Abstract Considering dynamic and meaningful learning, the present study aimed to analyze the use of Storytelling applied remotely as a teaching activity for students of an undergraduate nursing course who participate in an academic association. A cross-sectional analytical and qualitative study was carried out, whose participants were students linked to an academic association at a federal public university, in the city of Rio de Janeiro (RJ), Brazil (BR). Data collection was carried out through an electronic form and remote focus group, demonstrated by descriptive statistics and analysis of the thematic content by category, with the Significance Units identified by colorimetry from the meaning of each Record Unit that gave rise to two categories: 1) Storytelling during the teaching-learning process and 2) Storytelling perceived by students. The stories demonstrate the students’ perception in relation to the planning and teaching-learning experience, regarding the use of Storytelling and the collective construction of the story presented, based on the challenges and contributions that this process brought to their training. It was observed that Storytelling can be used as a strategy to mobilize emotions and feelings, dynamic and meaningful, adaptable to the digital format and positively accepted among undergraduate students. Its use is suggested in the teaching-learning process and in research to measure its effectiveness and efficiency.

Resumen Considerando el aprendizaje dinámico y significativo, el presente estudio tuvo como objetivo analizar el uso del storytelling (narración de cuentos) aplicado en forma remota como actividad de enseñanza para alumnos de un curso de pregrado en enfermería que participan en una asociación académica. Se llevó a cabo un estudio transversal analítico y cualitativo, cuyos participantes fueron alumnos vinculados a una asociación académica en una universidad pública federal, en la ciudad de Río de Janeiro (RJ), Brasil (BR). La recolección de datos se realizó a través de un formulario electrónico y grupo focal remoto, demostrados por estadística descriptiva y análisis del contenido temático por categoría, siendo las Unidades de Significación identificadas por colorimetría a partir del significado de cada Unidad de Registro que originaron dos categorías: 1) Storytelling durante el proceso de enseñanza-aprendizaje y 2) Storytelling percibida por los alumnos. Los relatos demuestran la percepción de los alumnos en relación con la planificación y experiencia enseñanza-aprendizaje, mediante el uso del Storytelling y la construcción colectiva de la historia presentada, a partir de desafíos y contribuciones que dicho proceso trajo para su formación. Se observó que el storytelling puede ser utilizado como una estrategia movilizadora de emociones y sentimientos, dinámica y significativa, adaptable al formato digital y de aceptación positiva entre los alumnos de pregrado. Se sugiere su uso en el proceso de enseñanza-aprendizaje y en la investigación para medir su eficacia y eficiencia.

The tomato (Solanum lycopersicon L.) crop has great economic relevance, being one of the most processed agricultural products worldwide. Some pesticides are chemically stable and can remain in food even after processing. In this context, the objective of this work was to analyze food products derived from tomatoes (extract, sauce and ketchup), regarding the levels of pesticide residues. Fifteen samples were acquired from Vale do Jaguaribe, Ceará, Brazil. Six pesticides (bifenthrin, chlorothalonil, chlorpyrifos, cyfluthrin, pyriproxyfen, trifluralin) authorized by Agência Nacional de Vigilância Sanitária (Anvisa) for tomato cultivation were selected for the study. QuEChERS (quick, easy, cheap, effective, rugged, safe) extraction and gas chromatography coupled to mass spectrometry (GC-MS) were used in method validation, according to the recommendations of SANTE 11312/2021 guidelines. Statistical analyses of linearity showed that the six pesticides studied were classified as heterocesdastic. Limits of detection (LOD) and quantification (LOQ) values (0.01-0.03 and 0.03-0.10 mg kg-1, respectively) were below the established maximum residue limits (MRLs) for tomatoes. Accuracy and precision (78-121 and 2.3-16.7%, respectively) were satisfactory. The results indicated that among the 15 analyzed samples, one active ingredient was detected (0.05 mg kg-1) in a tomato sauce sample, lower than MRLs (Anvisa 0.15 mg kg-1 and FAO 0.3 mg kg-1). The results show the relevance of monitoring pesticide residues in tomato-derived products and the validation of new methodologies for food control.

