RESUMO Objetivo: Streptococcus do grupo A (SGA) são cocos gram-positivos que colonizam a nasofaringe e/ou a pele e em casos raros podem causar infecções graves. Embora essas infecções tenham diminuído durante a pandemia da COVID-19, alguns países observaram um aumento no número de doenças invasivas pelo SGA nos últimos anos. O objetivo deste estudo foi descrever uma série de doenças invasivas pelo S. pyogenes em crianças internadas em um hospital de referência para tratamento de doenças infecciosas em Minas Gerais, Brasil, entre setembro de 2022 e agosto de 2023. Os dados foram obtidos dos prontuários médicos. O SGA foi isolado do sangue, líquido pleural, cerebrospinal ou fluido articular. Descrição do caso: O total de nove pacientes, quatro do sexo masculino e cinco do sexo feminino, com idade entre oito meses e dez anos, foram admitidos. Ao todo, três (33%) tiveram pneumonia, três (33%) síndrome do choque tóxico, três (33%) artrite séptica, um (11%) osteomielite, dois (22%) meningite e dois (22%) celulite. A maioria dos pacientes (5) apresentou complicações, incluindo derrame pleural, choque séptico, vasculite cerebral e amputações de membros. Ao todo, sete (75%) pacientes foram admitidos na unidade de terapia intensiva, e um paciente morreu. Comentários: É importante estar atento à possibilidade de infeção por S. pyogenes em crianças com infecções pulmonares, neurológicas, osteoarticulares, cutâneas ou em casos graves de choque séptico. Diante da ausência de sinais clínicos específicos, dados epidemiológicos que demonstrem o aumento da incidência da doença são de grande importância e devem servir de alerta para o diagnóstico da doença. Objetivo (SGA grampositivos gram positivos eou COVID19, COVID19 COVID 19, 19 COVID-19 anos S Gerais Brasil 202 2023 médicos sangue pleural articular caso feminino todo 33% 33 (33% pneumonia tóxico séptica 11% 11 (11% osteomielite 22% 22 (22% celulite 5 (5 complicações séptico membros 75% 75 (75% intensiva morreu Comentários pulmonares neurológicas osteoarticulares específicos COVID1 1 COVID-1 20 3 (33 (11 2 (22 ( 7 (75 COVID- (3 (1 (2 (7

ABSTRACT Objective: Group A Streptococcus (GAS) are Gram-positive cocci that colonize the nasopharynx and/or skin and in rare cases may cause severe invasive infections. Although these infections decreased during the COVID-19 pandemic, some countries have observed an increased number of invasive GAS (iGAS) diseases in recent years. The objective of this study was to describe a series of iGAS diseases in a referral hospital for the treatment of pediatric infectious disease in Minas Gerais State, Brazil, between September 2022 and August 2023. The data were obtained from medical records, and GAS was isolated from blood, pleural, cerebrospinal, or joint fluid. Case description: A total of nine patients, four male and five female, between eight months and ten years of age, were admitted. Of the patients observed, three (33%) had pneumonia, three (33%) had toxic shock syndrome, three (33%) had septic arthritis, one (11%) had osteomyelitis, two (22%) had meningitis, and two (22%) cellulitis. The majority of patients (5) experienced complications, including pleural effusion, septic shock, cerebral vasculitis, and limb amputations. In total, seven (75%) patients were admitted to the intensive care unit, and one patient died. Comments: It is important to be aware of the possibility of S. pyogenes infection in children with pulmonary, neurological, osteoarticular, skin infections or in severe cases of septic shock. Given the absence of specific clinical signs, epidemiological data showing an increase in the local incidence of S. pyogenes infections is of great importance and should serve as an alert for the diagnosis of the disease. Objective (GAS Grampositive Gram positive andor COVID19 COVID 19 COVID-1 pandemic (iGAS State Brazil 202 2023 records blood cerebrospinal fluid description female age 33% 33 (33% pneumonia syndrome arthritis 11% 11 (11% osteomyelitis 22% 22 (22% meningitis cellulitis 5 (5 complications effusion vasculitis amputations 75% 75 (75% unit died Comments S pulmonary neurological osteoarticular signs COVID1 1 COVID- 20 3 (33 (11 2 (22 ( 7 (75 (3 (1 (2 (7

