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OBJETIVO: Refletir acerca das Unidades de Pronto Atendimento 24h como cenário de atuação para a Prática Avançada de Enfermeiros nos serviços de urgência e emergência. MÉTODO: Este estudo utilizou a metodologia de reflexão. RESULTADOS: A Enfermagem de Prática Avançada é uma especialidade em que atuam enfermeiros com conhecimento e habilidades ampliado, capazes de tomar decisões complexas, além de possuírem nível avançado de práticas específicas. Os serviços de urgência e emergência são cenários promissores ao desenvolvimento da Enfermagem de Prática Avançada, incluindo as Unidade de Pronto Atendimento 24h, pela capacidade de atendimentos de alta complexidade e atuação de profissionais altamente capacitados. Portanto, há necessidade de reflexão sobre avanços e entraves na atuação, regulamentação, sobretudo no que se refere a este cenário, pouco discutido no contexto da Enfermagem de Prática Avançada no Brasil. CONCLUSÃO: Existe grande necessidade de ampliação da discussão da Enfermagem de Prática Avançada para os demais níveis de atenção no Brasil. Há serviços com amplo potencial a serem desenvolvidos, sendo um deles as Unidades de Pronto Atendimento 24h. Observa-se que o enfermeiro de práticas avançadas nestes serviços poderá trazer grandes benefícios para a população, além de melhorar a qualidade da assistência, trazendo maior autonomia aos profissionais destes serviços.
OBJECTIVE: To reflect about the Emergency Care Unit an action scenario for the Advanced practice of nurses in emergency and urgency services. METHOD: This study utilized the methodology of reflection. RESULTS: Advanced Practice Nursing is a specialty in which nurses with expanded knowledge and additional skills can make complex decisions in addition to having an advanced level of specific practices. Emergency and urgency services are promising scenarios for the development of Advanced Practice Nursing, including the 24-hour Care Unit, especially due to the capacity of high complexity care and the performance of highly qualified professionals. Therefore, there is a need for reflection on the advances, obstacles in the performance and regulation, especially in relation to this scenario, which is little discussed in the context of Advanced Practice Nursing in Brazil. CONCLUSION: There is a great need to expand the discussion of Advanced Practice Nursing to the other levels of care in Brazil. There are services with vast potential to be developed, one of them being the 24-hour Care units. It is observed that nurses from advanced practices in these services can bring great benefits to the population, in addition to improving the quality of care, bringing greater autonomy for nurses in these services.
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Serviços Médicos de Emergência , Prática Avançada de Enfermagem , Assistência Ambulatorial , Atenção Primária à Saúde , Enfermagem em Saúde Pública , Atenção à Saúde , Enfermagem Baseada em EvidênciasRESUMO
As modalidades de tratamento Medicina Tradicional Chinesa/Acupuntura (MTC/A) fazem parte das Práticas Integrativas e Complementares em Saúde implementadas pelo Ministério da Saúde, via Sistema Único de Saúde (SUS). Realizar o mapeamento dos municípios do Estado do Pará que ofertam serviço de acupuntura e suas complementares. A pesquisa foi realizada em dados secundários fornecidos pela Secretaria de Saúde do Pará (SESPA), revisão de literatura narrativa e bases legais. O mapeamento das práticas MTC/A em 89 municípios, de janeiro a maio de 2022, tomou por base a estrutura das Regionais de Saúde do Pará. Os dados impossibilitam avaliar a frequência mensal dos atendimentos, pois as informações foram compactadas pelo total dos cinco meses. O gestor estadual não monitora o registro de dados nos sistemas do SUS; o que foi expresso permite afirmar que, efetivamente, as práticas de MTC/A não estão implantadas no SUS Pará, sendo registros pontuais
The treatment modalities Traditional Chinese Medicine/Acupuncture (TCM/A) are part of the Integrative and Complementary Health Practices implemented by the Ministry of Health, through the Unified Health System (SUS). To map the municipalities in the State of Pará that offer acupuncture services and their complements. The research was conducted on secondary data provided by the Pará Health Department (SESPA), review of narrative literature and legal bases. The mapping of TCM/A practices in 89 municipalities, from January to May 2022, was based on the structure of the Pará Health Regions. The data make it impossible to evaluate the monthly frequency of visits, since the information was compressed for the total of five months. The state manager does not monitor the recording of data in the SUS systems; what was expressed allows us to affirm that, effectively, the practices of TCM/A are not implemented in SUS Pará, being punctual records.
