Cross-Mapping the Portuguese Nursing Ontology with ICNP, SNOMED CT and NANDA-I.

EHR Interoperability is crucial to obtain a set of benefits. This can be achieved by using data standards, like ontologies. The Portuguese Nursing Ontology (NursingOntos) is a reference model describing a set of nursing concepts and their relationships, to represent nursing knowledge in the Electronic Health Records (EHR). The purpose of this work was to define a set of correspondences between Nursing Ontology concepts of NursingOntos and other terminologies, which have the same or similar meaning. In this project, we are using the ISO/TR12300:2016 standard on the principles of mapping between terminological systems. Regarding the domain of "airway clearance", we can say that Portuguese Nursing Ontology has a good level of mapping with other terminologies. In conclusion, we can say that Portuguese Nursing Ontology can be used in EHR with the purpose of a global digitalization of health.

Cancer is not a risk factor for severe COVID-19 in children, except in patients with recent allogeneic hematopoietic stem cell transplantation or comorbidities.

The EPICO (Spanish general registry of COVID-19 in children)-SEHOP (Spanish Society of Pediatric Hematology and Oncology) platform gathers data from children with SARS-CoV-2 in Spain, allowing comparison between children with cancer or allogeneic hematopoietic stem cell transplantation (alloHSCT) and those without. The infection is milder in the cancer/alloHSCT group than in children without comorbidities (7.1% vs. 14.7%), except in children with recent alloHSCT (less than 300 days), of which 35.7% experienced severe COVID-19. These data have been shared with the SEHOP members to support treatment and isolation policies akin to those for children without cancer, except for those with recent alloHSCT or additional comorbidities. This highlights the collaborative registries potential in managing pandemic emergencies.

Infective endocarditis in pediatric patients: a decade of insights from a leading Spanish heart surgery reference center.

Infective endocarditis (IE) is a rare disease in children and is associated with significant morbidity and mortality. In recent years, significant changes have occurred in pediatric care that could have influenced the microbiology and presentation of IE. The aim of this work was to study epidemiological, microbiological, and clinical features of IE treated at a Pediatric Cardiac Surgery Reference Center located in Madrid (Spain) in a 10-years' period. A descriptive observational retrospective study was performed, including pediatric patients < 16 years old with definite or possible IE admitted to a reference center between January 2012 and December 2021. Thirty-two IE episodes were identified. Twenty-eight (87.5%) had congenital heart disease (CHD), 8 (25.0%) were preterm infants, 1 (3.1%) was immunocompromised and 6 (18.8%) had other chronic conditions; in 11 (34.4%) episodes more than one underlying condition was associated. In 20 (62.5%) episodes there was an indwelling central venous catheter (CVC); children with other comorbidities (preterm, immunocompromised, other chronic conditions) were more likely to have a CVC at diagnosis compared with patients with isolated CHD (p < 0.001). Thirty-six microbiological isolates were obtained in the 32 episodes; 4 (12.5%) episodes had 2 isolated microorganisms. Microbiological isolates were 20 (55.6%) Gram-positive bacteria (GPB), 10 (27.8%) non-HACEK Gram-negative bacteria (GNB), 1 (2.8%) HACEK-group bacterium, 4 (11.1%) fungi and 1 (2.8%) Coxiella burnetii. In 10 (31.3%) episodes, patients were colonized by multidrug-resistant bacteria (MDRB) and the etiology of IE in 3 (30.0%) of those episodes was the colonizing MDRB. MDRB colonization was associated with MDRB IE (p = 0.007). The most common complication was septic embolism: 11 (34.4%) episodes (9 pulmonary and 2 cerebral). In-hospital mortality was 6.3% (n = 2), all of them due to underlying conditions and not to IE or its complications. Clinical features and complications of IE episodes caused by non-HACEK GNB and those caused by GPB were compared, finding no statistically significant differences.    Conclusion: Risk factors for developing IE, the proportion of embolic complications, and mortality rate were consistent with previously published findings. Proportion of IE cases attributed to non-HACEK GNB was higher than previously reported, suggesting an evolving epidemiology of IE. One-third of children colonized with MDRB subsequently developed IE caused by the same MDRB strains, so empirical coverage of MDRB organisms must be considered when IE is suspected in MDRB colonized patients. No significant differences in clinical features and complications were observed when comparing IE episodes caused by non-HACEK GNB and those caused by GPB, however larger cohort studies are needed. What is Known: • Infective endocarditis (IE) is a rare disease in children, associated with significant morbidity and mortality. • The main risk factor for developing IE in children is an underlying congenital heart disease. What is New: • With current changing epidemiology in pediatric IE, a higher proportion of IE caused by non-HACEK Gram-negative bacteria should be expected. • A significant percentage of children colonized by multidrug-resistant bacteria can develop an IE due to those bacteria.