Abstract Objective To develop the second evidence-based Brazilian Society of Rheumatology consensus for diagnosis and treatment of lupus nephritis (LN). Methods Two methodologists and 20 rheumatologists from Lupus Comittee of Brazilian Society of Rheumatology participate in the development of this guideline. Fourteen PICO questions were defined and a systematic review was performed. Eligible randomized controlled trials were analyzed regarding complete renal remission, partial renal remission, serum creatinine, proteinuria, serum creatinine doubling, progression to end-stage renal disease, renal relapse, and severe adverse events (infections and mortality). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to develop these recommendations. Recommendations required ≥82% of agreement among the voting members and were classified as strongly in favor, weakly in favor, conditional, weakly against or strongly against a particular intervention. Other aspects of LN management (diagnosis, general principles of treatment, treatment of comorbidities and refractory cases) were evaluated through literature review and expert opinion. Results All SLE patients should undergo creatinine and urinalysis tests to assess renal involvement. Kidney biopsy is considered the gold standard for diagnosing LN but, if it is not available or there is a contraindication to the procedure, therapeutic decisions should be based on clinical and laboratory parameters. Fourteen recommendations were developed. Target Renal response (TRR) was defined as improvement or maintenance of renal function (±10% at baseline of treatment) combined with a decrease in 24-h proteinuria or 24-h UPCR of 25% at 3 months, a decrease of 50% at 6 months, and proteinuria < 0.8 g/24 h at 12 months. Hydroxychloroquine should be prescribed to all SLE patients, except in cases of contraindication. Glucocorticoids should be used at the lowest dose and for the minimal necessary period. In class III or IV (±V), mycophenolate (MMF), cyclophosphamide, MMF plus tacrolimus (TAC), MMF plus belimumab or TAC can be used as induction therapy. For maintenance therapy, MMF or azathioprine (AZA) are the first choice and TAC or cyclosporin or leflunomide can be used in patients who cannot use MMF or AZA. Rituximab can be prescribed in cases of refractory disease. In cases of failure in achieving TRR, it is important to assess adherence, immunosuppressant dosage, adjuvant therapy, comorbidities, and consider biopsy/rebiopsy. Conclusion This consensus provides evidence-based data to guide LN diagnosis and treatment, supporting the development of public and supplementary health policies in Brazil. evidencebased evidence LN. . (LN) 2 guideline performed remission doubling endstage end stage disease relapse infections mortality. mortality mortality) Assessment GRADE (GRADE 82 ≥82 favor conditional intervention diagnosis, (diagnosis opinion involvement but procedure parameters developed TRR (TRR ±10% 10 (±10 24h 24 25 months 50 08 0 8 0. g24 g g/2 1 period ±V, V ±V , (±V) MMF, (MMF) cyclophosphamide TAC, (TAC) therapy AZA (AZA adherence dosage biopsyrebiopsy rebiopsy biopsy/rebiopsy Brazil (LN ≥8 ±10 (±1 5 g2 g/ (±V (MMF (TAC ≥ ±1 (± ± (

RESUMEN Las especies de Plinia comprenden un grupo subestimado de árboles frutales nativos de los neotrópicos de América del Sur y Central. Sus frutos tienen un alto potencial como alimento nutracéutico y para la industria medicinal. Sin embargo, entre las 80 especies aceptadas, se cultivan menos de una docena. En esta revisión, se actualizó el estado del arte de la diversidad genética y las técnicas de propagación vegetativa de Plinia spp. Con ello, se propondrá impulsar nuevos estudios para dilucidar genéticamente la clasificación taxonómica de la especie y el desarrollo de protocolos de propagación hacia el establecimiento de plantaciones comerciales. El establecimiento de plantaciones comerciales de especies de Plinia spp. puede abrir nuevos mercados para este cultivo de frutas, pero la ausencia de programas de mejoramiento genético y plántulas de calidad superior obstaculizan tales esfuerzos. Los principales resultados de este estudio son la necesidad de utilizar enfoques moleculares para resolver las incertidumbres taxonómicas entre las especies de Plinia y los protocolos de micropropagación para superar las dificultades relacionadas con la propagación vegetativa de esta especie.

