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The performance of a commercial immunofluorescence assay (IFA commercial), an in-house immunofluorescence assay (IFA in-house) and an indirect enzyme-linked immunosorbent assay (ELISA) were evaluated in the detection of antibodies anti-C. burnetii in the serum of Q fever patients and persons without the disease. For the study, seropositive and seronegative samples for Q fever (n = 200) from a serum bank of the Instituto Adolfo Lutz in Brazil were used. Commercial IFA was considered in this study as the gold standard for diagnosing Q fever. The in-house IFA demonstrated good agreement with the commercial test, showing high sensitivity (91%) and specificity (97%) compared to the gold standard, with a Kappa coefficient of 0.8954. The indirect ELISA test showed lower agreement with the gold standard, showing low sensitivity (67%), although the specificity of the technique was high (97%) and the Kappa coefficient was moderate (0.6631). In-house IFA is an excellent alternative for diagnosing Q fever.

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The multisystem impairment promoted by COVID-19 may be associated with a reduction in exercise capacity. Cardiopulmonary abnormalities can change across the acute disease severity spectrum. We aimed to verify exercise physiology differences between COVID-19 survivors and SARS-CoV-2-naïve controls and how illness severity influences exercise limitation. A single-centre cross-sectional analysis of prospectively collected data from COVID-19 survivors who underwent cardiopulmonary exercise testing (CPET) in their recovery phase (x = 50[36;72] days). Patients with COVID-19 were stratified according to severity as mild [M-Cov (outpatient)] vs severe/critical [SC-Cov(inpatients)] and were compared with SARS-CoV-2-naïve controls (N-Cov). Collected information included demographics, anthropometrics, previous physical exercise, comorbidities, lung function test and CPET parameters. A multivariate logistic regression analysis was performed to identify low aerobic capacity (LAC) predictors post COVID-19. Of the 702 included patients, 310 (44.2%), 305 (43.4%) and 87 (12.4%) were N-Cov, M-Cov and SC-Cov, respectively. LAC was identified in 115 (37.1%), 102 (33.4%), and 66 (75.9%) of N-CoV, M-CoV and SC-CoV, respectively (p < 0.001). SC-Cov were older, heavier with higher body fat, more sedentary lifestyle, more hypertension and diabetes, lower forced vital capacity, higher prevalence of early anaerobiosis, ventilatory inefficiency and exercise-induced hypoxia than N-Cov. M-Cov had lower weight, fat mass, and coronary disease prevalence and did not demonstrate more CEPT abnormalities than N-Cov. After adjustment for covariates, SC-Cov was an independent predictor of LAC (OR = 2.7; 95% CI, 1.3-5.6). Almost two months after disease onset, SC-CoV presented several exercise abnormalities of oxygen uptake, ventilatory adaptation and gas exchange, including a high prevalence of LAC.Highlights Weeks after the acute disease phase, one-third of mild and three-quarters of severe and critical patients with COVID-19 presented a reduced aerobic capacity. Previous studies including SARS-CoV-1 survivors observed much lower values.A severe or critical COVID-19 case was an independent predictor for low aerobic capacity.In our sample, pre-COVID-19 exercise significantly reduced the odds of post-COVID-19 low aerobic capacity. Even severe or critical patients who exercised regularly had a prevalence of low aerobic capacity 2.5 times lower than those who did not have this routine before sickening.

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Abstract Background Implementing stroke care protocols has intended to provide better care quality, favor early functional recovery, and achieving long-term results for the rehabilitation of the patient. Objective To analyze the effect of implementing care protocols on the outcomes of acute ischemic stroke. Methods Primary studies published from 2011 to 2020 and which met the following criteria were included: population should be people with acute ischemic stroke; studies should present results on the outcomes of using protocols in the therapeutic approach to acute ischemic stroke. The bibliographic search was carried out in June 2020 in 7 databases. The article selection was conducted by two independent reviewers and the results were narratively synthesized. Results A total of 11,226 publications were retrieved in the databases, of which 30 were included in the study. After implementing the protocol, 70.8% of the publications found an increase in the rate of performing reperfusion therapy, such as thrombolysis and thrombectomy; 45.5% identified an improvement in the clinical prognosis of the patient; and 25.0% of the studies identified a decrease in the length of hospital stay. Out of 19 studies that addressed the rate of symptomatic intracranial hemorrhage, 2 (10.5%) identified a decrease. A decrease in mortality was mentioned in 3 (25.0%) articles out of 12 that evaluated this outcome. Conclusions We have identified the importance of implementing protocols in increasing the performance of reperfusion therapies, and a good functional outcome with improved prognosis after discharge. However, there is still a need to invest in reducing post-thrombolysis complications and mortality.