Resumo Introdução: O acolhimento é uma prática presente nas relações de cuidado, entre trabalhadores de saúde e usuários, nos atos de receber e escutar as pessoas, sendo um mecanismo de ampliação e facilitação do acesso. Objetivos: Compreender, na percepção dos enfermeiros que atuam na Atenção Primária à Saúde, como ocorre o processo de acolhimento nas Unidades Básicas de Saúde da Região Norte do Distrito Federal. Métodos: Trata-se de um estudo descritivo, exploratório de cunho qualitativo, realizado com 33 enfermeiros. A coleta de dados ocorreu no período de 10 de outubro a 30 de novembro de 2022. Os dados foram analisados por meio da análise de conteúdo de Bardin: pré-análise, exploração do material e tratamento dos resultados, inferência e interpretação. Resultados: Foi possível encontrar dois núcleos de sentido que foram divididos em duas categorias: 1- processo de trabalho do enfermeiro no atendimento à demanda espontânea; e 2-necessidades de aprendizagem na percepção do enfermeiro. Conclusões: Verificou-se a necessidade de ampla divulgação dos documentos norteadores com as atividades a serem desenvolvidas pelo enfermeiro do acolhimento, com clareza dos fluxos e dos papéis de cada profissional, além de ampla capacitação de todos os profissionais, definição de matriz de alinhamento da equipe ou equipes ESF em cada UBS com o enfermeiro do acolhimento, a fim de que sejam estabelecidas a organização e a condução do processo de acolhimento com base nas necessidades do território e na organização interna da equipe.

Abstract Introduction: Welcoming is a practice present in care relationships, between health workers and users, in the acts of receiving and listening to people, being a mechanism for expanding and facilitating access. Objectives: Understand, in the perception of nurses who work in Primary Health Care, how the reception process occurs in Basic Health Units in the North Region of the Federal District. Methods: This is a descriptive, exploratory qualitative study, carried out with 33 nurses. Data collection took place from October 10 to November 30, 2022. Data were analyzed using Bardin's content analysis: pre-analysis, material exploration and treatment of results, inference and interpretation. Results: It was possible to find two core meanings that were divided into two categories: 1- The nurse's work process in meeting spontaneous demand and 2- Learning needs in the nurse's perception. Conclusions: There was a need for wide dissemination of guiding documents with the activities to be developed by the reception nurse, clearly of the flows and roles of each professional, besides wide training of all professionals, Definition of team alignment or teams in each UBS with the host nurse, in order to establish the organization and conduct of the reception process based on the needs of the territory and the internal organization of the team.

Objectives: To summarize evidence-based cognitive-behavioral therapy (CBT) treatment and propose clinical interventions for adult patients with obsessive-compulsive disorder (OCD). Methods: The literature on CBT interventions for adult OCD, including BT and exposure and response prevention, was systematically reviewed to develop updated clinical guidelines for clinicians, providing comprehensive details about the necessary procedures for the CBT protocol. We searched the literature from 2013-2020 in five databases (PubMed, Cochrane, Embase, PsycINFO, and Lilacs) regarding study design, primary outcome measures, publication type, and language. Selected articles were assessed for quality with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association. Results: We examined 44 new studies used to update the 2013 American Psychiatric Association guidelines. High-quality evidence supports CBT with exposure and response prevention techniques as a first-line treatment for OCD. Protocols for Internet-delivered CBT have also proven efficacious for adults with OCD. Conclusion: High-quality scientific evidence supports the use of CBT with exposure and response prevention to treat adults with OCD.

Abstract Objective: To analyze the reliability of estimating the percentage of rhinopharyngeal obstruction by the adenoid using nasofibroscopy and its correlation with clinical symptoms. Methods: Cross-sectional observational study was conducted, involving 80 patients between 4 and 14 years old, recruited from Santa Casa of São Paulo general otorhinolaryngology outpatient service during the years of 2020 and 2021. All patients underwent nasal endoscopy examination, and the recorded videos were randomly assigned to four evaluators in two different sessions, with a minimum interval of 1 month. The evaluators estimated the percentage of rhinopharyngeal obstruction caused by the adenoid. Intra- and inter-evaluator correlations were established by comparing the reports from each evaluator. The data were compared to the Pro Image J Software report, that also estimates a percentage of obstruction by computer graphics. To correlate the grading of obstruction with clinical symptoms, all patients completed the OSA (Obstructive Sleep Apnea) 18 questionnaire, a validated tool for assessing sleep apnea in children. The questionnaire data were then compared to the average scores assigned by the evaluators. Results: Satisfactory intra- and inter-rater correlations were observed, and the results were consistent with the Pro Image J Software. However, no correlation was found between the percentage of obstruction and the severity of clinical symptoms. Conclusion: Nasofibroscopy demonstrates good reliability in assessing a percentage of rhinopharyngeal obstruction caused by adenoids. However, there is no correlation between the degree of obstruction of the rhinopharynx and the clinical symptoms. Level of evidence: 4.

