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ABSTRACT This study assessed the technical performance of a rapid lateral flow immunochromatographic assay (LFIA) for the detection of anti-SARS-CoV-2 IgG and compared LFIA results with chemiluminescent immunoassay (CLIA) results and an in-house enzyme immunoassay (EIA). To this end, a total of 216 whole blood or serum samples from three groups were analyzed: the first group was composed of 68 true negative cases corresponding to blood bank donors, healthy young volunteers, and eight pediatric patients diagnosed with other coronavirus infections. The serum samples from these participants were obtained and stored in a pre-COVID-19 period, thus they were not expected to have COVID-19. In the second group of true positive cases, we chose to replace natural cases of COVID-19 by 96 participants who were expected to have produced anti-SARS-CoV-2 IgG antibodies 30-60 days after the vaccine booster dose. The serum samples were collected on the same day that LFIA were tested either by EIA or CLIA. The third study group was composed of 52 participants (12 adults and 40 children) who did or did not have anti-SARS-CoV-2 IgG antibodies due to specific clinical scenarios. The 12 adults had been vaccinated more than seven months before LFIA testing, and the 40 children had non-severe COVID-19 diagnosed using RT-PCR during the acute phase of infection. They were referred for outpatient follow-up and during this period the serum samples were collected and tested by CLIA and LFIA. All tests were performed by the same healthcare operator and there was no variation of LFIA results when tests were performed on finger prick whole blood or serum samples, so that results were grouped for analysis. LFIA’s sensitivity in detecting anti-SARS-CoV-2 IgG antibodies was 90%, specificity 97.6%, efficiency 93%, PPV 98.3%, NPV 86.6%, and likelihood ratio for a positive or a negative result were 37.5 and 0.01 respectively. There was a good agreement (Kappa index of 0.677) between LFIA results and serological (EIA or CLIA) results. In conclusion, LFIA analyzed in this study showed a good technical performance and agreement with reference serological assays (EIA or CLIA), therefore it can be recommended for use in the outpatient follow-up of non-severe cases of COVID-19 and to assess anti-SARS-CoV-2 IgG antibody production induced by vaccination and the antibodies decrease over time. However, LFIAs should be confirmed by using reference serological assays whenever possible.

https://doi.org/10.1590/s1678-9946202264049

Guidelines on COVID-19 vaccination in patients with immune-mediated rheumatic diseases: a Brazilian Society of Rheumatology task force
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Tavares, Anna Carolina Faria Moreira Gomes

; Melo, Ana Karla Guedes de

; Cruz, Vítor Alves

; Souza, Viviane Angelina de

; Carvalho, Joana Starling de

; Machado, Ketty Lysie Libardi Lira

; Valadares, Lilian David de Azevedo

; Reis Neto, Edgard Torres dos

; Rezende, Rodrigo Poubel Vieira de

; Guimarães, Maria Fernanda Brandão de Resende

; Ferreira, Gilda Aparecida

; Braz, Alessandra de Sousa

; Vieira, Rejane Maria Rodrigues de Abreu

; Pinheiro, Marcelo de Medeiros

; Ribeiro, Sandra Lúcia Euzébio

; Bica, Blanca Elena Gomes Rios

; Baptista, Kátia Lino

; Costa, Izaias Pereira da

; Marques, Claudia Diniz Lopes

; Lopes, Maria Lúcia Lemos

; Martinez, José Eduardo

; Giorgi, Rina Dalva Neubarth

; Mota, Lícia Maria Henrique da

; Loures, Marcos Antônio Araújo da Rocha

; Paiva, Eduardo dos Santos

; Monticielo, Odirlei André

; Xavier, Ricardo Machado

; Kakehasi, Adriana Maria

; Pileggi, Gecilmara Cristina Salviato

Advances in Rheumatology

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2022, Volume 62 elocation 3

Abstract: En | Text: En | PDF: En

Abstract Objective: To provide guidelines on the coronavirus disease 2019 (COVID-19) vaccination in patients with immune-mediated rheumatic diseases (IMRD) to rheumatologists considering specific scenarios of the daily practice based on the shared-making decision (SMD) process. Methods: A task force was constituted by 24 rheumatologists (panel members), with clinical and research expertise in immunizations and infectious diseases in immunocompromised patients, endorsed by the Brazilian Society of Rheumatology (BSR), to develop guidelines for COVID-19 vaccination in patients with IMRD. A consensus was built through the Delphi method and involved four rounds of anonymous voting, where five options were used to determine the level of agreement (LOA), based on the Likert Scale: (1) strongly disagree; (2) disagree, (3) neither agree nor disagree (neutral); (4) agree; and (5) strongly agree. Nineteen questions were addressed and discussed via teleconference to formulate the answers. In order to identify the relevant data on COVID-19 vaccines, a search with standardized descriptors and synonyms was performed on September 10th, 2021, of the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and LILACS to identify studies of interest. We used the Newcastle–Ottawa Scale to assess the quality of nonrandomized studies. Results: All the nineteen questions-answers (Q&A) were approved by the BSR Task Force with more than 80% of panelists voting options 4—agree—and 5—strongly agree—, and a consensus was reached. These Guidelines were focused in SMD on the most appropriate timing for IMRD patients to get vaccinated to reach the adequate covid-19 vaccination response. Conclusion: These guidelines were developed by a BSR Task Force with a high LOA among panelists, based on the literature review of published studies and expert opinion for COVID-19 vaccination in IMRD patients. Noteworthy, in the pandemic period, up to the time of the review and the consensus process for this document, high-quality evidence was scarce. Thus, it is not a substitute for clinical judgment.

https://doi.org/10.1186/s42358-022-00234-7

Nurses and the Manchester: rearranging the work process and emergency care?
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Carapinheiro, Graça