Resumo Antecedentes A implementação de protocolos de acidente vascular cerebral (AVC) visa proporcionar uma melhor qualidade da assistência, favorecer a recuperação funcional precoce e alcançar resultados para a reabilitação do paciente. Objetivo Analisar o efeito da implantação de protocolos nos desfechos do AVC isquêmico agudo. Métodos Foram incluídos estudos primários publicados entre 2011 e 2020 e que atendiam aos seguintes critérios: população deveria ser constituída de pessoas com AVC isquêmico agudo; apresentar resultados sobre os desfechos do uso de protocolos na abordagem terapêutica ao AVC isquêmico agudo. A busca bibliográfica foi realizada em junho de 2020 em 7 bases de dados. A seleção dos artigos foi feita por dois revisores independentes e a síntese dos resultados foi feita de forma narrativa. Resultados Foram recuperadas 11.226 publicações, das quais 30 foram incluídas no estudo. Após a implementação do protocolo, 70,8% das publicações constataram aumento na taxa de realização de terapia de reperfusão, como a trombólise e a trombectomia; 45,5% identificaram melhora no prognóstico clínico do paciente; e 25,0% dos estudos identificaram diminuição no tempo de internação hospitalar. De 19 estudos que abordaram a taxa de hemorragia intracraniana sintomática, 2 (10,5%) identificaram diminuição nesta taxa. A diminuição da mortalidade foi citada em 3 (25,0%) artigos de 12 que avaliaram tal desfecho. Conclusões Identificou-se a importância da implantação de protocolos no aumento da realização das terapias de reperfusão, e ao bom desfecho funcional com melhora do prognóstico após a alta. No entanto, ainda há que se investir na diminuição das complicações pós trombólise e da mortalidade.

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SUMMARY OBJECTIVE: Acute appendicitis is one of the most common surgical causes of an acute abdomen among patients admitted to the emergency room due to abdominal pain. The clinical diagnosis of acute appendicitis is usually difficult and is made by evaluating the clinical, laboratory, and radiological findings together. The aim of this study was to investigate the diagnostic potential of signal peptide-CUB-EGF-like domain-containing protein 1 as a biomarker for acute appendicitis. METHODS: A total of 67 adult patients without any comorbidities who presented to the emergency department with abdominal pain and were clinically diagnosed with acute appendicitis were included in the case group. The patients included in the study were classified into the negative appendectomy group and the acute appendicitis group according to their histopathological final diagnosis. In addition, 48 healthy volunteers without comorbidities were included in the control group. Signal peptide-CUB-EGF-like domain-containing protein 1 levels of patients and the control group were measured. RESULTS: According to postoperative histopathological examinations of the patients, 7 (10.4%) patients were diagnosed with negative appendectomy, and 60 (89.6%) patients were diagnosed with acute appendicitis. Signal peptide-CUB-EGF-like domain-containing protein 1 levels were higher in the patients with acute appendicitis than in negative appendectomy patients (p=0.012). Signal peptide-CUB-EGF-like domain-containing protein 1 levels were also higher in the case group compared to the control group (p=0.001). CONCLUSION: The admission signal peptide-CUB-EGF-like domain-containing protein 1 level was significantly higher in adults with acute appendicitis. The SCUBE1 level is a novel but promising biomarker that aids in the diagnosis of acute appendicitis.

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Introducción: Los avances en la ciencia y tecnología han permitido la supervivencia de las personas que ingresan a la unidad de cuidado intensivo (UCI), algunas de ellas con estancia prolongada en el área crítica. Al retornar al hogar, presentan alteraciones físicas, mentales y cognitivas que los hacen dependientes de cuidado, requiriendo del apoyo de un familiar quien debe asumir el rol de cuidador lo cual le implica cambios en el contexto donde se desempeña ya sea desde lo social, laboral, familiar o personal. Objetivo: Comprender el significado de adoptar el rol de cuidador familiar de la persona que cursó una estancia prolongada en la UCI al retornar al hogar. Método: Estudio cualitativo, utilizando herramientas de la teoría fundamentada. Realizado en la ciudad de Medellín, Colombia, de noviembre de 2021 a diciembre de 2022. Se aplicaron 12 entrevistas semiestructuradas a 10 cuidadores familiares de personas que habían sufrido un evento agudo grave, con una internación prolongada en la UCI. La codificación, abierta, axial y selectiva, la elaboración de memos analíticos, diagramas y el muestreo teórico, fueron fundamentales en el análisis. Resultados: Al momento del alta hospitalaria, el cuidador familiar considera que asumir el cuidado es difícil y complicado, pues debe enfrentarse a algo nuevo, esto hace que la vida le cambie de forma drástica de un momento a otro. Conclusiones: Ejercer el rol de cuidador familiar de personas con estancia prolongada en la UCI al retornar al hogar implica un cambio drástico e inesperado para el cuidador familiar, e invita al profesional de enfermería a crear estrategias para el cuidado a los cuidadores previniendo la crisis situacional que se pueda presentar y la sobrecarga de cuidado.