Sex-based differences and risk of recurrence in patients with atrial fibrillation undergoing pulmonary vein isolation.

INTRODUCTION: Studies suggest increased likelihood of atrial fibrillation (AF) recurrence after catheter ablation (CA) in women than in men, indicating that sex may be an independent risk factor for recurrence. Nevertheless, the influence of sex on AF recurrence and underlying mechanisms remains unclear. METHODS: Retrospective, single-centre study including patients undergoing AF CA between 2017 and 2021. Late recurrence (LR) was defined as AF recurrence ≥90 days after ablation, whereas early recurrence (ER) occurred within 90 days. RESULTS: 656 patients (32% women) were included, with a median follow-up period of 26 months. Compared to men, women undergoing CA were older, had higher body mass indexes, and had higher rates of hypertension, thyroid dysfunction, and valvular disease. Women also had increased LR risk after CA (HR 1.76, 95% CI [1.19, 2.59]). A time-split multivariable analysis at one year of follow-up showed no difference in LR risk during the first 12 months after CA (HR 1.19, 95% CI [0.73, 1.94]); however, LR risk increased in women (HR 2.90, 95% CI [1.68, 5.01]) after 12 months. In a sex-stratified analysis, coronary calcium score (CCS) >100 was associated with increased LR risk in men (HR 1.81, 95% CI [1.06, 3.08]), but not in women. Cardiac adipose tissue volume was not associated with increased LR risk. CONCLUSIONS: Fewer women underwent CA than men and LR was more frequent in women, particularly one year after the procedure. CCS was associated with increased LR risk in men.

Preoperative risk factors for early postoperative bleeding after Roux-en-Y gastric bypass surgery: a systematic review and meta-analysis.

PURPOSE: Although bariatric surgery is an effective intervention for obesity, it comes with risks such as early postoperative bleeding (EPB). Identifying preoperative risk factors for this complication can help patients' risk stratification and optimization. We performed a systematic review and meta-analysis to find predictors for early postoperative bleeding after Roux-en-Y gastric bypass (RYGB). METHODS: We conducted a systematic review, searching PubMed, Cochrane Library, and Web of Science until November 2023. We performed a random-effects meta-analysis to explore preoperative risk factors associated with early postoperative bleeding after RYGB. Sources of heterogeneity were explored by leave-one-out analyses. RESULTS: 23 studies were included, comprising 232,488 patients. Male gender (meta-analytical RR = 1.42, 95%CI = 1.21-1.66, I2 = 18%, Q Cochran test p-value = 0.29) and revisional surgery (meta-analytical RR = 1.35, 95%CI = 1.12-1.62, I2 = 22%, Q Cochran test p = 0.21) were associated with higher risk of EPB. On average, patients with EPB were older than the remainder (MD for the mean age = 2.82 years, 95%CI = 0.97-4.67, I2 = 0.00%, Q Cochran test p = 0.46). Except for hypertension (meta-analytical RR = 1.33, 95%CI = 1.02-1.73, I2 = 66%, Q Cochran test p < 0.0001), comorbidities were not associated with a higher risk of EPB. CONCLUSION: Preoperative risk factors, including age, gender, hypertension, and revisional bariatric surgery, are associated with early postoperative bleeding after RYGB. Further primary studies, with higher methodological quality, are required to detail more risk factors.

The challenging approach of a young patient with a primary intimal sarcoma of the heart: a case report.