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Humanos , Masculino , FemininoRESUMO
BACKGROUND: Ceftazidime-Avibactam (CAZ-AVI) is a new antimicrobial against carbapenem-resistant Klebsiella pneumoniae. The aim of the study is to examine the cost-effectiveness of CAZ-AVI compared to colistin-meropenem (COL+MEM) in Colombia. METHODS: A decision tree model was developed from health-care system perspective assuming a 30-day time horizon. The clinical course was simulated based on treatment response between 48 and 72 hours, and the duration of the treatment was 7-14 days. Cost inputs were extracted from a published Colombian manual tariffs and official databases, expressed in 2019 dollars (USD). RESULTS: In the base case analysis, CAZ-AVI was associated with reduced mortality, length of hospital stay and fewer add-on antibiotics, resulting in an increase of 1.76 QALYs per patient versus COL+MEM and incremental costs associated in CAZ-AVI were $2,521 higher per patient compared to COL+MEM ($755 versus $3,276). The incremental costs were partially increased due to the lower mortality rate observed with CAZ-AVI. The incremental cost-effectiveness ratio was estimated to be $3,317 per QALY. In the probabilistic sensitivity analysis, with a willingness to pay above $2,438, CAZ-AVI has higher probability of being cost-effective. CONCLUSION: CAZ-AVI demonstrates cost-effectiveness as a treatment for Carbapenem-resistant Klepsiella pneumoniae infections by reducing the number of deaths and increasing QALYs. EXPERT COMMENTARY: Previous studies and surveillance programs from Colombia have reported prevalence of pathogens and the antimicrobial susceptibility of infections caused by multidrug-resistant Gram-negative bacteria. The health authorities have to consider and plan adequate surveillance systems in order to predict the resistance type and in choose the optimal antibiotics when infections occur.
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Colistina , Klebsiella pneumoniae , Antibacterianos , Compostos Azabicíclicos , Carbapenêmicos/farmacologia , Carbapenêmicos/uso terapêutico , Ceftazidima , Colistina/farmacologia , Colômbia , Análise Custo-Benefício , Combinação de Medicamentos , Humanos , Meropeném/farmacologia , Meropeném/uso terapêutico , Testes de Sensibilidade MicrobianaRESUMO
A acupuntura é uma das técnicas do segmento Medicina Tradicional Chinesa/Acupuntura que faz parte das Práticas Integrativas e Complementares em Saúde implementada pelo Ministério da Saúde, via Sistema Único de Saúde. O objetivo do trabalho foi realizar um mapeamento dos municípios do Estado do Pará que ofertam o serviço de acupuntura e suas complementares, no período de 2017 a 2019. A pesquisa foi realizada em dados secundários fornecidos pela Secretaria de Saúde do Pará, revisão de literatura narrativa e bases legais. O mapeamento de municípios que ofereceram as práticas foi realizado no período de janeiro a maio de 2022, tomou por base a estrutura das Regionais de Saúde. Os dados não permitiram avaliar a prestação de serviço da Acupuntura nos 89 municípios pesquisados, pois estavam compactados no conjunto dos meses. As práticas de saúde não estão efetivamente implantadas no Pará e não há monitoramento de suas atividades
Acupuncture is one of the techniques of the Traditional Chinese Medicine/Acupuncture segment that is part of the Integrative and Complementary Health Practices implemented by the Ministry of Health, via the Unified Health System. The objective of this work was to perform a mapping of the municipalities of the State of Pará that offer the acupuncture service and its complementary, in the period from 2017 to 2019. The research was carried out in secondary data provided by the Health Department of Pará, review of narrative literature and legal bases. The mapping of municipalities that offered the practices was carried out from January to May 2022, based on the structure of the Regional Health. The data did not allow evaluating the provision of acupuncture service in the 89 municipalities research, because they were compacted in the set of months. Health practices are not effectively enforced in Pará and there is not monitoring of their activities.
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Humanos , Masculino , Feminino , Terapias ComplementaresRESUMO
OBJECTIVE: To analyze nurses' experiences in the front line of the fight against the COVID-19 pandemic regarding the performance of emotional labor (EL), aiming at its characterization and identification of support strategies and development opportunities of nurses and practices. METHODS: Qualitative, descriptive, and exploratory study, with content analysis of eleven written narratives and reports from a focus group composed of nurses with experience in caring for patients with COVID-19 from different Hospital Centers in Lisbon, Portugal. RESULTS: Five themes were extracted: 1) Challenges experienced by nurses in the frontline; 2) Emotions experienced by nurses in service care; 3) Emotional responses of nurses and patients: impact on care; 4) EL of nurses in the patient care process; 5) Opportunities for development in the face of the emotional challenge required of nurses in combating COVID-19. FINAL CONSIDERATIONS: The nurses demonstrated the ability to transform this profoundly emotional experience positively.
