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BACKGROUND Chikungunya is a mosquito-borne virus that has been causing large outbreaks in the Americas since 2014. In Brazil, Asian-Caribbean (AC) and East-Central-South-African (ECSA) genotypes have been detected and lead to large outbreaks in several Brazilian states. In Rio Grande do Sul (RS), the southernmost state of Brazil, the first cases were reported in 2016. OBJECTIVES AND METHODS We employed genome sequencing and epidemiological investigation to characterise the Chikungunya fever (CHIKF) burden in RS between 2017-2021. FINDINGS We detected an increasing CHIKF burden linked to travel associated introductions and communitary transmission of distinct lineages of the ECSA genotype during this period. MAIN CONCLUSIONS Until 2020, CHIKV introductions were most travel associated and transmission was limited. Then, in 2021, the largest outbreak occurred in the state associated with the introduction of a new ECSA lineage. CHIKV outbreaks are likely to occur in the near future due to abundant competent vectors and a susceptible population, exposing more than 11 million inhabitants to an increasing infection risk.

https://doi.org/10.1590/0074-02760220259

Construção e validação de curso online para enfermeiros sobre cateteres venosos centrais em crianças no domicílio
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Boettcher, Simone

; Santos, Marcelo Machado dos

; Leonhardt, Gabriela Beatriz

; Mallon, Milena

; Vidal, Elisângela de Fraga

; Souza, Luccas Melo de

; Paz, Adriana Aparecida

Escola Anna Nery

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2023, Volume 27 elocation e20220343

Abstract: En Es Pt | Text: En Es Pt | PDF: En | PDF: Es | PDF: Pt

Abstract Objective to construct an online, self-instructional course for nurses who provide care to children using a central venous catheter at home and validate the course content by experts. Method this is a methodological study, based on Instructional Design using the ADDIE model, developed in two stages between September 2019 and May 2020: course construction; and content validity by a committee of eight experts, recruited by the snowball method through electronic. The Educational Content Validation Instrument in Health was used, with a cut-off point ≥0.8 for content validity. Results twenty-five technological products are created for the course’s final production: four pedagogical action plans, six storyboards, nine educational video resources and 6 course modules in Sharable Content Object Reference Model format, applicable on different platforms. All modules presented a Content Validity Index ≥0.80 in all domains and in the overall assessment. Conclusion and implications for practice the content of all modules has been validated by experts. The course contributes to care practice, allowing updating based on current and scientifically validated content. It can be used in other pedagogical proposals, as long as the Creative Commons Attribution 4.0 International License premises are met.

Resumen Objetivo construir un curso en línea y de auto instrucción para enfermeras que brindan atención a niños utilizando un catéter venoso central en el hogar y validar el contenido del curso por especialistas. Método estudio metodológico, basado en Diseño Instruccional por el modelo ADDIE, desarrollado en dos etapas entre septiembre de 2019 y mayo de 2020: construcción del curso; y validación del contenido por un comité de ocho especialistas, reclutados por el método bola de nieve, electrónicamente. Se utilizó el Instrumento de Validación de Contenidos Educativos en Salud y se adoptó el punto de corte ≥0.8 para la validación de contenidos. Resultados en siete meses, se elaboran 25 productos tecnológicos para la producción final del curso: cuatro planes de acción pedagógica, seis storyboards, nueve recursos educativos de video y 6 módulos del curso en formato Sharable Content Object Reference Model, aplicables en diferentes plataformas. Todos los módulos mostraron un Índice de Validez de Contenido ≥0,80 en todos los dominios y en la evaluación general. Conclusión e implicaciones para la práctica el contenido de los módulos ha sido respaldado por especialistas. El curso contribuye a la práctica del cuidado, permitiendo la actualización a partir de contenidos actualizados y científicamente validados. Puede ser utilizado en otras propuestas pedagógicas, siempre que se cumplan las premisas de la Licencia Creative Commons 4.0 Internacional.

Resumo Objetivo construir um curso online e autoinstrucional para enfermeiros que realizam assistência às crianças em uso de cateter venoso central no domicílio e validar o conteúdo do curso por especialistas. Método estudo metodológico, alicerçado no Design Instrucional pelo modelo ADDIE, desenvolvido em duas etapas entre setembro de 2019 e maio de 2020: construção do curso; e validação do conteúdo por um comitê de oito especialistas, recrutados pelo método bola de neve por meio eletrônico. Utilizou-se o Instrumento de Validação de Conteúdo Educativo em Saúde, com ponto de corte ≥0,8 para a validação de conteúdo. Resultado s: elaboram-se 25 produtos tecnológicos para a produção final do curso: quatro planos de ação pedagógica, seis storyboards, nove recursos educativos em vídeo e 6 módulos do curso em formato Sharable Content Object Reference Model, aplicável em diferentes plataformas. Todos os módulos apresentaram Índice de Validade de Conteúdo ≥0,80 em todos os domínios e na avaliação global. Conclusão e implicações para a prática o conteúdo de todos os módulos foi validado pelos especialistas. O curso contribui para a prática assistencial, permitindo atualização com base em conteúdo atual e validado cientificamente. Ele pode ser utilizado em outras propostas pedagógicas, desde que atendidas as premissas da Licença Creative Commons 4.0 Internacional.