; Chioro, Arthur

; Andreazza, Rosemarie

; Spedo, Sandra Maria

; Souza, Ana Lúcia Medeiros de

; Araújo, Eliane Cardoso de

; Correia, Tiago

; Cecilio, Luiz Carlos de Oliveira

Revista Brasileira de Enfermagem

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2021, Volume 74 N. 1 elocation e20200450

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

RESUMO Objetivos: compreender as mudanças de papéis dos enfermeiros na organização da divisão do trabalho no hospital a partir da implantação do Sistema Manchester de Classificação de Risco em hospital de urgência e emergência. Métodos: estudo etnográfico, com o emprego de diferentes técnicas de produção e de análise de dados. Resultados: o Sistema Manchester de Classificação de Risco organizou os fluxos e lugares, resultando em qualidade do cuidado e em mudanças nos processos de trabalho. Relações de conflito relacionadas às discordâncias na classificação do risco estiveram presentes. Considerações finais: os papé is tradicionais dos enfermeiros se transformaram, mas não se pode afirmar que houve mudança estrutural da posição deles na organização da divisão do trabalho no hospital. As fronteiras da autonomia, portanto de aumento de profissionalização dos enfermeiros, não são fixas nem estáveis, alargando ou contraindo de acordo com as mudanças micropolíticas da governabilidade do cuidado.

ABSTRACT Objective: to understand the changing roles of nurses in labor division organization in hospitals from the Manchester Triage System implementation in an emergency hospital. Methods: this is an ethnographic study that used different production techniques and data analysis. Results: the Manchester Triage System organized flows and places resulting in quality of care and changes in work processes. Conflict relationships related to disagreements in risk stratification were present. Final considerations: the traditional roles of nurses have been transformed, but it cannot be said that there was a structural change in their position in labor division organization in hospitals. The frontiers of autonomy, therefore of increasing the professionalization of nurses, are neither fixed nor stable, expanding or contracting according to the micropolitical changes in the governance of care.

RESUMEN Objetivo: comprender los roles cambiantes de las enfermeras en la organización de la división del trabajo en el hospital desde la implementación del Sistema de Triaje Manchester en un hospital de urgencia y emergencia. Métodos: estudio etnográfico, utilizando diferentes técnicas de producción y análisis de datos. Resultados: el Sistema de Triaje Manchester organizó flujos y lugares, lo que resultó en calidad de atención y cambios en los procesos de trabajo. Estuvieron presentes relaciones conflictivas relacionadas con desacuerdos en la clasificación del riesgo. Consideraciones finales: los roles tradicionales de las enfermeras se han transformado, pero no se puede decir que hubo un cambio estructural en su posición en la organización de la división del trabajo en el hospital. Las fronteras de la autonomía, por tanto de incrementar la profesionalización del enfermero, no son fijas ni estables, ampliándose o contrayéndose según los cambios micropolíticos en la gobernanza del cuidado.

https://doi.org/10.1590/0034-7167-2020-0450

Chronic use of hydroxychloroquine did not protect against COVID-19 in a large cohort of patients with rheumatic diseases in Brazil
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Pileggi, Gecilmara Salviato

; Ferreira, Gilda Aparecida

; Gomides Reis, Ana Paula Monteiro

; Reis Neto, Edgard Torres

; Abreu, Mirhelen Mendes

; Albuquerque, Cleandro Pires

; Araújo, Nafice Costa

; Bacchiega, Ana Beatriz

; Bianchi, Dante Valdetaro

; Bica, Blanca

; Bonfa, Eloisa Duarte

; Borba, Eduardo Ferreira

; Brito, Danielle Christinne Soares Egypto

; Duarte, Ângela Luzia Branco Pinto

; Santo, Rafaela Cavalheiro Espírito

; Fernandes, Paula Reale

; Guimarães, Mariana Peixoto

; Gomes, Kirla Wagner Poti

; Kakehasi, Adriana Maria

; Klumb, Evandro Mendes

; Lanna, Cristina Costa Duarte

; Marques, Claudia Diniz Lopes

; Monticielo, Odirlei André

; Mota, Licia Maria Henrique

; Munhoz, Gabriela Araújo

; Paiva, Eduardo Santos

; Pereira, Helena Lucia Alves

; Provenza, José Roberto

; Ribeiro, Sandra Lucia Euzébio

; Rocha Junior, Laurindo Ferreira

; Sampaio, Camila Santana Justo Cintra

; Sampaio, Vanderson Souza

; Sato, Emília Inoue

; Skare, Thelma

; de Souza, Viviane Angelina

; Valim, Valeria

; Lacerda, Marcus Vinícius Guimarães

; Xavier, Ricardo Machado

; Pinheiro, Marcelo Medeiros

Advances in Rheumatology

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2021, Volume 61 elocation 60

