Resumo Introdução: A lesão renal aguda (LRA) foi descrita em pacientes com doença do Coronavírus 2019 (COVID-19) e é considerada um marcador de gravidade da doença e fator prognóstico negativo para sobrevivência. Neste estudo, os autores visaram estudar o impacto da lesão renal aguda transitória e persistente (LRAp) na mortalidade hospitalar em pacientes com COVID-19. Métodos: Estudo observacional retrospectivo de pacientes internados com COVID-19 no Departamento de Medicina do Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal, entre Março-Agosto de 2020. Realizou-se análise multivariada para prever desenvolvimento de LRA e mortalidade hospitalar. Resultados: De 544 pacientes com COVID-19, 330 desenvolveram LRA: 166 LRA persistente (LRAp), 164, LRA transitória. Pacientes com LRA eram mais velhos, apresentaram mais comorbidades prévias, maior necessidade de serem medicados com inibidores do SRAA, apresentaram creatina sérica basal mais elevada (CrS) (1,60 mg/dL vs 0,87 mg/dL), maior razão NL, e acidemia mais grave na admissão hospitalar, e necessitaram mais frequentemente de internação na UTI, ventilação mecânica, e uso de vasopressores. Pacientes com LRA persistente apresentaram maior nível de CrS (1,71 mg/dL vs 1,25 mg/dL) na admissão hospitalar. A mortalidade hospitalar foi de 14,0% e foi maior em pacientes com LRA (18,5% vs 7,0%). A DRC e ferritina sérica foram preditores independentes de LRA. A LRA não previu mortalidade, mas a LRAp foi um preditor independente de mortalidade, assim como idade e nível de lactato. Conclusão: A LRAp foi associada independentemente à mortalidade hospitalar em pacientes com COVID-19, mas seu impacto no acompanhamento de longo prazo ainda precisa ser determinado.

Abstract Introduction: Acute kidney injury (AKI) has been described in Coronavirus Disease 2019 (COVID-19) patients and is considered a marker of disease severity and a negative prognostic factor for survival. In this study, the authors aimed to study the impact of transient and persistent acute kidney injury (pAKI) on in-hospital mortality in COVID-19 patients. Methods: This was a retrospective observational study of patients hospitalized with COVID-19 in the Department of Medicine of the Centro Hospitalar Universitario Lisboa Norte, Lisbon, Portugal, between March 2020 and August 2020. A multivariate analysis was performed to predict AKI development and in-hospital mortality. Results: Of 544 patients with COVID-19, 330 developed AKI: 166 persistent AKI (pAKI), 164 with transient AKI. AKI patients were older, had more previous comorbidities, had higher need to be medicated with RAAS inhibitors, had higher baseline serum creatine (SCr) (1.60 mg/dL vs 0.87 mg/dL), higher NL ratio, and more severe acidemia on hospital admission, and more frequently required admission in intensive care unit, mechanical ventilation, and vasopressor use. Patients with persistent AKI had higher SCr level (1.71 mg/dL vs 1.25 mg/dL) on hospital admission. In-hospital mortality was 14.0% and it was higher in AKI patients (18.5% vs 7.0%). CKD and serum ferritin were independent predictors of AKI. AKI did not predict mortality, but pAKI was an independent predictor of mortality, as was age and lactate level. Conclusion: pAKI was independently associated with in-hospital mortality in COVID-19 patients but its impact on long-term follow-up remains to be determined.

SUMMARY OBJECTIVE: The objective of this study was to evaluate the quality of life of patients with noncystic fibrosis bronchiectasis during a 1-year follow-up by using the EuroQol – 5 Dimensions – 3 Levels (EQ-5D-3L) questionnaire. METHODS: A cohort study was conducted with 100 patients with noncystic fibrosis bronchiectasis and followed up with face-to-face visits or by telephone contact every 3 months for 1 year. All patients were recruited from a single referral center for bronchiectasis. At the time of recruiting and at the end of 1 year, the EQ-5D-3L questionnaire was applied to evaluate the patients’ quality of life. Variables, such as exacerbation, emergency care, comorbidities, hemoptysis, colonization, and hospitalization, were assessed. RESULTS: Of the 100 patients, 99 completed the study and 72% were women. There were no marked limitations in the mobility and self-care domains during the follow-up. At the end of the follow-up, 32 patients were extremely anxious or depressed. The quality of life assessed by using EQ-5D-3L had an initial mean score of 0.545 and of 0.589 after 1 year, which was statistically significant (p=0.011). CONCLUSION: Patients with noncystic fibrosis bronchiectasis have a poor quality of life, and the EQ-5D-3L questionnaire may be a tool for monitoring patients with bronchiectasis.