https://doi.org/10.1590/2177-9465-ean-2022-0343pt

Predictors of functional communication in people with aphasia after stroke
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Fernandes, Adriana

; Fraga-Maia, Helena

; Maso, Iara

; Matos, Isabela Guimarães

; Gomes, Lene

; Matos, Matheus

; Santana, Andressa

; Oliveira-Filho, Jamary

; Jesus, Pedro Antônio de

; Pinto, Elen Beatriz

Arquivos de Neuro-Psiquiatria

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jul 2022, Volume 80 N. 7 Pages 681 - 688

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

Abstract Background Aphasia, the most common language disorder secondary to stroke, has been associated with increased mortality, longer hospitalization and rehabilitation times, worse performance in daily activities, increased financial burden, and short- and long-term complications. Aphasia can negatively impact functional communication skills, including social networks, social activities, relationships with other people and social support. Objective To evaluate patients with poststroke aphasia in their respective residences to investigate potential predictors of functional communication. Methods The prospective cohort included patients with poststroke aphasia aged 18 years or older who resided in the city of Salvador, Northeastern Brazil. Following discharge from the Stroke Unit (SU), the individuals themselves, or their guardians, were contacted by telephone to schedule a home visit no less than three months after discharge. At baseline, sociodemographic and clinical data were collected, in addition to the scores on the National Institutes of Health Stroke Scale (NIHSS) and modified Barthel Index (mBI). The American Speech-Language-Hearing Association Functional Assessment of Communication Skills for Adults (ASHA FACS) was applied at the patients’ homes. Multivariate linear regression was employed using the total score on the ASHA FACS as the outcome of interest. Results A multivariate analysis of the associated factors identified using the linear regression revealed that only functional capacity (as assessed by the mBI) upon discharge from the SU remained as an independent predictor of functional communication performance (β = 0.042; 95% confidence interval [95%CI] = 0.013–0.071; p = 0.002). Conclusion The functional capacity to perform daily activities, evaluated upon discharge from a stroke unit, was identified as a potential predictor of functional communication performance, regardless of the time elapsed after the stroke.

Resumo Antecedentes A afasia, distúrbio de linguagem mais comum secundário ao acidente vascular cerebral (AVC), está associada ao aumento da mortalidade, a um maior tempo de internação e reabilitação, ao pior desempenho nas atividades diárias, ao aumento da carga financeira, e às complicações de curto e longo prazos. Pode impactar negativamente as habilidades de comunicação funcional, incluindo atividades sociais, relacionamento com outras pessoas, e o apoio social. Objetivo Avaliar pacientes com afasia pós-AVC em suas respectivas residências para investigar potenciais preditores de comunicação funcional. Métodos A coorte prospectiva incluiu pacientes com afasia pós-AVC com 18 anos de idade ou mais, residentes em Salvador, Brasil. Após a alta da Unidade de AVC (UAVC), os próprios indivíduos, ou seus responsáveis, foram contatados por telefone para agendamento de visita domiciliar no mínimo três meses após a alta. Inicialmente, foram coletados dados sociodemográficos e clínicos, além das pontuações na National Institutes of Health Stroke Scale (NIHSS) e no Índice de Barthel modificado (IBM). O American Speech-Language-Hearing Association Functional Assessment of Communication Skills for Adults (ASHA FACS) foi aplicado no domicílio dos pacientes. A regressão linear multivariada foi empregada usando a pontuação total no ASHA FACS como o desfecho de interesse. Resultados A análise multivariada por meio de regressão linear revelou que apenas a capacidade funcional avaliada na alta da UAVC permaneceu como preditor independente do desempenho da comunicação funcional (β = 0,042; intervalo de confiança de 95% [IC95%] = 0,013–0,071; p = 0,002). Conclusão A capacidade funcional para realizar as atividades diárias, avaliada na alta hospitalar, foi identificada como potencial preditor do desempenho da comunicação funcional, independente do tempo desde o AVC.

https://doi.org/10.1055/s-0042-1755267

Organização e oferta da assistência fisioterapêutica em resposta à pandemia da COVID-19 no Brasil
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Souza, Thiago Santos de

; Aleluia, Ítalo Ricardo Santos

; Pinto, Elen Beatriz

; Pinto Junior, Elzo Pereira

; Pedreira, Rhaine Borges Santos

; Fraga-Maia, Helena

; Pinto, Juliana Martins

Ciência & Saúde Coletiva

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jun 2022, Volume 27 N. 6 Pages 2133 - 2142