Abstract: En | Text: En | PDF: En

Abstract Background: There is a lack of information on the role of chronic use of hydroxychloroquine during the SARS-CoV-2 outbreak. Our aim was to compare the occurrence of COVID-19 between rheumatic disease patients on hydroxychloroquine with individuals from the same household not taking the drug during the first 8 weeks of community viral transmission in Brazil. Methods: This baseline cross-sectional analysis is part of a 24-week observational multi-center study involving 22 Brazilian academic outpatient centers. All information regarding COVID-19 symptoms, epidemiological, clinical, and demographic data were recorded on a specific web-based platform using telephone calls from physicians and medical students. COVID-19 was defined according to the Brazilian Ministry of Health (BMH) criteria. Mann-Whitney, Chi-square and Exact Fisher tests were used for statistical analysis and two binary Final Logistic Regression Model by Wald test were developed using a backward-stepwise method for the presence of COVID-19. Results: From March 29th to May 17st, 2020, a total of 10,443 participants were enrolled, including 5166 (53.9%) rheumatic disease patients, of whom 82.5% had systemic erythematosus lupus, 7.8% rheumatoid arthritis, 3.7% Sjögren’s syndrome and 0.8% systemic sclerosis. In total, 1822 (19.1%) participants reported flu symptoms within the 30 days prior to enrollment, of which 3.1% fulfilled the BMH criteria, but with no significant difference between rheumatic disease patients (4.03%) and controls (3.25%). After adjustments for multiple confounders, the main risk factor significantly associated with a COVID-19 diagnosis was lung disease (OR 1.63; 95% CI 1.03-2.58); and for rheumatic disease patients were diagnosis of systemic sclerosis (OR 2.8; 95% CI 1.19-6.63) and glucocorticoids above 10 mg/ day (OR 2.05; 95% CI 1.31-3.19). In addition, a recent influenza vaccination had a protective effect (OR 0.674; 95% CI 0.46-0.98). Conclusion: Patients with rheumatic disease on hydroxychloroquine presented a similar occurrence of COVID-19 to household cohabitants, suggesting a lack of any protective role against SARS-CoV-2 infection. Trial registration Brazilian Registry of Clinical Trials (ReBEC; RBR - 9KTWX6).

https://doi.org/10.1186/s42358-021-00217-0 22 downloads

Differences in children and adolescents with SARS-CoV-2 infection: a cohort study in a Brazilian tertiary referral hospital
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Marques, Heloisa Helena de Sousa

; Pereira, Maria Fernanda Badue

; Santos, Angélica Carreira dos

; Fink, Thais Toledo

; Paula, Camila Sanson Yoshino de

; Litvinov, Nadia

; Schvartsman, Claudio

; Delgado, Artur Figueiredo

; Gibelli, Maria Augusta Bento Cicaroni

; Carvalho, Werther Brunow de

; Odone Filho, Vicente

; Tannuri, Uenis

; Carneiro-Sampaio, Magda

; Grisi, Sandra

; Duarte, Alberto José da Silva

; Antonangelo, Leila

; Francisco, Rossana Pucineli Vieira

; Okay, Thelma Suely

; Batisttella, Linamara Rizzo

; Carvalho, Carlos Roberto Ribeiro de

; Brentani, Alexandra Valéria Maria

; Silva, Clovis Artur

; Eisencraft, Adriana Pasmanik

; Rossi Junior, Alfio

; Fante, Alice Lima

; Cora, Aline Pivetta

; Reis, Amelia Gorete A. de Costa

; Ferrer, Ana Paula Scoleze

; Andrade, Anarella Penha Meirelles de

; Watanabe, Andreia

; Gonçalves, Angelina Maria Freire

; Waetge, Aurora Rosaria Pagliara

; Silva, Camila Altenfelder

; Ceneviva, Carina

; Lazari, Carolina dos Santos

; Abellan, Deipara Monteiro

; Santos, Emilly Henrique dos

; Sabino, Ester Cerdeira

; Bianchini, Fabíola Roberta Marim

; Alcantara, Flávio Ferraz de Paes

; Ramos, Gabriel Frizzo

; Leal, Gabriela Nunes

; Rodriguez, Isadora Souza

; Pinho, João Renato Rebello

; Carneiro, Jorge David Avaizoglou

; Paz, Jose Albino

; Ferreira, Juliana Carvalho

; Ferranti, Juliana Ferreira

; Ferreira, Juliana de Oliveira Achili

; Framil, Juliana Valéria de Souza

; Silva, Katia Regina da

; Kanunfre, Kelly Aparecida

; Bastos, Karina Lucio de Medeiros

; Galleti, Karine Vusberg

; Cristofani, Lilian Maria

; Suzuki, Lisa

; Campos, Lucia Maria Arruda

; Perondi, Maria Beatriz de Moliterno

; Diniz, Maria de Fatima Rodrigues

; Fonseca, Maria Fernanda Mota

; Cordon, Mariana Nutti de Almeida

; Pissolato, Mariana

; Peres, Marina Silva

; Garanito, Marlene Pereira

; Imamura, Marta

; Dorna, Mayra de Barros

; Luglio, Michele

; Rocha, Mussya Cisotto

; Aikawa, Nadia Emi

; Degaspare, Natalia Viu

; Sakita, Neusa Keico

; Udsen, Nicole Lee

; Scudeller, Paula Gobi

; Gaiolla, Paula Vieira de Vincenzi

; Severini, Rafael da Silva Giannasi

; Rodrigues, Regina Maria

; Toma, Ricardo Katsuya

; Paula, Ricardo Iunis Citrangulo de

; Palmeira, Patricia

; Forsait, Silvana

; Farhat, Sylvia Costa Lima

; Sakano, Tânia Miyuki Shimoda

; Koch, Vera Hermina Kalika

; Cobello Junior, Vilson

Clinics

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2021, Volume 76 elocation e3488