Objectives: To summarize evidence-based pharmacological treatments and provide guidance on clinical interventions for adult patients with obsessive-compulsive disorder (OCD). Methods: The American Psychiatric Association (APA) guidelines for the treatment of OCD (2013) were updated with a systematic review assessing the efficacy of pharmacological treatments for adult OCD, comprising monotherapy with selective serotonin reuptake inhibitors (SSRIs), clomipramine, serotonin and norepinephrine reuptake inhibitors (SNRIs), and augmentation strategies with clomipramine, antipsychotics, and glutamate-modulating agents. We searched for the literature published from 2013-2020 in five databases, considering the design of the study, primary outcome measures, types of publication, and language. Selected articles had their quality assessed with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association (ACC/AHA). Results: We examined 57 new studies to update the 2013 APA guidelines. High-quality evidence supports SSRIs for first-line pharmacological treatment of OCD. Moreover, augmentation of SSRIs with antipsychotics (risperidone, aripiprazole) is the most evidence-based pharmacological intervention for SSRI-resistant OCD. Conclusion: SSRIs, in the highest recommended or tolerable doses for 8-12 weeks, remain the first-line treatment for adult OCD. Optimal augmentation strategies for SSRI-resistant OCD include low doses of risperidone or aripiprazole. Pharmacological treatments considered ineffective or potentially harmful, such as monotherapy with antipsychotics or augmentation with ketamine, lamotrigine, or N-acetylcysteine, have also been detailed.

RESUMO OBJETIVO Identificar as normas jurídicas publicadas nos anos de 2020 e 2021 para regular direta ou indiretamente o teletrabalho em saúde no Brasil, analisando-as sob o enfoque dos seguintes temas, no contexto do teletrabalho: tempo da jornada de trabalho; ergonomia; ambiente laboral; segurança e saúde do trabalhador. MÉTODOS Pesquisa legislativa e documental, com abordagem qualitativa descritiva. Foram coletadas e selecionadas todas as normas jurídicas que tratam direta ou indiretamente da regulação do teletrabalho em saúde no Brasil, publicadas nas bases da Imprensa Nacional e dos Conselhos Profissionais da área da saúde até junho de 2021. RESULTADOS Destacam-se os seguintes: até junho de 2021 havia 113 normas jurídicas vigentes sobre a regulação do teletrabalho em saúde, sendo mais da metade (64) publicadas no ano de 2020. Dentre os achados, identificou-se um baixo número de normas voltadas a regular ou orientar aspectos relacionados ao tempo da jornada de trabalho; à ergonomia; ao ambiente laboral; à segurança e à saúde do trabalhador. Do total das 113 normas, apenas uma trata da jornada de trabalho e somente 13 destacaram a importância de que os ambientes de trabalho tenham condições para o oferecimento de um bom serviço. DISCUSSÃO Identificamos ausências, nas normas jurídicas selecionadas, de dispositivos que regulam o teletrabalho em saúde, a fim de prover a defesa dos direitos do trabalhador e dos pacientes, ou ainda para garantir condições favoráveis à realização do teletrabalho, seja realizado nos domicílios, seja em outro espaço.