Background: Primary intimal sarcomas of the heart are extremely rare and have a dismal prognosis. Their management represents a complex clinical challenge since complete surgical resection is the only reliable possibility of cure but is only possible in 50% of patients. In non-resectable disease, anthracycline-based therapy is the most effective treatment, but pazopanib may be used in patients unfit to receive anthracyclines. Case summary: A 38-year-old man presented with acute right heart failure symptoms due to a primary intimal sarcoma of the heart. A definite diagnosis was made after cardiac surgery. Multi-modality cardiac imaging showed early recurrence of disease with mitral valve and pulmonary veins' invasion, and the patient was deemed inoperable. Due to chronic kidney disease and previous heart failure symptoms, he was started on first-line pazopanib palliative treatment. After 11 months of chemotherapy, there was good clinical tolerance and no evidence of disease progression, which occurred after 13 months. Discussion: This case highlights the value of a multi-modality imaging approach for cardiac masses. Most importantly, it reports the successful treatment of a young patient with a primary intimal sarcoma of the heart who was started on palliative pazopanib, with a significantly higher progression-free survival than is reported in the literature. This finding may support pazopanib as a good alternative as first-line treatment when there is contraindication for anthracycline-based chemotherapy.

New Perspective for Using Antimicrobial and Cell-Penetrating Peptides to Increase Efficacy of Antineoplastic 5-FU in Cancer Cells.

This study explores the effectiveness of the antineoplastic agent 5-FU in cancer cells by leveraging the unique properties of cationic antimicrobial peptides (CAMPs) and cell-penetrating peptides (CPPs). Traditional anticancer therapies face substantial limitations, including unfavorable pharmacokinetic profiles and inadequate specificity for tumor sites. These drawbacks often necessitate higher therapeutic agent doses, leading to severe toxicity in normal cells and adverse side effects. Peptides have emerged as promising carriers for targeted drug delivery, with their ability to selectively deliver therapeutics to cells expressing specific receptors. This enhances intracellular drug delivery, minimizes drug resistance, and reduces toxicity. In this research, we comprehensively evaluate the ADMET (absorption, distribution, metabolism, excretion, and toxicity) properties of various AMPs and CPPs to gain insights into their potential as anticancer agents. The peptide synthesis involved a solid-phase synthesis using a Liberty Microwave Peptide Synthesizer. The peptide purity was confirmed via LC-MS and HPLC methods. For the ADMET screening, computational tools were employed, assessing parameters like absorption, distribution, metabolism, excretion, and toxicity. The cell lines A549 and UM-UC-5 were cultured and treated with 5-FU, CAMPs, and CPPs. The cell viability was measured using the MTT assay. The physicochemical properties analysis revealed favorable drug-likeness attributes. The peptides exhibited potential inhibitory activity against CYP3A4. The ADMET predictions indicated variable absorption and distribution characteristics. Furthermore, we assessed the effectiveness of these peptides alone and in combination with 5-FU, a widely used antineoplastic agent, in two distinct cancer cell lines, UM-UC-5 and A549. Our findings indicate that CAMPs can significantly reduce the cell viability in A549 cells, while CPPs exhibit promising results in UM-UC-5 cells. Understanding these multifaceted effects could open new avenues for antiviral and anticancer research. Further, experimental validation is necessary to confirm the mechanism of action of these peptides, especially in combination with 5-FU.

Complicações Neurológicas em Pacientes com Endocardite Infecciosa: Perspectivas de um Centro Terciário / Neurological Complications in Patients with Infective Endocarditis: Insights from a Tertiary Centre