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo A recuperação das pessoas acometidas pela COVID-19 é um processo que continua para além do quadro agudo da infecção pelo Sars-CoV-2. O comprometimento de diversos sistemas corporais pode acarretar impactos funcionais e demandar assistência fisioterapêutica contínua tanto na atenção ambulatorial quanto na atenção primária à saúde (APS). Neste ensaio, busca-se discutir os desafios da organização e da oferta de assistência fisioterapêutica em resposta à pandemia da COVID-19 no Brasil. A análise foi sumarizada em três dimensões: oferta da assistência fisioterapêutica na APS e na atenção ambulatorial, e oferta de atenção fisioterapêutica por telessaúde. Conclui-se que: a reabilitação funcional depende da capacidade de resposta da APS; existe um déficit de serviços de reabilitação que antecede a pandemia, e pode comprometer respostas satisfatórias às demandas do atual contexto epidemiológico; faz-se necessária a articulação entre as equipes de fisioterapia ambulatorial e da APS; embora a telessaúde seja um recurso e uma oportunidade para ampliar o acesso da população à reabilitação funcional, sua utilização exige cautela; o fisioterapeuta possui papel crucial em todo o continuum de cuidados da COVID-19.

Abstract The recovery of people affected by COVID-19 is a process that continues beyond the acute condition of infection by Sars-CoV-2. The impairment of several body systems can cause functional impacts and demand continuous physical therapy assistance both in outpatient care and in Primary Health Care (PHC). In this essay, we seek to discuss the challenges of organizing and offering Physical Therapy assistance in response to the COVID-19 pandemic in Brazil. The analysis was summarized in three dimensions: offering physical therapy assistance in PHC, outpatient care, via telehealth. It is concluded that functional rehabilitation depends on the PHC’s response capacity; there is a shortage of rehabilitation services that precedes the pandemic, and may not respond satisfactorily to the demands of the current epidemiological context; it is necessary to articulate the outpatient physiotherapy and PHC teams; although telehealth is a resource and an opportunity to increase the population’s access to functional rehabilitation, its use requires caution; the physiotherapist plays a crucial role in the entire COVID-19 care continuum.

https://doi.org/10.1590/1413-81232022276.00752022

Organização e oferta da assistência fisioterapêutica em resposta à pandemia da COVID-19 no Brasil
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Souza, Thiago Santos de

; Aleluia, Ítalo Ricardo Santos

; Pinto, Elen Beatriz

; Pinto Junior, Elzo Pereira

; Pedreira, Rhaine Borges Santos

; Fraga-Maia, Helena

; Pinto, Juliana Martins

Ciência & Saúde Coletiva

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jun 2022, Volume 27 N. 6 Pages 2133 - 2142

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/1413-81232022276.00752022

Pertinencia de los laboratorios de simulación como herramienta de educación avanzada en salud
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Cuenca Garcell, Katiuska

; de Armas Águila, Yamila

; Bello Méndez, Alejandro

; Figueira Ricardo, Isnaidel

; Areña Fraga, Beatriz

Revista Cubana de Medicina Militar

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jun 2022, Volume 51 N. 2 elocation e1661

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

ABSTRACT The constant improvement of the educational process of man demands the enrichment of the practices of advanced education. It is necessary to carry out transformations in the educational work, so it is essential that it be oriented in such a way that it allows each student to enhance those aspects that make it easier for them to know, in a more significant way, the historical moment in which they live. Virtual simulators, as a learning method in medical sciences, are learning enhancers and help to avoid the obstacle of limited hours in clinical practice, large groups, inconsistencies in the observation of high-risk or unusual diseases. In Cuba, the use of these has not been exploited to the maximum. The studies that have evaluated the effectiveness of these simulators in improving the performance of health professionals have yielded very positive results, but the high price of the simulators has constituted the greatest barrier to their full introduction in Cuba. This work expresses the position of the authors on the relevance of simulation laboratories as a tool for advanced health education. The use of simulation laboratories in medical education is a positive practice in the improvement of professional skills and offers the security of health care, it is not a substitute for supervised practice in a real environment, but a desirable complement to an expertise safe and effective, which allows developing skills, knowledge and attitudes, that is, capacities for optimal performance.