ABSTRACT OBJECTIVE To identify the legal norms published in 2020 and 2021 aimed at directly or indirectly regulating telework in health in Brazil, focusing on these contexts: workday length; ergonomics; work environment; worker safety and health. METHODS Legislative and documentary research, with a descriptive qualitative approach. We collected and selected all legal norms dealing directly or indirectly with the regulation of telework in health in Brazil, published in the bases of the National Press and Health Professional Councils until June 2021. RESULTS Until June 2021, there were 113 valid legal norms on the regulation of telework in health, and more than half of them (64) were published in 2020. We identified only a few norms aimed at regulating or guiding aspects related to workday length; ergonomics; work environment; and worker safety and health. From the 113 norms, only one deals with workday length and just 13 pointed out the importance of working environments for offering a good service. DISCUSSION We identified that the selected legal norms lack of devices which regulate telework in health, failing to defend workers’ and patients’ rights, or to guarantee favorable remote work conditions, whether at home or somewhere else.

ABSTRACT Objective: to describe the experience in the elaboration and implementation of a remote course on Cardiopulmonary Resuscitation for health professionals by means of Telesimulation. Development: an experience report about a course for Cardiopulmonary Resuscitation training, developed remotely and synchronously with 227 health professionals between June and July 2021 in the state of Rio de Janeiro - Brazil. The course was taught for 35 groups of students by applying the following: pre-test, video class and post-test 1; and Telesimulation and post-test 2 with perception assessment. In the assessment, Telesimulation stood out as a motivation strategy for improved learning about the topic, evidenced by the increase in the number of correct answers between the tests. Conclusion: the participants showed interest in the course, which proved to be a learning strategy, also considered as an innovation possibility for permanent education in health.

RESUMEN Objetivo: describir la experiencia en la elaboración e implementación de un curso a distancia de Reanimación Cardiopulmonar para profesionales de la salud mediante Telesimulación. Desarrollo: informe de experiencia de un curso de capacitación en Reanimación Cardiopulmonar, realizado con 227 profesionales de la salud entre junio y julio de 2021, de forma remota y sincrónica, en el estado de Río de Janeiro, Brasil. Se dictó el curso a 35 grupos y se los sometió a: pretest; video clase y postest 1; y Telesimulación y postest 2 con evaluación de la percepción. En la evaluación, la Telesimulación se destacó como estrategia para motivar un mayor aprendizaje sobre el tema, como revela el aumento del número de aciertos entre los tests. Conclusión: el curso fue de interés para los participantes y demostró ser una estrategia de aprendizaje, además de ser considerado una posibilidad de innovación para la educación permanente en salud.

RESUMO Objetivo: descrever a experiência na elaboração e implementação de um curso remoto sobre Reanimação Cardiopulmonar para profissionais de saúde por meio da Telessimulação. Desenvolvimento: relato de experiência de um curso para capacitação em Reanimação Cardiopulmonar, desenvolvido com 227 profissionais de saúde entre junho e julho de 2021, de forma remota e síncrona, no estado do Rio de Janeiro - Brasil. O curso foi ministrado para 35 turmas por meio da aplicação de: pré-teste; videoaula e pós-teste 1; e Telessimulação e pós-teste 2 com avaliação de percepção. Na avaliação, a Telessimulação se destacou como estratégia de motivação para maior aprendizado sobre o tema, evidenciado pelo aumento do número de acertos entre os testes. Conclusão: o curso teve interesse dos participantes e se mostrou como estratégia de aprendizagem, sendo, ainda, considerado uma possibilidade de inovação para a educação permanente em saúde.

ABSTRACT BACKGROUND: Coronavirus disease 2019 (COVID-19) can damage cardiac tissue by increasing troponin levels and inducing arrhythmias, myocarditis, and acute coronary syndrome. OBJECTIVES: To analyze the impact of COVID-19 on cardiac autonomic control in mechanically ventilated intensive care unit (ICU) patients. DESIGN AND SETTING: This cross-sectional analytical study of ICU patients of both sexes receiving mechanical ventilation was conducted in a tertiary hospital. METHODS: Patients were divided into COVID-19-positive (COVID(+)) and COVID-19-negative (COVID(-)) groups. Clinical data were collected and heart rate variability (HRV) records obtained using a heart rate monitor. RESULTS: The study sample comprised 82 subjects: 36 (44%) in the COVID(-) group (58.3% female; median age, 64.5 years) and 46 (56%) in the COVID(+) group (39.1% females; median age, 57.5 years). The HRV indices were lower than the reference values. An intergroup comparison identified no statistically significant differences in the mean normal-to-normal (NN) interval, standard deviation of the NN interval, or root mean square of successive differences in NN intervals. The COVID(+) group had an increased low frequency (P = 0.05), reduced high frequency (P = 0.045), and increased low frequency/high frequency (LF/HF) ratio (P = 0.048). There was a weak positive correlation between LF/HF and length of stay in the COVID(+) group. CONCLUSION: Patients who received mechanical ventilation had lower overall HRV indices. COVID(+) patients who received mechanical ventilation had lower vagal HRV components. These findings likely indicate clinical applicability, as autonomic control impairments are associated with a greater risk of cardiac death.