ABSTRACT Plinia species comprise a group of underrated fruit trees native to the South and Central American neotropics. Their fruits have high potential as a nutraceutical food and to the medicinal industry. However, among the 80 accepted species, less than a dozen are cultivated. In this review, the state-of-the-art of the genetic diversity and the techniques of vegetative propagation of Plinia spp. was updated. Therewith, it is intended to encourage further studies for genetically disentangle the taxonomic classification the species, and the development of propagation protocols towards the establishment of commercial plantations. Establishing commercial orchards of Plinia species may open new markets for this fruit crop, but the absence of breeding programs and superior quality seedlings hinder such endeavors. The main outcomes of this study are the need of using molecular approaches for solving the taxonomic uncertainties among Plinia species and micropropagation protocols to overcome the difficulties concerning to the vegetative propagation of this species.

RESUMO Objetivo Avaliar a qualidade da assistência em uma Unidade de Terapia Intensiva Materna, tendo por base indicadores de estrutura, processo e resultados. Material e método Estudo descritivo, de análise documental com abordagem quantitativa. A coleta de dados ocorreu entre os meses de janeiro e fevereiro de 2017 na Unidade de Terapia Intensiva materna de uma maternidade de referência do Piauí. Utilizou-se roteiro observacional com amostra censitária de 72 pacientes. Resultados O eixo higiene, conforto e segurança demonstraram uma assistência global desejável, exceto para os indicadores nutrição e hidratação que apresentaram assistência sofrível ou limítrofe. O eixo que apresentou melhores resultados foi anotações de enfermagem com assistência desejável em grande parte dos itens analisados. Conclusão O estudo evidenciou resultados satisfatórios de forma geral, entretanto, chama-se atenção para melhoras na assistência de enfermagem às pacientes internadas na Unidade de Terapia Intensiva Materna, sobretudo para os indicadores nutrição e hidratação.

ABSTRACT Objective To evaluate the quality of care provided in a maternal intensive care unit, based on indicators of structure, process and results. Material and methods Descriptive study of documentary analysis with a quantitative approach. Data collection happened between January and February 2017 at the Maternal Intensive Care Unit of a reference maternity hospital in Piauí. An observational script with a census sample of 72 patients was used. Results The hygiene, comfort and safety axis showed adequate care. However, the nutrition and hydration indicators presented with risky and undesirable care. The axis that presented the best results was nursing records with adequate care in most of the analyzed items. Conclusion The study showed satisfactory results in general; however, attention should be given to improvements in nursing care for patients hospitalized in the Maternal Intensive Care Unit, especially for the nutrition and hydration indicators.

RESUMEN Objetivo Evaluar la calidad de la asistencia en una Unidad de Cuidados Intensivos maternos, ha tenido por base indicadores de estructura proceso y resultados. Material y método Estudio descriptivo, de análisis documental con abordaje cuantitativo. La colecta de datos ocurrió entre enero y febrero de 2017 en la Unidad de Cuidados Intensivos maternos de una maternidad de referencia en Piauí. Fue utilizado un guion observacional con muestra censal de 72 pacientes. Resultados El eje higiene, confort y seguridad mostró una asistencia global deseable, excepto para los indicadores de nutrición e hidratación que presentaron asistencia tolerable o limíte. El eje que presentó mejores resultados fue las anotaciones de enfermería con asistencia deseable en gran parte de los artículos analizados. Conclusión El estudio evidenció resultados satisfactorios de forma general, sin embargo, es importante que ocurran mejoras en la asistencia de enfermería a las pacientes ingresadas en la unidad de cuidados intensivos maternosl, sobre todo para los indicadores de nutrición e hidratación.