Resumo: Neste artigo traço, em linhas gerais, primeiramente, um breve esboço da genealogia do conceito de interseccionalidade, suas contribuições relevantes para os feminismos e suas apropriações equívocas para, em um segundo momento, analisar a leitura crítica que María Lugones faz do conceito e assinalar alguns limites dessa avaliação.

Abstract: In this article, I outline, first, a brief genealogy of the concept of intersectionality, its relevant contributions to feminisms and its equivocal appropriations. Second, I analyze the critical reading that María Lugones makes of this concept and point to some of the limitations of her assessment.

Resumen: En este artículo presento, en primer lugar, un breve esbozo de la genealogía del concepto de interseccionalidad, sus relevantes aportes a los feminismos y sus apropiaciones equívocas y, luego, analizo la lectura crítica que hace María Lugones del concepto, señalando algunos límites de su evaluación.

SUMMARY OBJECTIVE: This study aims to analyze the risk factors for in-hospital mortality in a cohort of patients admitted to a newly adapted intensive care unit in a public hospital in Rio de Janeiro. METHODS: This was an observational, retrospective, and descriptive study. Data were obtained from electronic medical records. Coronavirus disease 2019 (COVID-19) was diagnosed by detecting viral ribonucleic acid using reverse transcription polymerase chain reaction. Factors associated with the risk/protection from death were determined using the odds ratio and adjusted odds ratio. RESULTS: Fifty-one patients were admitted to the hospital. The median age of the patients was 63 years, 60% were male patients, and 54% were white patients. Sixty-seven percent of the patients were diagnosed with COVID-19. Sepsis at admission increased the chance of in-hospital death by 21 times (adjusted odds ratio=21.06 [0.79–555.2]; p=0.06). The strongest risk factor for death was the development of septic shock during hospitalization (adjusted odds ratio=98.56 [2.75–352.5]; p=0.01), and one in four patients had multidrug-resistant bacteria. Mechanical ventilation, vasopressors, neuromuscular blockers, and sedatives were also the risk factors for in-hospital mortality. The in-hospital mortality rate was 41%, and the mortality rate of patients on mechanical ventilation was 60%. The diagnosis of COVID-19 was not statistically related to the adverse outcomes. CONCLUSIONS: In this cohort, the strongest risk factor for in-hospital death was the development of nosocomial septic shock. Healthcare-associated infections have a significant impact on mortality rates. Therefore, to have a better outcome, it is important to consider not only the availability of beds but also the way healthcare is delivered.

RESUMO Objetivo sintetizar o conhecimento relacionado às estratégias para redução de erros de medicação durante a hospitalização de pacientes adultos Método revisão integrativa da literatura realizada em outubro de 2020 por meio da busca de publicações nas bases de dados eletrônicas: Web of Science, Pubmed, Cumulative Index of Nursing and Allied Health Literature, Literatura Latino-Americana e do Caribe em Ciências da Saúde e Google Scholar Resultados amostra composta por 12 estudos, cujas estratégias para a redução de erros de medicação foram apresentadas de acordo com as categorias: envolvimento do farmacêutico clínico nas atividades clínicas, implantação de tecnologias da informação, estratégias educacionais mediadas por simulação e jogos, e redução da carga de trabalho Conclusão associado às tecnologias, o envolvimento do farmacêutico clínico com a equipe médica e de enfermagem resultará em melhorias na redução dos eventos adversos a medicamentos e na qualidade da assistência prestada ao paciente