Resumo Fundamento: Complicações neurológicas são comuns em pacientes com endocardite infecciosa (EI). Dados recentes sugerem que os eventos neurológicos são os principais determinantes do prognóstico e que a cirurgia é crítica para melhorar o resultado. Objetivo: Caracterizar pacientes com EI e complicações neurológicas e determinar preditores de embolização para o sistema nervoso central (SNC) e mortalidade. Métodos: Análise retrospectiva de pacientes internados em centro terciário com diagnóstico de EI no período de 2006 a 2016. Significância estatística foi definida por um valor de p <0,05. Resultados: Identificamos 148 episódios de EI, 20% dos quais tinham evidências de embolização do SNC. Em pacientes com embolização do SNC, 76% apresentaram acidente vascular cerebral isquêmico. Durante o seguimento, 35% foram submetidos à cirurgia e a mortalidade hospitalar e em um ano foi de 39%. Esses pacientes tiveram hospitalizações mais longas, mas não houve diferenças significativas em relação à mortalidade em pacientes com e sem embolização do SNC. Os preditores independentes de complicações neurológicas foram diabetes (p = 0,005) e ausência de febre na apresentação (p = 0,049). A cirurgia foi associada a menor mortalidade (0 vs. 58%; p = 0,003), enquanto os pacientes com choque séptico tiveram pior prognóstico (75 vs. 25%; p = 0,014). Na regressão multivariada de Cox, a infecção pelo vírus da imunodeficiência humana (HIV) foi o único preditor independente de mortalidade hospitalar e de 1 ano (p = 0,011 em ambos). Conclusões: Nessa população, a embolização para o SNC foi comum, mais frequentemente apresentada como acidente vascular cerebral isquêmico, e esteve associada a maior tempo de internação, embora sem diferenças significativas na mortalidade. Nos pacientes com embolização do SNC, os submetidos à cirurgia tiveram boa evolução clínica, enquanto os pacientes com choque séptico e infecção pelo HIV tiveram pior evolução. Esses resultados devem ser interpretados com cautela, levando em consideração que os pacientes com complicações mais graves ou mais frágeis foram provavelmente menos considerados para a cirurgia, resultando em viés de seleção.

Background: Neurological complications are common in patients with infective endocarditis (IE). Recent data suggest that neurologic events are a major determinant of prognosis, and that surgery is critical in improving the outcome. Objective: To characterize patients with IE and neurological complications and to determine predictors of embolization to the central nervous system (CNS) and mortality. Methods: Retrospective analysis of patients admitted to a tertiary center with the diagnosis of IE from 2006 to 2016. Statistical significance was defined by a p-value < 0.05. Results: We identified 148 episodes of IE, 20% of which had evidence of CNS embolization. In patients with CNS embolization, 76% presented with ischemic stroke. During follow-up, 35% were submitted to surgery and both in-hospital and one-year mortality were 39%. These patients had longer hospitalizations, but there were no significant differences regarding mortality in patients with and without CNS embolization. The independent predictors of neurological complications were diabetes (p=0.005) and the absence of fever at presentation (p=0.049). Surgery was associated with lower mortality (0 vs. 58%; p=0.003), while patients with septic shock had a poorer prognosis (75 vs. 25%; p=0.014). In multivariate Cox regression, human immunodeficiency virus (HIV) infection was the only independent predictor of in-hospital and 1-year mortality (p=0.011 in both). Conclusions: In this population, embolization to the CNS was common, more often presented as ischemic stroke, and was associated with longer hospitalization, although without significant differences in mortality. In patients with CNS embolization, those submitted to surgery had a good clinical evolution, while patients with septic shock and HIV infection had a worse outcome. These results should be interpreted with caution, taking into consideration that patients with more severe complications or more fragile were probably less often considered for surgery, resulting in selection bias.

Risk Factors for In-Hospital Mortality in Infective Endocarditis / Fatores de Risco para Mortalidade Hospitalar na Endocardite Infecciosa

Abstract Background: Infective endocarditis (IE) is associated with severe complications and high mortality. The assessment of mortality rates and predictors for fatal events is important to identify modifiable factors related to the pattern of treatment, in order to improve outcomes. Objectives: We sought to evaluate clinical outcomes of patients with IE and to determine predictors of in-hospital mortality. Methods: Retrospective single-center study including patients with IE admitted during a 10-year period (2006-2015). Data on comorbidities, clinical presentation, microbiology and clinical outcomes during hospitalization were evaluated. Risk factors of in-hospital death were analyzed. A p-value < 0.05 was considered significant. Results: A total of 134 cases were included (73% males, mean age of 61 ± 16 years-old). Half of them had previous valvular heart disease. Healthcare-associated IE and negative blood-cultures occurred in 22% and prosthetic IE in 25%. The aortic valve was the one most often affected by infection. Staphylococcus aureus was the most commonly isolated microorganism. Forty-four (32.8%) patients underwent cardiac surgery. The in-hospital mortality rate was 31.3% (42 patients). The identified risk factors for in-hospital mortality were Staphylococcus aureus etiology (OR 6.47; 95% CI: 1.07-39.01; p = 0.042), negative blood-cultures (OR 9.14; 95% CI: 1.42-58.77; p = 0.02), evidence of valve obstruction in echocardiography (OR 8.57; 95% CI: 1.11-66.25; p = 0.039), clinical evolution with heart failure (OR 4.98; 95%CI: 1.31-18.92; p = 0.018) or septic shock (OR 20.26; 95% CI: 4.04-101.74; p < 0.001). Cardiac surgery was a protective factor of mortality (OR 0.14; 95% CI 0.03-0.65; p = 0.012). Conclusion: The risk factors for in-hospital mortality were clinical (heart failure, septic shock), evidence of valve obstruction in echocardiography, Staphylococcus aureus etiology or negative blood cultures. Invasive treatment by surgery significantly decreased the mortality risk.