Abstract: En | Text: En | PDF: En

OBJECTIVES: To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged <18 years) between April 11, 2020 and April 22, 2021. During this period, 102/5,951 (1.7%) of all admissions occurred in neonates, children, and adolescents. Furthermore, 3,962 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection samples were processed in patients aged <18 years, and laboratory-confirmed COVID-19 occurred in 155 (4%) inpatients and outpatients. Six/155 pediatric patients were excluded from the study. Therefore, the final group included 149 children and adolescents (n=97 inpatients and 52 outpatients) with positive SARS-CoV-2 results. RESULTS: The frequencies of sore throat, anosmia, dysgeusia, headache, myalgia, nausea, lymphopenia, pre-existing chronic conditions, immunosuppressive conditions, and autoimmune diseases were significantly reduced in children and adolescents (p<0.05). Likewise, the frequencies of enoxaparin use (p=0.037), current immunosuppressant use (p=0.008), vasoactive agents (p=0.045), arterial hypotension (p<0.001), and shock (p=0.024) were significantly lower in children than in adolescents. Logistic regression analysis showed that adolescents with laboratory-confirmed COVID-19 had increased odds ratios (ORs) for sore throat (OR 13.054; 95% confidence interval [CI] 2.750-61.977; p=0.001), nausea (OR 8.875; 95% CI 1.660-47.446; p=0.011), and lymphopenia (OR 3.575; 95% CI 1.355-9.430; p=0.010), but also had less hospitalizations (OR 0.355; 95% CI 0.138-0.916; p=0.032). The additional logistic regression analysis on patients with preexisting chronic conditions (n=108) showed that death as an outcome was significantly associated with pediatric severe acute respiratory syndrome (SARS) (OR 22.300; 95% CI 2.341-212.421; p=0.007) and multisystem inflammatory syndrome in children (MIS-C) (OR 11.261; 95% CI 1.189-106. 581; p=0.035). CONCLUSIONS: Half of the laboratory-confirmed COVID-19 cases occurred in adolescents. Individuals belonging to this age group had an acute systemic involvement of SARS-CoV-2 infection. Pediatric SARS and MIS-C were the most important factors associated with the mortality rate in pediatric chronic conditions with COVID-19.

https://doi.org/10.6061/clinics/2021/e3488

Deinstitutionalization and network of mental health services: a new scene in health care
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Lima, Alice Medeiros

; Souza, Ândrea Cardoso de

; Silva, Ana Lúcia Abrahão da

Revista Brasileira de Enfermagem

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2020, Volume 73 elocation e20180964

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

RESUMO Objetivo: analisar o processo de desinstitucionalização resultante do fechamento de um hospital psiquiátrico, e conhecer o destino dos usuários após a desospitalização. Método: estudo descritivo, qualitativo, fundamentado na perspectiva crítico-analítica, que teve como cenário o Hospital Colônia de Rio Bonito. Foram analisados documentos institucionais e narrativas de cinco gestores que participaram do processo de desinstitucionalização. Resultados: o processo de desinstitucionalização do Hospital Colônia durou um tempo maior que o esperado. Para que se concretizasse, foi necessária uma intervenção tripartite e, especial, a mobilização das redes e implementação das Redes de Atenção Psicossocial pelos municípios internantes. Quanto ao destino dos usuários, a maior parte foi encaminhada para residências terapêuticas ou transinstitucionalizada. Considerações finais: o processo de desinstitucionalização do Hospital Colônia provocou o estabelecimento de conexões entre serviços e pessoas, inferindo-se que este foi um dispositivo potente para a implementação das Redes de Atenção Psicossocial em âmbito municipal.

ABSTRACT Objective: to analyze the process of deinstitutionalization resulting from a psychiatric hospital shut down, and know the fate of users after dehospitalization. Method: a descriptive, qualitative study based on the critical-analytical perspective, which had as its setting the Hospital Colônia de Rio Bonito. Institutional documents and narratives of five managers who participated in the deinstitutionalization process were analyzed. Results: Hospital Colônia deinstitutionalization lasted longer than expected. For this to happen, a tripartite intervention was necessary, and especially the mobilization of networks and implementation of Psychosocial Care Networks by the cities. Regarding destination of users, most were referred to therapeutic or transinstitutionalized residences. Final considerations: Hospital Colônia deinstitutionalization led to the establishment of connections between services and people. This was a powerful device for the implementation of Psychosocial Care Networks at municipal level.

RESUMEN Objetivo: analizar el proceso de desinstitucionalización resultante del cierre de un hospital psiquiátrico, y conocer el destino de los usuarios después de salir del hospital. Método: Estudio descriptivo, cualitativo, que tuvo como escenario el Hospital Colônia de Rio Bonito. Se analizaron documentos institucionales y narrativas de cinco gestores que participaron del proceso de desinstitucionalización. Resultados: el proceso de desinstitucionalización del Hospital Colônia duró un tiempo mayor que lo esperado. Para que se concretizara, fue necesaria una intervención tripartita y, especialmente, la movilización e implementación de las Redes de Atención Psicosocial por los municipios que internaban. Cuanto al destino de los usuarios, la mayor parte fue encaminada para residencias terapéuticas o transinstitucionalizadas. Consideracion finales: el proceso de desinstitucionalización del Hospital Colônia provocó el estabelecimiento de conexiones entre los servicios y las personas, deduciéndose que este fue un dispositivo potente para implementar las Redes de Atención Psicosocial en el ámbito municipal.

https://doi.org/10.1590/0034-7167-2018-0964

Deinstitutionalization and network of mental health services: a new scene in health care
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Lima, Alice Medeiros

; Souza, Ândrea Cardoso de

; Silva, Ana Lúcia Abrahão da

Revista Brasileira de Enfermagem

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2020, Volume 73 Suppl. 1 elocation e20180964

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

https://doi.org/10.1590/0034-7167-2018-0964 44 downloads

O agir leigo e a produção de mapas de cuidado mistos público-privados
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Meneses, Consuelo Sampaio

; Cecilio, Luiz Carlos de Oliveira

; Andreazza, Rosemarie

; Carapinheiro, Graça

; Andrade, Maria da Graça Garcia

; Santiago, Sílvia Maria

; Araújo, Eliane Cardoso

; Souza, Ana Lúcia Medeiros

; Reis, Denizi Oliveira

; Pinto, Nicanor Rodrigues da Silva

; Spedo, Sandra Maria

Ciência & Saúde Coletiva

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jun 2017, Volume 22 N. 6 Pages 2013 - 2024