RESUMEN El constante perfeccionamiento del proceso educativo del hombre demanda el enriquecimiento de las prácticas de la educación avanzada. Es preciso efectuar transformaciones en el trabajo educativo, por lo que resulta indispensable que se oriente de forma tal que permita potenciar en cada estudiante aquellos aspectos que le faciliten conocer, de una manera más significativa, el momento histórico en que viven. Los simuladores virtuales, como método de aprendizaje en ciencias médicas, son potenciadores del aprendizaje y ayudan a evadir el obstáculo de horas limitadas en la práctica clínica, grupos numerosos, inconsistencias en la observación de enfermedades de alto riesgo o inusuales. En Cuba, la utilización de estos no ha sido explotada al máximo. Los estudios que han evaluado la efectividad de estos simuladores en la mejoría del desempeño de los profesionales de la salud, han arrojado resultados muy positivos, pero el elevado precio de los simuladores ha constituido la mayor barrera para su completa introducción en Cuba. Este trabajo expresa la posición de los autores sobre la pertinencia de los laboratorios de simulación como herramienta de educación avanzada en salud. El uso de los laboratorios de simulación en la educación médica, es una práctica positiva en el perfeccionamiento de las competencias profesionales y ofrece la seguridad de la atención sanitaria; no es un sustituto de la práctica supervisada en entorno real, sino un complemento deseable para una pericia segura y efectiva que permite desarrollar habilidades, conocimientos y actitudes, es decir, capacidades para su óptimo desempeño.

[SciELO Preprints] - Organization and offer of physiotherapeutic assistance in response to the COVID-19 pandemic in Brazil
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de Souza, Thiago Santos Aleluia, Ítalo Ricardo Santos Pinto, Elen Beatriz Pinto Junior, Elzo Pereira Pedreira, Rhaine Borges Santos Fraga-Maia, Helena Pinto, Juliana Martins

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Publication date: 2021-07-06

Abstract: En Pt

The recovery of people affected by COVID-19 is a process that continues beyond the acute condition of infection by Sars-CoV-2. The impairment of several body systems can cause functional impacts and demand continuous Physical Therapy assistance both in outpatient care and in Primary Health Care (PHC). In this essay, we seek to discuss the challenges of organizing and offering Physical Therapy assistance in response to the COVID-19 pandemic in Brazil. The analysis was summarized in four dimensions: distribution of physical therapists in the country; offering physical therapy assistance in PHC and outpatient care; and provision of physical therapy care via telehealth. It is concluded that there is inequity in the regional distribution of physical therapists in Brazil; functional rehabilitation depends on the PHC's response capacity, which is threatened by the ongoing disruption process; there is a shortage of rehabilitation services that precedes the pandemic, and may not respond satisfactorily to the demands of the current epidemiological context; it is necessary to articulate the outpatient physiotherapy and PHC teams; telehealth, although a resource and an opportunity to increase the population's access to functional rehabilitation, requires caution; the physiotherapist plays a crucial role in the entire COVID-19 care continuum.

A recuperação das pessoas acometidas pela COVID-19 é um processo que continua para além do quadro agudo da infecção pelo Sars-CoV-2. O comprometimento de diversos sistemas corporais pode acarretar impactos funcionais e demandar assistência fisioterapêutica contínua tanto na atenção ambulatorial quanto na Atenção Primária à Saúde (APS). Neste ensaio, busca-se discutir os desafios da organização e da oferta de assistência fisioterapêutica em resposta a pandemia da COVID-19 no Brasil. A análise foi sumarizada em quatro dimensões: distribuição de fisioterapeutas no país; oferta da assistência fisioterapêutica na APS e na atenção ambulatorial; e oferta de atenção fisioterapêutica por Telessaúde. Conclui-se haver iniquidade na distribuição regional de fisioterapeutas no Brasil; a reabilitação funcional depende da capacidade de resposta da APS, a qual se encontra ameaçada pelo processo de desestruturação em curso; existe um déficit de serviços de reabilitação que antecede a pandemia, e pode não responder satisfatoriamente às demandas do atual contexto epidemiológico; faz-se necessária a articulação entre as equipes de fisioterapia ambulatorial e da APS; a telessaúde embora seja um recurso e uma oportunidade para ampliar o acesso da população à reabilitação funcional exige cautela; o fisioterapeuta possui papel crucial em todo o continuum de cuidados da COVID-19.

https://doi.org/10.1590/SciELOPreprints.2538

Is there a Role for Antenatal Corticosteroids in Term Infants before Elective Cesarean Section?
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Arruda, Augusta

; Ormonde, Mariana

; Stokreef, Sarah

; Fraga, Beatriz

; Franco, Catarina

; Dâmaso, Catarina

; Lima, Ana

Revista Brasileira de Ginecologia e Obstetrícia

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apr 2021, Volume 43 N. 4 Pages 283 - 290

