente intra-hospitalar. Métodos: revisão dissertativa de literatura com artigos originais publicados entre 2011 e 2021 nas bases de dados eletrônicos PubMed, Scielo e Science Direct com descritores utilizados mediante consulta ao Mesh e DeCS, conforme a base selecionada, em português, inglês e espanhol. Também foram verificadas as referências dos artigos relevantes para identificar estudos potencialmente elegíveis, assim como foram utilizadas legislações, resoluções e normas técnicas para maior fidelização da revisão proposta. Revisão de Literatura: os estudos encontrados em sua grande maioria foram trabalhos quantiqualitativos, além de revisões integrativas de literatura, que apresentaram resultados originais e copilados de informações, respectivamente, sobre a temática analisada. A revisão foi dividida em duas abordagens: “A Lesão Renal Aguda e a hemodiálise como principal Terapia Renal Substitutiva (TRS)” e “cuidados em pacientes hemodialíticos no ambiente intra-hospitalar”. Na primeira parte foram abordadas situações referentes ao tratamento empregado na LRA, os acessos disponíveis para realização da TRS, enquanto na segunda parte analisou-se as principais áreas de cuidados necessários ao paciente dialítico. Conclusão: Devido ao paciente que apresenta disfunção renal necessitar de inúmeros cuidados específicos, se faz necessário o entendimento das possíveis intercorrências, assim como maior adesão a formação continuada acerca do quadro e cuidados desta população, por toda equipe multidisciplinar

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Measuring the health-related Sustainable Development Goals in 188 countries : a baseline analysis from the Global Burden of Disease Study 2015

Background In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015). Methods We applied statistical methods to systematically compiled data to estimate the performance of 33 health-related SDG indicators for 188 countries from 1990 to 2015. We rescaled each indicator on a scale from 0 (worst observed value between 1990 and 2015) to 100 (best observed). Indices representing all 33 health-related SDG indicators (health-related SDG index), health-related SDG indicators included in the Millennium Development Goals (MDG index), and health-related indicators not included in the MDGs (non-MDG index) were computed as the geometric mean of the rescaled indicators by SDG target. We used spline regressions to examine the relations between the Socio-demographic Index (SDI, a summary measure based on average income per person, educational attainment, and total fertility rate) and each of the health-related SDG indicators and indices. Findings In 2015, the median health-related SDG index was 59.3 (95% uncertainty interval 56.8-61.8) and varied widely by country, ranging from 85.5 (84.2-86.5) in Iceland to 20.4 (15.4-24.9) in Central African Republic. SDI was a good predictor of the health-related SDG index (r(2) = 0.88) and the MDG index (r(2) = 0.2), whereas the non-MDG index had a weaker relation with SDI (r(2) = 0.79). Between 2000 and 2015, the health-related SDG index improved by a median of 7.9 (IQR 5.0-10.4), and gains on the MDG index (a median change of 10.0 [6.7-13.1]) exceeded that of the non-MDG index (a median change of 5.5 [2.1-8.9]). Since 2000, pronounced progress occurred for indicators such as met need with modern contraception, under-5 mortality, and neonatal mortality, as well as the indicator for universal health coverage tracer interventions. Moderate improvements were found for indicators such as HIV and tuberculosis incidence, minimal changes for hepatitis B incidence took place, and childhood overweight considerably worsened. Interpretation GBD provides an independent, comparable avenue for monitoring progress towards the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasises that investments in these areas alone will not be sufficient. Although considerable progress on the health-related MDG indicators has been made, these gains will need to be sustained and, in many cases, accelerated to achieve the ambitious SDG targets. The minimal improvement in or worsening of health-related indicators beyond the MDGs highlight the need for additional resources to effectively address the expanded scope of the health-related SDGs.Peer reviewe

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Avaliação da qualidade de vida em pacientes com asma grave

Introdução: A asma é uma doença crônica que pode causar consideráveis restrições físicas, emocionais e sociais, afetando a qualidade de vida (QV) do indivíduo. A asma persistente grave evolui com um pior prognóstico e elevadas taxas de mortalidade. A QV é uma medida de desfecho que avalia o impacto da doença na vida do paciente. Objetivo: Avaliar a QV nos pacientes com asma grave e caracterizar os domínios comprometidos, a associação com o controle da doença e com demais variáveis sociodemográficas e clínicas. Metodologia: estudo transversal de 108 pacientes acompanhados na Central de Referência do Programa para Controle da Asma na Bahia (ProAR), entre setembro de 2012 e março de 2013. Eles responderam três questionários, o sócio-biológico para identificação e caracterização do paciente; o SF-36 sobre qualidade de vida; e o ACQ-6 para análise do controle da asma. Resultados: foram avaliados 100 pacientes, a maioria do sexo feminino (82%), com média de idade de 49,77 ± 13,14 anos , duração dos sintomas de asma de 21,68 ± 15,83 anos com tratamento regular no ProAR há 6,01 ± 2,22 anos, em média. Pela avaliação do SF-36, observou-se comprometimento da QV nos diferentes domínios – estado geral de saúde, capacidade funcional, desempenho físico, aspectos emocionais, aspectos sociais, dor, vitalidade e saúde mental – no paciente com asma grave. Os escores foram de 40,00 para o componente físico e de 56,98 para o mental, sendo a pontuação máxima 100. Os escores foram ainda menores para o sexo feminino nos domínios de saúde mental, dor e capacidade funcional; e para os pacientes com asma não controlada, em todos os domínios com diferença estatisticamente significante (P<0,05). A avaliação do controle da asma pelo ACQ-6 mostrou que 33% dos pacientes obtiveram escores ≥ 1,5, sendo classificados como não controlados. Discussão: A asma persistente grave está associada a reduzida qualidade de vida neste subgrupo de pacientes, afetando principalmente o desempenho físico e o estado geral de saúde. O sexo feminino apresenta menor QV que o masculino, decorrente principalmente do comprometimento do aspecto emocional. O controle da asma tem um efeito significativo sobre a QV em qualquer um dos domínios, os quais diminuem à medida que o controle da asma piora. Os pacientes com asma não controlada referem mais visitas às emergências, necessidade de uso de corticoide oral e absenteísmo. As internações hospitalares são um importante indicador de uma pior QV na asma grave