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COVID-19 , Emoções , Recursos Humanos de Enfermagem Hospitalar , Humanos , Pandemias , Portugal , SARS-CoV-2RESUMO
ABSTRACT Objective: To analyze nurses' experiences in the front line of the fight against the COVID-19 pandemic regarding the performance of emotional labor (EL), aiming at its characterization and identification of support strategies and development opportunities of nurses and practices. Methods: Qualitative, descriptive, and exploratory study, with content analysis of eleven written narratives and reports from a focus group composed of nurses with experience in caring for patients with COVID-19 from different Hospital Centers in Lisbon, Portugal. Results: Five themes were extracted: 1) Challenges experienced by nurses in the frontline; 2) Emotions experienced by nurses in service care; 3) Emotional responses of nurses and patients: impact on care; 4) EL of nurses in the patient care process; 5) Opportunities for development in the face of the emotional challenge required of nurses in combating COVID-19. Final considerations: The nurses demonstrated the ability to transform this profoundly emotional experience positively.
RESUMEN Objetivo: Analizar las experiencias de enfermeros de primera línea frente a la pandemia de COVID-19 cuanto al desempeño del trabajo emocional (TE) visando su caracterización e identificación de estrategias de suporte y oportunidades de desarrollo de enfermeros y de prácticas. Métodos: Estudio cualitativo, descriptivo y exploratorio, con análisis de contenido de 11 narrativas escritas y relatos de un grupo focal compuesto por enfermeros con experiencia de cuidados a pacientes con COVID-19, de diferentes Centros Hospitalarios de Lisboa, Portugal. Resultados: Extrajeron cinco temas: 1) Desafíos vividos por enfermeros en primera línea; 2) Emociones experienciadas por enfermeros en la prestación de cuidados; 3) Respuestas emocionales de enfermeros y pacientes: impacto en los cuidados; 4) TE de enfermeros en el proceso de cuidados al paciente; 5) Oportunidades de desarrollo delante desafío emocional exigido de los enfermeros frente a la COVID-19. Consideraciones finales Los enfermeros demostraron capacidad de transformar positivamente esta experiencia profundamente emocional.
RESUMO Objetivo: Analisar as experiências de enfermeiros da linha de frente do combate à pandemia de COVID-19 quanto ao desempenho do trabalho emocional (TE) visando à sua caracterização e identificação de estratégias de suporte e oportunidades de desenvolvimento dos enfermeiros e das práticas. Métodos: Estudo qualitativo, descritivo e exploratório, com análise de conteúdo de 11 narrativas escritas e relatos de um grupo focal composto por enfermeiros com experiência de cuidados a pacientes com COVID 19, de diferentes Centros Hospitalares de Lisboa, Portugal. Resultados: Extraíram-se cinco temas: 1) Desafios vividos pelos enfermeiros na linha de frente; 2) Emoções experienciadas por enfermeiros na prestação de cuidados; 3) Respostas emocionais de enfermeiros e pacientes: impacto nos cuidados; 4) Trabalho Emocional de enfermeiros no processo de cuidados ao paciente; 5) Oportunidades de desenvolvimento face ao desafio emocional exigido dos enfermeiros no combate à COVID-19. Considerações finais: Os enfermeiros demonstraram capacidade de transformar positivamente esta experiência profundamente emocional.
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INTRODUCTION: Altered lower limb movement patterns during weight-bearing activities have been described as risk factors for several injuries. The lateral step-down test (LSD) was developed to be a simple, clinician-friendly tool to facilitate the assessment of lower extremity quality of movement during a functional activity. However, there is still conflicting information across the literature regarding how the LSD should be performed. OBJECTIVE: To critically review the literature regarding the assessment of quality of movement using the LSD and to provide an overview of how this test has been used, describing confounding factors and factors associated with altered movement patterns. METHODS: A literature review was conducted in PubMed/MEDLINE, COCHRANE, PEDro, SciELO and LILACS databases, by two independent reviewers. RESULTS: Sixteen articles met the inclusion criteria. One was a prospective cohort study to identify risk factors for injuries in military recruits. The fifteen remaining were cross-sectional studies involving healthy military recruits, physically active individuals, athletes and/or sedentary subjects, as well as participants with knee and ankle disorders. Worst quality of movement during the LSD has been associated with deficits in hip external rotation and knee extension strength as well as in ankle dorsiflexion range of motion. The reliability of the LSD has been reported to be moderate (κâ¯=â¯0.59-0.81). CONCLUSIONS: The LSD has adequate reliability and is a simple tool that can be used to quantify lower extremity quality of movement. Future studies should include standardized methods for application, scoring and interpretation of the test, so that confounding factors can be minimized.