Introduction: Advances in science and technology have allowed the survival of people admitted to the intensive care unit (ICU), some of them with a prolonged stay in the critical area. Upon returning home, they present physical, mental and cognitive alterations that make them dependent on care, requiring the support of a family member who must assume the role of caregiver, which implies changes in the context in which he or she works, whether from a social, work, family or personal perspective. Objective: To understand the meaning of adopting the role of family caregiver for the person who had a prolonged stay in the ICU upon returning home. Method: Qualitative study, using grounded theory tools. Carried out in the city of Medellin, Colombia, from November 2021 to December 2022. 12 semi-structured interviews were applied to 10 family caregivers of people who had suffered a severe acute event, with prolonged hospitalization in the ICU. The coding, open, axial and selective, the elaboration of analytical memos, diagrams and theoretical sampling, were fundamental in the analysis. Results: At the time of hospital discharge, the family caregiver considers that assuming care is difficult and complicated, since he must face something new, this makes his life change drastically from one moment to the next. Conclusions: Playing the role of family caregiver for people with a prolonged stay in the ICU upon returning home implies a drastic and unexpected change for the family caregiver and invites the nursing professional to create strategies for caring for caregivers, preventing the situational crisis that may occur and care overload.

Introdução: Os avanços da ciência e da tecnologia permitiram a sobrevivência de pessoas internadas em unidade de terapia intensiva (UTI), algumas delas com permanência prolongada na área crítica. Ao retornarem para casa, apresentam alterações físicas, mentais e cognitivas que os tornam dependentes de cuidados, necessitando do apoio de um familiar que deve assumir o papel de cuidador, o que implica mudanças no contexto em que atua, seja na perspectiva social, profissional, familiar ou pessoal. Objetivo: Compreender o significado de adotar o papel de cuidador familiar da pessoa que teve permanência prolongada na UTI ao retornar para casa. Método: Estudo qualitativo, utilizando ferramentas da teoria fundamentada. Realizado na cidade de Medellín, Colômbia, de novembro de 2021 a dezembro de 2022. Foram aplicadas 12 entrevistas semiestruturadas a 10 cuidadores familiares de pessoas que sofreram um evento agudo grave, com internação prolongada na UTI. A codificação, aberta, axial e seletiva, a elaboração de memorandos analíticos, diagramas e amostragem teórica, foram fundamentais na análise. Resultados: No momento da alta hospitalar, o cuidador familiar considera que assumir o cuidado é difícil e complicado, pois deve enfrentar algo novo, isso faz com que sua vida mude drasticamente de um momento para o outro. Conclusões: Desempenhar o papel de cuidador familiar de pessoas com permanência prolongada na UTI ao retornar para casa implica uma mudança drástica e inesperada para o cuidador familiar e convida o profissional de enfermagem a criar estratégias para cuidar dos cuidadores, prevenindo a crise situacional que possa ocorrer e sobrecarga de cuidados.

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Existing acute febrile illness (AFI) surveillance systems can be leveraged to identify and characterize emerging pathogens, such as SARS-CoV-2, which causes COVID-19. The US Centers for Disease Control and Prevention collaborated with ministries of health and implementing partners in Belize, Ethiopia, Kenya, Liberia, and Peru to adapt AFI surveillance systems to generate COVID-19 response information. Staff at sentinel sites collected epidemiologic data from persons meeting AFI criteria and specimens for SARS-CoV-2 testing. A total of 5,501 patients with AFI were enrolled during March 2020-October 2021; >69% underwent SARS-CoV-2 testing. Percentage positivity for SARS-CoV-2 ranged from 4% (87/2,151, Kenya) to 19% (22/115, Ethiopia). We show SARS-CoV-2 testing was successfully integrated into AFI surveillance in 5 low- to middle-income countries to detect COVID-19 within AFI care-seeking populations. AFI surveillance systems can be used to build capacity to detect and respond to both emerging and endemic infectious disease threats.

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Abstract Background The treatment of acute ischemic stroke with cerebral reperfusion therapy requires rapid care and recognition of symptoms. Objective To analyze the effectiveness of implementing protocols for acute ischemic stroke in reducing care time. Methods Systematic review, which was performed with primary studies in Portuguese, English, and Spanish published between 2011 and 2020. Inclusion criteria: study population should comprise people with acute ischemic stroke and studies should present results on the effectiveness of using urgent care protocols in reducing care time. The bibliographic search was conducted in June 2020 in the LILACS, MEDLINE, Embase, Scopus, CINAHL, Academic Search Premier, and SocINDEX databases. The articles were selected, and data were extracted by two independent reviewers; the synthesis of the results was performed narratively. The methodological quality of articles was evaluated through specific instruments proposed by the Joanna Briggs Institute. Results A total of 11,226 publications were found, of which 35 were included in the study. Only one study reported improvement in the symptoms-onset-to-door time after protocol implementation. The effectiveness of the therapeutic approach protocols for ischemic stroke was identified in improving door-to-image, image-to-needle, door-to-needle and symptoms-onset-to-needle times. The main limitation found in the articles concerned the lack of clarity in relation to the study population. Conclusions Several advances have been identified in in-hospital care with protocol implementation; however, it is necessary to improve the recognition time of stroke symptoms among those who have the first contact with the person affected by the stroke and among the professionals involved with the prehospital care.