Abstract: En | Text: En | PDF: En

Abstract Objective Cesarean section (CS) delivery, especially without previous labor, is associated with worse neonatal respiratory outcomes. Some studies comparing neonatal outcomes between term infants exposed and not exposed to antenatal corticosteroids (ACS) before elective CS revealed that ACS appears to decrease the risk of respiratory distress syndrome (RDS), transient tachypnea of the neonate (TTN), admission to the neonatal intensive care unit (NICU), and the length of stay in the NICU. Methods The present retrospective cohort study aimed to compare neonatal outcomes in infants born trough term elective CS exposed and not exposed to ACS. Outcomes included neonatal morbidity at birth, neonatal respiratory morbidity, and general neonatal morbidity. Maternal demographic characteristics and obstetric data were analyzed as possible confounders. Results A total of 334 newborns met the inclusion criteria. One third of the population study (n=129; 38.6%) received ACS. The present study found that the likelihood for RDS (odds ratio [OR]=1.250; 95% confidence interval [CI]: 0.454-3.442), transient TTN (OR=1.,623; 95%CI: 0.556-4.739), and NIUC admission (OR=2.155; 95%CI: 0.474-9.788) was higher in the ACS exposed group, although with no statistical significance. When adjusting for gestational age and arterial hypertension, the likelihood for RDS (OR=0,732; 95%CI: 0.240-2.232), TTN (OR=0.959; 95%CI: 0.297--3.091), and NIUC admission (OR=0,852; 95%CI: 0.161-4.520) become lower in the ACS exposed group. Conclusion Our findings highlight the known association between CS-related respiratory morbidity and gestational age, supporting recent guidelines that advocate postponing elective CSs until 39 weeks of gestational age.

https://doi.org/10.1055/s-0041-1726055 87 downloads

Alcohol (70%) versus alcoholic chlorhexidine solution (0.5%) in skin antisepsis for neuraxial blocks: a randomized clinical trial
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TOSTES, LUIZ CARLOS SOUZA

; LOYOLA, ANA BEATRIZ ALKMIM TEIXEIRA

; FRAGA, ADILSON DE OLIVEIRA

; GAZZI, LETÍCIA AZEVEDO

; PAIVA, LUIZ FRANCISLEY DE

; JULIANO, YARA

; VEIGA, DANIELA FRANCESCATO

Revista do Colégio Brasileiro de Cirurgiões

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2021, Volume 48 elocation e20202633

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: comparar o uso de solução alcoólica de clorexidina 0,5% e de álcool 70% na antissepsia da pele para bloqueios do neuroeixo. Método: ensaio clínico randomizado de não inferioridade, com dois braços paralelos. Foram selecionados 70 pacientes candidatos à bloqueio do neuroeixo, randomicamente alocados para o grupo A (n=35), em que a antissepsia foi realizada com clorexidina alcoólica 0,5%, ou para o grupo B (n=35), em que se utilizou álcool etílico hidratado 70%. Foram coletadas, com swab, amostras para cultura em três momentos: antes da antissepsia, dois minutos após aplicação do antisséptico, e imediatamente após a punção. As amostras foram semeadas em três meios de cultura e foi contabilizado o número de unidades formadoras de colônias (UFC) por cm². Resultados: não houve diferença entre os grupos quanto à idade, ao sexo, ao índice de massa corporal, ao tempo para realização do bloqueio ou tipo de bloqueio. Também não houve diferenças entre os grupos na contagem de UFC/cm² antes da antissepsia. Constatou-se menor crescimento bacteriano no grupo B dois minutos após aplicação do antisséptico (p=0,048), mas não houve diferença entre os grupos quanto ao número de UFC/cm² ao final da punção. Conclusão: o álcool 70% mostrou-se mais efetivo em reduzir o número de UFC/cm² após dois minutos, e não houve diferença entre os dois grupos quanto à colonização da pele ao final do procedimento. Esses resultados sugerem que o álcool 70% pode ser opção para antissepsia da pele antes de bloqueios do neuroeixo. Registro ensaio clínico: ClinicalTrials.gov, NCT02833376.

ABSTRACT Objective: to compare the use of 0.5% alcoholic chlorhexidine and 70% alcohol in skin antisepsis for neuraxial blocks. Method: this is a non-inferiority randomized clinical trial, with two parallel arms. Seventy patients who were candidates for neuraxial block were randomly allocated to group A (n = 35), in whom antisepsis was performed with 0.5% alcoholic chlorhexidine, or to group B (n = 35), in whom we used 70% hydrated ethyl alcohol. Swabs were harvested for culture at three times: before antisepsis, two minutes after application of the antiseptic, and immediately after puncture. The samples were sown in three culture media and the number of colony forming units (CFU) per cm² was counted. Results: there was no difference between the groups regarding age, sex, body mass index, time to perform the block or type of block. There were no differences between groups in the CFU/cm² counts before antisepsis. There was less bacterial growth in group B two minutes after application of the antiseptic (p = 0.048), but there was no difference between the groups regarding the number of CFU/cm² at the end of the puncture. Conclusion: 70% alcohol was more effective in reducing the number of CFU/cm² after two minutes, and there was no difference between the two groups regarding skin colonization at the end of the procedure. These results suggest that 70% alcohol may be an option for skin antisepsis before neuraxial blocks. Trial registration: ClinicalTrials.gov, NCT02833376.

https://doi.org/10.1590/0100-6991e-20202633 2984 downloads

10.