ABSTRACT Objective to synthesize the knowledge related to strategies to reduce medication errors during the hospitalization of adult patients Method integrative literature review carried out in October 2020 through the search for publications in electronic databases: Web of Science, Pubmed, Cumulative Index of Nursing and Allied Health Literature, Latin American and Caribbean literature in Health Sciences and Google Scholar Results sample composed of 12 studies, whose strategies for the reduction of medication errors were presented according to the categories: involvement of the clinical pharmacist in clinical activities, implementation of information technologies, educational strategies mediated by simulation and games, and workload reduction Conclusion associated with technologies, the involvement of the clinical pharmacist in the medical and nursing team will result in improvements in the reduction of adverse medication events and in the quality of care provided to the patient

RESUMEN Objetivo sintetizar el conocimiento relacionado a las estrategias para reducción de errores de medicación durante la hospitalización de pacientes adultos Método revisión integradora de la literatura realizada en octubre de 2020 por medio de la búsqueda de publicaciones en las bases de datos electrónicas: Web of Science, Pubmed, Cumulative Index of Nursing and Allied Health Literature, Literatura Latinoamericana y del Caribe en Ciencias de la Salud y Google Scholar Resultados muestra compuesta por 12 estudios, cuyas estrategias para reducir los errores de medicación se presentaron según las categorías: implicación del farmacéutico clínico en las actividades clínicas, implementación de tecnologías de la información, estrategias educativas mediadas por simulación y juegos, y reducción de la carga de trabajo Conclusión asociada a las tecnologías, la implicación del farmacéutico clínico con el equipo médico y de enfermería se traducirá en mejoras en la reducción de los efectos adversos de los medicamentos y en la calidad de la atención al paciente

RESUMO A fibrose pulmonar idiopática (FPI) é uma forma de pneumopatia intersticial crônica fibrosante de causa desconhecida, que acomete preferencialmente homens idosos, com história atual ou pregressa de tabagismo. Mesmo sendo uma doença incomum, ela assume grande importância devido a sua gravidade e prognóstico reservado. Nas últimas décadas, diversas modalidades terapêuticas farmacológicas foram investigadas para o tratamento dessa doença, de tal modo que conceitos clássicos vêm sendo revisados. O objetivo destas diretrizes foi definir recomendações brasileiras baseadas em evidências em relação ao emprego de agentes farmacológicos no tratamento da FPI. Procurou-se fornecer orientações a questões de ordem prática, enfrentadas pelos clínicos no seu cotidiano. As perguntas PICO (acrônimo baseado em perguntas referentes aos Pacientes de interesse, Intervenção a ser estudada, Comparação da intervenção e Outcome [desfecho] de interesse) abordaram aspectos relativos ao uso de corticosteroides, N-acetilcisteína, tratamento medicamentoso do refluxo gastroesofágico, inibidores dos receptores da endotelina, inibidores da fosfodiesterase-5, pirfenidona e nintedanibe. Para a formulação das perguntas PICO, um grupo de especialistas brasileiros atuantes na área foi reunido, sendo realizada uma extensa revisão bibliográfica sobre o tema. As revisões sistemáticas com meta-análises previamente publicadas foram analisadas quanto à força das evidências compiladas e, a partir daí, foram concebidas recomendações seguindo a metodologia Grading of Recommendations Assessment, Development and Evaluation. Os autores acreditam que o presente documento represente um importante avanço a ser incorporado na abordagem de pacientes com FPI, objetivando principalmente favorecer seu manejo, e pode se tornar uma ferramenta auxiliar na definição de políticas públicas relacionadas à FPI.

ABSTRACT Idiopathic pulmonary fibrosis (IPF) is a form of chronic interstitial lung disease of unknown cause, which predominantly affects elderly men who are current or former smokers. Even though it is an uncommon disease, it is of great importance because of its severity and poor prognosis. In recent decades, several pharmacological treatment modalities have been investigated for the treatment of this disease, and the classic concepts have therefore been revised. The purpose of these guidelines was to define evidence-based recommendations regarding the use of pharmacological agents in the treatment of IPF in Brazil. We sought to provide guidance on the practical issues faced by clinicians in their daily lives. Patients of interest, Intervention to be studied, Comparison of intervention and Outcome of interest (PICO)-style questions were formulated to address aspects related to the use of corticosteroids, N-acetylcysteine, gastroesophageal reflux medications, endothelin-receptor antagonists, phosphodiesterase-5 inhibitors, pirfenidone, and nintedanib. To formulate the PICO questions, a group of Brazilian specialists working in the area was assembled and an extensive review of the literature on the subject was carried out. Previously published systematic reviews with meta-analyses were analyzed for the strength of the compiled evidence, and, on that basis, recommendations were developed by employing the Grading of Recommendations Assessment, Development and Evaluation approach. The authors believe that the present document represents an important advance to be incorporated in the approach to patients with IPF, aiming mainly to improve its management, and can become an auxiliary tool for defining public policies related to IPF.