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

Resumo O artigo problematiza parte dos resultados de estudo realizado em dois municípios do ABCD paulista no período de 2010 a 2012 com o objetivo de evidenciar a existência de lógicas regulatórias não estatais na viabilização do acesso e consumo de serviços de saúde. Na primeira etapa, foram realizadas entrevistas com atores estratégicos (gestores e políticos) e atores-trabalhadores-chave. Na segunda, foram coletadas histórias de vida de 18 pessoas com elevada frequência de utilização de serviços de saúde. O estudo revelou o papel protagonista dos usuários na construção de “mapas do cuidado”, com destaque para a utilização frequente de recursos públicos e privados nos seus percursos, contornando ou se mesclando com a regulação governamental, para a obtenção do cuidado de que necessitam. Os diferentes formatos do mix público-privado observados transcendem as concepções “oficiais” ainda vigentes sobre a distinção nítida entre os dois sistemas, revelando a importância desse tema para a gestão pública da saúde.

Abstract This paper discusses part of the results obtained from a study carried out in two cities of the so-called ABCD Paulista Region in the period 2010-2012, in an attempt to spot the existence of non-state regulatory rationale towards access and consumption of health care services. The first stage includes interviews carried out with strategic stakeholders (managers and politicians) and key workers players. The second stage collected the stories of 18 very frequent users of health care services. This study revealed the leading role played by users to produce “health care maps”, with emphasis on the frequent use of public and private resources in their itineraries, circumventing or merging with government regulation to obtain the care they need. The different formats of public-private mix transcend the still prevailing “official” concepts about the clear distinction between the two systems, which reveals the importance of this theme to public health management.

https://doi.org/10.1590/1413-81232017226.14822016 2214 downloads

O agir leigo e a produção de mapas de cuidado mistos público-privados
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Meneses, Consuelo Sampaio

; Cecilio, Luiz Carlos de Oliveira

; Andreazza, Rosemarie

; Carapinheiro, Graça

; Andrade, Maria da Graça Garcia

; Santiago, Sílvia Maria

; Araújo, Eliane Cardoso

; Souza, Ana Lúcia Medeiros

; Reis, Denizi Oliveira

; Pinto, Nicanor Rodrigues da Silva

; Spedo, Sandra Maria

Ciência & Saúde Coletiva

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jun 2017, Volume 22 N. 6 Pages 2013 - 2024

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

https://doi.org/10.1590/1413-81232017226.14822016 388 downloads

10.

Screening, production and biochemical characterization of a new fibrinolytic enzyme produced by Streptomyces sp. (Streptomycetaceae) isolated from Amazonian lichens
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SILVA, Germana Michelle de Medeiros e

; BEZERRA, Raquel Pedrosa

; TEIXEIRA, José António

; SILVA, Flávio Oliveira

; CORREIA, Juliana Mendes

; PORTO, Tatiana Souza

; LIMA-FILHO, José Luis

; PORTO, Ana Lúcia Figueiredo

Acta Amazonica

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sep 2016, Volume 46 N. 3 Pages 323 - 332

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

RESUMO A trombose é uma doença patofisiológica causada pelo acúmulo de fibrina no sangue. Proteases fibrinolíticas com potente atividade trombolítica são produzidas por diversas fontes microbianas. Considerando a biodiversidade microbiana da região amazônica, o presente estudo teve como objetivo a seleção, produção e caracterização bioquímica da enzima fibrinolítica de Streptomyces sp. isolado de líquens da Amazônia. Streptomyces DPUA1576 foi a melhor produtora com atividade fibrinolítica de 283 mm2. Três variáveis em dois níveis foram utilizadas para determinar as variáveis mais relevantes na produção da enzima fibrinolítica (FA). Os parâmetros estudados foram agitação (0.28 - 1.12 g), temperatura (28 - 36 ºC) e pH (6.0 - 8.0) e todos obtiveram efeitos significativos na produção fibrinolítica. A maior atividade fibrinolítica (304 mm2) foi obtida a 1.12 g, 28 ºC e pH 8.0. O extrato bruto da fermentação foi usado para determinar as propriedades bioquímicas da enzima. Atividades proteásica e fibrinolítica foram estáveis durante 6 horas no intervalo de pH entre 6.8 - 8.4 e 5.8 - 9.2, respectivamente. Temperatura ótima para a atividade proteásica foi entre 35 - 55 °C, enquanto que para a atividade fibrinolítica foi de 45 ºC. Atividade proteásica foi inibida por íons Cu2+ e Co2+, fluoreto de fenilmetilsulfonil e pepstatina A, na qual sugere que a enzima é uma serino-protease. O extrato enzimático degradou o fibrinogênio nas subunidades Aα, Aβ e γ. Os resultados apresentados indicam que Streptomyces sp. DPUA 1576 produz enzimas com atividade fibrinolítica e fibrinogenolítica, enzimas com aplicações importantes na indústria farmacêutica.