Diffuse alveolar hemorrhage in childhoodonset systemic lupus erythematosus: a severe disease flare with serious outcome
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Blay, Gabriela

; Rodrigues, Joaquim C.

; Ferreira, Juliana C. O.

; Leal, Gabriela N.

; Gormezano, Natali W.

; Novak, Glaucia V.

; Pereira, Rosa M. R.

; Terreri, Maria T.

; Magalhães, Claudia S.

; Molinari, Beatriz C.

; Sakamoto, Ana P.

; Aikawa, Nadia E.

; Campos, Lucia M. A.

; Fernandes, Taciana A. P.

; Clemente, Gleice

; Peracchi, Octavio A. B.

; Bugni, Vanessa

; Marini, Roberto

; Sacchetti, Silvana B.

; Carvalho, Luciana M.

; Fraga, Melissa M.

; Castro, Tânia C. M.

; Ramos, Valéria C.

; Bonfá, Eloisa

; Silva, Clovis A.

Advances in Rheumatology

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2018, Volume 58 elocation 39

Abstract: En | Text: En | PDF: En

Abstract Objective: To evaluate prevalence, clinical manifestations, laboratory abnormalities and treatment in a multicenter cohort study including 847 childhood-onset systemic lupus erythematosus (cSLE) patients with and without diffuse alveolar hemorrhage (DAH), as well as concomitant parameters of severity. Methods: DAH was defined as the presence of at least three respiratory symptoms/signs associated with diffuse interstitial/alveolar infiltrates on chest x-ray or high-resolution computer tomography and sudden drop in hemoglobin levels. Statistical analysis was performed using Bonferroni correction (p < 0.0022). Results: DAH was observed in 19/847 (2.2%) cSLE patients. Cough/dyspnea/tachycardia/hypoxemia occurred in all cSLE patients with DAH. Concomitant parameters of severity observed were: mechanical ventilation in 14/19 (74%), hemoptysis 12/19 (63%), macrophage activation syndrome 2/19 (10%) and death 9/19 (47%). Further analysis of cSLE patients at DAH diagnosis compared to 76 cSLE control patients without DAH with same disease duration [3 (1–151) vs. 4 (1–151) months, p = 0.335], showed higher frequencies of constitutional involvement (74% vs. 10%, p < 0.0001), serositis (63% vs. 6%, p < 0.0001) and sepsis (53% vs. 9%, p < 0.0001) in the DAH group. The median of disease activity score(SLEDAI-2 K) was significantly higher in cSLE patients with DAH [18 (5–40) vs. 6 (0–44), p < 0.0001]. The frequencies of thrombocytopenia (53% vs. 12%, p < 0.0001), intravenous methylprednisolone (95% vs. 16%, p < 0.0001) and intravenous cyclophosphamide (47% vs. 8%, p < 0.0001) were also significantly higher in DAH patients. Conclusions: This was the first study to demonstrate that DAH, although not a disease activity score descriptor, occurred in the context of significant moderate/severe cSLE flare. Importantly, we identified that this condition was associated with serious disease flare complicated by sepsis with high mortality rate.

https://doi.org/10.1186/s42358-018-0038-4 467 downloads

11.

CLINICAL MANAGEMENT OF LOCALIZED BCG ADVERSE EVENTS IN CHILDREN
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MOREIRA, Thais das Neves Fraga

; MORAES-PINTO, Maria Isabel de

; COSTA-CARVALHO, Beatriz Tavares

; GRUMACH, Anete Sevciovic

; WECKX, Lily Yin

Revista do Instituto de Medicina Tropical de São Paulo

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2016, Volume 58 elocation 84

Abstract: En | Text: En | PDF: En

SUMMARY BCG adverse events (BCG-AE) are rare conditions with no well-established treatment. This study aims to describe clinical characteristics and outcome of localized BCG-AE. Children with BCG-AEs who were treated at the Reference Center for Special Immunobiologicals of the Federal University of São Paulo from 2009 to 2011 were included. Patients were followed monthly until 3 months after healing. One hundred and twenty-seven patients with localized BCG-AE were followed: 67 (52.7%) had suppurative lymphadenitis; 30 (23.6%) injection-site abscess; five (3.9%) had enlarged lymph node > 3 cm; four (3.1%) had ulcer > 1 cm; and one (0.8%) had a local bacterial infection. Five patients (3.9%) had more than one BCG-AE simultaneously. Fifteen patients (11.8%) had atypical manifestations: seven wart-like lesions; five BCG reactivations; two other dermatologic lesions and one with vasomotor phenomenon. Isoniazid was used in 96 patients with typical BCG-AE (85.7%) until lesion resolution which took place 3.1 months later (in median); the healing rate was 90.6%. Patients with atypical manifestations had an individual approach. Regarding the outcome, 105/112 patients with typical AE and 13/15 patients with atypical AE had resolution of BCG-AE. Localized BCG-AE caused by BCG Moreau RJ had positive outcome when treated with a short course of isoniazid. Atypical BCG-AE are not infrequent.

https://doi.org/10.1590/S1678-9946201658084 4260 downloads

12.