Resumo Antecedentes O tratamento do acidente vascular cerebral (AVC) isquêmico com terapia de reperfusão requer rápido atendimento e reconhecimento dos sintomas. Objetivo Analisar a efetividade da implementação de protocolos para AVC isquêmico agudo na redução do tempo de atendimento. Métodos Revisão sistemática realizada com estudos primários em português, inglês e espanhol publicados entre 2011 e 2020. Critérios de inclusão: a população do estudo foi constituída por pessoas com AVC isquêmico agudo e estudos que apresentassem resultados sobre a efetividade da implantação de protocolos no tempo de atendimento. A pesquisa bibliográfica foi realizada em junho de 2020 nas bases de dados LILACS, MEDLINE, Embase, Scopus, CINAHL, Academic Search Premier e SocINDEX. A seleção dos artigos e a extração dos dados foram feitas por dois revisores independentes; a síntese dos resultados foi feita de forma narrativa. A qualidade metodológica dos artigos foi avaliada por meio de instrumentos do Joanna Briggs Institute. Resultados Foram encontradas 11.226 publicações, das quais 35 foram incluídas no estudo. Apenas um estudo relatou melhora no tempo início dos sintomas-porta após a implementação do protocolo, no entanto, foi efetiva na melhora dos tempos porta-imagem, imagem-agulha, porta-agulha e início dos sintomas-agulha. A principal limitação encontrada nos artigos diz respeito à falta de clareza quanto à população de estudo. Conclusões Vários avanços foram identificados no atendimento intra-hospitalar com implantação de protocolo; porém, é necessário melhorar o tempo de reconhecimento dos sintomas do AVC entre aqueles que têm o primeiro contato com a pessoa acometida e entre os profissionais envolvidos com o atendimento pré-hospitalar.

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Phlegmasia cerulea dolens, a rare and potentially fatal complication of acute deep vein thrombosis, is characterized by substantial edema, intense pain, and cyanosis. Phlegmasia cerulea dolens may compromise limb perfusion and lead to acute ischemia, gangrene, amputation, and death. We present the case of a 61-year-old woman with a history of breast cancer who had signs and symptoms of phlegmasia cerulea dolens in her left leg. She was treated promptly with open surgical thrombectomy and sequential distal compression with use of an Esmarch bandage to ensure complete thrombus extraction. These techniques restored venous flow and saved her leg. Open surgical thrombectomy should be considered in the presence of limb-threatening acute deep vein thrombosis presenting as phlegmasia cerulea dolens.

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RESÚMEN: Introducción y Objetivo: La apendicitis aguda es una de las patologías quirúrgicas de emergencia frecuente, el diagnóstico es principalmente clínico y en caso de ser tardío tiene alto riesgo de complicaciones. El presente estudio busca ver la Utilidad diagnostica de los criterios de Alvarado para apendicitis aguda en el Instituto Gastroenterológico Boliviano Japonés - La Paz durante el año 2019. Material y Métodos: Se realizó un estudio prospectivo, descriptivo de corte transversal, en el IGBJ - La Paz, se desarrolló un cuestionario para una entrevista semiestructurada a pacientes internados con sospecha de apendicitis aguda. Resultados: El estudio reunió 54 pacientes, de los cuales 64.8% varones y 35.2% varones. La prueba para diagnosticar apendicitis aguda con un valor mayor a 7, tuvo una sensibilidad de 90% y especificidad es de 50% por lo que no se permite descartar una apendicitis ya que el 50% es un valor bajo, con un valor predictivo positivo de 96% y valor predictivo negativo de 29%, al realizar un corte en 9 o más para diagnóstico de apendicitis aguda complicada tuvo una sensibilidad de 63% y especificidad de 67%, el valor predictivo positivo de 81%, valor predictivo negativo de 43%. Conclusiones: Concluimos que los Criterios de Alvarado es una herramienta útil para el diagnóstico de casos de apendicitis complicada; pero no todas las variables nos sirven para el diagnóstico, las más representativas son el dolor en fosa iliaca derecha y rebote por lo tanto se recomienda el uso de la escala en los servicios de urgencias.

ABSTRACT: Introduction and Objective: Acute appendicitis is one of the frequent emergency surgical pathologies, the diagnosis is mainly clinical and if it is late it has a high risk of complications. The present study seeks to see the diagnostic utility of the Alvarado criteria for acute appendicitis at the Japanese Bolivian Gastroenterological Institute- La Paz during the year 2019. Material and Methods: A prospective, descriptive cross-sectional study was carried out at the IGBJ - La Paz, a questionnaire was developed for a semi- structured interview with inpatients with suspected acute appendicitis. Results: The study included 54 patients, of whom 64.8% were men and 35.2% were men. The test for acute appendicitis with a value greater than 7 had a sensitivity of 90% and a specificity of 50%, so appendicitis cannot be ruled out since 50% is a low value, with a positive predictive value of 96% and negative predictive value of 29%, when making a cut of 9 or more for diagnosis of complicated acute appendicitis had a sensitivity of 63% and specificity of 67%, positive predictive value of 81%, negative predictive value of 43%. Conclusions: We conclude that the Alvarado Criteria is a useful tool for the diagnosis of cases of complicated appendicitis; but not all variables are useful for diagnosis, the most representative are pain in the right iliac fossa and rebound, therefore the use of the scale is recommended in emergency services.