RESUMO Objetivo: Analisar os sintomas em diferentes momentos do dia em pacientes com DPOC. Métodos: Estudo observacional multicêntrico de corte transversal em oito centros brasileiros. Foram avaliados os sintomas matinais, diurnos e noturnos em pacientes com DPOC estável. Resultados: Foram incluídos 593 pacientes em tratamento regular, sendo 309 (52,1%) do sexo masculino e 92 (15,5%) fumantes ativos. A média de idade foi de 67,7 anos, e a média de VEF1 foi de 49,4% do valor previsto. Os pacientes com sintomas mais graves (n = 183; 30,8%), em comparação com aqueles com sintomas leves e moderados, apresentaram pior nível de atividade física (p = 0,002), maior limitação ao fluxo aéreo (p < 0,001), exacerbações ambulatoriais (p = 0,002) e hospitalares (p = 0,043) mais frequentemente e piores resultados em instrumentos específicos. Os sintomas matinais e noturnos mais frequentes foram dispneia (em 45,2% e 33,1%, respectivamente), tosse (em 37,5% e 33,3%, respectivamente) e chiado (em 24,4% e 27,0%, respectivamente). Houve forte correlação da intensidade dos sintomas diurnos com sintomas matinais (r = 0,65, p < 0,001), sintomas noturnos (r = 0,60, p < 0,001), bem como com o escore do COPD Assessment Test (r = 0,62; p < 0,001); porém, houve uma correlação fraca com VEF1 (r = −0,205; p < 0,001). Conclusões: A dispneia foi mais frequente no período matinal do que no período noturno. Ter sintomas matinais e/ou noturnos foi associado à pior gravidade dos sintomas diurnos. A intensidade dos sintomas foi fortemente associada a pior qualidade de vida e frequência de exacerbações, mas fracamente associada à limitação ao fluxo aéreo.

ABSTRACT Objective: To analyze symptoms at different times of day in patients with COPD. Methods: This was a multicenter, cross-sectional observational study conducted at eight centers in Brazil. We evaluated morning, daytime, and nighttime symptoms in patients with stable COPD. Results: We included 593 patients under regular treatment, of whom 309 (52.1%) were male and 92 (15.5%) were active smokers. The mean age was 67.7 years, and the mean FEV1 was 49.4% of the predicted value. In comparison with the patients who had mild or moderate symptoms, the 183 (30.8%) with severe symptoms were less physically active (p = 0.002), had greater airflow limitation (p < 0.001), had more outpatient exacerbations (p = 0.002) and more inpatient exacerbations (p = 0.043), as well as scoring worse on specific instruments. The most common morning and nighttime symptoms were dyspnea (in 45.2% and 33.1%, respectively), cough (in 37.5% and 33.3%, respectively), and wheezing (in 24.4% and 27.0%, respectively). The intensity of daytime symptoms correlated strongly with that of morning symptoms (r = 0.65, p < 0.001) and that of nighttime symptoms (r = 0.60, p < 0.001), as well as with the COPD Assessment Test score (r = 0.62; p < 0.001), although it showed only a weak correlation with FEV1 (r = −0.205; p < 0.001). Conclusions: Dyspnea was more common in the morning than at night. Having morning or nighttime symptoms was associated with greater daytime symptom severity. Symptom intensity was strongly associated with poor quality of life and with the frequency of exacerbations, although it was weakly associated with airflow limitation.