ABSTRACT Thrombosis is a pathophysiological disorder caused by accumulation of fibrin in the blood. Fibrinolytic proteases with potent thrombolytic activity have been produced by diverse microbial sources. Considering the microbial biodiversity of the Amazon region, this study aimed at the screening, production and biochemical characterization of a fibrinolytic enzyme produced by Streptomyces sp. isolated from Amazonian lichens. The strain Streptomyces DPUA1576 showed the highest fibrinolytic activity, which was 283 mm2. Three variables at two levels were used to assess their effects on the fibrinolytic production. The parameters studied were agitation (0.28 - 1.12 g), temperature (28 - 36 ºC) and pH (6.0 - 8.0); all of them had significant effects on the fibrinolytic production. The maximum fibrinolytic activity (304 mm2) was observed at 1.12 g, 28 ºC, and pH of 8.0. The crude extract of the fermentation broth was used to assess the biochemical properties of the enzyme. Protease and fibrinolytic activities were stable during 6 h, at a pH ranging from 6.8 to 8.4 and 5.8 to 9.2, respectively. Optimum temperature for protease activity ranged between 35 and 55 °C, while the highest fibrinolytic activity was observed at 45 ºC. Proteolytic activity was inhibited by Cu2+ and Co2+ ions, phenylmethylsulfonyl fluoride (PMSF) and pepstatin A, which suggests that the enzyme is a serine protease. Enzymatic extract cleaved fibrinogen at the subunits Aα-chain, Aβ-chain, and γ-chain. The results indicated that Streptomyces sp. DPUA 1576 produces enzymes with fibrinolytic and fibrinogenolytic activity, enzymes with an important application in the pharmaceutical industry.

https://doi.org/10.1590/1809-4392201600022 3275 downloads

11.

Diretrizes de conduta e tratamento de síndromes febris periódicas: síndrome de febre periódica, estomatite aftosa, faringite e adenite
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Terreri, Maria Teresa R.A.

; Bernardo, Wanderley Marques

; Len, Claudio Arnaldo

; Silva, Clovis Artur Almeida da

; Magalhães, Cristina Medeiros Ribeiro de

; Sacchetti, Silvana B.

; Ferriani, Virgínia Paes Leme

; Piotto, Daniela Gerent Petry

; Cavalcanti, André de Souza

; Moraes, Ana Júlia Pantoja de

; Sztajnbok, Flavio Roberto

; Oliveira, Sheila Knupp Feitosa de

; Campos, Lucia Maria Arruda

; Bandeira, Marcia

; Santos, Flávia Patricia Sena Teixeira

; Magalhães, Claudia Saad

Revista Brasileira de Reumatologia

Journal Metrics
- Sobre o periódico
- SciELO Analytics

feb 2016, Volume 56 N. 1 Pages 52 - 57

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

Resumo Objetivo: Estabelecer diretrizes baseadas em evidências científicas para manejo da síndrome de febre periódica, estomatite aftosa, faringite e adenite (PFAPA). Descrição do método de coleta de evidência: A Diretriz foi elaborada a partir de cinco questões clínicas que foram estruturadas por meio do Pico (Paciente, Intervenção ou Indicador, Comparação e Outcome), com busca nas principais bases primárias de informação científica. Após definir os estudos potenciais para sustento das recomendações, esses foram graduados pela força da evidência e pelo grau de recomendação. Resultados: Foram recuperados e avaliados pelo título e resumo 806 trabalhos e selecionados 32 artigos, para sustentar as recomendações. Recomendações: 1. O diagnóstico da PFAPA é clínico e de exclusão, deve a suspeita ser considerada em crianças que apresentam episódios febris de origem indeterminada recorrentes e periódicos ou amidalites de repetição, intercalados com períodos assintomáticos, sobretudo em crianças em bom estado geral e com desenvolvimento pondero-estatural mantido; 2. Os achados laboratoriais são inespecíficos. Não existem alterações patognomônicas nos exames complementares; 3. A evidência que sustenta a indicação do tratamento cirúrgico (tonsilectomia com ou sem adenoidectomia) é baseada em dois ensaios clínicos randomizados não cegos que incluíram pequeno número de pacientes; 4. O uso de prednisona no início do quadro febril em pacientes com PFAPA mostrou ser eficaz. Melhores evidências ainda são necessárias para apoiar seu uso na PFAPA; 5. Apesar de os resultados obtidos de estudos com inibidores de IL-1ß serem promissores, esses são limitados a poucos relatos de casos.

Abstract Objective: To establish guidelines based on scientific evidence for the management of periodic fever, aphthous stomatitis, pharyngitis and adenitis (PFAPA) syndrome. Description of the evidence collection method: The Guideline was prepared from 5 clinical questions that were structured through PICO (Patient, Intervention or indicator, Comparison and Outcome), to search in key primary scientific information databases. After defining the potential studies to support the recommendations, these were graduated considering their strength of evidence and grade of recommendation. Results: 806 articles were retrieved and evaluated by title and abstract; from these, 32 articles were selected to support the recommendations. Recommendations: 1. PFAPA is a diagnosis of exclusion established on clinical grounds, and one must suspect of this problem in children with recurrent and periodic febrile episodes of unknown origin, or with recurrent tonsillitis interspersed with asymptomatic periods, especially in children in good general condition and with preservation of weight and height development. 2. Laboratory findings are nonspecific. Additional tests do not reveal pathognomonic changes. 3. The evidence supporting an indication for surgical treatment (tonsillectomy with or without adenoidectomy), is based on two non-blinded randomized clinical trials with small numbers of patients. 4. The use of prednisone at the onset of fever in patients with PFAPA proved to be an effective strategy. There is still need for more qualified evidence to support its use in patients with PFAPA. 5. Despite promising results obtained in studies with IL-1β inhibitors, such studies are limited to a few case reports.

https://doi.org/10.1016/j.rbr.2015.08.005 12264 downloads

12.

Diretrizes de conduta e tratamento de síndromes febris periódicas associadas à criopirina (criopirinopatias – CAPS)
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Terreri, Maria Teresa R.A.

; Bernardo, Wanderley Marques

; Len, Claudio Arnaldo

; Silva, Clovis Artur Almeida da

; Magalhães, Cristina Medeiros Ribeiro de

; Sacchetti, Silvana B.