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ABSTRACT ACS is a potentially lethal condition caused by any event that produces an increase in IAP, inducing systemic collapse, tissue hypoperfusion and organ dysfunction. Thus, ACS is not exclusively a problem of the traumatic and surgical patient population.Iatrogenic ACS predisposes patients to multiple organ failure if no urgent action is taken.

RESUMO A SCA é uma condição potencialmente letal causada por qualquer evento que produza aumento da PIA induzindo colapso sistêmico, hipoperfusão tecidual e disfunção orgânica. Assim, a SCA não é um problema exclusivamente da população de pacientes traumáticos e cirúrgicos. A SCA iatrogénica predispõe os pacientes à falência de múltiplos órgãos se nenhuma ação urgente for tomada.

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BACKGROUND & AIMS: Acutely ill older adults are at higher risk of malnutrition. This study aimed to explore the applicability and accuracy of the GLIM criteria to diagnose malnutrition in acutely ill older adults in the emergency ward (EW). METHODS: We performed a retrospective secondary analysis, of an ongoing cohort study, in 165 participants over 65 years of age admitted to the EW of a Brazilian university hospital. Nutrition assessment included anthropometry, the Simplified Nutritional Assessment Questionnaire (SNAQ), the Malnutrition Screening Tool (MST), and the Mini-Nutritional Assessment (MNA). We diagnosed malnutrition using GLIM criteria, defined by the parallel presence of at least one phenotypic [nonvolitional weight loss (WL), low BMI, low muscle mass (MM)] and one etiologic criterion [reduced food intake or assimilation (RFI), disease burden/inflammation]. We used the receiver operating characteristic (ROC) curves and Cox and logistic regression for data analyses. RESULTS: GLIM criteria, following the MNA-SF screening, classified 50.3% of participants as malnourished, 29.1% of them in a severe stage. Validation of the diagnosis using MNA-FF as a reference showed good accuracy (AUC = 0.84), and moderate sensitivity (76%) and specificity (75.1%). All phenotypic criteria combined with RFI showed the best metrics. Malnutrition showed a trend for an increased risk of transference to intensive care unit (OR = 2.08, 95% CI 0.99, 4.35), and severe malnutrition for in-hospital mortality (HR = 4.23, 95% CI 1.2, 14.9). CONCLUSION: GLIM criteria, following MNA-SF screening, appear to be a feasible approach to diagnose malnutrition in acutely ill older adults in the EW. Nonvolitional WL combined with RFI or acute inflammation were the best components identified and are easily accessible, allowing their potential use in clinical practice.

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Introdução: O potencial de transformação maligna de células-tronco hematopoiéticas portadoras de mutações no gene glicosilfostatidilinositolclasse A (PIG-A) para leucemias agudas, embora raro, já é bem descrito na literatura. Objetivo: Neste estudo, porém, buscou-se evidenciar pela primeira vez na literatura o surgimento ou a manutenção de clones de hemoglobinúria paroxística noturna (HPN) em pacientes diagnosticados com leucemia aguda ou ainda após o início do tratamento quimioterápico. Método: A pesquisa de clones de HPN foi realizada por citometria de fluxo em blastos, hemácias, granulócitos ou monócitos de 47 amostras de sangue periférico e medula óssea de pacientes submetidos à investigação diagnóstica ou acompanhamento terapêutico, provenientes de dois hospitais oncológicos e públicos de Belém, no período de dezembro de 2017 a dezembro de 2018. Resultados: A presença de clones de HPN foi observada em 19/47 (40,4%) amostras de pacientes, em investigação diagnóstica ou acompanhamento terapêutico, que realizaram pelo menos um estudo de acompanhamento terapêutico e ainda tiveram o surgimento ou a manutenção do clone de HPN mesmo após iniciado o tratamento quimioterápico. Conclusão: Foi possível evidenciar, de forma primária, a presença de clones de HPN em pacientes diagnosticados com leucemia aguda tanto no período de investigação diagnóstica como durante o acompanhamento terapêutico, independentemente da ontogenia celular. Sem, porém, que se possa ainda avaliar a importância da presença desses clones de HPN para a evolução da doença primária, prognóstico ou necessidade de tratamento específico.

Introduction: The potential for malignant transformation of hematopoietic stem cells carrying mutations in theglycosylphosphatidylinositol class A (PIG-A) gene for acute leukemias, although rare, is already well described in the literature. Objective: In this study, however, it was attempted to show for the first time in the literature the emergence or maintenance of paroxysmal nocturnal hemoglobinuria (PNH) clones in patients diagnosed with acute leukemia or even after the beginning of the chemotherapy treatment. Method: The search of PNH clones was performed by flow cytometry in blasts, erythrocytes, granulocytes or monocytes of 47 samples of peripheral blood and bone marrow from patients undergoing diagnostic investigation or therapeutic follow-up in two oncological and public hospitals in Belém, from December 2017 to December 2018. Results: The presence of PNH clones was observed in 19/47 (40.4%) patient samples, in diagnostic investigation or therapeutic follow-up, who participated of at least one therapeutic follow-up study and still experience the appearance or maintenance of the PNH clone even after the beginning of the chemotherapy treatment. Conclusion: Primarily, it was possible to demonstrate the presence of PNH clones in patients diagnosed with acute leukemia both during the diagnostic investigation period and therapeutic follow-up, regardless of cell ontogeny. However, the importance of the presence of these PNH clones for the evolution of the primary disease, prognosis or need for specific treatment was not evaluated yet.