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Teste de Esforço/métodos , Teste de Esforço/normas , Extremidade Inferior/fisiologia , Movimento/fisiologia , Fenômenos Biomecânicos , Estudos Transversais , Humanos , Estudos Prospectivos , Amplitude de Movimento Articular , Reprodutibilidade dos Testes , Fatores de Risco , Suporte de CargaRESUMO
Hepatozoon spp. are Apicomplexan protozoa that parasitize a wide diversity of vertebrate hosts. In Brazil, few studies have reported the occurrence of Hepatozoon spp. in rodent species. Additionally, an evaluation of the population structure and distribution of Hepatozoon species over several Brazilian biomes has not yet been performed. The present work aimed to investigate the genetic diversity of Hepatozoon spp. in rodents from 31 genera sampled in five Brazilian biomes. Samples were submitted to PCR assays for Hepatozoon spp. targeting two regions of the 18S rRNA gene. Infection by Hepatozoon spp. was detected in 195 (42.2%) rodents comprising 24 genera. Phylogenetic analyses of 18S rRNA sequences grouped all sequences in the clade of Hepatozoon spp. previously detected in rodents and reptiles, apart from those detected in domestic/wild carnivores. These data raise two non-exclusive hypotheses: (i) rodents play an important role as intermediate or paratenic hosts for Hepatozoon infections in reptiles; and (ii) rodents do not seem to participate in the epidemiology of Hepatozoon infections of domestic/wild canids and felids in Brazil. TCS analyses performed with available 18S rRNA Hepatozoon sequences detected in rodents from Brazil showed the occurrence of six haplotypes, which were distributed in two large groups: one from rodents inhabiting the coastal region of Brazil and Mato Grosso state, and another from rodents from the central region of the country. A wide survey of the South American territory will help to elucidate the evolutionary history of Hepatozoon spp. parasitizing Rodentia in the American continent.
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Apicomplexa/genética , Variação Genética , Roedores/parasitologia , Animais , Apicomplexa/patogenicidade , Brasil , Carnívoros/parasitologia , Haplótipos , Filogenia , Infecções Protozoárias em Animais/parasitologia , RNA Ribossômico 18SRESUMO
Knowledge about ticks (Acari) and screening of ticks parasitizing various hosts are necessary to understand the epidemiology of tick-borne pathogens. The objective of this study was to investigate tick infestations on snakes (Reptilia: Squamata: Serpentes) arriving at the serpentarium at the Institute Vital Brazil, Rio de Janeiro. Some of the identified ticks were individually tested for the presence of bacteria of the genera Rickettsia (Rickettsiales: Rickettsiaceae), Borrelia (Spirochaetales: Spirochaetaceae), Coxiella (Legionellales: Coxiellaceae), Bartonella (Rhizobiales: Bartonellaceae), Ehrlichia (Rickettsiales: Anaplasmataceae), Anaplasma (Rickettsiales: Anaplasmataceae), and Apicomplexa protozoa of the genera Babesia (Piroplasmida: Babesiidae) and Hepatozoon (Eucoccidiorida: Hepatozoidae). A total of 115 hard ticks (Ixodida: Ixodidae) were collected from 17 host individuals obtained from four Brazilian states. Two species of tick were identified: Amblyomma dissimile Koch 1844 (four larvae, 16 nymphs, 40 adults), and Amblyomma rotundatum Koch 1844 (12 nymphs, 43 adults). Rickettsia bellii was found in A. rotundatum and A. dissimile ticks and Rickettsia sp. strain Colombianensi, Anaplasma-like and Hepatozoon sp. in A. dissimile ticks. Among the tested ticks, no DNA of Borrelia, Bartonella, Coxiella or Babesia was found. The present findings extend the geographic range of Rickettsia sp. strain Colombianensi in Brazil and provide novel tick-host associations.
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Apicomplexa/isolamento & purificação , Bactérias/isolamento & purificação , Interações Hospedeiro-Parasita , Ixodidae/microbiologia , Ixodidae/parasitologia , Serpentes/parasitologia , Animais , Brasil , Ixodidae/fisiologia , Infestações por Carrapato/parasitologia , Infestações por Carrapato/veterináriaRESUMO
This paper describes the diversity of rodent fauna in an area endemic for hantavirus cardiopulmonary syndrome (HCPS) in Brazil, the population dynamics and the relationship of rodents with hantavirus in the Cerrado (savanna-like) biome. Additionally, an analysis is made of the partial S segment sequences of the hantaviruses obtained from serologically confirmed human HCPS cases and from rodent specimens. Rodents were collected during four campaigns. Human serum samples were collected from suspected cases of HCPS at hospitals in the state of Minas Gerais. The samples antibody-reactive by ELISA were processed by RT-PCR. The PCR product was amplified and sequenced. Hantavirus was detected only in Necromys lasiurus, the wild rodent species most prevalent in the Cerrado biome (min-max: 50-83·7%). All the six human serum samples were hantavirus seropositive and five showed amplified PCR products. The analysis of the nucleotide sequences showed the circulation of a single genotype, the Araraquara hantavirus. The environmental changes that have occurred in the Cerrado biome in recent decades have favoured N. lasiurus in interspecific competition of habitats, thus increasing the risk of contact between humans and rodent species infected with hantavirus. Our data corroborate the definition of N. lasiurus as the main hantavirus reservoir in the Cerrado biome.