Resumo Fundamento: A endocardite infecciosa (EI) está associada a complicações graves e alta mortalidade. A avaliação das taxas de mortalidade e preditores de eventos fatais é importante para identificar fatores modificáveis relacionados ao padrão de tratamento, com o objetivo de melhorar os desfechos. Objetivos: Avaliar os desfechos clínicos de pacientes com EI e determinar preditores de mortalidade hospitalar. Métodos: Estudo retrospectivo de centro único, incluindo pacientes com EI admitidos durante um período de 10 anos (2006-2015). Foram avaliados dados de comorbidades, apresentação clínica, microbiologia e desfechos clínicos durante a internação. Foram analisados os fatores de risco de morte hospitalar. Um valor de p < 0,05 foi considerado significativo. Resultados: Foram incluídos 134 casos (73% do sexo masculino, média de idade de 61 ± 16 anos). Metade dos casos apresentava cardiopatia valvar prévia. A EI associada a cuidados de saúde e hemoculturas negativas ocorreram em 22%, e a EI associada a prótese em 25%. A válvula aórtica foi a mais frequentemente afetada por infecção. Staphylococcus aureus foi o microrganismo mais comumente isolado. Quarenta e quatro (32,8%) pacientes foram submetidos à cirurgia cardíaca. A taxa de mortalidade hospitalar foi de 31,3% (42 pacientes). Os fatores de risco identificados para mortalidade hospitalar foram etiologia do Staphylococcus aureus (OR 6,47; IC 95%: 1,07-39,01; p = 0,042), hemoculturas negativas (OR 9,14; IC 95%: 1,42-58,77; p = 0,02), evidência de obstrução valvar na ecocardiografia (OR 8,57; IC 95%: 1,11-66,25; p = 0,039), evolução clínica com insuficiência cardíaca (OR 4,98; IC 95%: 1,31-18,92; p = 0,018) ou choque séptico (OR 20,26; IC 95%: 4,04-101,74; p < 0,001). A cirurgia cardíaca foi um fator protetor de mortalidade (OR 0,14; IC95%: 0,03-0,65; p = 0,012). Conclusão: Os fatores de risco para mortalidade hospitalar foram clínicos (insuficiência cardíaca, choque séptico), evidência de obstrução valvar no ecocardiograma, etiologia do Staphylococcus aureus ou hemoculturas negativas. O tratamento invasivo por cirurgia diminuiu significativamente o risco de mortalidade.

First report of antibodies to Neospora spp. in horses from Portugal / Primeira ocorrência de anticorpos anti-Neospora spp. em cavalos de Portugal

Abstract Neospora spp. are intracellular protozoa with worldwide distribution and closely related to Toxoplasma gondii, which can infect a variety of mammals including horses. From September 2013 to June 2014, 185 horses from northern, central and southern parts of mainland Portugal were randomly sampled and tested for detection of immunoglobulin (Ig) G antibodies to Neospora spp. using an indirect multi-species enzyme-linked immunosorbent assay (ELISA) commercial test (ID Screen® Neospora caninum Indirect Multi-species; ID.vet Innovative Diagnostics, Grabels, France). Two horses (1.1%; CI: 0.1-3.8%), one male and one female, were found to be seropositive for Neospora spp. Both seropositive animals were horses housed indoors but with access to outdoors, used for leisure activities and were apparently healthy, with good body condition and with no alterations at physical examination. This was the first serologic survey of antibodies to Neospora spp. carried out in horses from Portugal.