Introducción: El potencial de transformación maligna de las células madre hematopoyéticas que portan mutaciones en el gen glicosofosfatidilinositol (GPI) clase A (PIGA) para las leucemias agudas, aunque raro, ya está bien descrito en la literatura. Objetivo: En este estudio, sin embargo, buscamos mostrar por primera vez en la literatura la aparición o mantenimiento de clones de HPN en pacientes diagnosticados de leucemia aguda o incluso después del inicio de la quimioterapia. Método: La investigación de clones de hemoglobinuria paroxística nocturna (HPN) se realizó mediante citometría de flujo en blastos, eritrocitos, granulocitos o monocitos de 47 muestras de sangre periférica y médula ósea de pacientes sometidos a investigación diagnóstica o seguimiento terapéutico de dos hospitales oncológicos y públicos de Belém, durante el período. de diciembre de 2017 a diciembre de 2018. Resultados: La presencia de clones HPN se observó en 19/47 (40,4%) muestras de pacientes, en investigación diagnóstica o seguimiento terapéutico, que realizaron al menos un estudio de seguimiento terapéutico y aún tenían la aparición o mantenimiento del clon HPN incluso después de iniciado el tratamiento de quimioterapia. Conclusión: Se pudo evidenciar, de forma primaria, la presencia de clones de HPN en pacientes diagnosticados de leucemia aguda tanto durante el período de investigación diagnóstica como durante el seguimiento terapéutico, independientemente de la ontogenia celular. Sin embargo, no podemos todavía evaluar la importancia de la presencia de estos clones de HPN para la evolución de la enfermedad primaria, el pronóstico o la necesidad de un tratamiento específico.

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The increasing incidence of calcaneal tendon ruptures has substantially impacted orthopedic care and costs related to its treatment and prevention. Primarily motivated by the increasing of life expectancy, the growing use of tenotoxic drugs and erratic access to physical activity, this injury accounts for considerable morbidity regardless of its outcome. In recent years, the evolution of surgical and rehabilitation techniques gave orthopedists better conditions to decide the most appropriate conduct in acute tendon rupture. Although still frequent due to their high neglect rate, Achilles chronic ruptures currently find simpler and more biological surgical options, being supported by a new specialty-focused paradigm.

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Objetivo: compreender a experiência vivenciada de famílias de adultos frente à morte encefálica e a opção pela não doação de órgãos. Método: estudo qualitativo fundamentado no Interacionismo Simbólico, realizado em um hospital público, no estado do Rio Grande do Sul, com seis famílias, que tiverem um familiar potencial doador de órgãos diagnosticado com morte encefálica e negaram a doação. Os dados foram obtidos por meio de entrevista narrativa no período de maio a novembro de 2016, após aprovação do Comitê de Ética da instituição, e analisados com ênfase no conteúdo. Resultados: refere-se a uma situação inesperada e desconhecida, de incertezas, dor e sofrimento ante o adoecimento, a morte encefálica e a decisão pela doação de órgãos ou não. Conclusão: Em um contexto interacional de incertezas, definido como o desmoronar da vida familiar por um evento inimaginável, a morte encefálica e a doação de órgãos é percebida como a intensificação da perda, o que corrobora na decisão pela não doação.

Objective: to understand the lived experience of adult families in cases of brain death and the option not to donate organs. Method: this qualitative study based on Symbolic Interactionism was conducted at a public hospital in Rio Grande do Sul state, with six families who had a potential organ donor family member diagnosed with brain death and who refused to donate. Data were obtained through narrative interviews between May and November 2016, after ethics committee approval, and analyzed with emphasis on content. Results: this was an unexpected and unknown situation of uncertainties, pain, and suffering from illness, brain death, and the decision whether to donate organs or not. Conclusion: in an interactional context of uncertainties, specifically the collapse of family life following an unimaginable event, brain death and organ donation were perceived to intensify the loss, which corroborated the decision to not donate.

Objetivo: comprender la experiencia vivida de las familias adultas en casos de muerte cerebral y la opción de no donar órganos. Método: este estudio cualitativo basado en Interaccionismo Simbólico se realizó en un hospital público del estado de Rio Grande do Sul, con seis familias que tenían un familiar donante potencial de órganos diagnosticado con muerte cerebral y que se negaron a donar. Los datos se obtuvieron a través de entrevistas narrativas entre mayo y noviembre de 2016, luego de la aprobación del comité de ética, y se analizaron con énfasis en el contenido. Resultados: se trata de una situación inesperada y desconocida de incertidumbre, dolor y sufrimiento por enfermedad, muerte cerebral y la decisión de donar órganos o no. Conclusión: en un contexto interaccional de incertidumbres, específicamente el colapso de la vida familiar tras un evento inimaginable, se percibió que la muerte encefálica y la donación de órganos intensificaban la pérdida, lo que corroboró la decisión de no donar.