; Ferriani, Virgínia Paes Leme

; Piotto, Daniela Gerent Petry

; Cavalcanti, André de Souza

; Moraes, Ana Júlia Pantoja de

; Sztajnbok, Flavio Roberto

; Oliveira, Sheila Knupp Feitosa de

; Campos, Lucia Maria Arruda

; Bandeira, Marcia

; Santos, Flávia Patricia Sena Teixeira

; Magalhães, Claudia Saad

Revista Brasileira de Reumatologia

Journal Metrics
- Sobre o periódico
- SciELO Analytics

feb 2016, Volume 56 N. 1 Pages 44 - 51

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

Resumo Objetivo: Estabelecer diretrizes baseadas em evidências científicas para manejo das síndromes periódicas associadas à criopirina (criopirinopatias – Caps). Descrição do método de coleta de evidência: A diretriz foi elaborada a partir de quatro questões clínicas que foram estruturadas por meio do PICO (Paciente, Intervenção ou Indicador, Comparação e Outcome), com busca nas principais bases primárias de informação científica. Após definir os estudos potenciais para sustento das recomendações, esses foram graduados pela força da evidência e pelo grau de recomendação. Resultado: Foram recuperados, e avaliados pelo título e resumo, 1.215 artigos e selecionados 42 trabalhos para sustentar as recomendações. Recomendações: 1. O diagnóstico de Caps é baseado na anamnese e nas manifestações clínicas e posteriormente confirmado por estudo genético. Pode se manifestar sob três fenótipos: FCAS (forma leve), MWS (forma intermediária) e Cinca (forma grave). Avaliações neurológica, oftalmológica, otorrinolaringológica e radiológica podem ser de grande valia na distinção entre as síndromes; 2. O diagnóstico genético com análise do gene NLRP3 deve ser conduzido nos casos suspeitos de Caps, isto é, indivíduos que apresentam, antes dos 20 anos, episódios recorrentes de inflamação expressa por urticária e febre moderada; 3. As alterações laboratoriais incluem leucocitose e elevação nos níveis séricos de proteínas inflamatórias; 4. Terapias alvo dirigidas contra a interleucina 1 levam a rápida remissão dos sintomas na maioria dos pacientes. Contudo, existem limitações importantes em relação à segurança em longo prazo. Nenhuma das três medicações anti-IL1β evita progressão das lesões ósseas.

Abstract Objective: To establish guidelines based on cientific evidences for the management of cryopyrin associated periodic syndromes. Description of the evidence collection method: The Guideline was prepared from 4 clinical questions that were structured through PICO (Patient, Intervention or indicator, Comparison and Outcome), to search in key primary scientific information databases. After defining the potential studies to support the recommendations, these were graduated considering their strength of evidence and grade of recommendation. Results: 1215 articles were retrieved and evaluated by title and abstract; from these, 42 articles were selected to support the recommendations. Recommendations: 1. The diagnosis of CAPS is based on clinical history and clinical manifestations, and later confirmed by genetic study. CAPS may manifest itself in three phenotypes: FCAS (mild form), MWS (intermediate form) and CINCA (severe form). Neurological, ophthalmic, otorhinolaryngological and radiological assessments may be highly valuable in distinguishing between syndromes; 2. The genetic diagnosis with NLRP3 gene analysis must be conducted in suspected cases of CAPS, i.e., individuals presenting before 20 years of age, recurrent episodes of inflammation expressed by a mild fever and urticaria; 3. Laboratory abnormalities include leukocytosis and elevated serum levels of inflammatory proteins; and 4. Targeted therapies directed against interleukin-1 lead to rapid remission of symptoms in most patients. However, there are important limitations on the long-term safety. None of the three anti-IL-1β inhibitors prevents progression of bone lesions.

https://doi.org/10.1016/j.rbr.2015.08.007 3351 downloads

13.

Diretrizes de conduta e tratamento de síndromes febris periódicas associadas a febre familiar do Mediterrâneo
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Terreri, Maria Teresa R.A.

; Bernardo, Wanderley Marques

; Len, Claudio Arnaldo

; Silva, Clovis Artur Almeida da

; Magalhães, Cristina Medeiros Ribeiro de

; Sacchetti, Silvana B.

; Ferriani, Virgínia Paes Leme

; Piotto, Daniela Gerent Petry

; Cavalcanti, André de Souza

; Moraes, Ana Júlia Pantoja de

; Sztajnbok, Flavio Roberto

; Oliveira, Sheila Knupp Feitosa de

; Campos, Lucia Maria Arruda

; Bandeira, Marcia

; Santos, Flávia Patricia Sena Teixeira

; Magalhães, Claudia Saad

Revista Brasileira de Reumatologia

Journal Metrics
- Sobre o periódico
- SciELO Analytics

feb 2016, Volume 56 N. 1 Pages 37 - 43

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

Resumo Objetivo: Estabelecer diretrizes baseadas em evidências científicas para manejo da febre familiar do Mediterrâneo (FFM). Descrição do método de coleta de evidência: A diretriz foi elaborada a partir de 5 questões clínicas que foram estruturadas por meio do PICO (Paciente, Intervenção ou Indicador, Comparação e Outcome), com busca nas principais bases primárias de informação científica. Após definir os estudos potenciais para sustento das recomendações, esses foram graduados pela força da evidência e pelo grau de recomendação. Resultados: Foram recuperados, e avaliados pelo título e resumo, 10.341 trabalhos e selecionados 46 artigos para sustentar as recomendações. Recomendações: 1. O diagnóstico da FFM é baseado nas manifestações clínicas, caracterizadas por episódios febris recorrentes associados a dor abdominal, torácica ou artrite de grandes articulações; 2. A FFM é uma doença genética que apresenta traço autossômico recessivo ocasionada por mutação no gene MEFV; 3. Exames laboratoriais são inespecíficos e demonstram níveis séricos elevados de proteínas inflamatórias na fase aguda da doença, mas também, com frequência, níveis elevados mesmo entre os ataques. Níveis séricos de SAA podem ser especialmente úteis no monitoramento da eficácia do tratamento; 4. A colchicina é a terapia de escolha e demonstrou eficácia na prevenção dos episódios inflamatórios agudos e progressão para amiloidose em adultos; 5. Com base na informação disponível, o uso de medicamentos biológicos parece ser opção para pacientes com FFM que não respondem ou que são intolerantes à terapia com colchicina.