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Reservatórios de Doenças/veterinária , Síndrome Pulmonar por Hantavirus/veterinária , Orthohantavírus/fisiologia , Doenças dos Roedores/epidemiologia , Roedores , Adulto , Animais , Brasil/epidemiologia , Feminino , Genótipo , Pradaria , Orthohantavírus/genética , Síndrome Pulmonar por Hantavirus/epidemiologia , Síndrome Pulmonar por Hantavirus/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Dados de Sequência Molecular , Filogenia , Dinâmica Populacional , Prevalência , Doenças dos Roedores/virologia , Roedores/fisiologia , Análise de Sequência de DNA , Estudos Soroepidemiológicos , Proteínas Virais/genética , Proteínas Virais/metabolismo , Adulto JovemRESUMO
Hantavirus pulmonary syndrome (HPS) is the most frequently reported fatal rodent-borne disease in Brazil, with the majority of cases occurring in Santa Catarina. We analysed the clinical, laboratory and epidemiological data of the 251 confirmed cases of HPS in Santa Catarina in 1999-2011. The number of cases ranged from 10 to 47 per year, with the highest incidences in 2004-2006. Gastrointestinal tract manifestations were found in >60% of the cases, potentially confounding diagnosis and leading to inappropriate therapy. Dyspnoea, acute respiratory failure, renal failure, increased serum creatinine and urea levels, increased haematocrits and the presence of pulmonary interstitial infiltrate were significantly more common in HPS patients who died. In addition, we demonstrated that the six cases from the midwest region of the state were associated with Juquitiba virus genotype. The case-fatality rate in this region, 19·2%, was lower than that recorded for other mesoregions. In the multivariate analysis increase of serum creatinine and urea was associated with death by HPS. Our findings help elucidate the epidemiology of HPS in Brazil, where mast seeding of bamboo can trigger rodent population eruptions and subsequent human HPS outbreaks. We also emphasize the need for molecular confirmation of the hantavirus genotype of human cases for a better understanding of the mortality-related factors associated with HPS cases in Brazil.
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Reservatórios de Doenças/veterinária , Síndrome Pulmonar por Hantavirus/epidemiologia , Orthohantavírus/fisiologia , Roedores , Adolescente , Adulto , Idoso , Animais , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Orthohantavírus/genética , Síndrome Pulmonar por Hantavirus/veterinária , Síndrome Pulmonar por Hantavirus/virologia , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Dados de Sequência Molecular , Estudos Retrospectivos , Doenças dos Roedores/epidemiologia , Doenças dos Roedores/virologia , Análise de Sequência de DNA , Proteínas Virais/genética , Proteínas Virais/metabolismo , Adulto JovemRESUMO
Rickettsia rickettsii infection is being increasingly recognized as an important cause of fatal acute illness in Brazil, where this tick-borne disease is designated Brazilian spotted fever (BSF). In this study we report five fatal cases of BSF in employees of an animal shelter in an urban area in the municipality of Rio de Janeiro in southeast Brazil after a natural disaster on 11 January 2011. Four of the cases occurred from 27 January to 11 April 2011, while the fifth fatal case was identified in April 2012. Three cases were confirmed by molecular analysis and two by epidemiological linkage. An investigation of BSF was performed in the animal shelter, and blood samples were collected from 115 employees and 117 randomly selected dogs. The presence of high levels (1024-4096) of antibodies against spotted fever group rickettsiae was found in three (2·6%) employees and 114 (97·5%) dogs. These findings emphasize the need to consider BSF as a possible cause of undifferentiated febrile illness, especially dengue and leptospirosis, in patients occupationally exposed to dogs heavily infested by ticks, mainly working at kennels and animal shelters that have inadequate space for the animals housed and frequently providing an environment conducive to exposure to pathogens such as R. rickettsii.