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Abstract The increasing incidence of calcaneal tendon ruptures has substantially impacted orthopedic care and costs related to its treatment and prevention. Primarily motivated by the increasing of life expectancy, the growing use of tenotoxic drugs and erratic access to physical activity, this injury accounts for considerable morbidity regardless of its outcome. In recent years, the evolution of surgical and rehabilitation techniques gave orthopedists better conditions to decide the most appropriate conduct in acute tendon rupture. Although still frequent due to their high neglect rate, Achilles chronic ruptures currently find simpler and more biological surgical options, being supported by a new specialty-focused paradigm.

Resumo A crescente incidência de rupturas do tendão calcâneo tem impactado substancialmente o cuidado ortopédico e os custos relacionados ao seu tratamento e prevenção. Motivada principalmente pelo aumento da expectativa de vida, o crescimento do uso de drogas tenotóxicas e o acesso errático à atividade física, essa lesão gera morbidade considerável aos pacientes qualquer seja o desfecho a ser considerado. A evolução das técnicas cirúrgicas e de reabilitação permitiu que ortopedistas, nos últimos anos, tivessem melhores condições para decidir a conduta mais apropriada nas roturas agudas do tendão calcâneo. Por mais que ainda frequentes pela sua alta taxa de negligência, as rupturas crônicas do Aquiles hoje encontram opções operatórias biológicas mais simples e são amparadas por um novo paradigma que se debruça sobre a especialidade.

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AIMS AND OBJECTIVES: To compare and evaluate interobserver (nurses and physicians) agreement for dengue clinical signs and symptoms, including the World Health Organization diagnostic algorithm. BACKGROUND: Agreement of clinical history defines the capacity of the examiner to measure a given clinical parameter in a reproducible and consistent manner, which is prerequisite for diagnosis validity. Nurses play a major role in the triage and care of dengue patients in many countries. STUDY DESIGN: This is a sub-study on interobserver agreement performed as part of a cross-sectional diagnostic accuracy study for acute febrile illness (AFI) using the checklist STARD. METHODS: A previously validated semi-structured sign and symptom standardised questionnaire for AFI was independently administered to 374 patients by physician and nurse pairs. The interobserver agreement was estimated using kappa statistics. RESULTS: For a set of 27 signs and symptoms, we found six interobserver discrepancies (examiner detected red eyes, lethargy, exanthema, dyspnoea, bleeding and myalgia) as identified by regular and moderate kappa indexes. Four signs (patient observed red eyes, cough, diarrhoea and vomiting) and one symptom (earache) had near-perfect agreement. Most signs and symptoms showed substantial agreement. The WHO (Dengue guidelines for diagnosis, treatment, prevention and control: new edition, World Health Organization, 2009) clinical criteria for dengue comprise a group of symptoms known as "pains and aches." Interobserver agreement for abdominal pain, retro-orbital pain and arthralgia exceed that found for headache and myalgia. CONCLUSIONS: During a dengue outbreak, the interobserver agreement for most of the signs and symptoms used to assess AFI was substantial. RELEVANCE TO CLINICAL PRACTICE: This result suggests good potential applicability of the tool by health professionals following training. A well-trained health professional is qualified to apply the standardised questionnaire to evaluate suspected dengue cases during outbreaks.

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Resumen: Introducción: la gastroenteritis aguda (GEA) es una enfermedad prevalente en la infancia. En 2014 se publica la guía nacional de abordaje de GEA, no existen estudios que evalúen su cumplimiento. Objetivo: determinar el grado de cumplimiento de las guías nacionales de abordaje terapéutico para GEA en niños menores de 3 años admitidos en el Centro Hospitalario Pereira Rossell durante los años 2015-2017. Material y método: estudio descriptivo, retrospectivo. Se incluyeron todos los menores de 3 años hospitalizados por GEA. Variables: edad, hidratación al ingreso, contraindicación para la vía oral, tratamientos. El cumplimiento de recomendaciones se evaluó comparando la conducta recomendada con la adoptada en cada caso, en forma global y en tres dominios: plan de hidratación; nutricional, y prescripción de antimicrobianos. Se catalogó al cumplimiento: bueno >80%, aceptable 60-79%, malo <60%. Resultados: se hospitalizaron 487 niños por GEA, mediana de edad 10,7 meses; con deshidratación 59% (289), leve (59), moderada (193), severa (37); con contraindicación de la vía oral 39%. Se indicó terapia de hidratación intravenosa (TRIV) a 44,5% de niños sin contraindicación de vía oral. El cumplimiento global de las recomendaciones nacionales fue de 77%: plan de hidratación 76%, (niños sin deshidratación 86%, con deshidratación: leve 69%, moderada 70% y severa 65%); plan nutricional 82% y en prescripción de antimicrobianos 72%. Conclusiones: el cumplimiento global de las recomendaciones fue aceptable. Si bien se detectaron algunos puntos a fortalecer: reservar la TRIV para situaciones en donde exista contraindicación a la vía oral/enteral y utilizar dosis y tiempos de infusión recomendados.