Resumo Neospora spp. são protozoários intracelulares com distribuição mundial e estreitamente relacionados com Toxoplasma gondii, que podem infectar uma variedade de mamíferos, incluindo cavalos. De setembro de 2013 a junho de 2014, 185 cavalos de áreas do Norte, Centro e Sul de Portugal continental foram aleatoriamente amostrados e testados para a detecção de anticorpos imunoglobulinas (Ig) G anti-Neospora spp., utilizando-se um ensaio imunoenzimático (ELISA) indireto multi-espécies comercial (ID Screen® Neospora caninum Indirect Multi-species; ID.vet Innovative Diagnostics, Grabels, France). Dois cavalos (1,1%; IC: 0,1-3,8%), um macho e uma fêmea, foram detectados como seropositivos para Neospora spp. Ambos os animais seropositivos eram cavalos mantidos em cocheiras mas com acesso aos piquetes, eram utilizados para atividades de lazer e estavam aparentemente saudáveis, com boa condição corporal e sem alterações ao exame físico. Essa é o primeiro rastreio de anticorpos para Neospora spp. realizado em cavalos de Portugal.

O cuidado para o desenvolvimento em neonatologia: posicionar para melhor cuidar / Care for development in neonatology: positioning for better care

Posicionamento Terapêutico do Recém-Nascido é uma das intervenções de enfermagem que mais precocemente se pode instituir, tendo benefícios no crescimento e desenvolvimento do Recém-Nascido. Este trabalho pretende desenvolver práticas promotoras do Posicionamento Terapêutico, transversais a todos os contextos da prática, bem como facilitar o desenvolvimento de competências comuns e especializadas de Enfermeiro Especialista e Enfermeiro Especialista em Enfermagem de Saúde da Criança e do Jovem, impulsionando ainda, o desenvolvimento de um projeto de investigação, onde se pretende efetuar a avaliação do posicionamento do Recém-Nascido, através da Adaptação Cultural e Validação Estatística do instrumento Infant Position Assessment Tool. Este relatório de estágio tem como objetivo a exposição das aprendizagens obtidas no percurso formativo experiencial e o consequente desenvolvimento e aquisição de competências de Enfermeiro Especialista e Enfermeiro Especialista em Enfermagem de Saúde da Criança e do Jovem. A metodologia de trabalho utilizada foi a descritiva, reflexiva e crítica, sustentada na reflexão sobre as práticas e o seu confronto com a evidência científica de enfermagem e de outras disciplinas afins, desenrolada nos diferentes contextos e promotora do desenvolvimento pessoal e profissional. Neste processo formativo, para sustentar teoricamente esta problemática e orientar o estudo, elegi a Teoria das Transições de Afaf Meleis e o Modelo dos Sistemas de Betty Neuman, ancorados nos pilares da Enfermagem Pediátrica, nomeadamente Cuidados Centrados na Família e Não Traumáticos, e alicerçado num corpo científico relacionado com os Cuidados para o Desenvolvimento. As atividades desenvolvidas deram resposta aos objetivos gerais nomeadamente desenvolver competências comuns de Enfermeiro Especialista e específicas de Enfermeiro Especialista em Enfermagem de Saúde da Criança e do Jovem, e desenvolver cuidados promotores do posicionamento terapêutico da criança e especificamente do Recém-Nascido. Estas mesmas atividades proporcionaram ainda a aquisição de conhecimento aprofundado na área da enfermagem de saúde infantil e pediatria, bem como habilidades para uma prestação de cuidados de nível avançado, numa lógica de cuidado humano e holístico, permitindo, em última análise, o desenvolvimento de saberes e competências científicas, técnicas e humanas especializadas em enfermagem de saúde infantil e pediatria.