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Anticorpos Antibacterianos/imunologia , Doenças do Cão/diagnóstico , Abrigo para Animais , Doenças Profissionais/diagnóstico , Rickettsia rickettsii/imunologia , Febre Maculosa das Montanhas Rochosas/veterinária , Carrapatos , Adulto , Animais , Brasil , Dengue/diagnóstico , Diagnóstico Diferencial , Cães , Evolução Fatal , Feminino , Humanos , Leptospirose/diagnóstico , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/imunologia , Febre Maculosa das Montanhas Rochosas/diagnóstico , Febre Maculosa das Montanhas Rochosas/imunologia , População UrbanaRESUMO
RFamide-related peptide-3 (RFRP-3), the orthologue of avian gonadotrophin-inhibitory hormone, and its receptor GPR147 have been recently identified in the human hypothalamus, and their roles in the regulation of reproductive axis has been studied. The present study aimed to investigate whether the presence of variants in the genes encoding human RFRP-3 (NPVF gene) and its receptor, GPR147 (NPFFR1 gene), is associated with the occurrence of gonadotrophin-releasing hormone-dependent pubertal disorders. Seventy-eight patients with idiopathic central precocious puberty (CPP) and 51 with normosmic isolated hypogonadotrophic hypogonadism (nIHH) were investigated. Fifty healthy subjects comprised the control group. The coding sequences of the NPVF and NPFFR1 genes were amplified and sequenced. Odds ratios (OR) were used to estimate the likelihood of CPP or nIHH in the presence of the described polymorphisms. All such polymorphisms have already been registered in the National Center for Biotechnology Information database. A three-nucleotide in frame deletion was identified in the NPVF gene (p.I71_K72), with a smaller proportion in the CPP (5%) compared to the nIHH (15%) group (P = 0.06). This results in the deletion of the isoleucine at position 71, adjacent to lysine at an endoproteolytic cleavage site of the precursor peptide. This polymorphism was associated with a lower risk of CPP (OR = 0.33; 95% confidence interval = 0.08-0.88); interestingly, only two men with nIHH were homozygotes for this variant. A total of five missense polymorphisms were found in the NPFFR1 gene, which encodes GPR147, with similar frequencies among groups and no association with pubertal timing. Our data suggest that RFRP-3/GPR147 may play secondary, modulatory roles on the regulation of pubertal development; a restraining modulatory effect of the NPVF p.I71_K72 variant on the activation of the gonadotrophic axis cannot be ruled out and deserves further investigation.
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Hipogonadismo/genética , Neuropeptídeos/genética , Polimorfismo Genético , Puberdade Precoce/genética , Receptores de Neuropeptídeos/genética , Adolescente , Criança , Pré-Escolar , Análise Mutacional de DNA , Feminino , Humanos , Hipogonadismo/metabolismo , Hipotálamo/metabolismo , Masculino , Neuropeptídeos/metabolismo , Puberdade Precoce/metabolismo , Receptores de Neuropeptídeos/metabolismo , Adulto JovemRESUMO
Pain is a common symptom in patients with cancer, including those with head and neck cancer (HNC). While studies suggest an association between chronic inflammation and pain, levels of inflammatory cytokines, such as C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α), have not been correlated with pain in HNC patients who are not currently undergoing anticancer treatment. The purpose of this study was to examine the relationship between these inflammatory markers and perceived pain in HNC patients prior to anticancer therapy. The study group consisted of 127 HNC patients and 9 healthy controls. Pain was assessed using the Brief Pain Inventory (BPI), and serum levels of CRP and TNF-α were determined using the particle-enhanced turbidimetric immunoassay (PETIA) and ELISA techniques, respectively. Patients experiencing pain had significantly higher levels of CRP (P<0.01) and TNF-α (P<0.05) compared with controls and with patients reporting no pain. There were significantly positive associations between pain, CRP level, and tumor stage. This is the first study to report a positive association between perceived pain and CRP in HNC patients at the time of diagnosis. The current findings suggest important associations between pain and inflammatory processes in HNC patients, with potential implications for future treatment strategies.