Abstract Objective: To establish guidelines based on scientific evidence for the management of familial Mediterranean fever. Description of the evidence collection method: The Guideline was prepared from 5 clinical questions that were structured through PICO (Patient, Intervention or indicator, Comparison and Outcome), to search in key primary scientific information databases. After defining the potential studies to support the recommendations, these were graduated considering their strength of evidence and grade of recommendation. Results: 10,341 articles were retrieved and evaluated by title and abstract; from these, 46 articles were selected to support the recommendations. Recommendations: 1. The diagnosis of FMF is based on clinical manifestations, characterized by recurrent febrile episodes associated with abdominal pain, chest or arthritis of large joints; 2. FMF is a genetic disease presenting an autosomal recessive trait, caused by mutation in the MEFV gene; 3. Laboratory tests are not specific, demonstrating high serum levels of inflammatory proteins in the acute phase of the disease, but also often showing high levels even between attacks. SAA serum levels may be especially useful in monitoring the effectiveness of treatment; 4. The therapy of choice is colchicine; this drug has proven effectiveness in preventing acute inflammatory episodes and progression towards amyloidosis in adults; 5. Based on the available information, the use of biological drugs appears to be an alternative for patients with FMF who do not respond or are intolerant to therapy with colchicine.

https://doi.org/10.1016/j.rbr.2015.08.006 7906 downloads

14.

Family Health Strategy professionals' view on the effects of Hansen's disease training
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Souza, Ana Lúcia Alves de

; Feliciano, Katia Virginia de Oliveira

; Mendes, Marina Ferreira de Medeiros

Revista da Escola de Enfermagem da USP

Journal Metrics
- Sobre o periódico
- SciELO Analytics

aug 2015, Volume 49 N. 4 Pages 0610 - 0618

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

OBJECTIVEEvaluating how professionals of family health teams from three municipalities of Pernambuco perceive and interpret the effects of Hansen's disease training.METHODSA qualitative study using the perspective of Habermas. Six focus groups, totaling 33 nurses and 22 doctors were formed. The guide consisted of: reactions to training, learning, transfer of knowledge and organizational results.RESULTSThere were recurrent positive opinions on instructor performance, course materials, and an alert attitude to the occurrence of cases; the negative points were about lack of practical teaching, a lot of information in a short period of time and little emphasis on basic content. Low perceived self-efficacy and low locus of control, ambiguity, conflict of skills and the lack of support for the learning application. Nurses showed greater dissatisfaction with the organizational support.CONCLUSIONThe low effectiveness of training reveals the need to negotiate structured training from work problematization, considering performance conditions.

OBJETIVOEvaluar cómo los profesionales de los equipos de salud de la familia de tres municipios de Pernambuco perciben e interpretan los efectos del entrenamiento de hanseniasis.MÉTODOEstudio cualitativo que utiliza la perspectiva habermasiana. Se formalizaron seis grupos focales, totalizando 33 enfermeras y 22 médicos. Figuraron en el guión: reacciones al entrenamiento, aprendizaje, transferencia de aprendizaje y resultados organizativos.RESULTADOSFueron recurrentes las opiniones positivas acerca del desempeño del instructor, el material didáctico, la actitud de alerta a la ocurrencia de casos, negativas sobre falta de enseñanza práctica, mucha información a corto plazo y poca énfasis a los contenidos básicos. Notaron baja autoeficacia y bajo locus de control, ambigüedad, conflicto de competencias y la falta de soporte a la aplicación de lo aprendido. Las enfermeras mostraron mayor insatisfacción con el soporte organizativo.CONCLUSIÓNLa baja efectividad del entrenamiento revela la necesidad de negociar la capacitación desde la problematización del trabajo, considerando las condiciones para el desempeño.

OBJETIVOAvaliar como os profissionais das equipes de saúde da família de três municípios de Pernambuco percebem e interpretam os efeitos do treinamento de hanseníase.MÉTODOEstudo qualitativo que utiliza perspectiva habermasiana. Formalizaram-se seis grupos focais, perfazendo 33 enfermeiras e 22 médicos. Constaram do roteiro: reações ao treinamento, aprendizagem, transferência de aprendizagem e resultados organizacionais.RESULTADOSForam recorrentes as opiniões positivas sobre o desempenho do instrutor, o material didático, a atitude de alerta à ocorrência de casos, negativas sobre falta de ensino prático, muita informação em curto tempo e pouca ênfase em conteúdos básicos. Perceberam baixa autoeficácia e baixo locus de controle, ambiguidade, conflito de competências e a falta de suporte à aplicação do aprendido. As enfermeiras mostraram maior insatisfação com o suporte organizacional.CONCLUSÃOA baixa efetividade do treinamento revela a necessidade de negociar a capacitação a partir da problematização do trabalho, considerando as condições para o desempenho.

https://doi.org/10.1590/S0080-623420150000400011 2 downloads

15.

Family Health Strategy professionals' view on the effects of Hansen's disease training
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Souza, Ana Lúcia Alves de

; Feliciano, Katia Virginia de Oliveira

; Mendes, Marina Ferreira de Medeiros

Revista da Escola de Enfermagem da USP

Journal Metrics
- Sobre o periódico
- SciELO Analytics

aug 2015, Volume 49 N. 4 Pages 0610 - 0618

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

https://doi.org/10.1590/S0080-623420150000400011 4882 downloads

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