Therapeutic Positioning of the Newborn is one of the earliest nursing interventions that can be instituted, having benefits on the growth and development of the Newborn. This work aims to develop practices that promote Therapeutic Positioning, transversal to all contexts of practice, as well as facilitating the development of common and specialized skills of Specialist Nurse and Specialist Nurse in Child and Youth Health Nursing, also boosting the development of a research project, where the aim is to evaluate the positioning of the Newborn, through Cultural Adaptation and Statistical Validation of the Infant Position Assessment Tool. This internship report aims to expose the learning obtained in the experiential training path and the consequent development and acquisition of Specialist Nurse and Specialist Nurse skills in Child and Young People's Health Nursing. The work methodology used was descriptive, reflective and critical, based on reflection on practices and their comparison with scientific evidence from nursing and other related disciplines, carried out in different contexts and promoting personal and professional development. In this training process, to theoretically support this problem and guide the study, I chose Afaf Meleis's Transitions Theory and Betty Neuman's Systems Model, anchored in the pillars of Pediatric Nursing, namely Family-Centered and Non-Traumatic Care, and based on a scientific body related to Developmental Care. The activities developed responded to the general objectives, namely to develop common skills of a Specialist Nurse and specific skills of a Specialist Nurse in Child and Young Health Nursing, and to develop care that promotes the therapeutic positioning of the child and specifically the Newborn. These same activities also provided the acquisition of in-depth knowledge in the area of ​​child health nursing and pediatrics, as well as skills for providing advanced level care, in a logic of human and holistic care, ultimately allowing the development of knowledge and specialized scientific, technical and human skills in child health nursing and pediatrics.

Aggregatibacter aphrophilus aortic valve infective endocarditis / Endocarditis infecciosa en válvula aórtica por Aggregatibacter aphrophilus

Nowadays, infective endocarditis remains a major cause of morbidity and mortality worldwide and there are concerns related to the increased number of infections associated with virulent agents and medical procedures. We present a case of a homeless man with unknown medical history, admitted for lumbar pain who became confused, hypotensive and tachy cardic, evolving to severe sepsis. His initial investigation was also suggestive of acute myocardial infarction but the transthoracic echocardiogram revealed massive aortic valve vegetation with perivalvular abscess leading to severe aortic regurgitation. The patient died with the final diagnosis of infective endocarditis. Later on the blood cultures was identified Aggregatibacter aphrophilus, an HACEK group agent. This case confirms that, albeit the general favorable outcomes, there are cases of serious infections, especially if the diagnosis and treatment were late.

Hoy día, la endocarditis infecciosa continúa siendo una causa importante de mor-bimortalidad en todo el mundo y es preocupante el aumento del número de infecciones asociadas con agentes virulentos y procedimientos médicos. Presentamos el caso de un indigente con antecedentes médicos desconocidos, ingresado por dolor lumbar, que comenzó a sentirse confuso, hipotenso y taquicárdico. Poco después de su ingreso su estado evolucionó a septicemia grave. Los resultados de las pruebas iniciales también eran indicativos de infarto agudo de miocardio, pero el ecocardiograma transtorácico reveló una vegetación masiva en la válvula aórtica con absceso perivalvular condicionando regurgitación aórtica grave. El paciente murió, con el diagnóstico definitivo de endocarditis infecciosa. Más tarde, en los hemocultivos se identificó Aggregatibacter aphrophilus, un microorganismo del grupo HACEK. Este caso confirma que, a pesar de los resultados favorables en general, hay casos de infecciones graves, sobre todo si el diagnóstico y el tratamiento fueron tardíos.

Uso de betabloqueador no choque cardiogênico da cardiomiopatia de Takotsubo / Use of beta-blockers in cardiogenic shock due to Takotsubo cardiomyopathy

A cardiomiopatia de Takotsubo se caracteriza por alterações reversíveis na função sistólica e segmentar do ventrículo esquerdo associada à coronariografia normal. O choque associado a essa cardiomiopatia é causado por disfunção sistólica e/ou obstrução dinâmica do trato de saída do ventrículo esquerdo. A identificação da etiologia do choque tem implicações terapêuticas. Relata-se o caso de paciente feminina, 76 anos, com cardiomiopatia de Takotsubo cuja apresentação mimetizou infarto agudo do miocárdio complicado com choque cardiogênico. O choque foi revertido após administração endovenosa de propranolol.

Takotsubo cardiomyopathy is characterized by reversible changes in the systolic and segmental left ventricular function associated with normal coronariography. The shock associated with this cardiomyopathy is caused by left ventricular systolic dysfunction and/or dynamic left ventricular outflow tract obstruction. Identification of the etiology of the shock has implications for treatment. This case study reports on a 76-year-old women diagnosed with Takotsubo cardiomyopathy whose presentation mimicked an acute myocardial infarction complicated by cardiogenic shock. The shock was reversed after intravenous administration of propanolol.