OBJECTIVES: To describe the experience of an outpatient clinic with the multidisciplinary evaluation of intensive care unit survivors and to analyze their social, psychological, and physical characteristics in a low-income population and a developing country. METHODS: Retrospective cohort study. Adult survivors from a general intensive care unit were evaluated three months after discharge in a post-intensive care unit outpatient multidisciplinary clinic over a period of 6 years (2008-2014) in a University Hospital in southern Brazil. RESULTS: A total of 688 out of 1945 intensive care unit survivors received care at the clinic. Of these, 45.2% had psychological disorders (particularly depression), 49.0% had respiratory impairments (abnormal spirometry), and 24.6% had moderate to intense dyspnea during daily life activities. Patients experienced weight loss during hospitalization (mean=11.7%) but good recovery after discharge (mean gain=9.1%), and 94.6% were receiving nutrition orally. One-third of patients showed a reduction of peripheral muscular strength, and 5.7% had moderate to severe tetraparesis or tetraplegia. There was a significant impairment in quality of life (SF-36), particularly in the physical and emotional aspects and in functional capacity. The economic impacts on the affected families, which were mostly low-income families, were considerable. Most patients did not have full access to rehabilitation services, even though half of the families were receiving financial support from the government. CONCLUSIONS: A significant number of intensive care unit survivors evaluated 3 months after discharge had psychological, respiratory, motor, and socioeconomic problems; these findings highlight that strategies aimed to assist critically ill patients should be extended to the post-hospitalization period and that this problem is particularly important in low-income populations.

Resumo A ocorrência de coloração anômala (albinismo, leucísmo e melanismo) em mamíferos é um fenômeno raro na natureza, mas ela tem sido relatada para diversas espécies. Neste trabalho nós relatamos a ocorrência de leucísmo em Eira barbara por meio do exame de três indivíduos encontrados mortos atropelados por veículos e pela visualização direta de indivíduos vivos na Reserva Particular do Patrimônio Natural Santuário do Caraça, sudeste brasileiro. Em adição, nós consultamos coleções de mamíferos em museus do Brasil e dos Estados Unidos da América. Os animais encontrados mortos e os avistados apresentavam pelagem amarela esbranquiçada no corpo e na cabeça, resultando em uma coloração muito mais clara que o padrão de coloração comumente observado em iraras. Apesar deste padrão de coloração mais claro, os espécimes apresentavam partes do tecido mole, tais como a íris e a pele, com pigmentação muito semelhante àquela presente em indivíduos com padrão de coloração típico da espécie. Este conjunto de fatores indicou que os espécimes registrados eram de fato leucísticos e não albinos. Dentre os espécimes examinados nas coleções científicas, nós encontramos nove indivíduos de diferentes localidades que apresentavam o padrão de coloração esbranquiçado. Alguns estudos atribuem a frequência elevada de casos de leucísmo a pequenas populações e / ou com algum mecanismo de isolamento reprodutivo. Dessa forma, análises da variabilidade genética de populações contendo indivíduos com essas características devem ser consideradas. Por outro lado, a ocorrência de fenótipos de coloração polimórficos em iraras indica que hipóteses podem ser testadas tanto com relação à fixação de caraterísticas recessivas, quanto sobre possíveis vantagens adaptativas ambientais desses fenótipos.

Abstract The occurrence of anomalous coloration (albinism, leucism and melanism) in mammals is a rare phenomenon in nature, but this phenomenon has been reported for several species of mammals. In this study, we report on the occurrence of leucism in Eira barbara by examining three road-killed individuals and two sightings of live animals in Reserva Particular do Patrimônio Natural Santuário do Caraça, southeastern Brazil. In addition, we examined tayra specimens housed in mammal collections from Brazil and USA. The animals found dead and those sighted had a whitish yellow fur on the body and head, resulting in lighter coloration than the coloring pattern commonly observed in tayras. Despite these lighter color pattern, the specimens showed parts of soft tissue, such as iris and the skin, with pigmentation very similar to that present in individuals with the typical color pattern. This set of factors indicates the specimens recorded were in fact leucistic and not albino. Among the specimens examined in the scientific collections, we found nine individuals from different localities that presented the whitish yellow color pattern. Some studies attribute the higher frequency of cases of leucism due to small populations and / or with some mechanism of reproductive isolation. Thus, analysis of the genetic variability of populations containing individuals with such characteristics should be considered. On the other hand, the occurrence of polymorphic color phenotype in tayras indicates that hypotheses related to the fixation of recessive characteristics, or on possible environmental adaptive advantages of these phenotypes can be tested.