Antimicrobial properties of lactic acid bacteria isolated from uruguayan artisan cheese
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Fraga Cotelo, Martín

; Perelmuter Schein, Karen

; Giacaman Salvo, Sheila Solange

; Zunino Abirad, Pablo Miguel

; Carro Techera, Silvana Beatriz

Food Science and Technology

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dec 2013, Volume 33 N. 4 Pages 801 - 804

Abstract: En | Text: En | PDF: En

Uruguayan artisan cheese is elaborated with raw milk and non-commercial starters. The associated native microbiota may include lactic acid bacteria and also potentially pathogenic bacteria. Lactic acid bacteria were isolated from artisan cheese, raw milk, and non-commercial starter cultures, and their potential bacteriocin production was assessed. A culture collection of 509 isolates was obtained, and five isolates were bacteriocin-producers and were identified as Enterococcus durans,Lactobacillus casei, and Lactococcus lactis. No evidence of potential virulence factors were found in E. durans strains. These are promising results in terms of using these native strains for cheese manufacture and to obtain safe products.

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13.

Desenvolvimento de bebês prematuros relacionado a variáveis neonatais e maternas
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Fraga, Daniele Abruzzi de

; Linhares, Maria Beatriz Martins

; Carvalho, Ana Emília Vita

; Martinez, Francisco Eulógio

Psicologia em Estudo

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jun 2008, Volume 13 N. 2 Pages 335 - 344

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

O estudo verificou a relação entre ansiedade materna, características neonatais e indicadores de desenvolvimento de crianças nascidas pré-termo aos 12 meses de idade cronológica corrigida. Foram avaliadas 14 crianças com as Escalas Bayley-II e suas mães com o Inventário de Ansiedade Traço-Estado. Os itens relativos à resolução de problemas, permanência do objeto, intencionalidade, linguagem e motricidade correlacionaram-se significativamente com variáveis neonatais do bebê e ansiedade materna. A maior gravidade de risco clínico neonatal associou-se com pior desempenho em itens relativos à permanência do objeto, linguagem e motricidade ampla. O nível de ansiedade materna mais elevado associou-se com melhor desempenho dos bebês em tarefas cognitivas e pior em tarefas de motricidade ampla e permanência do objeto. Dessa forma a ansiedade materna mostrou ter efeito diferencial em áreas do desenvolvimento da criança, podendo atuar como fator de risco ao desenvolvimento motor amplo e como mecanismo de proteção ao desenvolvimento cognitivo.

Current study analyzes the relation between mother’s anxiety, pre-term neonatal status and developmental outcome in 12-month-old (corrected age) infants. Fourteen preterm children with very low weight at birth were assessed by Bayley-II Scales and mothers were evaluated by State-Trait Anxiety Inventory. Resolution problems, permanence of objects, intentionality, language and motor factors were significantly correlated with the child’s neonatal variables and with mother’s anxiety. The severest neonatal clinical risk has been linked to the child’s lowest performance with regard to permanence of object, language and broad motor factors. Mother’s highest anxiety level was significantly correlated with better performance on cognitive tasks and worst performance with motor and permanence of objects tasks. Mother’s anxiety showed to have differential effects on the infant’s development in certain areas. It may be a risk factor for gross motor development and a protection mechanism for cognitive development.

El estudio verificó la relación entre ansiedad materna, características neonatales e indicadores de desarrollo de niños nacidos pré termo a los 12 meses de edad cronológica corregida. Fueron evaluados 14 niños con las Escalas Bayley-II y sus madres con el Inventario de Ansiedad Trazo-Estado. Los ítenes relativos a la resolución de problemas, permanencia del objeto, intencionalidad, lenguaje y motricidad se correlacionaron significativamente con variables neonatales del bebé y ansiedad materna. La mayor gravedad de riesgo clínico neonatal se asoció con peor desempeño en ítenes relativos a la permanencia del objeto, lenguaje y motricidad amplia. El nivel de ansiedad materna más elevado se asoció con mejor desempeño de los bebés en tareas cognitivas y peor en tareas de motricidad amplia y permanencia del objeto. De esa forma la ansiedad materna mostró tener efecto diferencial en áreas del desarrollo del niño, pudiendo actuar como factor de riesgo al desarrollo motor amplio y como mecanismo de protección al desarrollo cognitivo.

10295 downloads Cited 15 times in SciELO

14.