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Antineoplásicos/uso terapêutico , Proteína C-Reativa/análise , Carcinoma de Células Escamosas/patologia , Neoplasias de Cabeça e Pescoço/patologia , Dor/etiologia , Fator de Necrose Tumoral alfa/análise , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Carcinoma de Células Escamosas/complicações , Ensaio de Imunoadsorção Enzimática , Feminino , Neoplasias de Cabeça e Pescoço/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Tempo para o TratamentoRESUMO
Pain is a common symptom in patients with cancer, including those with head and neck cancer (HNC). While studies suggest an association between chronic inflammation and pain, levels of inflammatory cytokines, such as C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α), have not been correlated with pain in HNC patients who are not currently undergoing anticancer treatment. The purpose of this study was to examine the relationship between these inflammatory markers and perceived pain in HNC patients prior to anticancer therapy. The study group consisted of 127 HNC patients and 9 healthy controls. Pain was assessed using the Brief Pain Inventory (BPI), and serum levels of CRP and TNF-α were determined using the particle-enhanced turbidimetric immunoassay (PETIA) and ELISA techniques, respectively. Patients experiencing pain had significantly higher levels of CRP (P<0.01) and TNF-α (P<0.05) compared with controls and with patients reporting no pain. There were significantly positive associations between pain, CRP level, and tumor stage. This is the first study to report a positive association between perceived pain and CRP in HNC patients at the time of diagnosis. The current findings suggest important associations between pain and inflammatory processes in HNC patients, with potential implications for future treatment strategies.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antineoplásicos/uso terapêutico , Proteína C-Reativa/análise , Carcinoma de Células Escamosas/patologia , Neoplasias de Cabeça e Pescoço/patologia , Dor/etiologia , Fator de Necrose Tumoral alfa/análise , Biomarcadores/análise , Carcinoma de Células Escamosas/complicações , Ensaio de Imunoadsorção Enzimática , Neoplasias de Cabeça e Pescoço/complicações , Medição da Dor/métodos , Tempo para o TratamentoRESUMO
Hantavirus pulmonary syndrome (HPS) is a zoonosis and a public health concern in the Americas due to its high fatality rate. Since the first cases were identified in USA in 1993, HPS has been observed over a wide area of the American continents. Over 1600 HPS cases have been confirmed in Brazil since 1993, and different genotypes of hantavirus have been identified in several biomes in this country of continental dimensions. We performed a retrospective study of data from 2001 to 2011 that encompassed all notified cases of HPS in the National Disease Notification System (SINAN) of Brazil to determine the regional differences and temporal trends of the disease. During the study period, 1486 cases were reported, and analyses of the temporal trends of the disease revealed that the number of cases in Brazil increased over this period (P < 0·01). The frequency distributions of the cases stratified by region revealed different patterns of seasonality; however, these patterns were not statistically significant with the exception of the South region (P < 0·05). We found regional differences in the occurrence of the disease throughout the year and a trend towards an increasing number of cases. These findings reinforce the necessity of adjusting surveillance tools and control policies to respond effectively to this public health problem.
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Geografia , Síndrome Pulmonar por Hantavirus/epidemiologia , Estações do Ano , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
Objetivo: Identificar o perfil clínico-epidemiológico da Insuficiência renal aguda IRA, condições associadas a ela e taxa de mortalidade entre os neonatos. Método: estudo retrospectivo, descritivo e analítico de 15 prontuários de neonatos diagnosticados com IRA na UTI Neonatal da Fundação Santa Casa de Misericórdia do Pará (FSCMPA), entre junho de 2009 a junho de 2012. Resultados. A IRA neonatal na UTI neonatal da FSCMPA esteve em 3,76% dos pacientes. Dos pacientes estudados, 8 (53,3%) eram do sexo feminino e 7 (46,7%) do sexo masculino. Neonatos com até 07 dias de vida que desenvolveram IRA representaram 13 (86,7%) casos. A assistência pré-natal foi observada em 12 (80%) casos. Quanto ao diagnóstico, em 53% dos casos foram realizados em até 7 dias e em 47% após 7 dias. Condições associadas: elevada prematuridade (80%) e baixo peso (53,3%) neonatos, com mortalidade em 87,5%. Oligúria esteve presente em 13 (86,7%) pacientes, síndrome do desconforto respiratório em 40%, asfixia neonatal em 26,7%, sepse em 40% e nefropatia em 13,3%. A indicação de Nutrição Parenteral Prolongada ocorreu em 86,7% e a de diálise em 66,7% dos neonatos. A mortalidade observada foi em torno de 73%, sendo os prematuros os mais acometidos (82%). Conclusão: A IRA é causa frequente de morbidades em neonatos e os resultados obtidos em um curto período são semelhantes a outros estudos.
Acute Kidney Injury (AKI) is a common clinical pathology in neonatal intensive care units (ICU) often associated with conditions that contribute for AKI, such as sepsis, perinatal asphyxia and neonates preterms. Objective. Identify the clinical epidemiologic profile of AKI, its associated contributing conditions and the mortality rate among newborns Methods. Retrospective, descriptive and analytical study from among 15 promptuaries of neonates with AKI admitted to ICU of Fundação Santa Casa de Misericórdia do Pará (FSCMPA) from June 2009 to June 2012.Results. AKI was shown in 3,76%of the patients in FSCMPA neonatal ICU. Of the 15 neonates, 8 females and 7 males were reviewed in the study. Neonates with AKI aged until 7 days were 13 (86,7%) cases. Prenatal care was performed in 12 (80%) cases. Regarding the diagnosis, 53% were performed within 7 days and 47% were over 7 days. Associated contributing conditions: preterms were 80%, low birth weight was 53,3%, of whom 87,5% died. Oliguria was observed in 86,7%, respiratory distress syndrome, in 40%, perinatal asphyxia, in 26,7%, sepsis in 40% and nephropatologies, in 13,3% of the newborns. Prolonged Parenteral Nutrition was done in 86,7% and dialysis in 66,7% of the neonates. Mortality rate was significantly higher (73%), most of whom were preterms (82%). Conclusion. AKI is a common cause of diseases in neonates and short-term outcomes in our institution are similar with other studies.