Hábito alimentar, consumo de ultraprocessados e sua correlação com o estado nutricional de escolares da rede privada

 O presO presente estudo tem como objetivo avaliar o hábito alimentar, o consumo de alimentos ultraprocessados e sua correlação com o estado nutricional de escolares da rede privada em Teresina - PI. Trata-se de estudo observacional transversal, uma pesquisa de campo descritiva, exploratória, quantitativa, realizada com 82 crianças de 7 a 10 anos, de ambos os sexos, no período de maio de 2019. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa com parecer 3.158.930. Foram coletados dados antropométricos, tabulados no Excel 2016 e analisados no SPSS (versão, 20.0) e analisados dois recordatórios de 24 horas para verificação do consumo de alimentos ultraprocessados, utilizando o software Dietbox. Usou-se o teste Qui-quadrado para as variáveis qualitativas e o teste t Student para amostras pareadas com o intuito de verificar diferenças de proporções entre os dados adotando em ambos os testes um nível de significância de p < 0,05. Destacou-se a ocorrência de 24,4% de crianças (n=20) com sobrepeso/obesidade; 12,2% dos escolares (n=10) com excesso de adiposidade abdominal, fator que indica risco para doenças cardiovasculares. Os escolares apresentaram uma maior frequência no consumo de sucos industrializados, leite em pó, seguido dos bolos e biscoitos doces, achocolatado em pó e embutidos. Constatou-se que embora existiu um alto consumo de ultraprocessados, não foram encontradas relações significativas entre o estado nutricional e o consumo desses alimentos. Também foram obeservados taxas de sobrepeso/obesidade e excessos de gordura abdominal preocupantes, visto seu fator importante para o desenvolvimento de doenças cardiovasculares. El presente estudio tiene como objetivo evaluar los hábitos alimenticios, el consumo de alimentos ultraprocesados y su correlación con el estado nutricional de los estudiantes de escuelas privadas en Teresina - PI. Se trata de un estudio observacional transversal, una investigación de campo descriptiva, exploratoria y cuantitativa, realizada con 82 niños de 7 a 10 años de edad, de ambos sexos, en el período de mayo de 2019. La investigación fue aprobada por el Comité de Ética de la Investigación con una opinión de 3.158.930. Los datos antropométricos fueron recogidos, tabulados en Excel 2016 y analizados en SPSS (versión 20.0) y analizaron dos retiradas de productos durante 24 horas para verificar el consumo de alimentos ultra-procesados, utilizando el software Dietbox. La prueba de Chi-cuadrado se utilizó para las variables cualitativas y la prueba de T-Student para las muestras emparejadas con el fin de verificar las diferencias en las proporciones entre los datos, adoptando en ambas pruebas un nivel de significación de p < 0,05. Se observó un 24,4% de niños con sobrepeso/obesidad (n=20) y un 12,2% de escolares (n=10) con adiposidad abdominal excesiva, factor que indica riesgo de enfermedades cardiovasculares. Los escolares tenían una mayor frecuencia en el consumo de jugos industrializados, leche en polvo, seguido de tortas y galletas dulces, chocolate en polvo y salchichas. Se constató que, aunque existe un alto consumo de alimentos ultraprocesados, no se encontró una relación significativa entre el estado nutricional y el consumo de estos alimentos. También se observaron tasas de sobrepeso/obesidad y exceso de grasa abdominal, ya que son un factor importante para el desarrollo de enfermedades cardiovasculares.The present study aims to evaluate the eating habits, the consumption of ultra - processed foods and their correlation with the nutritional status of students from private schools in Teresina - PI. This is a cross-sectional observational study, a descriptive, exploratory and quantitative field research conducted with 82 children from 7 to 10 years old, of both sexes, in May 2019. The research was approved by the Research Ethics Committee with opinion 3,158,930. Anthropometric data were collected, tabulated in Excel 2016 and analyzed in SPSS (version, 20.0) and analyzed two 24-hour recalls to verify the consumption of ultra-processed foods using Dietbox software. Chi-square test for qualitative variables and Student's t-test for paired samples were used to verify proportional differences between the data, adopting a significance level of p <0.05 in both tests. The occurrence of 24.4% of overweight / obese children (n = 20) was highlighted; 12.2% of students (n = 10) with excess abdominal adiposity, a factor that indicates risk for cardiovascular disease. Students have a higher frequency of consumption of processed juices, milk powder, followed by cakes and sweet cookies, chocolate powder and sausages. It was found that although there was a high consumption of ultra-processed foods, no significant relationships were found between nutritional status and consumption of these foods. Worrying rates of overweight / obesity and excess abdominal fat were also observed, as it is an important factor for the development of cardiovascular diseases