Alelopatia intra-específica de extratos aquosos de folhas e raízes de alfafa na germinação e no crescimento inicial de plântulas de dois materiais de alfafa: crioulo e melhorado
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Pereira, Betânia Fraga

; Sbrissia, André Fischer

; Serrat, Beatriz Monte

Ciência Rural

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apr 2008, Volume 38 N. 2 Pages 561 - 564

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

A alfafa é uma das culturas conhecidas que apresentam um tipo específico de alelopatia denominado autotoxicidade. Dessa forma, o objetivo deste trabalho foi avaliar os efeitos da concentração de extratos aquosos de partes (folhas e raízes) da planta de alfafa (material Crioulo) na germinação e no crescimento inicial de plântulas de dois materiais de alfafa (Crioulo e P5454). Placas de Petri contendo 50 sementes de cada variedade foram umedecidas com 10ml dos extratos em duas concentrações: 50% e 100% (extrato puro). Água deionizada foi usada como controle. O delineamento experimental foi inteiramente casualizado, com cinco repetições para cada variedade. Após seis dias da germinação, procedeu-se à contagem do número de sementes germinadas, bem como à medição do comprimento do hipocótilo e da radícula de cada plântula. Os extratos aquosos das folhas inibiram a germinação e o comprimento da radícula e do hipocótilo das duas variedades. No entanto, para o material Crioulo, a inibição na germinação e no desenvolvimento inicial só ocorreu com o uso do extrato puro das folhas, enquanto que na P5454 o extrato diluído a 50% já reduziu tanto a germinação quanto o comprimento das plântulas. Os extratos aquosos das raízes não causaram inibição na germinação nem no comprimento das plântulas. Os resultados sugerem variações intra-específicas na tolerância aos compostos aleloquímicos e uma produção preferencial dos mesmos na parte aérea da planta de alfafa, material Crioulo.

Alfalfa is one of the known crops that present a specific type of allelopathy called autotoxicity. Hence, this research was aimed at evaluating the concentration effects of aqueous extracts of plant parts (leaves and roots) of alfalfa (var. Crioula) on germination and early development of seedlings of two alfalfa (Crioula and P5454) varieties. Fifty seed of each variety were placed in Petri dishes with moistened filter paper. Aliquots (ten ml) from each part extracts at two concentrations, 50 or 100% (pure extract), were added to petri dishes, and distilled water was used as a control. Treatments placed in Petri dishes were randomly arranged in a completely randomized design with five replicates. Measurements included: germination, and radicle and hypocotyl lengths taken six days after germination. The aqueous extracts of leaves inhibited germination and radicle and hypocotyl length of the two alfalfa varieties. However, on the var. Crioula germination and early development was inhibited only when it was used pure extracts of leaves, while in var. P5454 leaves extracts diluted to 50% already had some reduction on germination and seedlings length. The aqueous extracts of the alfalfa roots did not cause inhibition on germination and seedlings lengths. The results suggest intra-specific variations on tolerance to the allelochemicals and a preferential production of them in the aerial part of the alfalfa plant, var. Crioula.

2952 downloads Cited 2 times in SciELO

15.

Desenvolvimento de bebês nascidos pré-termo e indicadores emocionais maternos
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Fraga, Daniele Abruzzi de

; Linhares, Maria Beatriz Martins

; Carvalho, Ana Emília Vita

; Martinez, Francisco Eulógio

Psicologia: Reflexão e Crítica

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2008, Volume 21 N. 1 Pages 33 - 41

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

O objetivo do presente estudo longitudinal foi comparar o desenvolvimento de crianças nascidas pré-termo, em dois grupos diferenciados quanto à presença (G1) ou ausência (G2) de sintomas de ansiedade e depressão materna no período neonatal do bebê. A amostra foi composta por 32 crianças nascidas pré-termo, atendidas em seguimento psicológico desde a internação na UTI Neonatal até o final do primeiro ano de vida, sendo 11 do G1 e 21 do G2. Foram aplicados o Teste de Denver-II e a Escala do Desenvolvimento do Comportamento da Criança com as crianças, e o Inventário de Ansiedade Traço-Estado e o Inventário de Depressão Beck com as mães. As crianças de ambos os grupos apresentaram indicadores de desenvolvimento no primeiro ano de vida classificados como Normal, independentemente da presença de ansiedade e depressão materna.

The aim of this longitudinal study was to compare the developmental outcomes of preterm infants allocated into two different groups taking into account the presence (G1) or lack (G2) of mothers' anxiety and depression symptoms during the neonatal period of the babies. The sample was based on 32 preterm infants who had a psychological follow up from the NICU internship period the end of first year of life. Group 1 included 11 infants and mothers with clinical anxiety and depression symptoms and Group 2 included 21 infants and mothers without clinical symptoms (control group). The infants were assessed by the Denver-II Test and Infant Scale of Development and Behavior and the mothers by the Inventory State- Trait Anxiety and Beck Depression Inventory. The children of both groups showed indicators of development on the first year of life classified as normal, regardless of the anxiety and depression symptoms of their mothers.

6501 downloads Cited 14 times in SciELO

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