ABSTRACT Objective: This study aimed to investigate the association between 25OHD (total, bioavailable and free) with bone mass and microarchitecture among primary hyperparathyroidism (PHPT) patients and controls. Subjects and methods: Sixty-four patients in the preoperative period of PHPT and 63 matched controls, who had not taken vitamin D in the last three months. To calculate the bioavailable and free 25OHD, the genetic variants of the vitamin D-binding protein (DBP) were determined. Bone mineral density (BMD) was determined by dual-energy X-ray absorptiometry (DXA). The distributions of total, bioavailable and free 25OHD and their correlation with TBS and DXA were evaluated. Results: PHPT showed BMD and TBS values lower than CTRL in all locations (p < 0.05). There were no statistical differences in the levels of free, bioavailable and total 25OHD between the PHPT and CTRL groups [mean, min-max: 3.4 (1.4-8.6) vs. 3.1 (1.0-9.8) pg/mL, 1.51 (0.43-3.58) vs. 1.41 (0.38-3.48) ng/mL, 22.6 (11.0-39.9) vs. 20.6 (8.9-35.3) ng/dL, respectively; (p > 0.05). The distribution of DBP haplotypes was similar between groups. DXA showed no correlation with any form of 25OHD in both groups. TBS presented a weak correlation with the total 25OHD in PHPT (r = 0.28; p = 0.02) and a moderate correlation with the total, free and bioavailable 25OHD in CTRL (r = 0.42; r = 0.42; r = 0.43; respectively, p < 0.01). Conclusion: The concentrations of total, free and bioavailable 25OHD were similar in both the PHPT and control groups. 25OHD concentrations correlated positively with TBS and not with DXA, especially in controls, suggesting that this method may be more sensitive to assessing the consequences of vitamin D deficiency on bone quality in individuals without PHPT.

Abstract This work aimed to evaluate the energy quality of wood and charcoal obtained from the stem and root of the genus Eucalyptus spp. From the wood, the physical, chemical and energetic properties were evaluated. For the charcoal produced in ovens of the carbonization furnaces model in the industry and produced in a muffle furnace, the physical, chemical and energetic properties were evaluated. Based on the analysis of technological properties, wood from the root has higher basic density (731.45 kg m-3) and lignin content (26.44%), however, the fixed carbon content and higher calorific value of the root (17.54% and 4547.75 kcal kg-1) were lower than for the stem wood (21.36% and 4730.82 kcal kg-1). It is recommended to use the wood from the root, both for direct burning and for the production of charcoal. The charcoal obtained in the industry, compared to that produced in muffle, presented higher energy quality.

Abstract Currently, important gaps are identified in occupational therapy research that focus on the different concepts and objectives of Brazilian early childhood education. The objective of this research was to present the validation process of training workshops aimed at workers in early childhood education, through the consensus of specialists. Seven participatively elaborated workshops gave rise to the training framework and such information was presented in detail to the specialists in two rounds, according to the Delphi technique. Twenty-nine doctoral experts in early childhood education were invited, six of whom agreed to participate, with degrees in philosophy and literature, pedagogy and occupational therapy. A descriptive analysis of the responses was performed, based on the average of the results found. The workshops reached 95%-100% agreement. Some thematic enrichments were suggested, such as: school and preschool routine; neoliberalism and early childhood education; childhoods and their multiple determinations; the spontaneity of playing in early childhood education; children's culture and curriculum. The specialists also suggested dynamics and bibliographies for the workshops. Consensus denotes multidisciplinary theoretical-methodological consistency, which increases the complexity of the approach and the chances of generalization beyond the local interests of the institution that hosted this experience. The chart contains key themes, focused on current issues in early childhood education, which makes it possible for occupational therapists to use it in other contexts.