Summary: Introduction: acute gastroenteritis (AGE) is a prevalent disease in childhood. The AGE National Guidelines were published in 2014 in Uruguay, but there are no studies assessing its compliance. Objectives: to determine the degree of compliance with the AGE therapeutic guidelines for the case of children of under 3 years of age admitted at the Pereira Rossell Hospital Center during 2015-2017. Materials and methods: descriptive, retrospective study. All children under 3 years of age hospitalized for AGE were included. Variables: age, hydration level at admission, contraindication for oral administration treatments. Compliance with recommendations was evaluated by comparing the recommended behavior with the one actually adopted in each case, in general and specifically regarding three aspects: hydration plan; nutritional and antimicrobial prescription. Compliance was classified as: good >80%, acceptable 79-60, bad <60%. Results: 487 children were hospitalized for AGE, median age 10.7 months; dehydrated 59% (289), mild (59), moderate (193), severe (37); with contraindication of oral administration 39%. Intravenous hydration therapy (IVHT) was prescribed for 44.5% of children without oral contraindication. Overall compliance with national recommendations was 77%: hydration plan 76%, (children without dehydration 86%, with dehydration: mild 69%, moderate 70% and severe 65%); nutritional plan 82% and antimicrobial prescription 72%. Conclusions: global compliance with the recommendations was acceptable. However, some areas for improvement were identified: IVHT should be reserved for situations where there is contraindication to the oral / enteral route and the recommended dosage and infusion time should be respected.

Resumo: Introdução: a gastroenterite aguda (GEA) é uma doença prevalente na infância. As diretrizes nacionais de abordagem da GEA foram publicadas no ano 2014, más ainda não há estudos avaliando sua conformidade. Objetivos: determinar o grau de cumprimento com as diretrizes nacionais para a abordagem terapêutica da GEA em crianças menores de 3 anos internadas no Centro Hospitalar Pereira Rossell durante os anos 2015-2017. Materiais e métodos: estudo descritivo retrospectivo. Todas as crianças menores de 3 anos hospitalizadas por GEA foram incluídas. Variáveis: idade, nível de hidratação na admissão, contra-indicação para tratamentos por via oral. O cumprimento das recomendações foi avaliado comparando comportamento recomendado com o adotado em cada caso, a nível geral e em três aspectos: plano de hidratação; prescrição nutricional e antimicrobiana. A conformidade foi classificada como: boa >80%, aceitável 79-60, ruim <60%. Resultados: 487 crianças foram hospitalizadas por GEA, a idade mediana foi de 10,7 meses; 59% (289) estavam desidratadas, leves (59), moderadas (193), graves (37); com contra-indicação da via oral 39%. A terapia de hidratação intravenosa (THIV) foi indicada em 44,5% das crianças sem contra-indicação oral. O cumprimento geral das recomendações nacionais foi de 77%: plano de hidratação 76%, (crianças sem desidratação 86%, com desidratação: leve 69%, moderada 70% e grave 65%); plano nutricional 82% e prescrição de antimicrobianos 72%. Conclusões: o cumprimento global das recomendações foi aceitável. No entanto, foram identificadas algumas áreas de melhoria: A THV deve ser reservada para situações em que haja contra-indicação à via oral / enteral e a posologia e o tempo de infusão recomendados devem ser respeitados.

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Acute aortic syndromes include a spectrum of life-threatening aortic conditions. A review of the diagnostic aspects of the acute aortic syndrome was made, from the perspective of the imaging techniques available for this purpose. The advantages and disadvantages of each technique and its diagnostic performance were evaluated. Emphasis was placed on the relevance of clinical information as a fundamental tool for suspecting this syndrome and appropriately choosing the imaging technique. Our main objective is to provide information about the diagnosis of this condition, especially in the context of emergency services.

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Background: We aimed to screen for depressive mood experienced during acute chikungunya (CHIKV) infection, and to evaluate the association of several exposures with the risk of depressive symptoms. Methods: A cross-sectional analysis of a multicenter cohort study took place and data from 354 adult individuals with confirmed CHIKV infection were analyzed. Participants were recruited in primary health care settings and the Patient Health Questionnaire-2 (PHQ-2) was used. Prevalence odds ratios (OR) and 95% confidence intervals (CIs) estimated by means of logistic models were used. Results: Depressive mood (PHQ-2 score 3 or higher) was reported by 44.1% of individuals. Subjects with articular effusion (OR = 3.37, 95% CI 1.77⁻8.11), gastrointestinal manifestations (diarrhea, vomiting or abdominal pain, OR = 1.97, 95 CI 1.21⁻3.19), and higher length of severe arthralgia (reference ≤ 14 days: 15⁻30 days, OR = 3.38, 95% CI 1.78⁻6.41; ≥ 30 days, OR = 1.69, 95% CI 0.95⁻3.01) were more likely to self-report depressive mood. Increasing age (≥ 40 years old, OR = 0.55, 95% CI 0.31⁻0.95) and rash (OR = 0.54, 95% CI 0.30⁻0.98) were associated with a decreased risk of depressive mood. Conclusions: Depressive mood seemed to be a frequent event among analyzed individuals, and markers associated with its risk were identified.

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