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Acinetobacter baumannii has emerged as a major cause of healthcare-associated infections. Controversy exists as to whether antimicrobial resistance increases the risk of mortality. We conducted a systematic review and meta-analysis to examine this association. We searched MEDLINE and EMBASE databases up to May 2013 to identify studies comparing mortality in patients with carbapenem-resistant A. baumannii (CRAB) vs. carbapenem-susceptible A. baumannii (CSAB). A random-effects model was used to pool Odds Ratios (OR). Heterogeneity was examined using I(2). We included 16 observational studies. There were 850 reported deaths (33%) among the 2546 patients. Patients with CRAB had a significantly higher risk of mortality than patients with CSAB in the pooled analysis of crude effect estimates (crude OR = 2.22; 95% CI = 1.66, 2.98), although substantial heterogeneity was evident (heterogeneity I(2) = 55%). The association remained significant in the pooled adjusted OR of 10 studies. Studies reported that patients with CRAB compared to patients with CSAB were more likely to have severe underlying illness and also to receive inappropriate empirical antimicrobial treatment, which increases the risk of mortality. Our study suggests that carbapenem resistance may increase the risk of mortality in patients with A. baumannii infection. However, cautious interpretation is required because of the residual confounding factors and inadequate sample size in most studies.
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Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/mortalidade , Acinetobacter baumannii/efeitos dos fármacos , Antibacterianos/uso terapêutico , Carbapenêmicos/uso terapêutico , Farmacorresistência Bacteriana , HumanosRESUMO
Acinetobacter baumannii is a major cause of healthcare-associated infection, often affecting critically ill patients. The purpose of the study was to examine the associations of carbapenem resistance with mortality, length of hospital stay and hospital costs among patients infected with A. baumannii in intensive-care units (ICUs) in Colombia. A prospective, multicentre cohort study was conducted among 165 patients with A. baumannii infection admitted to ICUs between April 2006 and April 2010. Patients with carbapenem-resistant A. baumannii had higher risk of 30-day mortality than patients with carbapenem-susceptible A. baumannii in the univariate analysis (unadjusted hazard ratio = 2.12; 95% CI 1.14-3.95; p 0.018). However, carbapenem resistance was not significantly associated with risk of mortality (adjusted hazard ratio = 1.45; 95% CI 0.74-2.87; p 0.28) after adjusting for APACHE II score and other confounding factors. We did not find a significant difference in length of stay in ICU after the onset of infection between the two groups in the multivariate analysis (adjusted mean = 13.1 days versus 10.5 days; p 0.14). The average total cost of hospitalization among patients with carbapenem-resistant A. baumannii was significantly higher than that among patients with carbapenem-susceptible A. baumannii in the multivariate analysis (adjusted cost; US$ 11 359 versus US$ 7049; p <0.001). Carbapenem resistance was not significantly associated with mortality, though we are unable to rule out an increased risk due to the limited sample size. Carbapenem resistance was associated with an additional cost of hospitalization.
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Infecções por Acinetobacter/economia , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/efeitos dos fármacos , Carbapenêmicos/farmacologia , Custos de Cuidados de Saúde , Resistência beta-Lactâmica , Infecções por Acinetobacter/mortalidade , Acinetobacter baumannii/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Colômbia , Infecção Hospitalar/economia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Sobrevida , Resultado do TratamentoRESUMO
The purpose of this study was to evaluate the neuromuscular efficiency of the vastus medialis obliquus and postural balance in high-performance soccer athletes after anterior cruciate ligament (ACL) reconstruction, compared to the uninvolved leg. A cross-sectional study was conducted with 22 male professional soccer players after ACL reconstruction (4-12 months postoperatively). The athletes were submitted to functional rehabilitation with an accelerated protocol on the soccer team. They were evaluated using isokinetic dynamometer, surface electromyography and electronic baropodometer. There was no decrease or difference between neuromuscular efficiency of the VMO when comparing both the limbs after ACL reconstruction in the professional soccer athletes under treatment. The same result was found in postural balance. It can be concluded that the NME of the VMO in the involved member and postural balance were successfully re-established after the reconstruction procedure of the ACL in the sample group studied.