Resumo Atualmente, identificam-se importantes lacunas nas pesquisas em terapia ocupacional que enfoquem as diversas concepções e objetivos da educação infantil brasileira. O objetivo desta pesquisa foi apresentar o processo de validação de oficinas formativas voltadas para trabalhadoras da educação infantil, por meio do consenso de especialistas. Sete oficinas elaboradas participativamente deram origem ao quadro formativo e tais informações foram apresentadas detalhadamente aos especialistas em duas rodadas, conforme a técnica Delphi. Foram convidados 29 doutores experts em educação infantil, sendo que seis deles aceitaram participar, com formação em filosofia e letras, pedagogia e terapia ocupacional. Foi feita análise descritiva das respostas, a partir da média dos resultados encontrados. As oficinas alcançaram a 95%-100% de concordância. Foram sugeridos alguns enriquecimentos temáticos, como: o cotidiano escolar e pré-escolar; neoliberalismo e educação infantil; infâncias e suas múltiplas determinações; o espontaneísmo do brincar na educação infantil; cultura infantil e currículo. Os especialistas também sugeriram dinâmicas e bibliografias para as oficinas. O consenso denota consistência teórico-metodológica multidisciplinar, o que aumenta a complexidade da abordagem e as chances de generalização para além dos interesses locais da instituição que sediou esta experiência. O quadro contém temas-chave, focados nas problemáticas atuais da educação infantil, o que o torna passível de utilização por terapeutas ocupacionais em outros contextos.

ABSTRACT OBJECTIVE To identify the legal norms published in 2020 and 2021 aimed at directly or indirectly regulating telework in health in Brazil, focusing on these contexts: workday length; ergonomics; work environment; worker safety and health. METHODS Legislative and documentary research, with a descriptive qualitative approach. We collected and selected all legal norms dealing directly or indirectly with the regulation of telework in health in Brazil, published in the bases of the National Press and Health Professional Councils until June 2021. RESULTS Until June 2021, there were 113 valid legal norms on the regulation of telework in health, and more than half of them (64) were published in 2020. We identified only a few norms aimed at regulating or guiding aspects related to workday length; ergonomics; work environment; and worker safety and health. From the 113 norms, only one deals with workday length and just 13 pointed out the importance of working environments for offering a good service. DISCUSSION We identified that the selected legal norms lack of devices which regulate telework in health, failing to defend workers’ and patients’ rights, or to guarantee favorable remote work conditions, whether at home or somewhere else.

RESUMO OBJETIVO Identificar as normas jurídicas publicadas nos anos de 2020 e 2021 para regular direta ou indiretamente o teletrabalho em saúde no Brasil, analisando-as sob o enfoque dos seguintes temas, no contexto do teletrabalho: tempo da jornada de trabalho; ergonomia; ambiente laboral; segurança e saúde do trabalhador. MÉTODOS Pesquisa legislativa e documental, com abordagem qualitativa descritiva. Foram coletadas e selecionadas todas as normas jurídicas que tratam direta ou indiretamente da regulação do teletrabalho em saúde no Brasil, publicadas nas bases da Imprensa Nacional e dos Conselhos Profissionais da área da saúde até junho de 2021. RESULTADOS Destacam-se os seguintes: até junho de 2021 havia 113 normas jurídicas vigentes sobre a regulação do teletrabalho em saúde, sendo mais da metade (64) publicadas no ano de 2020. Dentre os achados, identificou-se um baixo número de normas voltadas a regular ou orientar aspectos relacionados ao tempo da jornada de trabalho; à ergonomia; ao ambiente laboral; à segurança e à saúde do trabalhador. Do total das 113 normas, apenas uma trata da jornada de trabalho e somente 13 destacaram a importância de que os ambientes de trabalho tenham condições para o oferecimento de um bom serviço. DISCUSSÃO Identificamos ausências, nas normas jurídicas selecionadas, de dispositivos que regulam o teletrabalho em saúde, a fim de prover a defesa dos direitos do trabalhador e dos pacientes, ou ainda para garantir condições favoráveis à realização do teletrabalho, seja realizado nos domicílios, seja em outro espaço.