Resumo A esclerose sistêmica (ES) é uma doença autoimune crônica de alta morbimortalidade. Ainda que a ciclofosfamida seja eficaz, para casos graves e refratários há demanda para novos tratamentos. A terapia biológica com depleção de células B com rituximabe (RTX) demonstrou eficácia para tal demanda em estudos abertos. Objetivo Avaliar retrospectivamente todos os pacientes que fizeram uso do RTX para tratamento de ES em nosso centro. Pacientes e métodos Foram avaliados retrospectivamente todos os prontuários de pacientes com ES que fizeram uso de RTX para tratamento da ES de janeiro de 2009 a janeiro de 2015. Dados de acometimento sistêmico, cutâneo, pulmonar e laboratoriais antes e seis meses após a primeira infusão de RTX foram coletados. Resultados Dez pacientes receberam o tratamento no período de estudo e foram incluídos na presente série de casos. Todos os pacientes tinham a forma difusa da doença. Cinco pacientes tinham formas iniciais (tempo de doença menor ou igual a quatro anos) e rapidamente progressiva da doença e cinco receberam o RTX em fases tardias da doença. Houve estabilização do quadro pulmonar em ambos os grupos de pacientes e redução no escore cutâneo nos pacientes com formas iniciais da doença. Discussão Similar ao encontrado em estudos prévios, o RTX foi eficaz no tratamento de formas iniciais e rapidamente progressivas da ES. Verificamos também benefício em pacientes com longa duração da doença.

Abstract Systemic sclerosis (SSc) is a chronic autoimmune disease with a high morbidity and mortality. Although cyclophosphamide is effective for severe and refractory cases, there is demand for new treatments. The biological treatment with B-cell depletion with rituximab (RTX) has demonstrated efficacy for this demand in open-label studies. Objective This study was conducted with the aim to retrospectively evaluate all patients who used RTX for the treatment of SSc in our center. Patients and methods We retrospectively evaluated medical records of all patients with SSc who used RTX to treat this disease from January 2009 to January 2015. Systemic, cutaneous, and pulmonary involvement data and laboratory results before and six months after the first infusion of RTX were collected. Results Ten patients received treatment during the study period and were included in this series. All patients had a diffuse form of the disease. Five patients suffered from an early (duration of disease shorter or equal to four years), rapidly progressive disease, and another five received RTX at late stages of the disease. In both groups of patients, stabilization of the pulmonary picture was observed, with a fall in the skin score in those patients with early forms of the disease. Discussion Similar to findings in previous studies, RTX was effective in treating early and rapidly progressive forms of SSc. We also found that patients with long-term illness may benefit from the treatment.

Neste artigo, refaço a trajetória dos debates nos estudos culturais feministas, principalmente nos Estados Unidos, tendo como foco três tipos de abordagem em relação às dicotomias realidade/representação e texto/contexto. Como apreender a materialidade do mundo sem abrir mão do fato de que nossas narrativas/representações são sempre constitutivas desse mundo? Argumento que vejo ecos do que as feministas materiais defendem nas propostas cosmopolíticas latino-americanas para um feminismo descolonial. Alego que a articulação desses dois projetos (um advindo dos debates no Norte e o outro do Sul) pode servir de inspiração para repensarmos - e descolonizarmos - as práticas dos estudos culturais na América Latina.

In this article, I retrace the trajectory of the debates in feminist cultural studies, particularly in the United States, focusing on three types of approaches to the dichotomies reality/representation and text/context. How to grasp the materiality of the world without giving up the fact that our narratives/representations are always already constitutive of that world? I see echoes of what material feminists advocate vis-à-vis the thorny issue of the materiality of the world in the cosmopolitical proposals advanced by Latin American decolonial feminisms. I claim that the articulation of these two projects (one derived from debates in the North and the other from the South) can serve as an inspiration to rethink - and decolonize - the practices of cultural studies in Latin America.