Abstract Objective To assess the Pediatric Alert Score (EPA) accuracy, usefulness, reproducibility and applicability in identifying clinical deterioration in hospitalized children and adolescents. Methods This is a prospective diagnostic test study, carried out between October/2018 and October/2019, to measure EPA diagnostic accuracy in a sample of 240 children, and its reproducibility and applicability in a sample of 60 children. Data were processed and analyzed on MedCalc and VassarStats.net. Results At cut-off point ≥ 3, the score had a sensitivity of 73.6%, specificity of 95.7%, positive predictive value of 83%, negative predictive value of 92.7, area under the ROC curve of 93.6%, estimated prevalence of 19.6%, positive probability ratio of 17.1, positive post-test probability of 77.8%, simple Kappa of 0.946. Conclusion The study provides evidence on EPA high accuracy, usefulness and reproducibility in identifying clinical deterioration in a Brazilian pediatric hospital setting, and considered the instrument applicable in the context of the research.

Resumen Objetivo Evaluar la precisión, utilidad, reproducibilidad y aplicabilidad del Sistema de Alerta Precoz Infantil (SAPI) en la identificación del deterioro clínico en niños y adolescentes hospitalizados. Métodos Estudio de prueba diagnóstica, prospectiva, realizada entre octubre de 2018 y octubre de 2019, para medir la precisión diagnóstica del SAPI en una muestra de 240 niños y su reproducibilidad y aplicabilidad en una muestra de 60 niños. Los datos fueron procesados y analizados en MedCalc y VassarStats.net. Resultados En el punto de corte ≥ 3, el puntaje presentó una sensibilidad del 73,6 %, especificidad del 95,7 %, valor predictivo positivo del 83 %, valor predictivo negativo de 92,7, área bajo la curva ROC del 93,6 %, prevalencia estimada por la prueba del 19,6 %, razón de probabilidad positiva 17,1, probabilidad posprueba positiva del 77,8 %, kappa simple de 0,946. Conclusión El estudio presenta evidencias sobre la elevada precisión, utilidad y reproducibilidad del SAPI en la identificación del deterioro clínico en un escenario hospitalario pediátrico brasileño, por lo que el instrumento se consideró aplicable en el contexto de la investigación.

Resumo Objetivo Avaliar a acurácia, utilidade, reprodutibilidade e aplicabilidade do Escore Pediátrico de Alerta (EPA) na identificação da deterioração clínica em crianças e adolescentes hospitalizados. Métodos Estudo de teste diagnóstico, prospectivo, realizado entre outubro/2018 a outubro/2019, para medir a acurácia diagnóstica do EPA em uma amostra de 240 crianças, e sua reprodutibilidade e aplicabilidade em uma amostra de 60 crianças. Os dados foram processados e analisados no MedCalc e VassarStats.net. Resultados No ponto de corte ≥ 3, o escore apresentou sensibilidade de 73,6%, especificidade de 95,7%, valor preditivo positivo de 83%, valor preditivo negativo de 92,7, área sob a curva ROC de 93,6%, prevalência estimada pelo teste de 19,6%, razão de probabilidade positiva 17,1, probabilidade pós-teste positivo de 77,8%, kappa simples de 0,946. Conclusão O estudo fornece evidências sobre a elevada acurácia, utilidade e reprodutibilidade do EPA na identificação da deterioração clínica em um cenário hospitalar pediátrico brasileiro, e considerou o instrumento aplicável no contexto da pesquisa.

ABSTRACT Leishmania infantum is a protozoan that causes visceral leishmaniasis (VL) in the Americas and some regions of Europe. The disease is mainly characterized by hepatosplenomegaly and fever, and can be fatal. Factors related to the host and parasite can contribute to the transmission of Leishmania and the clinical outcome. The intraspecific genetic variability of L. infantum strains may be one of these factors. In this study, we evaluated the genetic variability of L. infantum obtained from bone marrow smear slides from patients in the Sao Paulo State, Brazil. For this, the minicircle of the kDNA hypervariable region was used as target by Sanger sequencing. By analyzing the similarity of the nucleotides and the maximum likelihood tree (Fasttree), we observed a high similarity (98%) among samples. Moreover, we identified four different profiles of L. infantum. In conclusion, L. infantum strains from Sao Paulo State, Brazil, showed low diversity measured by minicircle of the kDNA hypervariable region.